Comparing novice nurses’ cognitive load in routine and non-routine simulations with mixed methods

Hutson, Jeremy

Item

Comparing novice nurses’ cognitive load in routine and non-routine simulations with mixed methods

Hutson, Jeremy

Date

2025-06-09

Abstract

Background: A readiness-for-practice gap exists within new graduate nurses entering the workforce. Educators use simulation to boost practice-readiness. Researchers are exploring how cognitive load impacts novice nurses’ learning and performance during simulation. A variety of measures have been used to capture cognitive load during skill-based and routine, holistic simulations; however, the impact of increasing client complexity within holistic simulations has yet to be explored. As such, the purpose of this body of research was to examine how cognitive load manifests in novice nurses during holistic simulations. Methods: Three investigations were performed. First, a conceptual paper summarized methodological choices pertaining to simulation cognitive load research. Second, psychometric analysis of the National Aeronautics & Space Administration – Task Load Index, a subjective instrument used across disciplines to quantify perceived cognitive load – was performed. Third, a mixed methods study compared physiologic and behavioral responses to increased cognitive load during routine and non-routine, holistic simulations. Participants were junior, undergraduate novice nurses enrolled in a dedicated simulation course at a nursing school in the Southern region of the United States. Results: This body of work contributes new knowledge to help researchers appreciate that triangulation of objective and subjective measures improves rigor and understanding. The NASA-TLX survey is a valid and reliable instruction for measuring novice nurses’ cognitive load in simulation. There was a difference in cognitive load between routine and non-routine simulation types (F(1, 10) = 23.99, p < 0.001, η2=.706). In non-routine simulation, participants’ pupil sizes were larger (B = 0.238, SE = 0.096, t = 2.47, p = 0.015). Novice nurses’ emotional experiences of increased cognitive load occurred on a spectrum. Conclusion: This body of research provides evidence that increases in client complexity impacts novice nurses’ cognitive load and that cognitive load decreases with exposure. Moreover, this research has uncovered additional questions regarding how individual characteristics may contribute to mitigating cognitive load, providing direction for future research.