Katrina Duncan and Dr. Patricia Ravert, College of Nursing
Recent studies have shown that only 35% of new registered nurse graduates demonstrate appropriate entry expectations for critical thinking and clinical judgment . As the present nursing shortage continues to escalate, adequate preparation of new graduate nurses becomes ever more important. Simulation is used in nursing education to prepare nurses prior to the clinical setting. It utilizes the principle explained by Confucius when he said “I hear and I forget, I see and I remember, I do and I understand.” Simulation provides the opportunity to apply the classroom and textbook learning in a safe environment so that students may fully grasp the idea prior to a clinical setting with real patients.
Simulation use in nursing education continues to expand as technology develops. Simulation includes anything from role-playing to using an orange to practice an injection to practicing skills with manikins. It has now advanced to using high-fidelity human patient simulators which simulate disease processes and actual pathological responses, such as breath sounds, heart rhythms, and pulses.
Through my observations working in the simulation labs, I was interested to see what perceptions students and new nurses have of the learning and skills taken from simulation into the clinical environment. I was also interested in what varying levels of simulation can offer to students regarding critical thinking abilities. The specific aims of this study were two-fold: (a) explore the role of simulation and its use in different nursing education program, both in Utah and in Ecuador; and (b) investigate the power of simulation in developing and improving new registered nurse graduates’ critical thinking and clinical judgment.
This was a descriptive qualitative research study. Utilizing Lasater’s clinical judgment model, a semi-structured interview guide was created containing six open-ended questions. These questions addressed simulation practices used in the participant’s nursing education, and how simulation helped develop abilities in noticing, interpreting, responding, and reflecting in the clinical setting. After receiving IRB approval, Utah participants were identified through purposeful sampling of personal contacts. Study participants included current nursing students in the state of Utah and recent nurse graduates (graduated up to three years ago) currently working as registered nurses in Utah. In Ecuador, after receiving permission to conduct the interviews from hospital administration, recent nurse graduates were identified and selected to participate.
Informed consent was received prior to each interview. Interviews were conducted in person and audio-taped to ensure accuracy. In Ecuador, a translator was present to interpret the interview. The tapes were later transcribed; only the English was transcribed for the Ecuador interviews. The interviews were then analyzed and common themes identified as results. A total of 12 interviews were conducted for this study. The four occurring in Ecuador were all interviews with recent nurse graduates. Of the remaining eight which occurred in Utah, four were current nursing students and four were recent nurse graduates.
After analyzing the interviews, I found common themes regarding simulation practices and its use to develop critical thinking. These are all supported by quotes from participants. The simulation practices in Ecuador are less technologically advanced due to limited resources. The actual role of a nurse in Ecuador also varies from that in Utah with limited skills and a very large patient:nurse ratio. Many doctors in Ecuador were observed doing those tasks typical of a nurse in the United States. Overall, many participants expressed that utilizing problem-based scenarios was more beneficial than practicing skills alone. Also, the use of simulation was perceived as a vital step in the journey to becoming a registered nurse. Last of all, despite the benefits of simulation, most participants felt that the clinical setting with real patients is better than simulation.
In conclusion, simulation is an excellent preparatory step in the journey to becoming a nurse. It provides a route to apply knowledge and skills learned in the classroom, building confidence and familiarity before experience with real patients. However, simulation is best used as an adjunct to clinical settings in the hospital and should not be a replacement, to best optimize critical thinking development. I found that the higher the fidelity of simulation, the better preparation and critical thinking abilities simulation can provide. Also, problem-based scenarios should be utilized more often in nursing education to enhance the benefits of simulation.
This has been a tremendous learning opportunity for me, especially in gaining an understanding of the research process. I did come across a couple barriers. As I traveled to Ecuador and began conducting interviews, I quickly realized that though the interview guide was translated into Spanish, a language barrier existed in understanding the concepts. Therefore, though I did learn much in Ecuador regarding simulation practices, the interviews provided little information regarding critical thinking abilities. The other barrier consisted of finding participants. Though my connections led me to several subjects, I often found contacting them regarding participation to be a challenge.
This research was presented through a podium presentation by the student researcher on November 3, 2008 at the BYU College of Nursing/Intermountain Healthcare Annual Research Conference. It will also be presented in a podium presentation at the UCUR Annual Conference at Westminster College on February 20, 2009. The student researcher and faculty mentor will also be writing a research brief to submit to an online journal for simulation in nursing.
- del Bueno, D. J. 2005. A crisis in critical thinking. Nursing Education Perspectives, 26(5), 278-282.
- Lasater, K. 2007b. Clinical judgment development: using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503.