Ji Young Kim; Eun Jung Kim

doi:10.7469/kjan.2015.27.5.604

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Kim and Kim: Effects of Simulation on Nursing Students’ Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study

Original Article

Korean J Adult Nurs 2015;27(5):604-611.

Published online: October 2015

DOI: https://doi.org/10.7469/kjan.2015.27.5.604

Effects of Simulation on Nursing Students’ Knowledge, Clinical Reasoning, and Self-confidence: A Quasi-experimental Study

Ji Young Kim¹, Eun Jung Kim^2,

^¹College of Nursing, Research Institute of Nursing Science, Chonbuk National University, Jeonju

^²Division of Nursing, Research Institute of Nursing Science, Hallym University, Chuncheon, Korea

Corresponding author: Kim, Eun Jung Division of Nursing, Research Institute of Nursing Science, Hallym University, 1 Hallymdaehak-gil, Chuncheon 200-702, Korea. Tel: +82-33-248-2725, Fax: +82-33-248-2734, E-mail: ejerkim@hallym.ac.kr

Received 16 July 20151 October 2015 Accepted 2 October 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Knowledge, clinical reasoning, and self-confidence are the basis for undergraduate education, and determine students’ level of competence. The purpose of this study was to assess the effects of the addition of a one-time simulation experience to the didactic curriculum on nursing students’ knowledge acquisition, clinical reasoning skill, and self-confidence.

Methods

Using a quasi-experimental crossover design consisted of intervention and wait-list control groups. Participants were non-randomly assigned to the first intervention group (Group A, n=48) or the wait-list control group (Group B, n=46). Knowledge level was assessed through a multiple choice written test, and clinical reasoning skill was measured using a nursing process model-based rubric. Self-confidence was measured using a self-reported questionnaire.

Results

Results indicated that students in the simulation group scored significantly higher on clinical reasoning skill and related knowledge than those in the didactic lecture group; no difference was found for self-confidence.

Conclusion

Findings suggest that undergraduate nursing education requires a simulation-based curriculum for clinical reasoning development and knowledge acquisition.

Keywords: Decision making, Knowledge, Undergraduate education, Patient simulation

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Figure 1.

Flowchart of the study.

Table 1.

Rubric for Evaluating the Clinical Reasoning Skill

Categories		Score and description
Collecting data	3 Appropriately collects the subjective and objective data related to the patient' s condition	2 Collects the most obvious data, missing some important information	1 Confuses the patient's condition and disorganizes the data
Diagnosing	2 Analyzes and synthesizes the data; describes the diagnosis relevant to data	1 Analyzes and synthesizes the data; describes the diagnosis but less relevant to data	0 Has difficulty analyzing and synthesizing the data; describes the diagnosis but not relevant to data
Prioritizing problem	2 Focuses on the most relevant and important data to patient's condition	1 Focuses on data relevant to patient's condition but less important or not priority	0 Has difficulty with prioritizing; data not relevant to patient's condition
Planning	3 Selects nursing interventions to resolve the problem; appropriately planned interventions based on relevant patient data	2 Selects nursing interventions to resolve the problem; less appropriately planned interventions based on most obvious data	1 Selects a single intervention, addressing a likely solution, but it may be vague, confusing, and/or incomplete

Table 2.

Homogeneity of the Participants' Characteristics between the Groups (N=94)

Characteristics	Categories	Group A (n=48)	Group B (n=46)	x² or t	^p
Characteristics	Categories	n (%) or M±SD	n (%) or M±SD	x² or t	^p
Gender	Male	6 (12.5)	5 (10.9)	0.06	.806
Gender	Female	42 (87.5)	41 (89.1)		.806
Age (year)		21.06±1.80	20.98±1.35	0.26	.799
Satisfaction for nursing major		3.60±0.71	3.50±0.86	0.64	.523
Grade point average (GPA)		3.59±0.46	3.53±0.43	0.64	.523
Self-confidence for GI bleed		33.09±5.44	32.60±5.75	0.46	.679
Self-confidence for CS		33.90±5.60	33.33±7.54	0.41	.682

GI bleed=gastrointestinal bleed; CS=compartment syndrome.

Table 3.

Comparison of Knowledge, Clinical Reasoning, and Self-confidence between the Groups (N=94)

Variables	Categories	Group (n)	M±SD	t	p
Knowledge for GI bleed	Simulation/lecture	A (48)	6.83±1.93	2.55	.012
Knowledge for GI bleed	Lecture only	B (46)	5.70±2.38	2.55	.012
Clinical reasoning for GI bleed	Simulation/lecture	A (48)	6.34±1.88	2.83	.006
Clinical reasoning for GI bleed	Lecture only	B (46)	5.22±1.94	2.83	.006
Self-confidence for GI bleed	Simulation/lecture	A (48)	37.56±6.03	-0.81	.418
Self-confidence for GI bleed	Lecture only	B (46)	38.50±5.09	-0.81	.418
Knowledge for CS	Simulation/lecture	B (46)	7.30±1.99	-2.11	.038
Knowledge for CS	Lecture only	A (48)	6.29±2.64	-2.11	.038
Clinical reasoning for CS	Simulation/lecture	B (46)	7.57±1.67	-3.60	.001
Clinical reasoning for CS	Lecture only	A (48)	6.29±1.76	-3.60	.001
Self-confidence for CS	Simulation/lecture	B (46)	38.13±6.55	1.10	.276
Self-confidence for CS	Lecture only	A (48)	39.53±5.76	1.10	.276

GI bleed=gastrointestinal bleed; CS=compartment syndrome.

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