Toward Enhancement of Clinical Judgment and Critical Thinking: Simulation in the Classroom

Abstract

Health-care systems are changing, thus changing the expectations and requirements for nursing students entering the profession (Kaddoura, 2011). Nursing education must address the changes and focus on the development of critical thinking and clinical reasoning. When students are unable to apply clinical reasoning or clinical judgment into practice, there is an increase in potential for negative patient outcomes (Jones, Passos-Neto, & Braghiroli, 2015). Case-based learning (CBL) and simulation-based learning (SBL) are both active learning methods that can enhance development of critical thinking, clinical reasoning, and clinical judgment (Forneris et al., 2015). The purpose is to compare the use of CBL and SBL in the classroom and potential impact on application of clinical judgment during a high-fidelity simulation. The following research question was addressed: What is the effect of recorded patient simulations in the classroom compared to the use of CBL on critical thinking, clinical judgment, skill performance, and knowledge application? This was a comparative action-research study of two non-equivalent groups of senior-level nursing students, enrolled in a complex care course. Both groups of students completed the Health Sciences Reasoning Test-Numeracy critical thinking assessment before classroom interventions. Students either engaged in the CBL classroom learning activities or the SBL classroom learning activities; both activities utilized the same patient scenarios. Following classroom activities students engaged in a high-fidelity patient simulation, with the same patient scenario from the classroom. During the simulation, students were rated using the Lasater Clinical Judgment Rubric scoring application of clinical judgment. Students completed the study with a post-HSRT-N assessment. The HSRT-N scores did not yield any statistically significant results for with the CBL or the SBL group pre or post review. The CBL group, however, scored statistically higher, on the LCJR, than the SBL group during the high-fidelity patient simulation. Both groups were satisfied with the learning events that occurred, with neither group scoring significantly higher than the other group. Results suggest that CBL in the classroom, when in conjunction with discussion and reflection, can enhance application of clinical judgment during a high-fidelity patient simulation. SBL activities used for audio and visual cueing in the classroom, alone, are not enough to enhance clinical judgment application during a high-fidelity patient simulation. Additional studies are needed for further comparison of the two methods both individually and combined.