Clinical Simulation in Nursing Assignment Paper
Picot Question
New graduate nurse preparedness for practice is a nursing practice problem that demands immediate attention. It has been found that most new graduate nurses, despite passing the National Council Licensure Exam for Registered Nurses, are not competent in the skills required to practice nursing, such as clinical reasoning (McGarity et al., 2023). As an adjunct to clinical, simulation labs have been instrumental in bridging the gap between theory and practice, providing students with a controlled environment to practice skills and scenarios (Saifan et al., 2021). This research will explore the effectiveness of different simulation forms, particularly virtual reality, in enhancing nursing students’ preparedness for practice. The PICO question is: in nursing students (P), what is the effect of virtual reality (VR) simulation (I) compared to traditional simulation (C) on clinical reasoning skills (O)? Clinical Simulation in Nursing Assignment Paper
Significance
This PICO question is relevant to nursing practice because the gap between nursing theory and nursing practice can be stressful for the new graduate nurse, leading to poor patient outcomes, medication errors, and high turnover rates in the first year (Saifan et al., 2021). Building competence in critical thinking, clinical reasoning, and clinical judgment in nursing school can help new graduates be more prepared to practice upon graduation (McGarity et al., 2023). While clinical rotations are meant to help bridge the gap between theory and practice and build upon the competencies needed to practice, nursing students often find that the benefits of clinical are variable and depend on the clinical instructor’s time and expertise and the current staff and patient mix at the clinical placement (Saifan et al., 2021). Simulation labs have been used as an adjunct to clinicals to help bridge the gap between theory and practice, allowing students to practice skills and scenarios in a controlled environment (Saifan et al., 2021). Even though simulation labs are commonly used in nursing schools, new graduate nurses are still unprepared for nursing practice (McGarity et al., 2023). This PICO question will explore whether using newer technologies in simulation labs can improve preparedness to practice nursing.
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Search Strategy
Articles relevant to the PICO question were found using appropriate keywords. The terms critical thinking and clinical judgment were used as alternate terms for clinical reasoning, as these terms are often used interchangeably in the literature (El Hussein et al., 2022). The keywords searched were: (nursing students OR student nurses) AND (virtual reality simulation OR virtual simulation OR traditional simulation OR mannikin simulation) AND (critical thinking OR clinical reasoning OR clinical judgment). Studies were found using CINAHL, ProQuest, and Ovid databases. The inclusion criteria were studies with student nurses as the subjects, studies pertaining to the PICO question, studies published in the past five years, and studies written in English. The exclusion criteria were studies that did not include nursing students, did not address the PICO question, were published more than five years ago, or were not written in English. Clinical Simulation in Nursing Assignment Paper
Critical Appraisal
Padilha et al. (2019), Lavoie et al. (2024), and Kiegaldie and Shaw (2023) all compared traditional and VR simulations to determine whether clinical reasoning was affected. Of the three, Padilha et al. (2019) was the only study that found VR simulation to increase clinical reasoning in the short term and long term. At the same time, Lavoie et al. (2024) found that clinical reasoning was not significantly different between simulation modalities. It is possible that the study design created this discrepancy in results. Padilha et al. (2019) used a randomized controlled design, although there were only 42 subjects in this study. The Lavoie et al. (2024) study was less rigorous, with a non-randomized quasi-experimental design and 179 subjects. The control group in this study comprised 65% of the whole group, which may have skewed the results (Lavoie et al., 2024). Also, the researchers created the methods used to measure clinical reasoning in both studies, and neither was tested for reliability with Cronbach’s alpha (Lavoie et al., 2024; Padilha et al., 2019). Kiegaldie and Shaw (2023) used a mixed-methods, randomized controlled design with 675 subjects and found VR simulation increases knowledge in the short term but not in the long term. Subjects in the focus group stated that VR simulation helped increase critical thinking. However, the focus group only included subjects in the VR simulation group, so it is unclear whether traditional simulation also increased critical thinking and to what degree.
Four studies compared traditional simulation alone to traditional simulation with VR simulation (Han & Jin, 2024; Lee & Baek, 2023; Lee & Han, 2022; Yang et al., 2024). Each study included a nonrandomized quasi-experimental design and used a reliable tool to measure clinical reasoning. The findings from each study indicated that adding VR simulation to traditional simulation could increase clinical reasoning in nursing students (Han & Jin, 2024; Lee & Baek, 2023; Lee & Han, 2022; Yang et al., 2024). Because these studies were not experimental, it is difficult to determine whether VR simulation is what caused the increase in clinical reasoning. It is possible that the increase in clinical reasoning could be due to another factor, such as increased exposure to the subject matter.
Three studies had subjects that participated in both VR and traditional simulation and compared the two in terms of clinical reasoning (Badowski et al., 2021; Martin & Tyndall, 2022; Vihos et al., 2024). Badowski et al. (2021) found that both modalities increased critical thinking. This study included a nonrandomized population of students who attended three different schools and had different simulation experiences. Also, the instrument used to measure critical thinking in this study was not measured for reliability (Badowski et al., 2021). Given these limitations, these findings may not be generalizable and may not be accurately measuring critical thinking. Martin and Tyndall (2022) found that both simulation modalities can increase aspects of clinical judgment. This integrative review compared studies that focused on VR and traditional simulation in nursing students, with all but one study focusing on only one modality (Martin & Tyndall, 2022). This makes it difficult to compare the two simulations adequately. Vihos et al. (2024) found in one-on-one interviews that subjects felt VR simulation increased critical thinking when compared to traditional simulation. These interviews used the Glaserian grounded approach, and therefore, interview questions were not structured. It is possible that some interviews were more likely to touch upon critical thinking than others due to the nature of the questions asked.
Integration of Evidence
Only one study from this review found that clinical reasoning was greater in traditional simulation than in VR simulation (Lavoie et al., 2024). The remaining studies found that clinical reasoning improved in VR simulations, although the findings were mixed as to whether these results remained in the long term (Kiegaldie & Shaw, 2023; Padilha et al., 2019). The evidence has shown that VR simulation does not need to replace traditional simulation completely but be an adjunct to pre-existing simulations to improve clinical reasoning in nursing students (Badowski et al., 2021; Han & Jin, 2024; Lee & Baek, 2023; Lee & Han, 2022; Martin & Tyndall, 2022; Yang et al., 2024). It is unclear, however, whether this increase in clinical reasoning is due to the VR simulation itself or increased time with the subject matter. Further randomized controlled studies would help to determine whether VR simulations improve clinical reasoning. In addition, the VR simulations in these studies varied in nature. Some used VR headsets, which allowed the students to be fully immersed in the simulation experience (Kiegaldie & Shaw, 2023; Lavoie et al., 2024; Lee & Han, 2022; Vihos et al., 2024) while others used three-dimensional web-based VR simulations (Badowski et al., 2021; Han & Jin, 2024; Lee & Baek, 2023; Padilha et al, 2019; Yang et al., 2024). It may be difficult to compare these two modalities accurately, and future research may need to be completed to determine the effect of different VR types on clinical reasoning. In addition, this review only includes one randomized controlled study, with the remaining studies providing lower levels of confidence in the findings (see Appendix) (Melnyk & Fineout-Overholt, 2023). Future randomized controlled studies may help strengthen the evidence. Clinical Simulation in Nursing Assignment Paper
References
Badowski, D., Rossler, K. L., & Reiland, N. (2021). Exploring student perceptions of virtual simulation versus traditional clinical and manikin-based simulation. Journal of Professional Nursing, 37(4), 683-689. https://www.doi.org/10.1016/j.profnurs.2021.05.005
El Hussein, M. T., Olfert, M., & Hakkola, J. (2022). Clinical judgment conceptualization scoping review protocol. Teaching and Learning in Nursing, 17, 84-101. https://www.doi.org/10.1016/j.teln.2021.10.003
Han, F., & Jin, S. (2024). Evaluation of the combination of virtual simulation and in-person simulation among undergraduate nursing students: A mixed methods study. Nurse Education in Practice, 75, 1-6. https://www.doi.org/10.1016/j.nepr.2024.103899
Kiegaldie, D., & Shaw, L. (2023). Virtual reality simulation for nursing education: Effectiveness and feasibility. BMC Nursing, 22, 1-13. https://www.doi.org/10.1186/s12912-023-01639-5
Lavoie, P., Lapierre, A., Mahou-Cadotte, M.-A., Brien, L.-A., Ledoux, I., & Gosselin, E. (2024). Nursing students’ engagement in virtual reality and hybrid simulations: A quasi-experimental study. Clinical Simulation in Nursing, 87, 1-10. https://www.doi.org/10.1016/j.ecns.2023.101496
Lee, E., & Baek, G. (2023). Development and effects of a virtual reality simulation nursing education program combined with clinical practice based on an information processing model. Computers, Informatics, Nursing, 41(12), 1016-1025. https://www.doi.org/10.1097/CIN.0000000000001051
Lee, H., & Han, J.-W. (2022). Development and evaluation of a virtual reality mechanical ventilation education program for nursing students. BMC Medical Education, 22, 1-9. https://www.doi.org/10.1186/s12909-022-03834-5
Martin, J. E., & Tyndall, D. (2022). Effect of manikin and virtual simulation on clinical judgment. Journal of Nursing Education, 61(12), 693-699. https://www.doi.org/10.3928/01484834-20221003-03
McGarity, T., Monahan, L., Acker, K., & Pollock, W. (2023). Nursing graduates’ preparedness for practice: Substantiating the call for competency-evaluated nursing education. Behavioral Sciences, 13(7), 1-12. https://www.doi.org/10.3390/bs13070553
Melnyk, B. M., & Fineout-Overholt, E. (2023). Evidence-based practice in nursing & healthcare: A guide to best practice (5th ed.). Wolters Kluwer.
Padilha, J. M., Machado, P. P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical virtual simulation in nursing education: Randomized controlled trial. Journal of Medical Internet Research, 21(3), 1-9. https://www.doi.org/10.2196/11529
Saifan, A., Devadas, B., Daradkeh, F., Abdel-Fattah, H., Aljabery, M., & Michael, L. M. (2021). Solutions to bridge the theory-practice gap in nursing education in the UAE: A qualitative study. BMC Medical Education, 21, 1-11. https://www.doi.org/10.1186/s12909-021-02919-x
Vihos, J., Chute, A., Carlson, S., Shah, M., Buro, K., & Velupillai, N. (2024). Virtual reality simulation in a health assessment laboratory course: A mixed-methods explanatory study examining student satisfaction and self-confidence. Nurse Educator. Advance online publication. https://www.doi.org/10.1097/NNE.0000000000001635
Yang, J., Zhou, W. J., Zhou, S. C., Lou, D., Lu, Q., Wang, A.-L., Yu, S.-H., Zhu, X.-P., He, X. Y., Hu, F., Yang, B. X., & Chen, J. (2024). Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: A mixed-methods study. BMC Medical Education, 24, 1-17. Clinical Simulation in Nursing Assignment Paper
