Thinking Like A Nurse: The Impact Of Simulation And Clinical Experiences On Clinical Judgment In Prelicensure Nursing Students

Introduction: The ability to make sound clinical judgments is essential to safe nursing practice. Clinical experiences allow nursing students to integrate theory and practice and demonstrate clinical judgment. Simulation is being used by nursing programs to replace clinical experiences. Limited research is published regarding the effectiveness of simulation in the development of clinical judgment. This study explored differences in clinical judgment among nursing students in a maternal-newborn clinical course participating in simulation or hospital-based clinical experiences. Methods: This study used Lasater’s Clinical Judgment Rubric (LCJR), based on Tanner’s Clinical Judgment Model, to evaluate nursing students’ clinical judgment following completion of simulation or hospital-based clinical experiences. The model includes four dimensions: noticing, interpreting, responding and reflecting. The LCJR catalogues the behaviors associated with each dimension of clinical judgment. Participants were students registered for a maternal-newborn clinical course at prelicensure nursing programs in the Midwest. Students completed simulation or clinical experiences as scheduled by the program. Following completion of the clinical rotation, each student participated in an evaluative high-risk maternal-newborn simulation. Evaluative simulation experiences were recorded. Recordings were viewed and evaluated using the LCJR. LCJR scores were calculated, associations between mean LCJR scores for each group were examined using an independent sample t-test. Data were analyzed to determine if there were any associations between demographic characteristics and clinical judgment scores. Results: There was no statistically significant difference in clinical judgment for nursing students participating in simulation as compared to hospital-based clinical experiences (t = -1.056, p = 0.295). Of the demographic variables analyzed, race/ethnicity and current employment explained significant variance in clinical judgment. White, non-Hispanic participants scored higher compared to African-Americans (t = -4.539 p < 0.001) and other ethnicities (t = -2.449 p = 0.018). Employed participants scored lower (t = -2.044, p = 0.046) than unemployed participants. This study provides evidence that replacing clinical experiences with simulation is effective in the maternal-newborn clinical area under conditions comparable to this study.