Using simulation to build clinical judgment and more: Don’t overlook this complement to onsite clinical experiences
Among the reasons contributing to dropping enrollments in nursing programs over the past few years is an insufficient number of clinical sites and clinical preceptors. As a result, interest in simulation has grown — and academic programs now recognize it as a valuable solution to replace or complement onsite clinical experiences for student nurses.
The National Council of State Boards of Nursing (NCSBN) defines high-quality simulation is “an activity or event replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role playing, skills stations, and computer-based critical-thinking simulations.”
To help faculty select simulation resources appropriate for nursing programs, the NCSBN has published specific guidance in its Simulation Guidelines for Prelicensure Nursing Education Programs.
Get guidance on simulation and clinical experiences
The utility of simulation in teaching clinical judgment is the subject of heightened research interest. Several studies published in 2023 and 2024 have demonstrated that screen-based simulations can be effective in building enhancing clinical judgement skills in prelicensure nursing students.
Two studies (Camp-Spivey et al, 2024; Fogg et al, 2023) are linked at the end of this article. In each study, the authors concluded that simulation helped students develop deeper understanding of course content and clinical judgment, and that simulation-based scenarios facilitated the development of clinical decision making.
Simulation provides distinct advantages compared to provider-based clinical experiences
Using simulation to build competence and confidence in clinical practice has some distinct advantages over strictly provider-based clinical experiences. Chief among them is that simulation avoids some of the unpredictability of the clinical setting.
“When we send students to clinical, we are really at the mercy of the patients who are there,” said Beth Phillips, PhD, RN, CNE, CHSE, Senior Manager of Content Strategy and Strategic Nursing Advisor at Ascend Learning Healthcare (ATI is an Ascend Learning Healthcare brand). “But with simulation and virtual environments, we can create and provide consistent experiences for students.”
Faculty sometimes question whether screen-based simulation delivers the emotional impact of real-life clinical interactions, but Dr. Phillips recommends setting aside such concerns.
“I’ve personally experienced, in virtual environments, feeling nervous that my patient was going to crump on me or was going to stop breathing,” she said. “I’ve seen in my previous work that when students saw a patient wasn’t doing well, they had a visceral reaction to it, even though it was on a computer screen. So, I know that we can learn in a simulated type of environment. I know that it can affect students’ processes and how they make decisions later on in their careers.”
In addition to providing students with authentic emotional experiences, simulation tools — such as Real Life® Clinical Reasoning, Swift River Simulations, and the Engage™️ Series — can develop critical thinking, clinical decision-making, and clinical judgment skills.
“Students become deeply engaged in the realistic client scenarios,” said Christine l. Heid, PhD, RN, CNE, CHSE, a certified healthcare simulation educator who has served as an ATI consultant educator. She completed the International Nursing Association for Clinical Simulation and Learning Fellowship Program in 2017.
“The scenarios (in ATI simulation resources) offer challenging situations in which students must make crucial healthcare decisions,” Dr. Heid said.
More specifically, screen-based simulations such as those from ATI provide two key advantages, Dr. Phillips and Dr. Heid said. These solutions:
1) Build and measure clinical decision-making skills
Using simulations, students will:
- deepen their learning as they select from options along branching-logic decision points, redoing each scenario and making different choices to learn which leads to the best outcomes
- develop stronger critical thinking, clinical decision-making, and clinical judgment via deeper engagement.
Educators who employ simulations in their lessons will:
- measure students’ clinical decision-making ability alongside competencies from Quality and Safety Education for Nurses (QSEN), NCLEX Client Need Categories, and relevant body functions.
2) Provide experience in real-life clinical situations
Simulation resources developed by ATI provide:
- credible scenarios providing experience with clinical situations that nurses face in real life, without the need for live clinical presence or any risk to client safety
- exposure to situations students will see every day in practice, as well as less common situations that traditional clinical rotations often miss
- a consistent clinical experience, ensuring that students encounter the same sets of clients and scenarios
- the opportunity to practice as often as students choose, to remediate and hone their skills with clients who exhibit a range of reactions — fostering an emotional connection to each situation.
The impact of simulation on safety and confidence is considerable
Dr. Phillips emphasized the importance of students gaining firsthand experience with life-threatening situations in risk-free environments. She mentioned pre-eclampsia and postpartum hemorrhage as examples of dangerous clinical situations students need to be familiar with. Exposure to acute mental health crises is also important.
“We can’t guarantee they’re going to see maternal clients with these illnesses during clinicals,” she explained. “We hope they don’t, because it means the mom is really, really sick. However, that would be something we would want them to experience.”
Simulation tools such as Real Life Clinical Reasoning Scenarios and Engage™️ Mental Health incorporate a variety of scenarios to provide that knowledge. For example, pre-eclampsia and postpartum hemorrhage are among the scenarios in Real Life's RN Maternal-Newborn module. And both Real Life and Engage offer modules on mental health presentations such as bipolar disorder, schizophrenia spectrum disorders, and psychosis.
The importance of scenarios in your simulation lessons
An important aspect to consider when choosing simulation tools is the scenarios they depict. Researchers stress that good scenario design is more important than the technology or method of the simulation. A good simulation tool requires:
- clear learning objectives
- problem-solving components
- comprehensive student support
- fidelity that is appropriate for the learning objectives
- structured debriefing opportunities.
Simulation solutions developed by ATI fulfill the needs listed above, by providing detailed lesson plans and in-depth learning activities.
“To build their clinical judgment skills, students need experience in making decisions — including wrong decisions,” Dr. Heid said. “Every experience adds to their knowledge and understanding of the impact of their actions.
“It’s so important to give them the opportunity to practice, practice, and practice some more,” she continued. “When they enter the real world of nursing, they’ll be prepared to think on their feet and deliver the compassionate, safe nursing care their patients need.”
Learn more about how to implement simulation inside and outside your classroom. Read “3 lesson plans for using screen-based simulation,” also on the ATI Educator Blog.
References
Camp-Spivey, L. J., Crawford, R. P., Bratnichenko, V. (2024). Bringing next generation NCLEX-RN case studies to life through simulation: Enhancing prelicensure nursing students’ clinical judgment. Innovations in Simulation, 91, 101535. https://doi.org/10.1016/j.ecns.2024.101535
Fogg, N., Yousef, M. G., Thompson, A., Bauman, E. B., Kardong-Edgren, S. (2023). Fostering clinical decision-making using screen-based simulations aligned with the NCSBN clinical judgment measurement model. Clinical Simulation in Nursing, 84, 101452. https://doi.org/10.1016/j.ecns.2023.101452
