Improving Critical Thinking of Undergraduate Nursing Students in Simulation Lab

Improving Critical Thinking of Undergraduate Nursing Students in Simulation Lab

Trinity Bownes, R.N., A.S.N.

West Coast University, School of Nursing

December 21st, 2018

Table of Contents

Introduction and Background----------------------------------------------------------------------------3

Problem Identification and Description Using PICOT Format------------------------------------3

Critical Appraisal/Integrative Literature Review-----------------------------------------------------4

Project Aims, Values, and Desired Outcomes--------------------------------------------------------14

Theoretical Framework-----------------------------------------------------------------------------------17

Proposed Evidence-Based Project Plan----------------------------------------------------------------21

Actual Outcomes/Evaluation-----------------------------------------------------------------------------23

Summary and Conclusions-------------------------------------------------------------------------------24

References----------------------------------------------------------------------------------------------------25

Appendices---------------------------------------------------------------------------------------------------26

Introduction and Background

Clinical simulations have increased as the accepted practice to prepare undergraduate nursing students for the reality of the nursing environment. However, there is still some debate regarding their effectiveness. For my study, my research topic will focus on improving critical thinking in undergraduate nursing students during their simulation lab exercise. Clinical simulation is the best environment in which students can ascertain confidence and mastery of skills, however if there are barrier that hinders this, the students have a decline in confidence and potential to be successful.

I chose this topic on the premise that critical thinking is the most vital and underdeveloped skill new nurses tend be deficient in. With that being said, North Florida Community College has allowed me to gain access in the status of how their students are performing during simulation lab. According to the nursing faculty, students have been stagnant in their progress and as they enter their final semester and have yet to grasp concepts in critical thinking. Local hospitals in “Big Bend” region recruit students from this institution and ensuring that these students are equipped with the skills necessary was the priority of the nursing faculty.  To do this, I examined how pre-simulations activities either decrease or increases students skills and confidence as simulated nurses. Through the issuance of a survey, and testing of knowledge of particular nursing skills, I will examine how the simulation impacts critical thinking in students.

Problem Identification and Description Using PICOT Format

Critical Appraisal/Integrative Literature Review

Critical thinking is an imperative aspect of being a nurse. Gaining multi-analytical skills can prepare a nurse for turbulent situations, improve patient outcomes, and develop an open mindset. Critical thinking skills are often developed using simulation labs and the clinical site. Multiple studies indicate the positive effects that using simulation labs have on a student’s critical thinking skills. In particular, stimulation labs can help pupils become better adapt at making difficult judgment calls, and gain practice in time management and kinetic profientcy in nursing interventions. For this literature review, I presented further evidence as to why critical thinking skills are important.

Developing Critical Thinking Skills

    Lakhanigam (2017) notes that critical thinking is a vital skill for nurses. Lakhanigam (2017) describes critical thinking as the process of the logical process of creating decisions that translate to impactful patient outcomes. These skills are necessary to develop the best methods of care, how to interact with patients, and how to address critical situations when they arrive. Critical thinking can help guide nurse interventions, and can help nurses develop a strong sense of focus and discipline. These skills are important because the decisions that nurse make impacts patients, their families, and their organization.

    In addition, Lakhanigam (2017) also describes the development of critical thinking skills can be formed by beginning nurses nurturing inquisitiveness by asking questions. For the author, the quest for knowledge will help the nurse to learn new things, and also become open-minded. The combination of  being inquisitive and open minded leads to develop critical thinking. For new nurses, developing this skill is key to their future success.

As previously mentioned, simulations can have positive effects, and can help to prepare nursing students. But additional studies suggest that other methods may be needed to supplement simulations. In their study, Azizi-Fini et.al (2015) compared critical thinking skills between freshmen and senior students. The study compared 150 freshman and senior undergraduate students during their last semester. Data was collected by including demographic information and question from the California Critical Thinking Skills Test.

The authors discovered that both freshman and senior students had low critical-thinking skills across all demographics. While this may suggest a weakness in this particular nursing program, it also highlights that additional methods may be needed to elevate critical-thinking skills in nursing students. This was an example of an over-reliance of nursing simulations, when the critical-think skill development process could be enhanced by creating a program that takes a holistic approach to critical thinking.

    While critical thinking is a necessary component for being a nurse, there are also challenges to developing critical thinking skills. Specifically, orientation course do not provide additional skills that are necessary to enhance critical thinking skills. In addition, ensuring that all nurses are equipped with critical thinking skills can be a daunting task, or nearly impossible to ensure. As more new nurses enter into the field, it can be become increasingly challenging for educators to ensure that each and every student develop critical thinking skills (Advisory Board, 2015).

In conclusion, critical thinking is a necessary skill to learn. They help a nurse develop confidence, as well as competence as their daily duties as a nurse. However, most students learn critical thinking from simulations. Students may need more than clinical simulations to develop multi-analytical abilities. It is also important to note that can be difficult for educators to ensure that all of their students have developed critical thinking skills in a quick enough time to prepare them for nursing. But, critical thinking is still an important skill that all nurses can learn if they remain inquisitive and keep an open mind.

How nurses approach differing populations can affect education outcomes. This is particular true for young and eager nursing students that are looking to transition from the theory to the practical side of nursing. For this course, I would like to research how to improve critical thinking during simulation labs for undergraduate students. I think this topic is important because I would like to discover how differing teaching approaches stimulate students to make critical decisions that during their labs. I think it will be important how students begin making critical decisions during their stimulation labs because it translates to skills that they will need in the real world.  

Multiple studies indicate the positive effects that using simulation labs have on a student’s critical thinking skills. In particular, stimulation labs can help nurses become better adapt at making tough judgement calls, and gain practice that is necessary for becoming an effective nurse. While simulations have become the most trusted method for allowing nurses to develop critical thinking skills, there are also other techniques that could improve critical thinking skills for nursing students. For this literature review, I will present the benefits of using simulations to improve critical thinking, while also presenting additional alternatives for simulations.

Are Simulations Effective

    Kaddoura (2010) notes that critical thinking activities in the simulation lab can help nurses become better thinkers, leaders, and problem solving. She notes that participants generally felt that simulation labs helped them to make crucial decisions when necessary when they became nurses. The simulations also helped them to gain the confidence needed to make life-or death decisions for when they became a nurse. Having a pre-disposure to nursing situations and simulations prepared the students to think quickly on their feet, as well as become confident within their skills.

    In addition, studies have shown that simulations improve clinical competence (Chen et. al,2017). Within this study, 31 students were randomly selected. They were divided based upon whether they had received clinical simulation training throughout their undergraduate career, or whether they hadn’t Over three months, the researchers measured the participants stress, competency, and confidence levels. The researchers concluded that the students that had conducted simulations performed better than nurses that didn’t. In a similar study (Cant & Cooper, 2017; Jeppensen et. al, 2017) also showed that simulation education significantly improved nursing students critical thinking skills.