Simulation Based Intervention

For the purpose of this study, CT is defined as the judgment nursing student’s use following assessment to purposefully intervene, thereby promoting patient health and improving outcomes. In addition, the following conceptual definitions will be used:
1. High-Fidelity Simulation (HFS): a computerized manikin allowing individualized programming and responses to physical and pharmacological interventions that closely resembles real life (Tuoriniemi & Schott-Baer, 2008).
2. Interactive Case Study (ICS): a paper-and-pencil method of presenting a problem and allowing the student to collaborate with others to gather information, identify signs and symptoms, problem-solve, and make clinical judgments based on findings (Raurell-Torreda et al., 2015).
This literature review will define CT and discuss two instruments used to measure CT dispositions and skills. The simulation-based interventions of ICS and HFS will be examined regarding the effects on CT scores and gaps in the literature are identified. A database search using Cochrane Central Register of Controlled Trials, ProQuest, Ebscohost, OATD, CINAHL, and MEDLINE identified studies for potential use. The search strategy consisted of searching for combined terms indicating the intervention of “simulation”, the subject of “nursing students”, and the outcome of “critical thinking”. Searches were limited to articles written in English, published between the years 2006 to 2016, and specific to simulation use in nursing students. Landmark studies or primary research greater than ten years were considered for inclusion. Ancestry searches were performed on relevant studies regarding simulation, CT, and simulation in nursing education. In addition, the National Council State Board of Nursing (NCSBN), American Association of Colleges of Nurses (AACN), and NLN websites were searched for position statements on simulation use in nursing education. Forty-three studies were retrieved with the initial database search. Studies
The results of the meta-analysis found HFS to have significant effects (p < .001) on the overall cognitive domains of learning, CT included. Lapkin et al. (2010) conducted a meta-analysis of simulation outcomes in nursing and found inconclusive results in terms of improved clinical reasoning, however, the components of knowledge, CT, and the ability of students to recognize deteriorating patients improved with simulation. Howard (2007) used a Health Education Systems, Inc (HESI) computerized exam to test CT scores in undergraduate nursing students. Howard (2007) found HFS to be a more effective educational intervention for CT skills (p = .051) compared to case studies. Utilizing the Korean Nurses’ Core Competency Scale (KNCCS), Shin, Sok, Hyun, and Kim (2015) compared traditional teaching methods of lecture to the active learning groups of HFS, case studies, and standardized patients. The active learning group scored significantly higher than the traditional learning group in overall competency (p < .001), and significantly higher in each of the five nursing competency domains (p < .001). Raurell-Torreda et al. (2015) used an objective structured clinical examination (OSCE) to compare traditional lecture and discussion with case-based learning and HFS to examine the