Abstract
Problem: The academic-practice gap has widened due to limited clinical placement opportunities for practicing decision-making skills, leading to a decline in entry-level competency among newly graduated registered nurses. Virtual simulation has been proposed to foster decision-making skills. However, there is a lack of research examining the effectiveness of virtual simulation in developing clinical judgment (CJ) among nursing students. This study aimed to compare the self-perceived CJ between high-fidelity mannequin simulation (HFMS) and virtual patient simulation (VPS), accounting for factors related to healthcare experience, virtual technology experience, and age.
Methodology: This quasi-experimental study with repeated measures mixed design examined the effectiveness of VPS in acquiring CJ compared to HFMS. The study also investigated the efficacy of VPS as a primer for HFMS using the Lasater Clinical Judgment Rubric (LCJR) among third-year Bachelor of Nursing prelicensure students, controlling for previous experiences in Healthcare and Virtual Technology and Age. Participants assigned to the control group (n = 48) received three HFMS scenarios, and the intervention group (n = 46) received three VPS scenarios, followed by three HFMS scenarios. Repeated measures using the LCJR measured clinical judgment for the HFMS (control) group at pretest (T1) and posttest (T2) and pretest (T1) and posttests (T2 and T3) for the VPS (intervention) group.
Results: Mixed ANCOVA and mixed MANCOVA examined the differences in the change of self-perceived CJ total scale score and subscale scores, respectively, from pretest to posttest between the HFMS and VPS groups. The interaction effect of Time by study group using the mixed ANCOVA for the self-perceived CJ total scale score was not significant for either group between T1 and T2 (p = .33) and T1 and T3 (p = .12). The interaction effect of Time by study group using mixed MANCOVA for the self-perceived CJ subscale scores was also not significant between T1 and T2 (p = .54) and T1 and T3 (p = .65). Results indicated that both groups showed similar increases over time for the self-perceived CJ total scale and subscale scores.
Discussion: The findings showed that the self-perceived CJ total scale and subscale scores improved across the repeated measures, and students benefited from HFMS, VPS, and combined simulation approaches. Both approaches were similarly effective in fostering participants’ clinical judgment development.
Notes
References: American Association of Colleges of Nursing. (2021). The essentials: Core competencies for professional nursing education. https://pncb.org/sites/default/files/resources/Essentials_Core_Competencies_Profession al_Nursing_Education.pdf
Kavanagh, J. M., & Szweda, C. (2017). A crisis in competency: The strategic and ethical imperative to assessing new graduate nurses' clinical reasoning. Nursing Education Perspectives, 38(2), 57-62. https://doi.org/10.1097/01.NEP.0000000000000112
Lasater, K. (2007). Clinical judgment development: Using simulation to create an assessment rubric. Journal of Nursing Education, 46(11), 496-503. https://doi.org/10.3928/01484834-20071101-04
National Council of State Boards of Nursing. (2019). The clinical judgment model and action model. Next Generation NCLEX News, Spring, 1-5. https://www.ncsbn.org/NGN_Spring19_ENG_29Aug2019.pdf
Tanner, C. A. (2006). Thinking like a nurse: A research-based model of clinical judgment in nursing. Journal of Nursing Education, 45(6), 204-211.
Sigma Membership
Zeta Kappa at-Large
Type
Presentation
Format Type
Text-based Document
Study Design/Type
Quasi-Experimental Study, Other
Research Approach
Mixed/Multi Method Research
Keywords:
Virtual Learning, Teaching and Learning Strategies, Simulation, Prelicensure Nursing Students
Recommended Citation
Millard, Monica, "Effectiveness of Virtual Simulation to Improve Clinical Judgment in Prelicensure Nursing Students" (2025). International Nursing Research Congress (INRC). 62.
https://www.sigmarepository.org/inrc/2025/presentations_2025/62
Conference Name
36th International Nursing Research Congress
Conference Host
Sigma Theta Tau International
Conference Location
Seattle, Washington, USA
Conference Year
2025
Rights Holder
All rights reserved by the author(s) and/or publisher(s) listed in this item record unless relinquished in whole or part by a rights notation or a Creative Commons License present in this item record.
Review Type
Abstract Review Only: Reviewed by Event Host
Acquisition
Proxy-submission
Effectiveness of Virtual Simulation to Improve Clinical Judgment in Prelicensure Nursing Students
Seattle, Washington, USA
Problem: The academic-practice gap has widened due to limited clinical placement opportunities for practicing decision-making skills, leading to a decline in entry-level competency among newly graduated registered nurses. Virtual simulation has been proposed to foster decision-making skills. However, there is a lack of research examining the effectiveness of virtual simulation in developing clinical judgment (CJ) among nursing students. This study aimed to compare the self-perceived CJ between high-fidelity mannequin simulation (HFMS) and virtual patient simulation (VPS), accounting for factors related to healthcare experience, virtual technology experience, and age.
Methodology: This quasi-experimental study with repeated measures mixed design examined the effectiveness of VPS in acquiring CJ compared to HFMS. The study also investigated the efficacy of VPS as a primer for HFMS using the Lasater Clinical Judgment Rubric (LCJR) among third-year Bachelor of Nursing prelicensure students, controlling for previous experiences in Healthcare and Virtual Technology and Age. Participants assigned to the control group (n = 48) received three HFMS scenarios, and the intervention group (n = 46) received three VPS scenarios, followed by three HFMS scenarios. Repeated measures using the LCJR measured clinical judgment for the HFMS (control) group at pretest (T1) and posttest (T2) and pretest (T1) and posttests (T2 and T3) for the VPS (intervention) group.
Results: Mixed ANCOVA and mixed MANCOVA examined the differences in the change of self-perceived CJ total scale score and subscale scores, respectively, from pretest to posttest between the HFMS and VPS groups. The interaction effect of Time by study group using the mixed ANCOVA for the self-perceived CJ total scale score was not significant for either group between T1 and T2 (p = .33) and T1 and T3 (p = .12). The interaction effect of Time by study group using mixed MANCOVA for the self-perceived CJ subscale scores was also not significant between T1 and T2 (p = .54) and T1 and T3 (p = .65). Results indicated that both groups showed similar increases over time for the self-perceived CJ total scale and subscale scores.
Discussion: The findings showed that the self-perceived CJ total scale and subscale scores improved across the repeated measures, and students benefited from HFMS, VPS, and combined simulation approaches. Both approaches were similarly effective in fostering participants’ clinical judgment development.
Description
The study used the Lasater Clinical Judgment Rubric to compare self-perceived clinical judgment between high-fidelity mannequin simulation and virtual patient simulation. The results demonstrated that VPS was as effective as HFMS in fostering clinical judgment.