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Purpose: The purpose of this study was to examine the effects of a standardized patient simulation experience on decision making, self efficacy and critical thinking. Standardized patient simulation is a simulation technique used in the curriculum of nursing and many healthcare professions (Wilson & Rockstraw, 2012).
Methods: This was a quasi-experimental pre-test post-test design study. The sample included medical assistant students, practical nurse students and undergraduate nursing students who were participating in a standardized patient simulation experience. Prior to the simulation experience each participant completed the following: 1) a demographic sheet; 2) the Decision Making Quality Scale (DMQS) with 7 questions; 3) the General Self-Efficacy Scale (GSE) with 10 questions; and 4) the Critical Thinking Disposition Scale (CTDS) with 75 questions. Immediately after completing the standardized patient simulation experience each participant completed the following: 1) the Decision Making Quality Scale (DMQS) with 7 questions; 2) the General Self-Efficacy Scale (GSE) with 10 questions; and 3) the Critical Thinking Disposition Scale (CTDS) with 75 questions. All data collected were anonymous but coded to match the pre-test with the post-test. All data were entered into SPSS version 20 and analyzed.
Results: A total of 388 students participated in the study. Participants included 6 medical assistant students (1.5%), 44 practical nurse students (11.3%) and 338 undergraduate nursing students (87%). The undergraduate nursing students were from a variety of programs including an associate degree nursing program (2 year program) 18%, a baccalaureate nursing traditional program (4 to 5 year program) 11.1% and a baccalaureate nursing accelerated program (11 month program) 58%. Participants were aged 19 to 62 years with the majority between the ages of 20 to 33. As for marital status of the participants, 75.5% were single, 20.9% were married, .3% were widowed, and 1.8% were divorced. For gender there were 16.7% were male and 83.3% were female. As for race 66.5% were White, .3% American Indian or Alaskan native, 7.7% were Asian, 21.1% were Black or African American, and 4.4% identified as more than one race. Due to the small number of medical assistant student participants they were excluded from the pre-test post-test analysis which left a total of 382 participants. The analysis will identify the main effect (F-test) of the independent variable (the four groups [practical nurse students, associate degree nursing students, baccalaureate traditional program nursing students and baccalaureate accelerated program nursing students]) on the post-test scores of each of the dependent variables (decision making, self efficacy, and critical thinking). The pre-test post-test comparisons were analyzed using an analysis of covariance (ANCOVA). A separate ANCOVA was used for each of the dependent variables of decision making, self efficacy and critical thinking. Covariates were pre-test scores from the dependent variable under consideration. Post-test scores served as the dependent variable. The results for Decision Making were F(2, 305) = 1.475, p = .230 showing no statistically significant difference in post-test scores after initial differences were controlled through covariation. The results for Self Efficacy were F(2, 304) = 1.021, p = .362 showing no statistically significant difference in post-test scores after initial differences were controlled through covariation. The results for Critical Thinking were F(2,308) = .933, p = .395 showing no statistically significant difference in post-test scores after initial differences were controlled through covariation. In summary there were no statistically-significant differences in post-test scores between the groups on any of the three dependent variables.
Conclusion: The analysis showed that here was no significant difference in any of the 4 groups (practical nurse students, associate degree nursing students, baccalaureate traditional program nursing students and baccalaureate accelerated program nursing students) when examining the dependent variables of decision making, self efficacy and critical thinking following a standardized patient simulation experience. Possible reasons for these results include 1) variation in the types of students; 2) variation in the simulation cases; 3) participant exhaustion due to the length of the pre-test and post-test and 4) other factors not yet identified. Future research plans include the following: 1) continued examination of the dependent variables of decision making, self efficacy and critical thinking along with other concepts important to healthcare education and patient safety; 2) Further examination of the subscales of decision making and critical thinking following a standardized patient simulation experience; and 3) examination of decision making, self efficacy and critical thinking following a human patient simulator simulation experience. Continued research is needed to find the simulation technique or technology that will have the biggest impact on nursing student education to foster student knowledge, student success and patient safety.