With the increasing complexity of healthcare, new nurses face increasing challenges in transitioning from educational to professional practice settings. Development of sound clinical judgment skills may facilitate this transition and enhance the provision of safe, effective patient care. Nurses must be able to notice, interpret, and respond to patients’ conditions as well as anticipate and reflect on the results of their subsequent actions. Experience is critical in developing clinical judgment (Tanner, 2006). Given increased competition for clinical sites, a challenge for faculty is to provide meaningful practice experiences for nursing students. With 87% of 1060 programs reporting use of HFS as a substitute for, or adjunct to traditional clinical experiences, high fidelity simulation may provide high quality clinical experiences for nursing students (Gore & Thompson, 2016). There is a substantial body of literature documenting the effectiveness of HFS in enhancing student development of clinical judgment skills (Bussard, 2016; Fawaz & Hamdan-Mansour, 2016; Ironside & Jeffries, 2016; Lavoie, Pepin, & Cossette, 2017; Page-Cutrara & Turk, 2017; Victor, Ruppert, & Ballasy; 2017), yet there remains a significant knowledge gap regarding how students translate simulated learning to practice.
Methods:
The aim of this qualitative exploratory study was to enhance understanding of how new nurses (with one to three years’ professional experience) interpret the contribution of their HFS experiences as student nurses to their subsequent development of clinical judgment and the role of HFS learning in their transition to practice. Guiding questions were: 1) What were the perceptions of nurses with one to three years’ experience related to the contribution of HFS to their development of clinical judgment; 2) In what ways do these nurses believe HFS enhanced their ability to notice, interpret, respond to, and reflect on patient conditions and responses; 3) What specific aspects of HFS were regarded as most helpful in development of clinical judgment? The research protocol was reviewed and approved by the Institutional Review Board. The primary researcher recruited and enrolled a purposive sample of 20 BSN graduates from ten different nursing programs located in the southeastern United States. Demographic data revealed racial and ethnic proportions consistent with the region (University of Georgia Board of Regents Center for Health Workforce Planning and Analysis, 2010; Office for Healthcare Workforce Analysis and Planning in the South Carolina Area Health Education Consortium [AHEC], 2014). Data collection consisted of semi-structured individual interviews, ranging from 45 to 60 minutes. The primary researcher conducted and transcribed all audio-recorded interviews which enhanced ongoing engagement with the data. Two researchers independently coded two transcripts and then met to review, compare, and discuss their initial open coding. Following this review of the initial coding, both researchers independently coded the remaining transcripts and subsequently convened to discuss their coding and interpretation of the data (Saldana, 2016, Sandelowski, 2000). They identified three major themes in the data: 1) Acting in the role of the nurse in simulation learning enhanced students’ synthesis of knowledge from multiple sources; 2) Students identified specific learning advantages of HFS over the clinical setting; 3) Knowledge, skills, and attitudes gained through HFS translated to the student clinical experience and into practice.
Results:
New nurses described HFS experiences as enhancing their development of clinical judgment. They reported having taken on the role of the nurse in a safe environment enabled them to practice clinical judgment skills and noted that clinical practice settings seldom afforded the same opportunities because of patient safety constraints. They identified advantages of the HFS environment, including the ability to make mistakes without negative consequences to an actual patient and the faculty’s ability to pause the simulation and provide explanations that might not be possible in front of an actual patient. Although these nurses found “thinking aloud” in HFS as uncomfortable at the time, they now credited these experiences as enhancing their development of clinical judgment.
Conclusion:
In contrast to prior studies examining student development of clinical judgment skills in HFS, this research focused on new nurses’ recalled experiences and their reflections on how HFS contributed to the development of clinical judgment skills. Compared to clinical practice settings, unique benefits of HFS include the opportunity for the nursing student to take on the role of the nurse and make independent judgments. Students perceived the HFS environment as safe in that it eliminated the risk of harm to actual patients and allowed them to practice decision making in a supportive environment. Nurses related that HFS enhanced their ability to synthesize information learned from multiple sources and to notice, interpret, and respond to patient conditions. They recalled debriefing as contributing to their ability to reflect on patient conditions and their nursing actions. Participants recalled how the knowledge, skills, and attitudes learned in HFS related to their current realm of practice and enhanced their ability to skillfully perform clinical judgment and provide safe, effective care to patients.