Research Abstract

 Title:

Effects of Interactive Electronic vs Face-to-Face Simulation on Clinical Judgment: A Pilot Study

Purpose: Simulation is emerging as an alternative to clinical placements. While multiple studies show the effectiveness of face-to-face simulation, the effectiveness of virtual simulations, serious gaming, and interactive electronic simulations on clinical judgment is minimal. However, they are more cost-effective than face-to-face simulations; and, therefore, are becoming more common. This experimental study evaluated nursing students’ performance in face-to-face and interactive electronic simulation to determine if they could demonstrate the same level of clinical judgment skills in both environments.

Introduction: Clinical facilities report seeing clinical judgment skills lacking in new nurses. At the same time, clinical sites are becoming difficult to secure and hands-on clinical experiences are limited. As a result, nursing programs are increasing the use of simulation to improve clinical judgment skills. While these experiences do result in improved clinical judgment, they are limited by cost, time, space, and availability of trained faculty. Interactive electronic simulations could be viable alternative.

Methodology/Implementation: An experimental design using convenience sampling recruited undergraduate baccalaureate nursing students in their junior and senior semesters over the fall and spring semesters (n=58) to participate in both face-to-face intradisciplinary high-fidelity simulations and interactive electronic simulations. Faculty used The Lasater Clinical Judgment Rubric to evaluate student performance in both environments. The Lasater Clinical Judgment rubric is an 11-item evaluation focusing on noticing cues, analyzing and interpreting data, responding appropriately, and self-reflection. The same faculty evaluated each student in both the interactive electronic and face-to-face simulation. Both groups of students participated in the same pre-brief and de-brief. Each simulation, whether face-to-face or electronic, covered the same nursing concepts. The Statistical Package for the Social Sciences (SPSS 27) was used to analyze all the data in this study. Collected data was analyzed using a paired t-test to measure the differences in Lasater Rubric scores in the face-to-face and interactive electronic simulation environments.

Evaluation/Results: Using a Likert scale ranging from beginning development (1) to exemplary development (4), the paired t-test showed no significant difference in the scoring between the face-to-face and interactive electronic simulations for questions 1-10. The questions with the most similar scores between the two groups focused on the ability for the student to perform a focused assessment and evaluate the effectiveness of the interventions (questions 2,8, and 9). The evaluation tool contained two self-reflection tools. The first, question 11, focused on the student’s ability to accurately evaluate their own performance. There was almost no significant difference between groups, p = 0.886. However, question 11, which focused the on the student’s commitment to improvement, showed their was a significant difference between the face-to-face and electronic simulation evaluations; t(57) = 2.457, p = 0.017. Faculty did note that students spoke up more and felt freer in making decisions when using the interactive virtual software. Students also did not express the same desire or commitment to change their actions and decisions with the virtual simulation during the debrief.

Conclusions/Recommendations: As simulation demand increases, virtual programs will continue to be used. This research project shows promise in the ability of the interactive electronic simulation program’s ability to improve clinical judgement, when compared to face-face simulation. However, this study contained a smaller sample size. Faculty did note that students spoke up more and felt freer in making decisions when using the interactive virtual software. This could be taken as both a positive and negative aspect of using the software, requiring further research.

Research study funded through Sam Houston State University Office of Research & Sponsored Programs Pilot Study Grant