Academic journal article Nursing Education Perspectives

Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students

Academic journal article Nursing Education Perspectives

Effectiveness of Integrated Simulation and Clinical Experiences Compared to Traditional Clinical Experiences for Nursing Students

Article excerpt


AIM The focus of this research study was the evaluation of the effectiveness of using high-fidelity simulations to replace 50 percent of traditional clinical experiences in obstetrics, pediatrics, critical care, and mental health nursing.

BACKGROUND Increasing student admissions to nursing programs require additional clinical learning opportunities to accommodate extra students.

METHOD Three schools with associate degree nursing programs partnered to identify, implement, and evaluate a creative solution to this dilemma. The resulting quasi-experimental study investigated if substituting half of the conventional clinical experiences with simulations was as effective as traditional clinical activities in obstetrics, pediatrics, mental health, and critical care. One hour of simulation counted for two hours of clinical time.

RESULTS Findings indicated combining simulations with conventional clinical experiences resulted in significantly higher scores on the pre-graduation exit exam than traditional clinical experiences alone.

CONCLUSIONS Findings have implications for articulation and basic students in associate degree nursing programs.

KEY WORDS High-Fidelity Simulation--Clinical and Simulation Ratios--Percentage of Simulation--Clinical Placement Clinical Requirements


The knowledge base of nursing is growing exponentially, with nurse educators diligently striving to meet the challenges of a faculty shortage and too few clinical sites (Jeffries, 2005, 2012). In many locales, where clinical resources are stretched to the maximum, nursing programs are limited in the number of students they can admit. Clinical learning opportunities in obstetrics, pediatrics, mental health, and critical care settings are frequently more limited than in other areas because these units/settings often accommodate only four to six students at a time.

To increase capacity in nursing programs, schools need to collaborate and share clinical resources. In addition, innovative strategies like high-fidelity simulation (HFS) must be developed to supplement clinical experiences.

Studies on knowledge outcomes of students when simulation activities are used in lieu of clinical experiences are varied. A systematic review of the simulation literature from 2003 to 2007 revealed a gap in the health care literature on the effectiveness of HFS (Harder, 2010). Harder's review identified two specific themes: a) simulation use for clinical skill performance and b) simulation use in the evaluation of perceived confidence/competence.

Objective measures are needed to evaluate the effectiveness of HFS experiences. Prion (2008) pointed out that research on simulation in nursing education is often indirect, involving only learner satisfaction and self-efficacy. Billings and Halstead (2012) asserted that active learning experiences, such as simulation, facilitate the development of cognitive abilities and knowledge, which can be evaluated by multiple-choice tests.

Davis, Kimble, and Gunby (2014) conducted a mixed-methods (qualitative and quantitative) study that indicated nursing programs are using a high percentage of HFS, but the literature on this topic is generally vague. Consequently, Davis and colleagues recommended that simulation usage be documented in clock hours, with the number of hours simulation is substituted for traditional clinical experiences identified along with the total number of clinical and didactic clock hours within the program. Davis et al. emphasized that research is needed to determine the optimal combination of traditional clinical and simulation experiences.


Multiple authors have specified that HFS allows faculty to create structured scenarios requiring specific and essential interventions that are predictable and reproducible for all students in a course. Brannan, White, and Bezanson (2008) conducted a quasi-experimental study to evaluate cognitive skills and confidence levels regarding acute myocardial infarction (AMI). …

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