Clinical judgment model-based nursing simulation scenario for patients with upper gastrointestinal bleeding: A mixed methods study

Abstract

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner’s clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the “noticing” clinical judgment phase was the most frequently observed phase, while “reflection” was the least frequently observed phase. Additionally, “education” was the most frequently observed nursing domain, and “anxiety” was the least frequently observed domain. Although further simulation repetitions are required to reinforce students’ self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students’ clinical judgment skills, especially “reflecting” and “emotional care.”

Simulated clinical scenarios: The experiences of Emergency Care Practitioner students

“…One of the concepts that emerged in the findings of this study, and that has been repeated continuously throughout simulation learning research, is that students appreciate a learning opportunity that poses no risk to human life. 2 Students feel that simulation learning prepares them for the work they will be doing after graduation, and it enables them to practise rare skills that they would not easily have been able to do in a real clinical setting. 20 Our findings also echo previous research which found that simulation learning improves student confidence.…”

“…2 When teaching the skills that are needed in any Emergency Medical Care (EMC) course, such as critical thinking, clinical reasoning and patient management, simulation has been found to be an effective educational approach. 3 It should be noted that simulated clinical scenarios are critical in the developmental process of a student's treatment plans and clinical thinking 2 and play an important role in bridging the gap between theory and clinical practice. 4 The use of simulation in paramedic, nursing and medical doctor training has proven to have a positive effect on patient safety.…”

An educational intervention to improve nurses’ knowledge and self-confidence: An integrated literature review

“…Hanley et al [14] used three concepts of Tanner's Model of Noticing, Interpreting, and Responding in clinical practice in their quality improvement process to improve patient safety by teaching the nurses how to operationalize in clinical practice. [15] Tanner's clinical judgment model in a high-fidelity simulation scenario for undergraduate nursing students to manage a patient with gastrointestinal bleeding. The result showed a significant increase in the students' theoretical knowledge, clinical performance skills, and self-confidence [15].…”

“…[15] Tanner's clinical judgment model in a high-fidelity simulation scenario for undergraduate nursing students to manage a patient with gastrointestinal bleeding. The result showed a significant increase in the students' theoretical knowledge, clinical performance skills, and self-confidence [15].…”

“…Improving nurses' ability to quickly recognize changes and apply appropriate intervention improves patients' chance of positive outcomes. The development of case scenarios based on the clinical judgment model and evaluation of nurses' clinical judgment during simulation practice will help construct a meaningful simulation experience that could impact nurses' care delivery [15]. Using Tanner's Clinical Judgment Model, the nurse would recognize the decline in patient condition, interpret the change, implement an intervention, and reflect on the outcomes on whether the interventions were effective.…”