The effect of simulation on the development of undergraduate nursing students' clinical decision making and judgement: A systematic review
Abstract Background Simulation-based learning (SBL) has become a widely recognized teaching method in nursing programs to bridge the gap between practice and education. Furthermore, simulation is becoming a successful method to address the shortage of clinical placements for nursing students, providing evidence-based, practical learning opportunities that enhance the development of clinical decision-making (CDM) and clinical judgement (CJ) skills, which are essential in today's complex healthcare settings. It is evident that there is a significant body of literature on simulation in nursing, providing unequivocal evidence on its effectiveness, particular on the development of CDM and CJ skills in undergraduate nursing students. Objectives The main objective of this systematic review is to assess the evidence for the effectiveness of SBL in developing CDM and CJ skills in undergraduate nursing students. A secondary objective is to assess the effect of SBL on critical thinking (CT) and clinical reasoning (CR). Search methods In conducting this review, the Cochrane Handbook for Systematic Reviews of Interventions (2020) and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement (Page et al. 2021) were followed. A systematic and comprehensive electronic search of different databases was conducted, including OVID MEDLINE, CINHAL, PubMed and the Cochrane Central Register of Controlled Trials. Selection criteria This review included Randomised Controlled Trials (RCTs) comparing SBL with a control group (any traditional training methods) in undergraduate nursing students. Data collection Data was extracted and summarised independently from reviewed studies. A second reviewer was consulted only in the event of any uncertainty. The included RCTs were appraised individually in terms of their reporting and methodological quality using the 3 CONSORT 2010 checklist and the Revised Cochrane risk-of-bias tool for randomized trials (RoB 2) for each bias type: selection, performance, attrition, and detection bias. Main results A total of five RCTs involving 625 students were included in this review. The RCTs utilised a wide range of instruments and simulation methodologies, with varying durations and numbers of simulated exposures. Three of the RCTs reported a positive effect of simulation teaching methods in comparison to other traditional methods, showing a statistically significant increase in CDM, CT, or CJ skills between the simulation group and the control group. The other two RCTs reported equivocal results, demonstrating that simulation-based learning was at least as effective as classical learning methods at improving CDM and CJ in undergraduate nursing students. Conclusion Current evidence suggests that SBL is equivalent or superior to traditional educational methods in the development of CDM and CJ skills in undergraduate nursing students. Although these findings are promising, they must be interpreted with caution, due to the moderate methodological quality of studies and significant heterogeneity across the included studies. In conclusion, further research is needed in this important area, with larger and higher quality multi-centred RCTs with larger sample sizes as well as rigorous randomisation and allocation concealment, to reach a definitive conclusion about the effectiveness of SBL in improving CDM and CJ skills in undergraduate nursing students. An umbrella review is recommended, since there have been previously published systematic reviews.