Describing How Scenario Topic, Situation Urgency and Complexity Level Impacts Simulation Observers’ Clinical Judgment: A Secondary Analysis

Introduction Nurses use clinical judgment (CJ), or the process of “thinking like a nurse” by recognizing and interpreting a patient's concerns, to guide care decisions. However, nursing students graduate without sufficient CJ for safe nursing practice. A prior investigation found observing simulations leads to significant, but inconsistent CJ gains, depending on learner ability. Observers watched diverse simulation designs with increasing complexity, highlighting the need to understand which conditions best support CJ development. Objective This secondary analysis of a prior investigation aims to describe how simulation designs (i.e., scenario topic and situation urgency) and complexity level impacts CJ. A secondary aim is to investigate how simulation designs and complexity level impacts CJ based on learner ability. Methods Sixty-one junior-level baccalaureate students participated in the study over a semester. Participants observed eight expert-modeled simulations, each focused on medical-surgical or mental health scenarios in either urgent or routine situations. After each simulation, participants responded to 11 CJ prompts, which were scored using the Lasater CJ Rubric (LCJR). The scenarios were rated for complexity (simple, moderate, difficult, complex) based on author-identified sources. Participants were grouped into low-, medium-, or high-ability categories based on their cumulative LCJR scores. Two separate two-way repeated measures ANOVAs examined how simulation topics and situation urgency influenced CJ, with analyses repeated for each ability group. Results Observers’ mean CJ is influenced by both simulation design and complexity level. CJ decreases in complex medical-surgical and mental health scenarios as complexity exceeds a “difficult” rating, regardless of ability. However, CJ improves in simple and moderately complex routine situations. Observing “difficult” and “complex” simulations hindered significant CJ gains, regardless of ability. Conclusions Nurse educators should consider learner ability and complexity level when designing simulation observations to prevent overwhelming observers’ CJ, especially during urgent and complex medical surgical or mental health scenarios.