Effectiveness of a Virtual Simulation Program as a Novel Approach to Improve Clinical Judgment in Prelicensure Nursing Students

Problem: Limited clinical placement opportunities for practicing decision-making skills have widened the academic-practice gap. Research shows a disturbing decline in entry-level competency among newly graduated registered nurses. Innovative strategies like virtual patient simulation may foster decision-making skills and prepare prelicensure nursing students for practice. However, research is lacking in examining virtual patient simulation (VPS) as an effective approach for developing clinical judgment in prelicensure nursing students. The American Association for Academic Nursing has determined that clinical judgment is an essential nursing attribute. Moreover, the National Council of State Boards of Nursing developed the Next Generation National Council Licensure Exam based on a clinical judgment model. Identifying effective novel teaching strategies is imperative for nursing programs to prepare nursing students for entry-level practice. Methodology: The study guided by the Tanner Clinical Judgment Model, integrating the three learning domains (cognitive, affective, and psychomotor), was used as the conceptual framework for the virtual simulation intervention. This quasi-experimental study with repeated measures mixed design examined the effectiveness of VPS in acquiring clinical judgment compared to high-fidelity mannequin simulation (HFMS). The study also investigated the efficacy of virtual patient simulation as a primer for HFMS using the Lasater Clinical Judgment Rubric among third-year Bachelor of Nursing prelicensure students, controlling for previous experiences in Healthcare and Virtual Technology and Age. Participants were assigned to the control group (n = 48) and received three HFMS scenarios, and the intervention group (n = 46) received three VPS, followed by three HFMS scenarios. Repeated measures using the Lasater Clinical Judgment Rubric measured clinical judgment at pretest (T1) and posttest (T2) for the HFMS (control group) and pretest (T1) and posttests (T2 and T3) for the VPS (intervention) group. Results: Mixed ANCOVA and mixed MANCOVA examined the differences in the change of self-perceived clinical judgment total scale score and subscale scores, respectively, from pretest to posttest between the HFMS and VPS groups. Statistical analyses were performed using an alpha level of .05. The mixed ANCOVA showed the interaction effect of Time by study group for the self-perceived clinical judgment total scale score was not significant for either group between T1 and T2 (p = .33) and between T1 and T3 (p = .12). The interaction effect of Time by study group using mixed MANCOVA for the self-perceived clinical judgment subscale scores were also not significant between T1 and T2 (p = .54) and between T1 and T3 (p = .65). The results indicated that both groups showed similar increases over time for the self-perceived clinical judgment total scale and subscale scores between HFMS and VPS among third-semester pre-licensure nursing students. Discussion: The findings showed that the self-perceived clinical judgment total scale and subscale scores improved across the repeated measures, and students benefited from HFMS, VPS, and combined simulation approaches. Both approaches were similarly effective in fostering students’ clinical judgment development. Implications: Virtual patient simulation is as effective as high-fidelity mannequin simulation and offers nursing programs another learning approach for promoting clinical judgment among prelicensure nursing students.