Key themes: Research and development

Academics:

• Dr. Naim Abdulmohdi, Senior Lecturer in Nursing, Anglia Ruskin University, naim.abdulmohdi@aru.ac.uk

Aims & Objectives:

This study aimed to strengthen nursing students’ clinical decision-making skills by using high-fidelity simulation combined with pluralistic research methods. The core goal was to explore how student nurses process information and make critical decisions when managing the care of a deteriorating patient, an area recognised as vital for patient safety but often under-developed in early nursing practice.
The primary aim was to investigate the types of clinical decision-making used by nursing students in a realistic acute care scenario, and to examine whether the simulation experience could enhance their reasoning skills. The objectives were threefold:
1. To identify how students use inductive (‘forward’) and deductive (‘backward’) reasoning processes when faced with patient deterioration;
2. To measure any change in clinical reasoning scores before and after the simulation;
3. To explore how students apply both analytical and intuitive processes.

Details:

The intervention involved a convergent parallel mixed-methods design. Twenty-three final-year nursing students participated in a high-fidelity simulation that replicated an acute surgical ward scenario involving a patient experiencing an anaphylactic reaction to a blood transfusion. Students were assessed using a Clinical Reasoning Test before and after the simulation to measure changes in clinical reasoning ability.
During the scenario, students used a ‘think aloud’ method, verbalising their thought processes while responding to the deteriorating patient. Their performance was audio-video recorded and supplemented by structured observation. A facilitated debriefing session followed, incorporating retrospective think aloud to encourage reflection, reinforce learning, and identify biases that might affect decision-making in real practice.

Impacts

The project demonstrated measurable improvements in students’ clinical reasoning scores, particularly in deduction and analysis sub-scales, suggesting that students developed backward reasoning skills through the experience particularly through debriefing and post simulation reflection. The data showed that students predominantly relied on cue acquisition during the scenario, while deeper cue interpretation emerged during debriefing. This highlights that simulation and debriefing each support distinct yet complementary aspects of decision-making.
A key insight was that students who focused on accurately interpreting critical cues, rather than collecting an excessive amount of information, were more successful in solving the scenario. This finding supports the value of structured simulation in helping students develop analytical reasoning skills early in their careers.

Next Steps

Future plans include refining the simulation scenarios and debriefing tools to further strengthen students’ reasoning and to integrate these approaches into broader nursing curricula.

Links

• Journal article: Investigating the clinical decision-making of nursing students using high-fidelity simulation, observation and think aloud: A mixed methods research study – https://onlinelibrary.wiley.com/doi/full/10.1111/jan.15507