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."
Highlights
Nursing academic institutions have difficulty securing practice facilities for their students’ clinical placements because of the COVID-19 pandemic
This study successfully developed and applied a simulation scenario for patients with upper gastrointestinal bleeding (UGIB) based on Tanner’s clinical judgment model (CJM)
It identified the effectiveness of simulations and the current level of clinical judgment among undergraduate nursing students
Summary
Nursing academic institutions have difficulty securing practice facilities for their students’ clinical placements because of the COVID-19 pandemic. Simulations have been actively used worldwide as an alternative format for clinical practice [1]. Understanding the clinical judgment process and how nurses think in actual clinical situations are essential.
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