Simulation and nursing knowledge: a cognitive constructivist investigation

Background: Increasingly, simulated learning environments are being used as a means to increase the competence of health professionals. However, there is insufficient evidence to support the investment in time and resources. The objective of this investigation was to test the clinical decision making abilities of undergraduate nursing students and explore cognitive, affective, and psychomotor attribute development from simulated learning environments in comparison to traditional education methods and learning environments. Method: The investigation reported in this thesis followed a logical sequence of mixed methods which included: a) pilot study, b) a randomised controlled trial, c) content analysis of interview transcripts, and d) a comparison of findings from the mixed methods investigations. Cognitive constructivist theory was the nature and structure of knowledge that was tested and explored, based on William Perry’s (1970) scheme. It was an assumption of this study, based on previous research that the higher the cognitive score the greater ability a nursing student would have to make informed valid decisions in their clinical practice. Following ethical approval from three Australian universities, fifty-eight third year undergraduate nursing students were randomised in a pre-test post-test group parallel controlled trial. The objective scoring instrument of cognitive development, the Learning Environment Preferences (LEP) was used to test cognitive abilities in order to refute the null hypothesis that activities in computer-based simulated learning environments have a negative effect on cognitive abilities when compared with activities in skills laboratory simulated learning environments. Subsequently, Perry’s (1970) scheme and previous research provided the initial coding framework in analysing post simulation interviews. Perry’s scheme was also used as the lens to interpret a student’s personal epistemological development from simulated learning environments in a content analysis of interview transcripts. Finally, any student quality or variance that may have influenced cognitive development was explored, analysed, and have been legitimised within Perry’s scheme. Results: The statistical results indicated that non-native English speaking nursing students preferred and have increased performance from activities in facilitated instructor-led skills laboratory simulated learning environments. However, there was no overall significant difference in cognitive development following two cycles of simulation activities. From the qualitative data, recommendations are made in the preparation and evaluation of simulation tasks to develop undergraduate nursing students’ attributes in preparation for practice as Registered Nurses. Furthermore, the ecological validity of simulated learning environments and theory—practice implications are made clear. This investigation supports the possibility of using mixed methods research processes to provide evidence for education practice and provides an example of an approach that can be replicated and further refined to enable and inform best practice guidelines for instructional theory and simulation practice. Future implications: This investigation identified future projects from non-confirming statistical results related to nursing curriculum, grade-point-average (GPA), cognitive scores, and level of previous education. The qualitative data informs and provides a schema that models student learning in simulated learning environments and clinical settings. This investigation provides nursing academics with a framework to understand the complexities of nursing knowledge and simulation training and over time will assist to inform best practice.