A comparison of educational strategies for the acquisition of nursing student’s performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies)

Zarifsanaiey et al. BMC Medical Education (2016) 16:294 DOI 10.1186/s12909-016-0812-0 RESEARCH ARTICLE Open Access A comparison of educational strategies for the acquisition of nursing student’s performance and critical thinking: simulation-based training vs. integrated training (simulation and critical thinking strategies) Nahid Zarifsanaiey1*, Mitra Amini2 and Farideh Saadat3 Abstract Background: There is a need to change the focus of nursing education from traditional teacher-centered training programs to student-centered active methods. The integration of the two active learning techniques will improve the effectiveness of training programs. The objective of this study is to compare the effects of the integrated training (simulation and critical thinking strategies) and simulation-based training on the performance level and critical thinking ability of nursing students. Methods: The present quasi-experimental study was performed in 2014 on 40 students who were studying practical nursing principles and skills course in the first half of the academic year in Shiraz University of Medical Sciences. Students were randomly divided into control (n = 20) and experimental (n = 20) groups. After training students through simulation and integrated education (simulation and critical thinking strategies), the students' critical thinking ability and performance were evaluated via the use of California Critical Thinking Ability Questionnaire B (CCTST) and Objective Structured Clinical Examination (OSCE) comprising 10 stations, respectively. The external reliability of the California Critical Thinking questionnaire was reported by Case B.to be between 0.78 and 0.80 and the validity of OSCE was approved by 5 members of the faculty. Furthermore, by using Split Half method (the correlation between odd and even stations), the reliability of the test was approved with correlation coefficient of 0.66. Data were analyzed using t-test and Mann–Whitney test. A significance level of 0.05 was considered to be statistically significant. Results: The mean scores of the experimental group performance level were higher than the mean score of the control group performance level. This difference was statistically significant and students in the experimental group in OSCE stations had significantly higher performance than the control group (P <0.001). However, the mean scores obtained for the critical thinking did not increase before and after the intervention. Conclusion: The results showed that, the students’ performance level was increased by the application of integrated training (simulation and critical thinking strategies). Keywords: Simulation, Critical Thinking Strategies * Correspondence: 1 Department of E-learning, Virtual School, Center of Excellence for e-Learning in Medical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran Full list of author information is available at the end of the article © The Author(s). 2016 Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. Zarifsanaiey et al. BMC Medical Education (2016) 16:294 Background Technical and treatment advancements and rapid changes of political, social and cultural factors demonstrate the need to use new active training strategies in medical and nursing education. The nursing students should be actively trained in order for them to sufficiently understand real clinical situations and gain the learning in a real context [1, 2]. Deubel stated that the use of an educational theory and subsequent use of a teaching model alone is not sufficient to advance learning and in order to design active courses and create the ground for learners to think, educational spectrum and teaching models must be integrated. The integration of these practices such as simulation and critical thinking strategies will improve the effectiveness of training programs and will help students gain Nursing skills [3]. Students have interest in simulation as one of the forms of interactive learning as well as a powerful way of transferring skills, which can be performed individually or in small groups. There are many types of simulation such as live simulation, virtual simulation, structural simulation, role-playing simulation and use of mannequins [4, 5]. Simulation helps students to understand the importance of nursing interventions to patient outcomes by reflecting on the performance [6, 7]. It was revealed in different studies that simulation strengthens confidence, interest and clinical skills in nursing students [8]. Nursing students should be active learners and think critically to provide safe patient care. Hence, nursing education has stressed critical thinking as a necessary nursing skill [4]. Critical thinking is an essential component of professional responsibility and quality nursing care. In nursing, critical thinking is the ability to think systematically and reflect on the reasoning process used to ensure safe nursing practice [9]. Therefore, critical thinking skills are helpful in making appropriate decisions and quality nursing care. The development of critical thinking strategies and activities that facilitate this process will assist nurse instructors in planning appropriate educational strategies and assessment techniques. Simpson et al. believe that, critical thinking practices can change the students' focus from remembering to active learning [10]. Critical thinking strategies are the active learning strategies to promote critical thinking. There are many educational methods for improving critical thinking such as using problem-based learning with case studies, group discussion and self reflection [11]. There is a close correlation between the simulation-based learning, critical thinking strategies and the principles of constructivist and collaborative learning. Furthermore, the integration of these strategies will strengthen learning [12], because students focus on problems in real clinical situations that could strengthen their understanding of concept Page 2 of 7 and prepare them to manage complex clinical situations [6, 13]. One of the major problems in training the nursing students is the utilization of traditional and nonactive education in the clinical training and practical skills, which makes it difficult for the students to follow the critical thinking, problem solving ability and clinical decision path [13, 14]. One of the problems for the nurse instructors is the implementation of crit (...truncated)