USING A THEORY-BASED MODEL OF CLINICAL DECISION MAKING TO ENHANCING LEARNING THROUGH SIMULATION

Introduction The ability of the nurse to make clinical decisions is an integral part of nursing practice and clinical competency1. The scarcity of clinical placements and the incidences of “failure to rescue” has driven the increased use of simulation in nursing education2. Yet, there is limited evidence on how manikin based high fidelity simulation (HFS) affects students’ decision-making skills3 and the way in which nursing students learn how to make decisions is not well understood4. Methods This study investigated nursing students’ clinical decision making using high fidelity simulation of a deteriorated patient scenario. A mixed-method design was used with two phases. The Health Science Reasoning Test (HSRT), think aloud and observations were used to examine the decision-making process in the first phase. In phase two, a follow up semi-structured interview was used to explore how students perceived the benefits of the simulated experience to their clinical practice. Results The results showed that students mainly used type two CDM and applied forward and backward reasoning to make decisions. The students were not always effective in the way they process clinical information and their decisions were affected by cognitive biases. Phase two revealed that simulation promoted reflective learning and increased students' self-awareness. Discussion A conceptual model of clinical decision making (CDM) was developed based on the study findings and the Dual Process Theory (DPT). It offers stepwise approaches to optimise both types of CDM, the analytical and the intuitive, and suggests a mitigation strategy to reduce the effect of cognitive biases on the quality of nurses’ decision. The proposed model has the potential to enhance the effectiveness of clinical simulation in teaching clinical decision making. This paper presents the developed model in this study. 1. Nursing and Midwifery Council, 2019. Standards for competence for registered nurses. London: Nursing and Midwifery Council. 2. Health Education England, 2016. Improving Safety Through Education and Training. Health Education England. 3. Mok, H.T., So, C.F. and Chung, J.W., 2016. Effectiveness of high-fidelity patient simulation in teaching clinical reasoning skills. Clinical Simulation in Nursing, 12, pp.453-467. 4. Thompson, C. and Stapely, S., 2011. Do educational interventions improve nurses’ clinical decision making and judgment? A systematic review. International Journal of Nursing Studies, 48 (7), pp.881-893.