Improving Critical Thinking and Clinical Reasoning in Nursing Students Through Post-Operative Scenario-Based Simulation

Enhancing the Ability of Critical Thinking and Clinical Reasoning Among Nursing Students on Post-operative Management Through Scenario-Based Simulation

The goal of this clinical trial is to determine whether scenario-based simulation training can effectively enhance critical thinking and clinical reasoning skills in nursing students in Bangladesh, focusing on postoperative nursing management.

The main questions it aims to answer are:

1. Does scenario-based simulation training improve critical thinking and clinical reasoning skills in postoperative nursing management?
2. Is scenario-based simulation training more effective than traditional skills training in enhancing these skills?

Researchers will compare an intervention group (receiving scenario-based simulation training) to a control group (receiving traditional skills training) to see if the intervention leads to greater improvements in critical thinking and clinical reasoning abilities.

Participants will:

• Attend lectures on postoperative nursing care, take a pre-test, and be randomly assigned to either the intervention or control group.
• The intervention group will undergo scenario-based simulation training, while the control group will receive traditional skills training.
• Both groups will engage in individual practice and complete post-training evaluations to assess critical thinking, clinical reasoning, and overall competency

This study aims to identify an effective teaching strategy for nursing students, enhancing their ability to handle complex clinical situations and improving patient care quality.

This study, titled "Enhancing the Ability of Critical Thinking and Clinical Reasoning among Nursing Students on Post-operative Management through Scenario-Based Simulation," evaluates the impact of scenario-based simulation training on developing critical thinking and clinical reasoning skills in 2nd-year Bachelor of Science in Nursing (BSN) students at the Grameen Caledonian College of Nursing (GCCN), Bangladesh.

Design and Methodology:

The research employs a prospective, open-label, randomised controlled trial (RCT) with a 1:1 parallel design and block randomization. The study consists of 57 participants, split into an intervention group (scenario-based simulation training) and a control group (traditional skills training).

• Study Duration: 11 months from November 2024 to September 2025, including preparation, intervention (3 months), and analysis.
• Educational Context: Participants will have no prior exposure to postoperative nursing theory or practice before this intervention.

Intervention Protocol

1. One week ( Both for intervention group and control group)

   • Two lectures on postoperative nursing management, critical thinking, and clinical reasoning.
   • Pre-test to assess baseline knowledge and randomise participants.

2. One to two weeks ( Based on the school schedule)

Training:

• Intervention Group: scenario-based simulation, including group activities with realistic clinical cases, guided debriefing, and individual practice.
• Control Group: Traditional skills training with standard demonstrations and hands-on practice.

Independent Practice:

• Individual practice in skill labs to reinforce learning.

Evaluation:

• Skills and knowledge assessments using a standardised checklist and post-tests.
• Participant reflections were collected for qualitative insights.

Evaluation Metrics

Primary Outcome:

Development of critical thinking and clinical reasoning, assessed using a customised checklist that evaluates domains such as analysis, inference, and evaluation.

Secondary Outcomes:

• Knowledge improvement through pre- and post-tests.
• Practical skills in postoperative management.
• Qualitative insights from participant reflections.

Technical Aspects

Randomisation:

Block randomisation is based on pre-test scores, ensuring balanced baseline knowledge across groups.

Assessment Tools:

• Knowledge Test: A 25-item multiple-choice questionnaire assessing theoretical understanding.
• Critical Thinking and Clinical Reasoning Checklist: Developed based on a theoretical framework by Facione and validated by Hiroshima University nursing faculty.
• Skills Evaluation: Measures ability in critical and practical components of postoperative nursing care.

Ethical and Data Management

• Ethical approval is secured from GCCN's Institutional Review Board (IRB).
• Participants' data are anonymised, securely stored on a cloud system, and will be deleted after five years.
• Participation is voluntary, with informed consent required, and withdrawal allowed without penalties.

Significance This study addresses skill gaps in critical thinking and clinical reasoning among Bangladeshi nursing students. Findings will inform curriculum improvements and promote innovative teaching strategies, with broader implications for global nursing education.

Inclusion Criteria:

• 2nd-year BSN students at GCCN who take "Adult medical & surgical nursing."
• Students who provide informed consent to participate in the study.

Exclusion Criteria:

•Students who have completed theory class and clinical practice in the postoperative ward in any hospital.