Mixed methods evaluation of megacode simulation training to enhance clinical reasoning and decision making in critical care nursing

Q2 Social Sciences

Educacion Medica Pub Date : 2025-09-24 DOI:10.1016/j.edumed.2025.101094

Rudena A. Madayag , Christian Leandro Monieno , Jonel Mallari , Angela Apostol , Evangeline Bautista , Rei Angelo Mangibin , Dennison Jose Punsalan , Isabelito Nabong

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Abstract

Background

Effective clinical judgment is essential for critical care nursing, yet few studies have comprehensively examined how simulation training impacts both technical and cognitive development. This study evaluated the effectiveness of megacode simulation training, coupled with structured debriefing, in enhancing clinical reasoning and decision-making among fourth-year Bachelor of Science in Nursing (BSN) students.

Materials and methods

A convergent parallel mixed methods design was employed. Quantitatively, 150 BSN students completed pre- and post-tests using the Lasater Clinical Judgment Rubric (LCJR), analyzed with non-parametric tests. Qualitatively, ten focus groups and 20 interviews were thematically analyzed under a constructivist paradigm. Findings were integrated through data triangulation.

Results

Quantitative findings demonstrated significant improvements across all LCJR domains (p < .001), with large effect sizes (Cohen's d ≥ 1.01), particularly in prioritizing data and skillful intervention. Qualitative analysis revealed six themes, including growth from chaos to clarity, increased confidence under pressure, improved communication, and enhanced critical thinking. Students described transformative learning experiences that bridged the gap between theoretical knowledge and clinical application. Integration of findings confirmed that megacode simulations foster both technical proficiency and cognitive-emotional development.

Conclusion

Megacode simulation training significantly enhances students' clinical judgment, critical thinking, and teamwork. Despite limitations in sampling and short-term outcome evaluation, the findings affirm the value of experiential, reflective simulation learning. Systematic integration of simulation across nursing curricula and longitudinal follow-up studies are recommended to maximize and sustain clinical competence development.

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巨码模拟训练提高重症护理临床推理和决策能力的混合方法评价

有效的临床判断对重症护理至关重要，但很少有研究全面考察模拟训练如何影响技术和认知发展。本研究评估了巨码模拟训练，结合结构化述职，在提高四年级护理学学士（BSN）学生的临床推理和决策的有效性。材料与方法采用收敛平行混合法设计。在定量方面，150名BSN学生使用激光临床判断量表（LCJR）完成了前后测试，并采用非参数测试进行分析。定性上，在建构主义范式下对10个焦点小组和20个访谈进行主题分析。研究结果通过数据三角测量进行整合。结果定量结果显示，LCJR各域均有显著改善（p <； ）。0.001)，具有较大的效应量（Cohen's d ≥ 1.01），特别是在优先排序数据和熟练干预方面。定性分析揭示了六个主题，包括从混乱到清晰的成长，在压力下增强信心，改善沟通和增强批判性思维。学生们描述了在理论知识和临床应用之间架起桥梁的变革性学习经历。综合研究结果证实，巨码模拟促进了技术熟练程度和认知情感发展。结论megacode模拟训练能显著提高学生的临床判断能力、批判性思维能力和团队合作能力。尽管在抽样和短期结果评估方面存在局限性，但研究结果肯定了经验性、反思性模拟学习的价值。建议在护理课程和纵向随访研究中系统整合模拟，以最大限度地提高和维持临床能力的发展。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Educacion Medica Social Sciences-Education

CiteScore

2.60

自引率

0.00%

发文量

审稿时长

63 days

期刊介绍： Educación Médica, revista trimestral que se viene publicando desde 1998 es editada desde enero de 2003 por la Fundación Educación Médica. Pretende contribuir a la difusión de los estudios y trabajos que en este campo se están llevando a cabo en todo el mundo, pero de una manera especial en nuestro entorno. Los artículos de Educación Médica tratarán tanto sobre aspectos prácticos de la docencia en su día a día como sobre cuestiones más teóricas de la educación médica. Así mismo, la revista intentará proporcionar análisis y opiniones de expertos de reconocido prestigio internacional.