2025 Theses Doctoral

The Effect of Simulated Experience on Anxiety, Clinical Judgment, Confidence, Knowledge, and Readiness to Practice in Final Semester Associate Degree Nursing Students

Yakoby, Jordan

Background: Little is known about the effect of high-fidelity simulation versus traditional clinical rotations on students’ perceptions of readiness to practice, anxiety and confidence with clinical decision making, knowledge, and clinical judgment. Additionally, there is a paucity of literature specifically related to associate degree nursing programs.Specific Aim: Examine the effect of a high-fidelity simulation program on perceptions of readiness to practice, anxiety, and confidence with clinical decision making, knowledge, and clinical judgment in final semester associate degree nursing students.

Design: Quasi-experimental pretest posttest comparison.

Setting: A prelicensure associate degree nursing program in New York City. Participants: 136 final semester prelicensure associate degree nursing students. Methods: The Preparation for Hospital Practice Questionnaire, Nursing Anxiety and Self-Confidence with Clinical Decision-Making scale, Clinical Judgment Examination®, and Lasater Clinical Judgment Rubric were used to measure participants’ perceptions of readiness to practice anxiety and confidence with clinical decision making, knowledge, and clinical judgment, respectively. A between groups analysis by type of instruction and semester was conducted using ANCOVA.

Results: High-fidelity simulation (HFS) resulted in increased readiness to practice as measured by the PHPQ on holistic care, management, and self-directed learning subscales, but not in confidence, collaboration, interpersonal skills, science, or prevention. HFS resulted in decreased anxiety, but not confidence with clinical decision making, knowledge or clinical judgment.

Conclusions: A high-fidelity simulation program combined with clinical rotations can lead to increased readiness to practice for holistic care, management, and self-directed learning, as well as decreased anxiety compared to clinical rotations alone. This study did not answer the question of how HFS can be used to impact clinical judgment, confidence, and knowledge and more study should be done to answer these questions. Future research should use a different readiness instrument, include more simulation instruction, and include standardized patients and interprofessional education to better approximate the clinical environment.