Date of Degree


Document Type


Degree Name





Eleanor T. Campbell

Committee Members

Keville Frederickson

Barbara Gail Montero

Joanne K. Singleton

Subject Categories

Educational Assessment, Evaluation, and Research | Nursing


Simulation, Critical Thinking, Undergraduate Nursing Students


Human patient simulation (HPS) is a time and cost intensive teaching modality that is used widely in nursing education, and has been implemented with little evidence to support its efficacy (Jeffries & Rizzolo, 2006). Researchers note the lack of reliable tools to measure learning using this teaching modality, and consequentially there is a paucity of research linking critical thinking and simulation (Jeffries, 2007; Kneebone, 2003; Nehring, 2008). Nursing clinical decision making affects patient outcomes. Critical thinking is a key factor in clinical decision making. A review of the relevant literature is equivocal on the use of simulation in undergraduate nursing programs to increase critical thinking skills. The need for further research to develop evidence that simulation can enhance critical thinking is integral to continue and expand the use of simulation as a teaching-learning strategy in undergraduate nursing programs (Hayden, Smiley, Alexander, Kardong-Edgren, & Jeffries, 2014). The purpose of this quasi-experimental study was to evaluate the effect of simulation implementation on nursing students’ critical thinking skills, as measured by Health Education Systems Incorporated (HESI) exit exam critical thinking sub-scores from cohorts of baccalaureate nursing graduates, in an undergraduate nursing education program. Benner’s (1984), model From Novice to Expert, provides a theoretical framework for identifying knowledge acquisition and level of clinical expertise based on skill competency, knowledge, and experience, and underpins this study. The findings from this study may: (a) provide insight into the relationship between simulation and critical thinking; and (b) may strengthen current nursing programs to provide meaningful learning experiences in the education of nursing students that can impact learning outcomes and can affect patient safety in the future. Nursing education programs are challenged to ensure that nursing graduates have the knowledge and higher order critical thinking skills to make accurate clinical decisions, and to provide safe, high quality, cost effective care (National Council of State Boards of Nursing [NCSBN], 2013; National League of Nursing [NLN], 2003).