This Is AuburnElectronic Theses and Dissertations

Simulation Design in Nursing Education: The Impact of Mid-Scenario Reflection on Learning Satisfaction and Self-Confidence




Raines, Kimberly

Type of Degree



Education Foundation, Leadership, and Technology


While high-fidelity simulation (HFS) is used increasingly in nursing education, there is a dearth of quantitative evidence regarding the most effective role of the instructor in simulation. This descriptive correlational study examined the effect of a simulation design incorporating mid-scenario reflection on learning outcomes. The results were obtained by employing descriptive statistical analysis (mean and standard deviation) and correlational statistical analysis (multiple linear regression). A convenience sample of 47 junior nursing students enrolled in a women’s health clinical course was used for this study. Students participated in a HFS obstetrical scenario and cared for a laboring patient who developed an infection. Once the students reached the point when it became necessary to telephone the CNM to request treatment orders, the instructor paused the simulation. The group then adjourned to an adjacent classroom for a five to ten minute instructor-led guided reflection period that included a discussion regarding assessment findings and the diagnoses based on the findings. At that time, the group mutually developed a plan of care and returned to the simulation lab in order to resume the scenario and begin interventions. Following the simulation, participants completed a demographic questionnaire, the Simulation Design Scale, and the Student Satisfaction and Self-Confidence in Learning Scale. Results from the Student Satisfaction and Self-Confidence in Learning Scale indicate that participants were satisfied with the simulation exercise and generally felt self-confident after the HFS. The participants perceived that all five design characteristics included in the Simulation Design Scale were incorporated into the HFS. The correlational analyses revealed that all five simulation design elements were significantly correlated with the learning outcomes of self-confidence and learner satisfaction. A multiple regression analysis indicted that the simulation design elements accounted for over half the variance in learning outcomes. The mid-scenario reflection did not significantly contribute to the level of self-confidence or learner satisfaction. Rather, the design characteristic of Outcomes was the single best predictor for both learning outcomes while Support significantly contributed to the level of learner satisfaction.