Clinical judgment model-based nursing simulation scenario for patients with upper gastrointestinal bleeding: A mixed methods study

Assisting patients with upper gastrointestinal bleeding is a crucial role for nurses, and as future nurses, students should demonstrate sound clinical judgment. Well-structured, high-quality simulations are useful alternatives to prepare students for clinical practice. However, nursing simulation scenarios focused on enhancing clinical judgment in managing upper gastrointestinal bleeding are limited. This study aims to develop, apply, and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding based on Tanner's clinical judgment model using a mixed methods study design. A high-fidelity patient simulation was conducted among 80 undergraduate nursing students divided into a simulated control group (n = 39) and an experimental group (n = 41). Subsequent student performance evaluations used questionnaires and video recordings. After scenario simulations, the students showed a statistically significant increase in theoretical knowledge (p = 0.001) and clinical performance skills (p < 0.001), but there was no significant increase in self-confidence (p = 0.291). According to the video analysis, the noticing clinical judgment phase was the most frequently observed phase, while reflection was the least frequently observed phase. Additionally, education was the most frequently observed nursing domain, and anxiety was the least frequently observed domain. Although further simulation repetitions are required to reinforce students' self-confidence when caring for patients with upper gastrointestinal bleeding, the scenario was deemed effective. Moreover, emphasis should be placed on developing various scenarios to strengthen students' clinical judgment skills, especially reflecting and emotional care.

Automated summary

The study aimed to develop and evaluate an effective nursing simulation scenario for patients with upper gastrointestinal bleeding using Tanner's clinical judgment model. Through high-fidelity patient simulation, students showed significant improvements in theoretical knowledge and clinical performance skills, but not in self-confidence. Video analysis revealed students excelled in the clinical judgment phase of noticing, but struggled with the reflection phase. Education was the most frequently observed nursing domain, while anxiety was the least observed domain.