Title : Enhancing clinical judgment in pharmacology through high-fidelity simulation in practical nursing education
Abstract:
Background: Developing clinical judgment in pharmacology remains a persistent challenge in practical nursing (PN) education and is critical for safe medication administration and patient safety. Traditional didactic approaches often fail to adequately support students’ ability to apply pharmacologic knowledge to dynamic clinical situations. High-fidelity simulation has emerged as an evidence-based strategy to bridge the gap between theory and practice; however, limited research focuses specifically on pharmacology-related clinical judgment in PN students.
Purpose: The purpose of this quality improvement project was to evaluate the impact of a high-fidelity pharmacology simulation on the development of clinical judgment among first-year practical nursing students.
Methods: A one-group pre–post design was implemented with pre-licensure PN students (n = 8 matched participants) enrolled at a rural college in New York. Participants completed an individual, high-fidelity medication administration simulation developed in alignment with INACSL Standards of Best Practice. Student performance was evaluated using the Creighton Competency Evaluation Instrument (C-CEI), a validated tool measuring competencies across Assessment, Communication, Clinical Judgment, and Patient Safety domains. Pre- and post-simulation scores were analyzed using descriptive statistics and paired Hedges’ g to determine effect size.
Results: Overall clinical performance improved from a pre-simulation mean score of 0.53 to a post-simulation mean of 0.76, yielding a large effect size (Hedges’ g = 1.40). Clinical judgment, the primary outcome, increased from 0.41 to 0.66 (g = 0.85). Notable improvements were observed in interpreting vital signs, prioritization, safe medication administration, and patient communication. Areas requiring refinement included articulation of evidence-based rationales and interprofessional communication.
Conclusion: High-fidelity simulation significantly enhanced clinical judgment and related competencies in pharmacology among PN students. Findings support the integration of structured simulation and intentional debriefing within pharmacology curricula to improve clinical reasoning, medication safety, and preparedness for practice.
