- Appendix A: Definition of Terms S42
- Appendix B: Creating a Comprehensive Standardized Simulation Curriculum for Prelicensure Nursing ProgramsAppendix B S43
- Appendix C: Example of a Simulation Day Schedule Appendix C S45
- Table C. Sample Simulation Day Schedule for Three Clinical Groups S45
- Appendix D: Results of ATI Content Mastery Series Assessments S46
- Appendix E: Results of the Clinical Learning Environment Comparison Survey (CLECS) S52
- Table E1. Clinical Learning Environment Comparison Survey: Fundamentals S52
- Table E2. Clinical Learning Environment Comparison Survey: Medical-Surgical Nursing S53
- Table E3. Clinical Learning Environment Comparison Survey: Advanced Medical-Surgical Nursing S54
- Table E4. Clinical Learning Environment Comparison Survey: Maternal-Newborn Nursing S55
- Table E5. Clinical Learning Environment Comparison Survey: Combined Maternal-Newborn and Pediatric Nursing S56
- Table E6. Clinical Learning Environment Comparison Survey: Pediatric Nursing S57
- Table E7. Clinical Learning Environment Comparison Survey: Mental Health Nursing S58
- Table E8. Clinical Learning Environment Comparison Survey: Community Health Nursing S59
- Appendix F: Results from Study Part II: Follow-Up S60
- Table F1. New Graduate Nurse Workplace Demographics S60
- Table F2. New Graduate Nurse Self-Assessments of Clinical Competency S61
- Table F3. New Graduate Nurse Self-Assessments of Critical Thinking S62
- Table F4. New Graduate Nurse Ratings of Preparation for Practice S63
- Figure F1. Workplace Stress Ratings: I Am Experiencing Stress at Work S64
- Figure F2. Workplace Stress Ratings: I Felt Overwhelmed by Patient Care Responsibilities S64
- Figure F3. Workplace Stress Ratings: I Felt Expectations of Me Were Unrealistic S64
Appendix A. Definition of Terms
Tabled
1
| Term | Definition |
|---|---|
| Simulation | An activity or event replicating clinical practice using scenarios, high-fidelity manikins, medium-fidelity manikins, standardized patients, role playing, skills stations, and computer-based critical thinking simulations (Hayden, Jeffries, Kardong-Edgren, & Spector, 2009). |
| High-fidelity simulation | “Experiences using full scale computerized patient simulators, virtual reality or standardized patients that are extremely realistic and provide a high level of interactivity and realism for the learner” (NLN-SIRC, as cited in Meakim et al., 2013). |
| Medium-fidelity simulation | “Experiences that are more technologically sophisticated such as computer-based self-directed learning systems simulations in which the participant relies on a two dimensional focused experience to problem solve, perform a skill and make decisions or the use of mannequins more realistic than static low fidelity ones having breath sounds, heart sounds and/or pulses” (NLN-SIRC, as cited in Meakim et al., 2013). |
| Debriefing | “An activity that follows a simulation experience, led by a facilitator. Participants’ reflective thinking is encouraged, and feedback is provided regarding the participants’ performance while various aspects of the completed simulation are discussed. Participants are encouraged to explore emotions and question, reflect, and provide feedback to one another. The purpose of debriefing is to move toward assimilation and accommodation in order to transfer learning to future situations” (NLN-SIRC, as cited in Meakim et al., 2013). |
| Traditional clinical experience | Academic time designated by the nursing education program for learning outside the classroom. Activities customarily include observation, hands-on experience with patients, and interaction with the interdisciplinary team. |
| Clinical competency | The ability to observe, gather information, recognize deviations from expected patterns, prioritize data, make sense of data, maintain a professional response demeanor, provide clear communication, execute effective interventions, perform nursing skills correctly, evaluate nursing interventions, and self-reflect to improve performance in a culture of safety (Hayden, Jeffries, Kardong-Edgren & Spector, 2009). |
| Clinical instructor | Faculty and staff members responsible for an assigned cohort of students in the traditional clinical and simulated environments. |
| Clinical preceptor | An RN supervising a student in the clinical setting. The preceptor provides oversight of the student’s patients and gives feedback to the student and clinical instructor. |
| Core nursing courses | Specialty courses in the prelicensure nursing curriculum where randomization occurred: Fundamentals of Nursing Medical-Surgical Nursing Advanced Medical-Surgical Nursing Maternal-Newborn Nursing Pediatric Nursing Mental Health Nursing Community/Public Health Nursing. |
| Study team | Faculty and staff members designated by the participating programs who dedicated a portion of their workload to the study. |
Appendix B. Creating a Comprehensive Standardized Simulation Curriculum for Prelicensure Nursing Programs
Establishing the Simulation Scenario Topics
A large task for the study was the assembly of the scenario curriculum. A three-round modified Delphi methodology was utilized for determining the key concepts and patient conditions to be included in the simulation curriculum used throughout the study. The Delphi technique is a group communication process that uses a series of questionnaires over multiple iterations to come to consensus of opinion in a select group of experts. Hsu and Sandford (2007) distinguish the difference between survey techniques as, “Common surveys try to identify “what is,” whereas the Delphi technique attempts to address “what could/should be” (Miller, 2006). (p.1).” A Delphi method enabled us to obtain opinions from educators across the United States regarding what simulations were most important to include in a prelicensure nursing curriculum in 2010.
There were two large nursing organizations devoted to or providing resources for early nursing simulation faculty, the International Nursing Association for Clinical Simulation and Learning (INACSL) and the National League for Nursing’s Simulation Innovation Resource Center (SIRC). The collective knowledge and expertise of both of these organizations and their members was used to assess what the faculty most familiar with simulation at the time thought should be included in the scenario curriculum being designed for the study.
Round 1
In Round 1, an electronic survey was developed to obtain data about what nurse educators and clinicians believed were the key concepts and behaviors students should be able to demonstrate in each major clinical course, and the main patient conditions (i.e., patient diagnoses) and health topics students should know related to each of these courses. The link to the electronic survey was posted on both the INACSL and SIRC Listservs and sent by e-mail to each of the schools participating in the multi-site study. The survey was active for 4 weeks (October 2010 to November 2010).
In order to have responses included in the analysis, the respondent needed to indicate his/her clinical specialty area and provide a minimum of three key concepts or health topics. Two hundred fifty-five nurse educator surveys met these criteria. Responses were received from 33 states; over half (56%) of the respondents indicated they were from urban or metropolitan areas; and the majority of respondents were from associate and baccalaureate programs. (See Table B1.)
Table B1Round 1 Survey Respondent Demographics
| % | n | Geographic Location of Nursing Program | % | n | Type of Nursing Program |
|---|---|---|---|---|---|
| 56% | 142 | Urban/metropolitan area | 45% | 115 | Baccalaureate degree |
| 21% | 52 | Suburban area | 44% | 111 | Associate degree |
| 17% | 43 | Rural area | 4% | 9 | Hospital/practice setting |
| 6% | 16 | Not answered | 1% | 3 | Practical program |
| 7% | 17 | Not answered |
In all, 1,682 key concepts and 2,124 responses for patient conditions were collected. Key concept and patient condition responses were sorted by clinical specialty area. Table B2 shows the number of respondents per specialty area, and the number of health conditions and key concepts received by clinical specialty during Round 1.
Table B2Round 1 Responses by Clinical Specialty Area
| Number of Respondents | Patient Conditions | Key Concepts | |||
|---|---|---|---|---|---|
| All Responses | Duplicates Consolidated | All Responses | Duplicates Consolidated | ||
| Nursing fundamentals | 46 | 374 | 177 | 273 | 148 |
| Medical-surgical nursing | 75 | 636 | 285 | 529 | 266 |
| Advanced medical-surgical nursing | 40 | 276 | 71 | 221 | 114 |
| Maternal-newborn nursing | 27 | 233 | 152 | 171 | 99 |
| Pediatric nursing | 22 | 234 | 136 | 184 | 106 |
| Mental health nursing | 17 | 153 | 63 | 118 | 62 |
| Community health nursing | 19 | 121 | 87 | 126 | 98 |
| Gerontological nursing | 9 | 97 | 68 | 60 | 59 |
| Total: | 255 | 2,124 | 1,039 | 1,682 | 952 |
Round 2
Each school participating in the study committed a team of people to conduct the study for the 2-year duration. All members of the study team from each of the 10 schools came together for a 2-day meeting to learn about the study protocol, build team cohesion, set the stage for high-fidelity simulations, and determine the simulation curriculum. For Round 2, study team members were grouped according to their clinical specialty areas. They reviewed the Round 1 responses for their clinical areas, narrowing the list of topics to approximately 40 patient conditions and 10 key concepts for each course. These became the patient conditions and key concepts included in the study simulation curriculum.
Round 3
Once the key concepts and patient conditions were identified by the clinical teams, these lists were sent back to each of the 10 participating study schools for their Round 3 ranking of the importance of each topic. Faculty, staff, and instructors in each major clinical course were asked to rate each item on the list according to three levels of importance:
- 1=most important content, all students should experience these simulations
- 2=important, 25% and 50% students should experience these simulations
- 3=good content to cover if time allows
This was important to gain buy-in from those study schools’ faculty who were less familiar with simulation at the time and to be sure we covered all areas faculty felt were crucial to their own programs. Key concepts varied by clinical course, but several themes emerged that were identified by the study team members as important throughout the curriculum: Safety, communication, and patient/family education were specifically listed in five of the seven courses, while documentation, assessment, and prioritization were included in four of the courses.
Obtaining Scenarios
Once topics were identified, the assembling of the scenario curriculum began. Scenarios utilized in the study curriculum needed to conform to the NLN/Jeffries Simulation Framework, and be validated either by inclusion in a major vendor package or by multiple uses at a school submitting the scenario. All scenarios required clear learning objectives and were designed to be run over a 15- to 30-minute time frame.
Simulations were readily available for the fundamentals, medical-surgical, maternal-newborn, and pediatric courses, and the majority of the patient conditions and key concepts were covered by commercially prepared scenarios for these courses. For the topics not available, particularly mental health and community/public health, calls were placed on the major simulation Listservs requesting scenarios for consideration for use in the study based on topics that were harder to find. The response was frequently overwhelming, with many choices available for inclusion. Scenarios that were donated by simulation faculty were reviewed by a professor of nursing and national expert in the field of simulation to ensure that the scenario content was accurate and conformed to the NLN/Jeffries Simulation Framework.
In addition to the scenarios, study schools received manikin programming files for each scenario in which a manikin could be appropriately used. For some mental health and community health scenarios, only a Standardized Patient was appropriate; therefore, programming files were not needed. A team of programmers reviewed each scenario included in the curriculum and created programming files for each type of human patient simulator being used at the study schools. Programming was provided for two reasons: Team members had varying levels of experience with running manikins prior to the study, and the programming ensured that the scenarios were being run the same way at each school.
Schools were not required to use any particular scenarios in a course but were required to use scenarios from the study curriculum when using simulation, to provide consistency across all sites. Study sites used the scenario curriculum like a menu and selected those scenarios that worked best for their curricular objectives.
All study-related scenario information was housed on a wiki accessible only to study team members. The wiki was organized by course and contained an overview of the scenarios available for that course, the scenario template, and the programming files.
Appendix C. Example of a Simulation Day Schedule
Table CSample Simulation Day Schedule for Three Clinical Groups
| Time | Clinical Group 1 | Clinical Group 2 | Clinical Group 3 |
|---|---|---|---|
| 0700-0725 | Pre-conference | Pre-conference | Pre-conference |
| 0730-0845 | Scenario: S M Bed: 1 Topics: Chemical ingestion, potential abuse | Scenario: J P Bed: 2 Topics: Tylenol overdose, depression | Scenario: J G Bed: 3 Topics: s/p appendectomy, POD#1 pain, nausea, vomiting |
| 0845-0900 | Break | Break | Break |
| 0900-1010 | Scenario: S R Bed: 4 Topics: Tay-Sachs disease, pneumonia, DNR | Scenario: J G Bed: 3 Topics: s/p appendectomy, POD#1 pain, nausea, vomiting | Scenario: S M Bed: 1 Topics: Chemical ingestion, potential abuse |
| 1010-1015 | Break | Break | Break |
| 1015-1125 | Scenario: J P Bed: 2 Topics: Tylenol overdose, depression | Scenario: S M Bed: 1 Topics: Chemical ingestion, potential abuse | Scenario: S R Bed: 4 Topics: Tay-Sachs disease, pneumonia, DNR |
| 1125-1205 | Lunch | Lunch | Lunch |
| 1205-1315 | Scenario: J G Bed: 3 Topics: s/p appendectomy, POD#1 pain, nausea, vomiting | Scenario: S R Bed: 4 Topics: Tay-Sachs disease, pneumonia, DNR | Scenario: J P Bed: 2 Topics: Tylenol overdose, depression |
| 1315-1330 | Break | Break | Break |
| 1330-1430 | Computerized critical thinking simulation | Computerized critical thinking simulation | Computerized critical thinking simulation |
| 1430-1530 | Post conference | Post conference | Post conference |
Note. Each Scenario time slot includes
- •10 minutes for report
- •20 to 25 minutes for simulation
- •10 minutes to document
- •30 minutes to debrief
Appendix D. Results of ATI Content Mastery Series Assessments
Table D1ATI Fundamentals of Nursing Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 800) | (n = 254) | (n = 279) | (n = 267) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 68.0 | 8.2 | 68.1 | 8.0 | 67.3 | 8.6 | 68.6 | 7.8 | 1.87 | 0.16 | 0.155 | – |
| Categories: | ||||||||||||
| Management of care | 70.5 | 18.1 | 71.1 | 17.2 | 68.8 | 18.7 | 71.7 | 18.2 | 1.92 | 0.15 | 0.148 | – |
| Safety & infection control | 62.4 | 13.8 | 62.3 | 12.9 | 62.1 | 14.4 | 62.9 | 14.0 | 0.26 | 0.06 | 0.773 | – |
| Health promotion & maintenance | 66.8 | 16.1 | 68.2 | 15.6 | 65.7 | 16.1 | 66.7 | 16.3 | 1.59 | 0.16 | 0.205 | – |
| Psychosocial integrity | 67.2 | 21.8 | 68.3 | 22.7 | 65.2 | 21.8 | 68.2 | 20.8 | 1.79 | 0.14 | 0.168 | – |
| Basic care & comfort | 60.6 | 13.4 | 59.8 | 13.1 | 60.5 | 13.9 | 61.7 | 13.1 | 1.35 | 0.15 | 0.259 | – |
| Pharmacological & parenteral therapies | 70.1 | 20.4 | 70.0 | 19.9 | 70.3 | 21.5 | 70.2 | 19.7 | 0.01 | 0.01 | 0.991 | – |
| Reduction of risk potential | 55.6 | 22.6 | 57.0 | 22.3 | 55.3 | 22.9 | 54.5 | 22.5 | 0.85 | 0.11 | 0.426 | – |
| Physiological adaptation | 61.7 | 25.7 | 59.8 | 25.4 | 61.2 | 25.8 | 64.1 | 25.6 | 1.84 | 0.16 | 0.159 | – |
| Dimensions: | ||||||||||||
| Clinical judgment/ Clinical thinking in nursing | 69.4 | 9.4 | 69.6 | 8.9 | 68.9 | 10.0 | 69.7 | 9.1 | 0.66 | 0.09 | 0.518 | – |
| Foundational thinking in nursing | 59.3 | 10.6 | 59.2 | 10.5 | 58.6 | 10.9 | 60.0 | 10.4 | 1.18 | 0.13 | 0.306 | – |
| Analysis/Diagnosis | 67.5 | 15.7 | 68.9 | 14.7 | 66.6 | 16.6 | 67.2 | 15.6 | 1.43 | 0.14 | 0.240 | – |
| Assessment | 73.1 | 18.3 | 72.7 | 17.8 | 73.0 | 18.5 | 73.6 | 18.4 | 0.15 | 0.05 | 0.864 | – |
| Evaluation | 60.8 | 15.1 | 59.5 | 14.9 | 60.3 | 15.5 | 62.7 | 14.9 | 3.14 | 0.21 | 0.044 | 50% > CTL |
| Implementation/Therapeutic nursing intervention | 55.5 | 11.5 | 56.1 | 12.0 | 54.9 | 11.3 | 55.7 | 11.3 | 0.76 | 0.10 | 0.468 | – |
| Planning | 78.4 | 12.1 | 78.6 | 12.1 | 77.8 | 12.6 | 78.8 | 11.7 | 0.51 | 0.08 | 0.599 | – |
| Priority setting | 74.3 | 14.5 | 75.2 | 14.3 | 73.6 | 15.3 | 74.3 | 14.0 | 0.85 | 0.11 | 0.427 | – |
Bold = statistically significant p value
Table D2ATI Adult Health Nursing Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 683) | (n = 225) | (n = 238) | (n = 220) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 64.1 | 9.0 | 62.7 | 9.8 | 64.1 | 9.0 | 65.5 | 8.1 | 5.37 | 0.31 | 0.005 | 50% > CTL |
| Categories: | ||||||||||||
| Safety & infection control | 57.8 | 28.8 | 58.7 | 31.0 | 55.5 | 28.9 | 59.3 | 26.0 | 1.20 | 0.14 | 0.303 | – |
| Health promotion & maintenance | 57.4 | 49.5 | 56.0 | 49.8 | 59.7 | 49.2 | 56.4 | 49.7 | 0.39 | 0.07 | 0.680 | – |
| Basic care & comfort | 75.5 | 16.8 | 75.7 | 17.0 | 75.8 | 16.9 | 75.2 | 16.4 | 0.09 | 0.04 | 0.912 | – |
| Pharmacological & parenteral therapies | 71.2 | 11.1 | 69.9 | 11.8 | 71.3 | 11.3 | 72.5 | 9.9 | 3.06 | 0.24 | 0.047 | 50% > CTL |
| Reduction of risk potential | 61.0 | 11.9 | 59.7 | 12.9 | 61.7 | 11.7 | 61.7 | 11.0 | 2.16 | 0.17 | 0.116 | – |
| Physiological adaptation | 62.6 | 11.7 | 60.6 | 12.2 | 62.2 | 11.8 | 65.1 | 10.8 | 8.70 | 0.39 | 0.000 | 50% > CTL & 25% |
| Dimensions: | ||||||||||||
| Clinical judgment/ Clinical thinking in nursing | 64.8 | 9.4 | 63.5 | 10.0 | 64.6 | 9.6 | 66.3 | 8.4 | 5.12 | 0.30 | 0.006 | 50% > CTL |
| Foundational thinking in nursing | 66.3 | 12.1 | 64.5 | 12.9 | 67.0 | 11.9 | 67.3 | 11.4 | 3.69 | 0.23 | 0.025 | 50% > CTL |
| Analysis/Diagnosis | 60.2 | 11.0 | 59.1 | 11.1 | 59.7 | 11.3 | 61.8 | 10.5 | 3.77 | 0.25 | 0.024 | 50% > CTL |
| Assessment | 68.1 | 13.5 | 66.0 | 14.2 | 68.5 | 13.7 | 69.9 | 12.3 | 4.66 | 0.29 | 0.010 | 50% > CTL |
| Evaluation | 65.0 | 14.0 | 64.5 | 14.1 | 64.7 | 14.6 | 65.9 | 13.3 | 0.69 | 0.10 | 0.500 | – |
| Implementation/Therapeutic nursing intervention | 69.0 | 11.8 | 67.3 | 12.8 | 69.7 | 11.8 | 70.2 | 10.4 | 3.95 | 0.25 | 0.020 | 50% > CTL |
| Planning | 62.4 | 17.0 | 61.1 | 18.3 | 61.9 | 16.0 | 64.3 | 16.4 | 2.15 | 0.18 | 0.117 | – |
| Priority setting | 59.1 | 12.9 | 57.6 | 13.9 | 58.6 | 12.7 | 61.2 | 11.8 | 4.66 | 0.28 | 0.010 | 50% > CTL |
Bold = statistically significant p value
Table D3ATI Maternal-Newborn Nursing Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 680) | (n = 225) | (n = 240) | (n = 215) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 69.5 | 9.7 | 68.4 | 10.7 | 69.2 | 9.7 | 71.1 | 8.5 | 4.51 | 0.28 | 0.011 | 50% > CTL |
| Categories: | ||||||||||||
| Management of care | 40.0 | 22.4 | 37.7 | 23.4 | 43.2 | 22.4 | 39.0 | 20.9 | 4.00 | 0.24 | 0.019 | 25% > CTL |
| Safety & infection control | 73.8 | 20.8 | 73.4 | 21.1 | 72.7 | 21.0 | 75.4 | 20.4 | 0.96 | 0.13 | 0.385 | – |
| Health promotion & maintenance | 64.1 | 13.3 | 63.0 | 14.8 | 63.8 | 12.6 | 65.4 | 12.4 | 1.90 | 0.18 | 0.151 | – |
| Psychosocial integrity | 92.8 | 25.9 | 92.0 | 27.2 | 92.9 | 25.7 | 93.5 | 24.7 | 0.19 | 0.06 | 0.831 | – |
| Basic care & comfort | 72.3 | 22.7 | 71.3 | 22.8 | 70.5 | 22.8 | 75.4 | 22.2 | 2.90 | 0.21 | 0.056 | – |
| Pharmacological & parenteral therapies | 57.6 | 17.6 | 58.0 | 18.6 | 56.2 | 17.3 | 58.7 | 16.8 | 1.27 | 0.15 | 0.280 | – |
| Reduction of risk potential | 59.3 | 16.7 | 57.6 | 17.3 | 59.1 | 17.1 | 61.3 | 15.4 | 2.71 | 0.22 | 0.067 | – |
| Physiological adaptation | 71.9 | 17.0 | 70.4 | 17.6 | 71.1 | 17.5 | 74.3 | 15.8 | 3.24 | 0.23 | 0.040 | 50% > CTL |
| Dimensions: | ||||||||||||
| Clinical judgment/Clinical thinking in nursing | 58.3 | 10.8 | 57.1 | 11.4 | 58.0 | 10.8 | 59.9 | 10.0 | 4.04 | 0.27 | 0.018 | 50% > CTL |
| Foundational thinking in nursing | 77.0 | 12.6 | 76.3 | 13.9 | 76.5 | 12.3 | 78.5 | 11.3 | 2.16 | 0.18 | 0.116 | – |
| Analysis/Diagnosis | 50.1 | 14.1 | 50.1 | 14.3 | 49.6 | 13.9 | 50.7 | 14.2 | 0.32 | 0.08 | 0.723 | – |
| Assessment | 63.2 | 18.5 | 60.8 | 19.8 | 63.5 | 18.7 | 65.4 | 16.6 | 3.37 | 0.25 | 0.035 | 50% > CTL |
| Evaluation | 71.2 | 20.1 | 69.4 | 22.0 | 69.9 | 19.7 | 74.7 | 17.9 | 4.61 | 0.26 | 0.010 | 50% > CTL & 25% |
| Implementation/Therapeutic nursing intervention | 70.6 | 10.4 | 69.2 | 11.0 | 70.3 | 10.5 | 72.2 | 9.4 | 4.60 | 0.29 | 0.010 | 50% > CTL |
| Planning | 65.5 | 20.9 | 64.8 | 20.5 | 64.9 | 22.4 | 67.0 | 19.6 | 0.76 | 0.11 | 0.470 | – |
| Priority setting | 59.7 | 12.7 | 58.2 | 13.0 | 60.3 | 12.6 | 60.4 | 12.4 | 2.25 | 0.18 | 0.107 | – |
Bold = statistically significant p value
Table D4ATI Nursing Care of Children Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 620) | (n = 201) | (n = 226) | (n = 193) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 65.2 | 9.7 | 63.7 | 9.5 | 65.0 | 10.2 | 67.1 | 9.0 | 6.30 | 0.37 | 0.002 | 50% > CTL |
| Categories: | ||||||||||||
| Safety & infection control | 53.8 | 28.2 | 51.6 | 27.7 | 53.5 | 29.7 | 56.5 | 26.9 | 1.51 | 0.18 | 0.222 | – |
| Health promotion & maintenance | 63.1 | 16.6 | 63.0 | 16.2 | 62.8 | 17.0 | 63.6 | 16.6 | 0.12 | 0.04 | 0.890 | – |
| Psychosocial integrity | 43.4 | 33.7 | 41.5 | 32.8 | 47.4 | 34.9 | 40.7 | 32.9 | 2.50 | 0.20 | 0.083 | – |
| Basic care & comfort | 58.1 | 20.0 | 57.0 | 20.0 | 56.8 | 20.1 | 60.6 | 19.8 | 2.31 | 0.19 | 0.100 | – |
| Pharmacological & parenteral therapies | 73.0 | 16.6 | 72.7 | 15.8 | 71.7 | 17.1 | 74.9 | 16.7 | 1.97 | 0.19 | 0.140 | – |
| Reduction of risk potential | 67.1 | 12.8 | 64.8 | 12.7 | 66.5 | 13.0 | 70.3 | 12.2 | 9.68 | 0.44 | <.001 | 50% > CTL & 25% |
| Physiological adaptation | 59.5 | 12.7 | 58.0 | 12.1 | 59.8 | 13.2 | 60.8 | 12.8 | 2.35 | 0.22 | 0.096 | – |
| Dimensions: | ||||||||||||
| Clinical judgment/Clinical thinking in nursing | 62.5 | 9.3 | 61.3 | 9.3 | 61.9 | 9.7 | 64.4 | 8.6 | 6.15 | 0.35 | 0.002 | 50% > CTL & 25% |
| Foundational thinking in nursing | 64.2 | 13.1 | 62.3 | 13.4 | 64.6 | 13.1 | 65.6 | 12.8 | 3.39 | 0.25 | 0.034 | 50% > CTL |
| Analysis/Diagnosis | 70.5 | 14.4 | 68.7 | 13.9 | 70.4 | 15.1 | 72.4 | 13.8 | 3.35 | 0.27 | 0.036 | 50% > CTL |
| Assessment | 56.5 | 15.6 | 54.0 | 15.8 | 56.6 | 16.1 | 59.1 | 14.3 | 5.49 | 0.34 | 0.004 | 50% > CTL |
| Evaluation | 55.8 | 15.2 | 56.4 | 15.6 | 55.6 | 15.9 | 55.5 | 14.1 | 0.23 | 0.06 | 0.796 | – |
| Implementation/Therapeutic nursing intervention | 65.7 | 10.9 | 64.3 | 10.8 | 65.4 | 10.9 | 67.5 | 10.9 | 4.45 | 0.30 | 0.012 | 50% > CTL |
| Planning | 60.6 | 24.2 | 58.4 | 24.0 | 58.4 | 25.4 | 65.5 | 22.4 | 5.75 | 0.30 | 0.003 | 50% > CTL & 25% |
| Priority setting | 63.6 | 15.6 | 61.6 | 15.6 | 63.3 | 15.9 | 65.9 | 15.1 | 3.83 | 0.28 | 0.022 | 50% > CTL |
Bold = statistically significant p value
Table D5ATI Mental Health Nursing Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 633) | (n = 206) | (n = 227) | (n = 200) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 65.0 | 9.8 | 63.4 | 10.9 | 65.2 | 10.0 | 66.3 | 8.1 | 4.53 | 0.30 | 0.011 | 50% > CTL |
| Categories: | ||||||||||||
| Management of care | 80.7 | 17.2 | 78.6 | 18.8 | 82.4 | 16.8 | 81.0 | 15.8 | 2.71 | 0.21 | 0.067 | – |
| Safety & infection control | 84.2 | 18.7 | 82.4 | 19.5 | 84.5 | 18.3 | 85.8 | 18.2 | 1.67 | 0.18 | 0.190 | – |
| Health promotion & maintenance | 62.8 | 32.0 | 61.9 | 32.6 | 63.7 | 31.0 | 62.8 | 32.5 | 0.16 | 0.06 | 0.849 | – |
| Psychosocial integrity | 67.9 | 10.4 | 66.3 | 11.4 | 68.1 | 10.7 | 69.2 | 8.7 | 3.96 | 0.28 | 0.020 | 50% > CTL |
| Pharmacological & parenteral therapies | 54.8 | 20.4 | 54.9 | 20.6 | 53.9 | 20.7 | 55.9 | 19.8 | 0.50 | 0.10 | 0.606 | – |
| Reduction of risk potential | 74.3 | 25.7 | 72.5 | 24.4 | 73.4 | 28.3 | 77.0 | 23.7 | 1.75 | 0.19 | 0.174 | – |
| Dimensions: | ||||||||||||
| Clinical judgment/Clinical thinking in nursing | 68.5 | 9.8 | 67.0 | 10.9 | 68.9 | 9.9 | 69.7 | 8.1 | 3.98 | 0.28 | 0.019 | 50% > CTL |
| Foundational thinking in nursing | 73.1 | 13.7 | 71.7 | 14.9 | 73.1 | 13.5 | 74.7 | 12.5 | 2.45 | 0.22 | 0.087 | – |
| Analysis/Diagnosis | 76.0 | 19.3 | 75.9 | 19.4 | 76.4 | 19.9 | 75.7 | 18.7 | 0.07 | 0.04 | 0.932 | – |
| Assessment | 66.6 | 16.8 | 64.6 | 17.0 | 67.2 | 16.9 | 68.1 | 16.5 | 2.31 | 0.21 | 0.100 | – |
| Evaluation | 71.0 | 17.1 | 70.4 | 18.1 | 69.9 | 17.1 | 72.7 | 15.8 | 1.55 | 0.17 | 0.213 | – |
| Implementation/Therapeutic nursing intervention | 68.1 | 11.4 | 65.9 | 12.2 | 68.7 | 11.4 | 69.7 | 10.0 | 6.33 | 0.34 | 0.002 | 50% & 25% > CTL |
| Planning | 70.0 | 13.0 | 69.7 | 13.7 | 70.0 | 13.8 | 70.4 | 11.3 | 0.14 | 0.05 | 0.867 | – |
| Priority setting | 71.3 | 13.0 | 68.9 | 13.9 | 72.1 | 12.7 | 73.1 | 12.1 | 5.94 | 0.32 | 0.003 | 50% & 25% > CTL |
Bold = statistically significant p value
Table D6ATI Community Health Nursing Scores
| Total | Control Group | 25% Group | 50% Group | Evaluation of Significance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
| (n = 344) | (n = 127) | (n = 116) | (n= 101) | |||||||||
| Mean | SD | Mean | SD | Mean | SD | Mean | SD | F value | Effect Size | p value | Significant Differences | |
| Total Score | 66.0 | 10.0 | 65.5 | 11.5 | 65.5 | 9.3 | 67.1 | 8.5 | 0.95 | 0.18 | 0.387 | – |
| Categories: | ||||||||||||
| Management of care | 64.8 | 12.9 | 64.5 | 13.8 | 64.2 | 13.2 | 66.0 | 11.3 | 0.64 | 0.15 | 0.526 | – |
| Safety & infection control | 68.4 | 13.3 | 67.7 | 14.4 | 67.7 | 12.6 | 70.1 | 12.6 | 1.17 | 0.19 | 0.313 | – |
| Health promotion & maintenance | 65.3 | 15.9 | 63.7 | 17.7 | 65.9 | 15.6 | 66.6 | 13.6 | 1.10 | 0.19 | 0.333 | – |
| Psychosocial integrity | 59.7 | 23.2 | 61.8 | 24.6 | 57.8 | 23.2 | 59.2 | 21.4 | 0.96 | 0.17 | 0.385 | – |
| Physiological adaptation | 81.3 | 24.2 | 82.7 | 23.9 | 80.2 | 24.6 | 80.7 | 24.5 | 0.36 | 0.10 | 0.698 | – |
| Dimensions: | ||||||||||||
| Clinical judgment/Clinical thinking in nursing | 65.1 | 10.4 | 64.4 | 12.0 | 65.0 | 9.9 | 66.2 | 8.7 | 0.91 | 0.17 | 0.405 | – |
| Foundational thinking in nursing | 69.8 | 15.6 | 70.4 | 17.0 | 68.0 | 13.8 | 71.2 | 15.8 | 1.26 | 0.21 | 0.285 | – |
| Analysis/Diagnosis | 69.7 | 14.9 | 68.9 | 15.8 | 69.5 | 14.9 | 70.8 | 13.9 | 0.46 | 0.13 | 0.633 | – |
| Assessment | 61.3 | 14.5 | 60.9 | 15.3 | 60.9 | 14.7 | 62.3 | 13.4 | 0.32 | 0.10 | 0.728 | – |
| Evaluation | 77.5 | 21.3 | 75.4 | 22.7 | 79.5 | 19.7 | 78.0 | 21.3 | 1.17 | 0.19 | 0.312 | – |
| Implementation/Therapeutic nursing intervention | 61.6 | 16.1 | 61.3 | 17.2 | 60.3 | 15.7 | 63.4 | 15.0 | 1.04 | 0.20 | 0.356 | – |
| Planning | 66.3 | 14.2 | 66.3 | 15.5 | 65.5 | 13.7 | 67.3 | 13.3 | 0.43 | 0.13 | 0.648 | – |
| Priority setting | 62.5 | 15.7 | 62.8 | 16.7 | 61.3 | 15.2 | 63.4 | 15.0 | 0.51 | 0.14 | 0.598 | – |
Appendix E. Results of the Clinical Learning Environment Comparison Survey (CLECS)
Table E1Clinical Learning Environment Comparison Survey: Fundamentals of Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 192 | 3.29 | 0.43 | 1.22 | 257 | 3.17 | 0.50 | 0.31 | 226 | 3.05 | 0.55 | 0.35 | 11.92 | 0.48 | <.001 | CTL > 25% 50% |
| Simulation | 164 | 2.59 | 0.71 | 255 | 3.01 | 0.54 | 226 | 3.23 | 0.47 | 61.58 | 1.10 | <.001 | 50% > 25% > CTL | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 190 | 3.41 | 0.48 | 1.36 | 257 | 3.26 | 0.58 | 0.49 | 226 | 3.18 | 0.58 | 0.02 | 8.88 | 0.43 | 0.000 | CTL > 50% & 25% |
| Simulation | 159 | 2.54 | 0.79 | 254 | 2.95 | 0.68 | 224 | 3.19 | 0.64 | 40.89 | 0.92 | <.001 | 50% > 25% > CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 190 | 3.38 | 0.50 | 0.93 | 257 | 3.33 | 0.54 | 0.29 | 226 | 3.21 | 0.57 | 0.24 | 5.34 | 0.32 | 0.005 | CTL & 25% > 50% |
| Simulation | 160 | 2.80 | 0.75 | 254 | 3.16 | 0.62 | 225 | 3.35 | 0.58 | 34.72 | 0.84 | <.001 | 50% > 25% > CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 191 | 3.03 | 0.63 | 1.21 | 257 | 2.82 | 0.71 | 0.23 | 226 | 2.66 | 0.78 | 0.29 | 13.72 | 0.52 | <.001 | CTL > 25% 50% |
| Simulation | 156 | 2.14 | 0.85 | 255 | 2.65 | 0.77 | 225 | 2.88 | 0.76 | 41.21 | 0.93 | <.001 | 50% > 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 186 | 3.24 | 0.68 | 0.79 | 246 | 3.06 | 0.76 | 0.16 | 216 | 2.90 | 0.87 | 0.60 | 9.62 | 0.43 | <.001 | CTL > 50% & 25% |
| Simulation | 155 | 2.59 | 0.97 | 248 | 3.18 | 0.76 | 218 | 3.36 | 0.66 | 45.36 | 0.96 | <.001 | 50% > 25% > CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 188 | 3.17 | 0.55 | 0.82 | 249 | 3.11 | 0.65 | 0.25 | 222 | 2.99 | 0.69 | 0.21 | 4.23 | 0.29 | 0.015 | CTL > 50% |
| Simulation | 159 | 2.59 | 0.86 | 248 | 2.94 | 0.71 | 222 | 3.13 | 0.63 | 25.68 | 0.74 | <.001 | 50% > 25% | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 189 | 3.51 | 0.53 | 0.81 | 249 | 3.39 | 0.56 | 0.09 | 222 | 3.29 | 0.62 | 0.75 | 7.49 | 0.38 | 0.001 | CTL > 50% |
| Simulation | 157 | 2.94 | 0.87 | 249 | 3.44 | 0.61 | 222 | 3.68 | 0.40 | 65.69 | 1.16 | <.001 | 50% > 25% > CTL | |||
Bold = statistically significant effect size or p value.
Table E2Clinical Learning Environment Comparison Survey: Medical-Surgical Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | P value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 157 | 3.36 | 0.49 | 0.83 | 237 | 3.31 | 0.44 | 0.35 | 211 | 3.20 | 0.49 | 0.33 | 4.95 | 0.33 | 0.007 | CTL > 50% |
| Simulation | 125 | 2.86 | 0.72 | 237 | 3.15 | 0.48 | 209 | 3.36 | 0.47 | 33.89 | 0.87 | <.001 | 50% > 25% >CTL | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 157 | 3.47 | 0.53 | 1.07 | 236 | 3.43 | 0.46 | 0.72 | 211 | 3.31 | 0.53 | 0.07 | 5.04 | 0.30 | 0.007 | CTL & 25% >50% |
| Simulation | 124 | 2.74 | 0.84 | 235 | 3.05 | 0.59 | 209 | 3.27 | 0.63 | 24.68 | 0.74 | <.001 | 50% > 25% >CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 157 | 3.47 | 0.54 | 0.64 | 236 | 3.46 | 0.47 | 0.16 | 211 | 3.38 | 0.53 | 0.22 | 1.97 | 0.17 | 0.140 | - |
| Simulation | 125 | 3.04 | 0.81 | 235 | 3.38 | 0.52 | 209 | 3.49 | 0.48 | 24.99 | 0.72 | <.001 | 50% & 25% >CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 157 | 3.10 | 0.66 | 0.93 | 237 | 3.03 | 0.61 | 0.29 | 211 | 2.87 | 0.71 | 0.28 | 6.19 | 0.33 | 0.002 | CTL % 25% > 50% |
| Simulation | 124 | 2.42 | 0.81 | 237 | 2.84 | 0.70 | 209 | 3.07 | 0.72 | 30.49 | 0.86 | <.001 | 50% > 25% >CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 155 | 3.35 | 0.64 | 0.45 | 234 | 3.26 | 0.66 | 0.20 | 209 | 3.12 | 0.72 | 0.68 | 5.27 | 0.33 | 0.005 | CTL > 50% |
| Simulation | 124 | 3.00 | 0.91 | 236 | 3.39 | 0.63 | 209 | 3.57 | 0.60 | 26.84 | 0.78 | <.001 | 50% > 25% >CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 155 | 3.30 | 0.58 | 0.58 | 236 | 3.17 | 0.61 | 0.20 | 211 | 3.17 | 0.62 | 0.28 | 2.37 | 0.22 | 0.094 | - |
| Simulation | 123 | 2.89 | 0.84 | 236 | 3.04 | 0.66 | 209 | 3.34 | 0.58 | 20.51 | 0.65 | <.001 | 50% > 25% &CTL | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 155 | 3.46 | 0.58 | 0.28 | 236 | 3.43 | 0.55 | 0.13 | 210 | 3.34 | 0.58 | 0.67 | 2.31 | 0.21 | 0.100 | - |
| Simulation | 124 | 3.27 | 0.80 | 236 | 3.50 | 0.53 | 208 | 3.68 | 0.43 | 20.47 | 0.69 | <.001 | 50% > 25% >CTL | |||
Bold = statistically significant effect size or p value.
Table E3Clinical Learning Environment Comparison Survey: Advanced Medical-Surgical Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 174 | 3.57 | 0.42 | 1.22 | 210 | 3.36 | 0.48 | 0.31 | 193 | 3.25 | 0.52 | 0.42 | 20.46 | 0.67 | <.001 | CTL > 25% > 50% |
| Simulation | 132 | 2.93 | 0.64 | 210 | 3.20 | 0.55 | 193 | 3.46 | 0.47 | 37.97 | 0.97 | <.001 | 50% > 25% > CTL | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 174 | 3.64 | 0.43 | 1.59 | 210 | 3.45 | 0.50 | 0.56 | 193 | 3.33 | 0.54 | 0.09 | 18.41 | 0.63 | <.001 | CTL > 25% > 50% |
| Simulation | 129 | 2.74 | 0.71 | 210 | 3.13 | 0.64 | 193 | 3.38 | 0.60 | 38.57 | 0.99 | <.001 | 50% > 25% > CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 174 | 3.64 | 0.45 | 0.92 | 210 | 3.46 | 0.46 | 0.11 | 193 | 3.41 | 0.55 | 0.42 | 10.52 | 0.46 | <.001 | CTL > 50% & 25% |
| Simulation | 130 | 3.14 | 0.65 | 210 | 3.40 | 0.58 | 193 | 3.63 | 0.49 | 28.71 | 0.88 | <.001 | 50% > 25% > CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 174 | 3.41 | 0.56 | 1.22 | 210 | 3.11 | 0.65 | 0.24 | 193 | 2.91 | 0.69 | 0.45 | 28.27 | 0.79 | <.001 | CTL > 25% > 50% |
| Simulation | 132 | 2.59 | 0.80 | 210 | 2.95 | 0.68 | 193 | 3.21 | 0.65 | 30.25 | 0.87 | <.001 | 50% > 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 172 | 3.57 | 0.55 | 0.71 | 209 | 3.39 | 0.63 | 0.02 | 193 | 3.23 | 0.69 | 0.60 | 12.88 | 0.54 | <.001 | CTL > 25% > 50% |
| Simulation | 131 | 3.12 | 0.73 | 210 | 3.38 | 0.65 | 192 | 3.61 | 0.57 | 22.60 | 0.77 | <.001 | 50% > 25% > CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 172 | 3.50 | 0.51 | 0.96 | 210 | 3.29 | 0.58 | 0.28 | 193 | 3.26 | 0.59 | 0.34 | 9.40 | 0.43 | <.001 | CTL > 50% & 25% |
| Simulation | 132 | 2.89 | 0.77 | 210 | 3.11 | 0.69 | 193 | 3.46 | 0.58 | 29.42 | 0.86 | <.001 | 50% > 25% > CTL | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 172 | 3.63 | 0.51 | 0.63 | 210 | 3.47 | 0.57 | 0.02 | 193 | 3.36 | 0.63 | 0.68 | 9.47 | 0.47 | <.001 | CTL > 50% & 25% |
| Simulation | 132 | 3.25 | 0.70 | 210 | 3.46 | 0.64 | 193 | 3.73 | 0.44 | 26.89 | 0.86 | <.001 | 50% > 25% > CTL | |||
Bold = statistically significant effect size or p value
Table E4Clinical Learning Environment Comparison Survey: Maternal-Newborn Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 112 | 3.47 | 0.50 | 0.74 | 185 | 3.31 | 0.46 | 0.33 | 159 | 3.13 | 0.58 | 0.67 | 14.63 | 0.62 | <.001 | CTL > 25% > 50% |
| Simulation | 91 | 3.05 | 0.64 | 184 | 3.14 | 0.56 | 159 | 3.48 | 0.46 | 24.28 | 0.81 | <.001 | 50% > CTL & 25% | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 112 | 3.56 | 0.52 | 0.99 | 185 | 3.42 | 0.48 | 0.59 | 158 | 3.27 | 0.58 | 0.24 | 9.86 | 0.52 | <.001 | CTL & 25% > 50% |
| Simulation | 91 | 2.90 | 0.81 | 184 | 3.07 | 0.68 | 158 | 3.41 | 0.61 | 19.46 | 0.74 | <.001 | 50% > CTL & 25% | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 112 | 3.56 | 0.52 | 0.45 | 185 | 3.44 | 0.46 | 0.21 | 158 | 3.26 | 0.60 | 0.64 | 10.87 | 0.53 | <.001 | CTL & 25% > 50% |
| Simulation | 91 | 3.30 | 0.63 | 184 | 3.33 | 0.59 | 158 | 3.61 | 0.48 | 13.72 | 0.57 | <.001 | 50% > CTL & 25% | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 112 | 3.24 | 0.69 | 0.73 | 185 | 3.03 | 0.69 | 0.17 | 159 | 2.87 | 0.73 | 0.62 | 9.25 | 0.52 | 0.000 | CTL > 50% & 25% |
| Simulation | 91 | 2.69 | 0.82 | 184 | 2.91 | 0.71 | 159 | 3.29 | 0.62 | 23.66 | 0.86 | <.001 | 50% > 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 110 | 3.50 | 0.60 | 0.41 | 184 | 3.28 | 0.67 | 0.01 | 158 | 3.08 | 0.84 | 0.75 | 10.86 | 0.56 | <.001 | CTL > 25% > 50% |
| Simulation | 89 | 3.20 | 0.86 | 182 | 3.27 | 0.72 | 158 | 3.62 | 0.57 | 13.99 | 0.61 | <.001 | 50% > CTL & 25% | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 110 | 3.41 | 0.56 | 0.48 | 184 | 3.22 | 0.59 | 0.35 | 158 | 3.08 | 0.69 | 0.54 | 9.06 | 0.52 | 0.000 | CTL > 50% & 25% |
| Simulation | 89 | 3.09 | 0.77 | 182 | 3.00 | 0.66 | 158 | 3.43 | 0.60 | 18.31 | 0.68 | <.001 | 50% > CTL & 25% | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 110 | 3.61 | 0.52 | 0.41 | 184 | 3.48 | 0.50 | 0.09 | 158 | 3.25 | 0.66 | 0.92 | 13.92 | 0.59 | <.001 | CTL & 25% > 50% |
| Simulation | 89 | 3.36 | 0.70 | 182 | 3.43 | 0.62 | 158 | 3.74 | 0.37 | 17.92 | 0.74 | <.001 | 50% > CTL & 25% | |||
Bold = statistically significant effect size or p value.
Table E5Clinical Learning Environment Comparison Survey: Combined Maternal-Newborn and Pediatric Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 55 | 3.41 | 0.40 | 0.84 | 54 | 3.38 | 0.45 | 0.35 | 46 | 3.29 | 0.52 | 0.62 | 0.92 | 0.26 | 0.400 | – |
| Simulation | 55 | 3.01 | 0.54 | 54 | 3.21 | 0.51 | 45 | 3.56 | 0.33 | 17.07 | 1.20 | <.001 | 50% > CTL & 25% | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 55 | 3.49 | 0.47 | 1.11 | 53 | 3.46 | 0.46 | 0.80 | 46 | 3.36 | 0.55 | 0.25 | 1.01 | 0.26 | 0.367 | – |
| Simulation | 55 | 2.81 | 0.73 | 53 | 3.03 | 0.60 | 45 | 3.49 | 0.49 | 15.32 | 1.07 | <.001 | 50% > CTL & 25% | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 55 | 3.51 | 0.45 | 0.61 | 53 | 3.49 | 0.47 | 0.02 | 46 | 3.37 | 0.52 | 0.81 | 1.17 | 0.29 | 0.314 | – |
| Simulation | 55 | 3.20 | 0.56 | 53 | 3.50 | 0.52 | 45 | 3.71 | 0.28 | 14.34 | 1.12 | <.001 | 50% & 25% > CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 55 | 3.22 | 0.55 | 0.82 | 54 | 3.22 | 0.58 | 0.16 | 46 | 3.04 | 0.72 | 0.75 | 1.35 | 0.28 | 0.261 | – |
| Simulation | 55 | 2.66 | 0.80 | 54 | 3.12 | 0.66 | 45 | 3.50 | 0.48 | 19.65 | 1.24 | <.001 | 50% > 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 54 | 3.41 | 0.57 | 0.28 | 52 | 3.39 | 0.66 | 0.02 | 46 | 3.40 | 0.68 | 0.29 | 0.01 | 0.03 | 0.994 | – |
| Simulation | 54 | 3.23 | 0.70 | 52 | 3.38 | 0.63 | 45 | 3.59 | 0.64 | 3.61 | 0.53 | 0.029 | 50% > CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 54 | 3.29 | 0.48 | 0.62 | 52 | 3.29 | 0.64 | 0.33 | 46 | 3.17 | 0.71 | 0.38 | 0.60 | 0.20 | 0.552 | – |
| Simulation | 54 | 2.95 | 0.61 | 52 | 3.06 | 0.75 | 45 | 3.41 | 0.54 | 6.74 | 0.79 | 0.002 | 50% > CTL & 25% | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 54 | 3.49 | 0.50 | 0.06 | 52 | 3.41 | 0.56 | 0.08 | 46 | 3.40 | 0.56 | 0.84 | 0.41 | 0.17 | 0.663 | – |
| Simulation | 54 | 3.46 | 0.58 | 52 | 3.36 | 0.63 | 45 | 3.79 | 0.34 | 8.17 | 0.83 | 0.000 | 50% > CTL & 25% | |||
Bold = statistically significant effect size or p value.
a Two study sites combined maternal-newborn and pediatric content into one course. This table represents the CLECS scores for these two programs.
Table E6Clinical Learning Environment Comparison Survey: Pediatric Nursing
| Control Group | 25% Group | 50% Group | Evaluatin of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 108 | 3.54 | 0.48 | 0.87 | 184 | 3.35 | 0.46 | 0.35 | 156 | 3.29 | 0.51 | 0.38 | 8.98 | 0.50 | 0.000 | CTL > 50% & 25% |
| Simulation | 85 | 3.06 | 0.63 | 182 | 3.17 | 0.56 | 156 | 3.48 | 0.48 | 21.04 | 0.78 | <.001 | 50% > CTL & 25% | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 108 | 3.61 | 0.49 | 1.22 | 183 | 3.42 | 0.49 | 0.59 | 156 | 3.38 | 0.55 | 0.11 | 7.19 | 0.44 | 0.001 | CTL > 50% & 25% |
| Simulation | 85 | 2.81 | 0.82 | 179 | 3.09 | 0.62 | 156 | 3.44 | 0.59 | 27.53 | 0.93 | <.001 | 50% > 25% > CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 108 | 3.66 | 0.46 | 0.73 | 183 | 3.45 | 0.50 | 0.15 | 156 | 3.41 | 0.53 | 0.44 | 9.02 | 0.50 | 0.000 | CTL > 50% & 25% |
| Simulation | 85 | 3.27 | 0.62 | 179 | 3.37 | 0.56 | 156 | 3.63 | 0.47 | 15.21 | 0.68 | <.001 | 50% > CTL & 25% | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 108 | 3.35 | 0.63 | 0.86 | 182 | 3.11 | 0.63 | 0.31 | 156 | 3.07 | 0.68 | 0.31 | 6.49 | 0.42 | 0.002 | CTL > 50% & 25% |
| Simulation | 84 | 2.71 | 0.87 | 181 | 2.90 | 0.73 | 156 | 3.28 | 0.66 | 19.19 | 0.77 | <.001 | 50% > CTL & 25% | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 105 | 3.50 | 0.64 | 0.42 | 181 | 3.34 | 0.67 | 0.04 | 156 | 3.26 | 0.66 | 0.44 | 4.12 | 0.37 | 0.017 | CTL > 50% |
| Simulation | 81 | 3.20 | 0.79 | 181 | 3.31 | 0.71 | 154 | 3.54 | 0.60 | 8.11 | 0.51 | 0.000 | 50% > CTL & 25% | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 105 | 3.48 | 0.52 | 0.64 | 182 | 3.30 | 0.56 | 0.33 | 156 | 3.22 | 0.63 | 0.14 | 6.26 | 0.44 | 0.002 | CTL > 50% & 25% |
| Simulation | 82 | 3.09 | 0.70 | 181 | 3.10 | 0.66 | 155 | 3.47 | 0.58 | 15.99 | 0.61 | <.001 | 50% > CTL & 25% | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 105 | 3.61 | 0.57 | 0.37 | 182 | 3.52 | 0.51 | 0.11 | 156 | 3.43 | 0.59 | 0.49 | 3.37 | 0.31 | 0.035 | CTL > 50% |
| Simulation | 82 | 3.40 | 0.56 | 181 | 3.46 | 0.61 | 156 | 3.69 | 0.46 | 10.21 | 0.58 | <.001 | 50% > CTL & 25% | |||
Bold = statistically significant effect size or p value.
Table E7Clinical Learning Environment Comparison Survey: Mental Health Nursing
| Control Group | 25% Group | 50% Group | Evaluatin of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 168 | 3.22 | 0.64 | 0.70 | 222 | 3.13 | 0.55 | 0.02 | 196 | 3.10 | 0.57 | 0.58 | 2.12 | 0.20 | 0.121 | – |
| Simulation | 73 | 2.73 | 0.82 | 220 | 3.12 | 0.56 | 193 | 3.41 | 0.49 | 38.39 | 1.14 | <.001 | 50% > 25% > CTL | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 166 | 3.22 | 0.67 | 0.66 | 222 | 3.10 | 0.65 | 0.11 | 196 | 3.05 | 0.61 | 0.41 | 3.15 | 0.27 | 0.044 | CTL > 50% |
| Simulation | 72 | 2.74 | 0.86 | 218 | 3.03 | 0.66 | 192 | 3.30 | 0.61 | 20.53 | 0.82 | <.001 | 50% > 25% > CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 166 | 3.27 | 0.69 | 0.54 | 222 | 3.23 | 0.63 | 0.00 | 196 | 3.21 | 0.62 | 0.54 | 0.50 | 0.09 | 0.607 | – |
| Simulation | 71 | 2.86 | 0.90 | 218 | 3.23 | 0.63 | 192 | 3.51 | 0.49 | 29.31 | 1.04 | <.001 | 50% > 25% > CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 168 | 3.14 | 0.71 | 0.71 | 222 | 2.97 | 0.66 | 0.07 | 196 | 2.92 | 0.76 | 0.53 | 4.71 | 0.30 | 0.009 | CTL > 50% |
| Simulation | 71 | 2.60 | 0.88 | 219 | 2.92 | 0.71 | 193 | 3.29 | 0.62 | 29.50 | 0.99 | <.001 | 50% > 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 161 | 3.09 | 0.82 | 0.41 | 220 | 3.00 | 0.83 | 0.25 | 194 | 2.94 | 0.85 | 0.63 | 1.51 | 0.18 | 0.222 | - |
| Simulation | 67 | 2.74 | 0.94 | 219 | 3.20 | 0.76 | 193 | 3.44 | 0.74 | 20.19 | 0.88 | <.001 | 50% > 25% > CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 163 | 3.21 | 0.70 | 0.63 | 221 | 3.08 | 0.62 | 0.06 | 196 | 3.10 | 0.67 | 0.47 | 2.08 | 0.20 | 0.126 | – |
| Simulation | 68 | 2.73 | 0.91 | 219 | 3.04 | 0.63 | 193 | 3.39 | 0.56 | 30.18 | 0.99 | <.001 | 50% > 25% > CTL | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 163 | 3.33 | 0.72 | 0.45 | 221 | 3.37 | 0.60 | 0.15 | 196 | 3.31 | 0.62 | 0.66 | 0.41 | 0.10 | 0.663 | – |
| Simulation | 69 | 2.99 | 0.81 | 219 | 3.46 | 0.61 | 193 | 3.67 | 0.45 | 34.14 | 1.20 | <.001 | 50% > 25% > CTL | |||
Bold = statistically significant effect size or p value.
Table E8Clinical Learning Environment Comparison Survey: Community Health Nursing
| Control Group | 25% Group | 50% Group | Evaluation of Significance | |||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | n | Mean | SD | Within Group Effect Size | F value | Between Group Effect Size | p value | Significant Differences | |
| Overall Rating | ||||||||||||||||
| Traditional | 57 | 3.43 | 0.44 | 1.59 | 88 | 3.27 | 0.52 | 0.24 | 72 | 3.02 | 0.74 | 0.55 | 8.31 | 0.66 | 0.000 | CTL & 25% > 50% |
| Simulation | 54 | 2.55 | 0.65 | 88 | 3.38 | 0.40 | 72 | 3.37 | 0.50 | 52.96 | 1.63 | <.001 | 50% & 25% > CTL | |||
| Subscale: Communication | ||||||||||||||||
| Traditional | 57 | 3.43 | 0.59 | 1.49 | 88 | 3.19 | 0.69 | 0.08 | 72 | 2.97 | 0.76 | 0.51 | 6.97 | 0.67 | 0.001 | CTL > 50% |
| Simulation | 53 | 2.40 | 0.79 | 88 | 3.24 | 0.56 | 72 | 3.31 | 0.57 | 38.88 | 1.35 | <.001 | 50% & 25% > CTL | |||
| Subscale: Nursing process | ||||||||||||||||
| Traditional | 57 | 3.50 | 0.52 | 1. 10 | 88 | 3.35 | 0.59 | 0.29 | 72 | 3.13 | 0.82 | 0.56 | 5.23 | 0.53 | 0.006 | CTL > 50% |
| Simulation | 52 | 2.75 | 0.82 | 88 | 3.50 | 0.45 | 72 | 3.51 | 0.49 | 33.43 | 1.22 | <.001 | 50% & 25% > CTL | |||
| Subscale: Holism | ||||||||||||||||
| Traditional | 57 | 3.28 | 0.68 | 1.47 | 88 | 3.18 | 0.64 | 0.12 | 72 | 2.82 | 0.82 | 0.50 | 7.90 | 0.60 | 0.001 | CTL & 25% > 50% |
| Simulation | 53 | 2.24 | 0.74 | 88 | 3.25 | 0.55 | 72 | 3.20 | 0.71 | 45.33 | 1.61 | <.001 | 50% & 25% > CTL | |||
| Subscale: Critical thinking | ||||||||||||||||
| Traditional | 53 | 3.35 | 0.62 | 1.01 | 82 | 3.27 | 0.64 | 0.42 | 70 | 2.91 | 0.88 | 0.56 | 7.04 | 0.56 | 0.001 | CTL & 25% > 50% |
| Simulation | 49 | 2.55 | 0.95 | 85 | 3.52 | 0.56 | 72 | 3.35 | 0.68 | 30.12 | 1.34 | <.001 | 50% & 25% > CTL | |||
| Subscale: Self-Efficacy | ||||||||||||||||
| Traditional | 55 | 3.44 | 0.52 | 1.22 | 87 | 3.34 | 0.56 | 0.04 | 72 | 3.17 | 0.76 | 0.28 | 3.00 | 0.40 | 0.052 | CTL > 50% |
| Simulation | 52 | 2.64 | 0.77 | 87 | 3.32 | 0.51 | 72 | 3.36 | 0.59 | 25.66 | 1.10 | <.001 | 50% & 25% > CTL | |||
| Subscale: Teaching-learning dyad | ||||||||||||||||
| Traditional | 55 | 3.58 | 0.49 | 1.01 | 87 | 3.39 | 0.61 | 0.56 | 72 | 3.17 | 0.85 | 0.67 | 5.96 | 0.57 | 0.003 | CTL > 50% |
| Simulation | 52 | 2.93 | 0.77 | 87 | 3.67 | 0.36 | 72 | 3.63 | 0.48 | 36.64 | 1.35 | <.001 | 50% & 25% > CTL | |||
Bold = statistically significant effect size or p value.
Appendix F. Results from Study Part II: Follow-Up
Table F1New Graduate Nurse Workplace Demographics
| Total | Control Group | 25% Group | 50% Group | Evaluation Of Significance | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| (n = 335) | (n = 101) | (n = 116) | (n = 118) | |||||||
| n | % | n | % | n | % | n | % | Cramer’s v | p value | |
| Employment location | ||||||||||
| Urban/Metropolitan | 218 | 65.1 | 65 | 64.4 | 66 | 56.9 | 87 | 73.7 | 0.11 | 0.102 |
| Suburban | 94 | 28.1 | 29 | 28.7 | 39 | 33.6 | 26 | 22.0 | ||
| Rural | 12 | 6.9 | 7 | 6.9 | 11 | 9.5 | 5 | 4.2 | ||
| Type of institution | ||||||||||
| Hospital/Medical center | 270 | 80.6 | 80 | 79.2 | 91 | 78.5 | 99 | 83.9 | 0.13 | 0.089 |
| Long-term care facility | 35 | 10.5 | 11 | 10.9 | 11 | 9.5 | 13 | 11.0 | ||
| Community-based or ambulatory setting | 23 | 6.9 | 5 | 5.0 | 13 | 11.2 | 5 | 4.2 | ||
| Other | 7 | 2.1 | 5 | 5.0 | 1 | 0.9 | 1 | 0.9 | ||
| Magnet® designation | ||||||||||
| Yes | 90 | 26.9 | 32 | 31.7 | 21 | 18.1 | 37 | 31.4 | 0.12 | 0.164 |
| No | 147 | 43.9 | 39 | 38.6 | 59 | 50.9 | 49 | 41.5 | ||
| Unsure | 46 | 13.7 | 12 | 11.9 | 16 | 13.8 | 18 | 15.3 | ||
| Not applicable | 52 | 15.5 | 18 | 17.8 | 20 | 17.2 | 14 | 11.9 | ||
| Patient care environment | ||||||||||
| Critical care | 113 | 33.2 | 31 | 30.4 | 33 | 28.0 | 49 | 40.8 | 0.16 | 0.680 |
| Medical-surgical unit | 85 | 25.0 | 25 | 24.5 | 29 | 24.6 | 31 | 25.8 | ||
| Pediatrics or nursery | 25 | 7.4 | 8 | 7.8 | 11 | 9.3 | 6 | 5.0 | ||
| Labor & delivery or postpartum | 21 | 6.2 | 9 | 8.8 | 8 | 6.8 | 4 | 3.3 | ||
| Psychiatry | 9 | 2.7 | 4 | 3.9 | 3 | 2.5 | 2 | 1.7 | ||
| Operating room or postanesthesia care | 8 | 2.4 | 2 | 2.0 | 3 | 2.5 | 3 | 2.5 | ||
| Long-term care facility | 37 | 10.9 | 13 | 12.8 | 11 | 9.3 | 13 | 10.8 | ||
| Ambulatory or outpatient care | 18 | 5.3 | 2 | 2.0 | 10 | 8.5 | 6 | 5.0 | ||
| Home health or home hospice | 7 | 2.1 | 2 | 2.0 | 3 | 2.5 | 2 | 1.7 | ||
| Acute rehab | 8 | 2.4 | 2 | 2.0 | 3 | 2.5 | 3 | 2.5 | ||
| Other | 9 | 2.7 | 4 | 3.9 | 4 | 3.4 | 1 | 0.8 | ||
Table F2New Graduate Nurse Self-Assessments of Clinical Competency
| New Graduate Nurse Self-Assesments of Clinical Competency | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 6 Week | 3 Month | 6 Month | |||||||
| n | Mean | SD | n | Mean | SD | n | Mean | SD | |
| Clinical Knowledge | |||||||||
| Control | 68 | 4.76 | 0.65 | 92 | 4.62 | 0.80 | 98 | 4.84 | 0.60 |
| 25% group | 99 | 4.64 | 0.72 | 106 | 4.74 | 0.73 | 108 | 4.81 | 0.63 |
| 50% group | 99 | 4.75 | 0.81 | 110 | 4.84 | 0.64 | 109 | 4.94 | 0.62 |
| Total | 266 | 4.71 | 0.74 | 308 | 4.74 | 0.73 | 315 | 4.87 | 0.62 |
| Effect size: 0.17 | Effect size: 0.31 | Effect size: 0.21 | |||||||
| p value: 0.449 | p value: 0.107 | p value: 0.256 | |||||||
| Technical Skills | |||||||||
| Control | 68 | 4.81 | 0.83 | 92 | 4.74 | 0.77 | 98 | 4.92 | 0.73 |
| 25% group | 99 | 4.55 | 0.86 | 106 | 4.75 | 0.86 | 108 | 4.78 | 0.82 |
| 50% group | 99 | 4.67 | 0.90 | 110 | 4.90 | 0.69 | 109 | 5.10 | 0.61 |
| Total | 266 | 4.66 | 0.87 | 308 | 4.80 | 0.78 | 315 | 4.93 | 0.73 |
| Effect size: 0.31 | Effect size: 0.22 | Effect size: 0.44 | |||||||
| p value: 0.159 | p value: 0.234 | p value: 0.005 | |||||||
| 50% > 25% | |||||||||
| Critical Thinking | |||||||||
| Control | 68 | 4.68 | 0.68 | 92 | 4.68 | 0.82 | 98 | 4.87 | 0.71 |
| 25% group | 99 | 4.75 | 0.75 | 106 | 4.86 | 0.75 | 108 | 4.85 | 0.73 |
| 50% group | 99 | 4.90 | 0.69 | 110 | 4.90 | 0.69 | 109 | 5.06 | 0.65 |
| Total | 266 | 4.79 | 0.71 | 308 | 4.82 | 0.76 | 315 | 4.93 | 0.70 |
| Effect size: 0.32 | Effect size: 0.29 | Effect size: 0.30 | |||||||
| p value: 0.112 | p value: 0.108 | p value: 0.062 | |||||||
| Communication | |||||||||
| Control | 68 | 5.09 | 0.69 | 92 | 5.04 | 0.84 | 98 | 5.13 | 0.68 |
| 25% group | 99 | 4.99 | 0.74 | 106 | 5.21 | 0.70 | 108 | 5.19 | 0.63 |
| 50% group | 99 | 5.15 | 0.72 | 110 | 5.19 | 0.72 | 109 | 5.32 | 0.61 |
| Total | 266 | 5.08 | 0.72 | 308 | 5.15 | 0.75 | 315 | 5.22 | 0.64 |
| Effect size: 0.22 | Effect size: 0.22 | Effect size: 0.29 | |||||||
| p value: 0.1282 | p value: 0.249 | p value: 0.097 | |||||||
| Professionalism | |||||||||
| Control | 68 | 5.44 | 0.61 | 92 | 5.28 | 0.73 | 98 | 5.38 | 0.62 |
| 25% group | 99 | 5.35 | 0.64 | 106 | 5.40 | 0.60 | 108 | 5.39 | 0.61 |
| 50% group | 99 | 5.47 | 0.63 | 110 | 5.39 | 0.62 | 109 | 5.50 | 0.57 |
| Total | 266 | 5.42 | 0.63 | 308 | 5.36 | 0.65 | 315 | 5.42 | 0.60 |
| Effect size: 0.19 | Effect size: 0.18 | Effect size: 0.20 | |||||||
| p value: 0.382 | p value: 0.390 | p value: 0.287 | |||||||
| Management of Responsibilities | |||||||||
| Control | 68 | 4.91 | 0.71 | 92 | 4.87 | 0.84 | 98 | 5.01 | 0.74 |
| 25% group | 99 | 4.91 | 0.69 | 106 | 4.91 | 0.68 | 108 | 5.07 | 0.67 |
| 50% group | 99 | 4.91 | 0.74 | 110 | 5.01 | 0.70 | 109 | 5.24 | 0.65 |
| Total | 266 | 4.91 | 0.71 | 308 | 4.93 | 0.74 | 315 | 5.11 | 0.69 |
| Effect size: 0.00 | Effect size: 0.18 | Effect size: 0.33 | |||||||
| p value: 1.000 | p value: 0.371 | p value: 0.046 | |||||||
Bold = statistically significant p value.
Table F3New Graduate Nurse Self-Assessments of Critical Thinking
| Critical Thinking Diagnostic | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 6 Week | 3 Month | 6 Month | |||||||
| n | Mean | SD | n | Mean | SD | n | Mean | SD | |
| Problem Recognition | |||||||||
| Control | 68 | 4.78 | 0.60 | 92 | 4.91 | 0.79 | 98 | 5.05 | 0.57 |
| 25% group | 99 | 4.80 | 0.61 | 105 | 4.95 | 0.61 | 108 | 5.09 | 0.58 |
| 50% group | 99 | 4.89 | 0.66 | 110 | 5.05 | 0.64 | 109 | 5.09 | 0.60 |
| Total | 266 | 4.83 | 0.63 | 307 | 4.97 | 0.68 | 315 | 5.08 | 0.58 |
| Effect size: 0.17 | Effect size: 0.20 | Effect size: 0.07 | |||||||
| p value: 0.470 | p value: 0.296 | p value: 0.815 | |||||||
| Clinical Decision Making | |||||||||
| Control | 68 | 5.04 | 0.47 | 92 | 5.07 | 0.65 | 98 | 5.16 | 0.51 |
| 25% group | 99 | 5.03 | 0.58 | 105 | 5.18 | 0.53 | 108 | 5.26 | 0.49 |
| 50% group | 99 | 5.16 | 0.53 | 110 | 5.25 | 0.49 | 109 | 5.25 | 0.47 |
| Total | 266 | 5.08 | 0.54 | 307 | 5.17 | 0.56 | 315 | 5.23 | 0.49 |
| Effect size: 0.24 | Effect size: 0.32 | Effect size: 0.20 | |||||||
| p value: 0.171 | p value: 0.083 | p value: 0.251 | |||||||
| Prioritization | |||||||||
| Control | 67 | 4.85 | 0.57 | 92 | 5.02 | 0.72 | 98 | 5.17 | 0.62 |
| 25% group | 99 | 4.92 | 0.68 | 105 | 5.02 | 0.56 | 107 | 5.21 | 0.57 |
| 50% group | 99 | 4.96 | 0.62 | 110 | 5.16 | 0.57 | 109 | 5.27 | 0.54 |
| Total | 265 | 4.92 | 0.63 | 307 | 5.07 | 0.62 | 314 | 5.21 | 0.58 |
| Effect size: 0.18 | Effect size: 0.25 | Effect size: 0.17 | |||||||
| p value: 0.518 | p value: 0.178 | p value: 0.443 | |||||||
| Clinical Implementation | |||||||||
| Control | 68 | 4.96 | 0.54 | 91 | 5.06 | 0.63 | 98 | 5.17 | 0.63 |
| 25% group | 97 | 4.98 | 0.62 | 103 | 5.08 | 0.58 | 107 | 5.23 | 0.56 |
| 50% group | 98 | 5.03 | 0.62 | 110 | 5.12 | 0.58 | 109 | 5.23 | 0.56 |
| Total | 263 | 4.99 | 0.60 | 304 | 5.08 | 0.60 | 314 | 5.21 | 0.58 |
| Effect size: 0.12 | Effect size: 0.10 | Effect size: 0.10 | |||||||
| p value: 0.786 | p value: 0.765 | p value: 0.692 | |||||||
| Reflection | |||||||||
| Control | 68 | 5.17 | 0.48 | 92 | 5.18 | 0.67 | 98 | 5.32 | 0.53 |
| 25% group | 99 | 5.18 | 0.58 | 106 | 5.22 | 0.50 | 108 | 5.31 | 0.50 |
| 50% group | 99 | 5.24 | 0.56 | 110 | 5.32 | 0.55 | 109 | 5.33 | 0.53 |
| Total | 266 | 5.20 | 0.55 | 308 | 5.24 | 0.57 | 315 | 5.32 | 0.52 |
| Effect size: 0.13 | Effect size: 0.23 | Effect size: 0.04 | |||||||
| p value: 0.610 | p value: 0.212 | p value: 0.963 | |||||||
Table F4New Graduate Nurse Ratings of Preparation for Practice
| 6-Week Survey New Graduate Nurse | ||||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| During your nursing program, how well did your clinical experiences (both traditional and simulated) prepare you for practice as a new RN? | ||||||||||
| Total | Control Group | 25% Group | 50% Group | |||||||
| (n = 266) | (n = 68) | (n = 99) | (n = 99) | |||||||
| freq | % | freq | % | freq | % | freq | % | Cramer’s v | p value | |
| Very well prepared | 71 | 26.7 | 15 | 22.1 | 20 | 20.2 | 36 | 36.4 | 0.16 | 0.030 |
| Quite a bit prepared | 103 | 38.7 | 25 | 36.8 | 42 | 42.4 | 36 | 36.4 | ||
| Somewhat prepared | 90 | 33.8 | 26 | 38.2 | 37 | 37.4 | 27 | 27.3 | ||
| Not at all prepared | 2 | 0.8 | 2 | 2.9 | 0 | 0.0 | 0 | 0.0 | ||
| Bold = statistically significant p value. | ||||||||||
| 3-Month Survey New Graduate Nurse | ||||||||||
| During your nursing program, how well did your clinical experiences (both traditional and simulated) prepare you for practice as a new RN? | ||||||||||
| Total | Control Group | 25% Group | 50% Group | |||||||
| (n = 308) | (n = 92) | (n = 106) | (n = 110) | |||||||
| freq | % | freq | % | freq | % | freq | % | Cramer’s v | p value | |
| Very well prepared | 70 | 22.7 | 22 | 23.9 | 17 | 16.0 | 31 | 28.2 | 0.15 | 0.025 |
| Quite a bit prepared | 142 | 46.1 | 38 | 41.3 | 46 | 43.4 | 58 | 52.7 | ||
| Somewhat prepared | 91 | 29.6 | 31 | 33.7 | 40 | 37.7 | 20 | 18.2 | ||
| Not at all prepared | 5 | 1.6 | 1 | 1.1 | 3 | 2.8 | 1 | 0.9 | ||
| Bold = statistically significant p value. | ||||||||||
| 6-Month Survey New Graduate Nurse | ||||||||||
| During your nursing program, how well did your clinical experiences (both traditional and simulated) prepare you for practice as a new RN? | ||||||||||
| Total | Control Group | 25% Group | 50% Group | |||||||
| (n = 315) | (n = 98) | (n = 108) | (n = 109) | |||||||
| freq | % | freq | % | freq | % | freq | % | Cramer’s v | p value | |
| Very well prepared | 64 | 20.3 | 14 | 14.3 | 21 | 19.4 | 29 | 26.6 | 0.11 | 0.261 |
| Quite a bit prepared | 130 | 41.3 | 44 | 44.9 | 40 | 37.0 | 46 | 42.2 | ||
| Somewhat prepared | 117 | 37.1 | 38 | 38.8 | 46 | 42.6 | 33 | 30.3 | ||
| Not at all prepared | 4 | 1.3 | 2 | 2.0 | 1 | 0.9 | 1 | 0.9 | ||
Figure F1Workplace Stress Ratings: I Am Experiencing Stress at Work
Figure F2Workplace Stress Ratings: I Felt Overwhelmed by Patient Care Responsibilities
Figure F3Workplace Stress Ratings: I Felt Expectations of Me Were Unrealistic
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© 2014 National Council of State Boards of Nursing, Inc. Published by Elsevier Inc. All rights reserved.
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