Effectiveness of using simulation in the development of clinical reasoning in undergraduate nursing students: A systematic review

This systematic review examines the effectiveness of undergraduate nursing students’ using simulation to acquire clinical reasoning. Use of simulation to positively impact practice outcomes is an established method in nursing education. Clinical reasoning is a graduate capability that contributes to safe practice, so developing clinical reasoning requires explicit scaffolding in undergraduate contexts. While research has primarily evaluated specific clinical reasoning frameworks, variability in clinical reasoning definitions has obscured simulation efficacy for clinical reasoning acquisition. This review uses the Joanna Briggs Institute Systematic Reviews approach. An electronic database search was conducted to identify studies published from May 2009 to January 2020 using a three-step search strategy. Selected papers were assessed by at least two independent reviewers for inclusion criteria, methodological validity, and data extraction. Ten studies using quasi-experimental designs involving 1532 students were included. Evidence regarding the effectiveness of simulation for undergraduate nursing students’ acquisition of clinical reasoning was limited but of high quality. Review results showed no statistically significant gains in clinical reasoning with a single simulation exposure. Two emerging concepts, situation awareness and teamwork support the enhancement of clinical reasoning within simulation. In order to draw future conclusions on the efficacy of simulation to develop clinical reasoning, more research is warranted. New insights about team-based simulations and situation awareness were identified as integral for development of clinical reasoning in the context of simulation. More consistent use of terminology in the context of simulation research is also recommended. •Simulation efficacy is obscured by imprecise definitions of clinical reasoning and inconsistent terminology in research.•Multiple simulation exposures are recommended as single exposure showed no statistically significant gains in clinical reasoning.•Focus on situation awareness and team-based simulations enhances development of clinical reasoning.•Further research is needed to draw conclusions on the efficacy of simulation for development of clinical reasoning.