Using Virtual Patient Simulation to Improve Clinical Reasoning in Pre-licensure Baccalaureate Nursing Students

Concurrent Session 7

Brief Abstract

Advances in technology have enabled a variety of electronic pedagogical approaches in nursing education. Research conducted at a midwestern university to determine the effect of virtual patient simulation on prelicensure baccalaureate nursing students’ clinical reasoning found statistically significant improved clinical reasoning scores.


Rhonda Williams is the RN to BSN Program Coordinator and an Associate Teaching Professor at Wichita State University. Rhonda teaches health assessment and care of populations in the fully online RN to BSN program. Rhonda serves as the Chair of the RN to BSN Committee, the Chair of the School of Nursing undergraduate Committee on Students, is a member of the Faculty Senate, and is a member of the Faculty Senate Planning and Budget Committee. Ms. Williams is also a member of Sigma Theta Tau and the National RN to Baccalaureate Faculty Forum, serving on its Essentials Committee.

Extended Abstract

Beginning live poll: role of attendees, whether attendees have used virtual patient simulation before, what skills they think could improve the most using this technology.

Clinical reasoning has long been a key aim of nursing education, as it is foundational to patient outcomes. A challenge for baccalaureate nursing faculty is to ensure quality experiential learning experiences while simultaneously maximizing the benefit of face-to-face class time. Nurse educators often turn to active learning strategies to develop clinical reasoning skills, including simulation. As technology has advanced, simulation has moved into the virtual setting, allowing standardized simulation experiences for all learners. There is a growing body of evidence to support virtual simulation in nursing and the health professions, but to date, no published research focused specifically on whether virtual patient simulation impacts clinical reasoning in on-campus baccalaureate pre-licensure nursing health assessment courses. Therefore, the purpose of this study was to determine whether virtual patient simulation is an effective approach for nurse educators who teach pre-licensure health assessment courses to improve students’ clinical reasoning skills.

A quantitative, one-group pre-test/post-test design using a virtual patient simulation product was used. (The simulation will be demonstrated at this time).

A sample of 19 students enrolled in the course completed an abdominal focused examination with a virtual patient as pre- and post-test. Clinical reasoning was measured using the Student Performance Index™(SPI), which provides a valid and reliable measure of subjective and objective data collection as well as therapeutic communication. In addition to statistically significant improved SPI scores, learners demonstrated improvements in the number of subjective and objective data items found, the number of interview questions asked, the number of empathy statements provided, the number of educational statements provided, and the number of words documented.

Nurse educators are tasked with instilling a variety of knowledge, skills, and attitudes for their students, making effective pedagogical approaches imperative. Both regulatory and accrediting bodies require students demonstrate the ability to think critically and use clinical reasoning, but little guidance is provided for nurse educators on best practices to help promote these concepts. The results of this study provide objective data that support using virtual patient simulation to improve a variety of skills including therapeutic communication, focused assessments, and decision-making, all of which are components of clinical reasoning. Additionally, with the recent increased need for remote courses due to the COVID-19 pandemic, virtual patient simulation becomes a key tool in ensuring students have effective opportunities to learn. Educators wishing to move a health assessment course to an online or hybrid course using virtual patient simulation now have data to present to academic nurse leaders that supports that change. Other implications include regulations, patient outcomes, and virtual simulation design.

From a regulatory standpoint, while some states include policies on the use of simulation in nursing education, these results provide support for updated polices that specifically include virtual patient simulation guidelines as well. An example is providing guidance on the ratio of virtual simulation hours that can replace on-site clinical hours. Another impact is to patient outcomes. Clinical reasoning is key to safe patient care, as it is the foundation for sound clinical judgment. Today’s users of healthcare often wait to seek treatment, leading to a tendency to arrive for care more acutely ill, yet conversely have shorter hospital stays to minimize cost. In these types of high-stakes environments, missing or misinterpreting cues of patient deterioration or negative trends in status could mean the difference between a positive outcome and a poor one. These factors render clinical reasoning an exceedingly important skill for new nurses to possess. Lastly, this project provides evidence to the designers of the virtual simulation program used in this study that the product is functioning as intended. In closing, the conclusion reached from this study is that virtual simulation positively impacts clinical reasoning in undergraduate nursing students taking an on-campus health assessment course and is therefore an appropriate tool to use. The results of this study may be used by nurse educators, academic nurse leaders, regulatory agencies, and virtual simulation companies as objective evidence to support the use of virtual simulation.