Simulation-Based Learning and Critical Thinking Skills as Predictors of Clinical Judgment among Nursing Students

Abstract

Simulation-based learning has become an essential instructional strategy in nursing education because of its potential to enhance students' critical thinking and clinical judgment. This study aimed to determine the relationship among simulation-based learning, critical thinking skills, and clinical judgment in nursing students and to explore their lived experiences with simulation-based learning. An explanatory sequential mixed-method design was employed. The quantitative phase involved 216 third- and fourth-year nursing students selected through stratified random sampling from a higher education institution in Ozamiz City. Data were collected using questionnaires on simulation-based learning, critical thinking skills, and clinical judgment. Descriptive statistics, the Spearman Rank Correlation Coefficient, and multiple linear regression were used to analyze the quantitative data. The qualitative phase involved seven purposively selected nursing students who participated in in-depth interviews. Qualitative data were analyzed using thematic analysis. Quantitative findings revealed that nursing students demonstrated high levels of simulation-based learning, critical thinking skills, and clinical judgment. Significant positive relationships were found between simulation-based learning and clinical judgment, and between critical thinking skills and clinical judgment. Furthermore, simulation-based learning and critical thinking skills significantly predicted clinical judgment among nursing students. Qualitative analysis generated four essential themes: Simulation as a Realistic Bridge Between Theory and Practice; Development of Critical Thinking and Clinical Judgment Through Active Decision-Making; Emotional Transformation Toward Confidence and Professional Growth; and Reflective Learning Through Debriefing and Collaboration. The essence of the lived experience revealed that simulation-based learning serves as a transformative educational process that bridges theory and practice while fostering critical thinking, clinical judgment, confidence, reflective learning, and professional growth. Simulation-based learning is a valuable pedagogical approach that enhances nursing students' preparedness for clinical practice. Nursing educators should enhance simulation-based learning through realistic clinical scenarios and structured debriefing to strengthen students’ critical thinking skills and clinical judgment.