The Effects of Nursing Program Simulation Experience Level and Type of Advanced Organizer on Clinical Judgment Performance, Satisfaction, Self-Confidence, and Perceived Cognitive Load of Pre-Licensure Nursing Students in Simulation Based Learnin

Nursing education programs face many challenges with training students to become professional nurses who will practice safely in an evolving and complex healthcare system. Nurse educators are obliged to prepare students to meet these challenges, with clinical experience being a key aspect of training. However, limited availability of clinical sites restricts adequate training. Simulation based learning (SBL) activities that mimic real world environments are now transforming the clinical experience, however, research is limited and additional research is needed.;By understanding the demand of cognitive load during SBL, nurse educators can design simulation activities that promote positive outcomes. Advanced organizers (AO) are one way of assisting students to retain information and aid recall. Therefore, this study focused on the effects of AO and participant Nursing Program Simulation (NPS) experience level on clinical judgment performance, satisfaction and self-confidence, and perception of CL during SBL. This study used a mixed methods sequential research design and examined 99 students enrolled in an associate degree nursing program. Participants were enrolled in one of three courses which used SBL.;Students were assigned to comparison groups based on their course level and assigned clinical instructor. Participants were given a mnemonic or a concept map during the SBL pre-briefing phase. A pretest simulation was completed followed by a posttest simulation within a 12-week period to assess for differences in clinical judgment performance. Students were given questionnaires post simulation to determine perception of satisfaction and self-confidence, as well as determine their perceived cognitive load. A focus group interview was conducted post simulation to identify additional emerging themes.;Quantitative analysis showed NPS experienced students had higher clinical judgment performance pretest-posttest scores than NPS novice students. There was an interaction between the combined effects of NPS experience level and type of AO showed NPS experienced students had higher scores with the use of a concept map over a mnemonic, whereas the NPS novice group showed no difference. The analysis found NPS novice group participants had higher perceived satisfaction and self-confidence with the use of a mnemonic, whereas the NPS experienced students had higher perceived satisfaction and self-confidence with a concept map. NPS novice group students had a higher perceived cognitive load with the use of a concept map compared to a mnemonic, but the NPS experienced group showed no differences. Qualitative results showed NPS novice participants seemed to feel more comfortable and satisfied with the use of the mnemonic as a memory aid. Conversely the NPS experienced group seemed more self-confident with the use of a concept map. Therefore, the selection of instructional strategies are important for educators to consider when developing SBL experiences.