This research was a quasi-experimental research with non-equivalent group pretest posttest design, which was carried out to compare the effect of simulation-based training and integrated training (simulation and critical thinking strategies) on the performance level and the critical thinking ability of nursing students studying at Shiraz Faculty of Nursing and Midwifery in 2014.
Samples and setting
The study samples include all first-year nursing students studying in the second semester of the academic year of 2014–2015 (n = 40) who were selected applying census method. In other words, the sample size is equal to the size of the population studied.
All students who took the 2-credit course of principles and practical nursing skills and wished to participate in the study were included.
Students who were enrolled as guest students at the semester and had no desire to participate in the research were excluded.
All the study subjects were divided into two groups according to age, sex, place of residence, and diploma average. Thereafter, two groups were randomly selected as the experimental group (n = 20) and the control group (n = 20).
Implementation stages of the research
Before the training, the level of critical thinking skills of both groups was investigated.
Two teaching techniques were carried out in each group. The experimental and intervention groups were trained using the integrated and simulation-based techniques, respectively.
The experimental group was trained for ten 2-h sessions using critical thinking strategies along with simulation.
The critical thinking strategies in this research include problem based learning with small group discussion
At each session, hypothetical scenarios of clinical conditions related to the subject matter, prepared utilizing patient records in hospitals and reference books containing clinical setting and strategic questions, were discussed.
Then, the solution to the problem was determined by students in small group discussion after changing the learning environment and the manner of seats arrangement in the lab in a U shape.
At this stage, the instructor was used as a facilitator and provided students with the necessary instructions and tried to encourage all students to participate in the discussion.
2- Simulation stage (role-playing and mannequins):
The simulation method alone was used in the control group in such a way that the related instructor taught the subject matter of the same session on the mannequins through role-playing, without any clinical background and students practiced in groups of 10.
At the end of the program, both groups participated in the critical thinking skills test and Objective Structured Clinical Examination (OSCE) test in order to measure their performance. OSCE test was carried out by planning 10 stations.
Data collection tool
The tool used in measuring the critical thinking ability was the California Critical Thinking Skills Test Form B (CCTST). This tool was developed to measure students' critical thinking skills and it contains 34 multiple-choice questions, designed in five areas of cognitive skills of critical thinking, which include analysis, inference, inductive reasoning, deductive reasoning and evaluation. Each person was awarded one score for each question which was answered correctly in the questionnaire and the total of correct answers constitutes the total score, the minimum and maximum of which were 0 and 34. Scores obtained in each section of the test was between the range of 0 and 16, such that in the analysis, inference, evaluation, inductive reasoning and deductive reasoning sections, 9, 11, 14, 16 and 14 scores were considered, respectively.
Objective Structured Clinical Examination (OSCE) test questions were utilized as a tool to assess the students' performance. This test was selected from 10 stations, including measuring blood pressure, dressing change, measuring body temperature, colostomy care, wound care clinical scenario, clinical bowel care scenario, pressure ulcer care, oxygen therapy, vital signs scenario, identifying devices by consulting with nursing team members.
Validity and reliability of tools
The external reliability of the California Critical Thinking Skills Test Form B(CCTST) was measured by Facione to be between 0.78 to 0.80 using the Kuder-Richardson formula 20 (KR-20) .
Objective Structured Clinical Examination (OSCE) validity was measured based on the content validity by five members of the faculty. Furthermore, the reliability of the test was approved with correlation coefficient of 0.66 using Split Half technique (the correlation between odd and even stations).
Data were collected and imported into SPSS.V.15. Thereafter, they were analyzed and evaluated using descriptive and analytic statistics. The mean scores obtained from the performance level of the two groups were compared using the independent t-test, after the intervention. The pair t-test was utilized to compare the mean scores for critical thinking before and after the intervention. In addition, Mann–Whitney test and chi-square test were utilized to compare different fields of the critical thinking.
A significant level of P < 0.05 was considered to be statistically significant.
One of the major limitations of this study was the presence of both groups of students in a collaborative learning environment. In addition, the implementation time of the training program of both groups was different due to less interaction between the two groups. Another limitation of this study was lack of educational sessions. Moreover, there was no possibility to hold more sessions in the curriculum of the faculty as a result of the coincidence of class hours.