Defense Date
7-20-2026
Graduation Date
Summer 8-7-2026
Submission Type
DNP Manuscript
Degree Name
Doctor of Nursing Practice (DNP)
Department
Doctor of Nursing Practice (DNP) Program
School
School of Nursing
Faculty Mentor
Marci Zsamboky, DNP, PMHNP-BC, CNE
Keywords
new graduate nurses, SET-M, high-fidelity simulation, nursing education, new graduate orientation
Abstract
New graduate nurses (NGNs) often have trouble recognizing and responding to patient deterioration because of limited clinical judgment and confidence during the transition to practice. This quality improvement project evaluated the implementation of a high-fidelity deteriorating patient simulation within a new graduate nurse orientation program at a Level I trauma center. Guided by the Plan-Do-Study-Act framework and the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice, the simulation focused on the assessment and management of a patient experiencing pulmonary embolism. Eight NGNs participated in the simulation and completed the Attitudes Toward Recognizing Early and Noticeable Deterioration (ATREND) scale before and after the intervention, the Simulation Effectiveness Tool-Modified (SET-M) following the simulation, and post-simulation focus groups. Although the increase in ATREND scores was not statistically significant (p = .268), descriptive findings demonstrated improved mean scores following the intervention. High SET-M ratings and thematic analysis revealed increased confidence, enhanced recognition of patient deterioration, improved prioritization of nursing interventions, and greater preparedness to communicate during emergent situations. These findings support the integration of high-fidelity simulation into NGN orientation as a valuable educational strategy to strengthen clinical judgment and confidence while promoting safe patient care. Future implementation with larger, multisite samples and objective measures of clinical judgment is recommended.
Recommended Citation
Mundell, Kasey, "Implementation of a Deteriorating Patient Simulation for New Graduate Nurses to Improve Clinical Judgment: A Quality Improvement Project" (2026). Doctor of Nursing Practice (DNP) Manuscripts. 74.
https://dsc.duq.edu/dnp/74