Defense Date


Graduation Date



Immediate Access

Submission Type


Degree Name





School of Nursing

Committee Chair

Joan Such Lockhart

Committee Member

Alfred Lupien

Committee Member

Gladys L. Husted


critical thinking abilities, high-fidelity computer simulation, human patient simulation, learning outcomes, simulation, undergraduate nursing students


Critical thinking abilities and learning outcomes are major components of nursing education. Initial critical thinking skills are often gained while the nursing student is learning the theoretical nursing principles in the classroom and is further enhanced in the clinical setting where learned knowledge is applied. A variety of instructional strategies are utilized to facilitate learning and promote critical thinking. Through the utilization of three complex and dynamic conceptual models, this study compared critical thinking abilities and learning outcomes of beginning baccalaureate undergraduate nursing students when three instructional strategies were used (classroom, simulation, and a combination of classroom and simulation).

A descriptive, quasi-experimental research design was utilized for this study that compared critical thinking abilities and learning outcomes of three groups of students utilizing three instructional strategies. Thirty-six nursing students completed the study. A 60-item customized HESI exam was administered as a pretest to all study participants and used to randomize the subjects into three treatment groups. Randomization occurred through a block rank ordering technique based on the initial critical thinking scores. Using one of the three instructional strategies, each group rotated through three learning activities, which illustrated the nursing care of clients experiencing an emergent cardiovascular or respiratory event: myocardial infarction, deep vein thrombosis leading to pulmonary embolism, and shock (anaphylactic and hypovolemic). After the completion of each learning activity, critical thinking abilities and learning outcomes were measured through the administration of a 20-item customized HESI exam which served as the posttest. One-way ANOVA calculations were conducted to determine the effect of instructional strategies on critical thinking ability and learning outcomes. Bonferroni post hoc comparisons were employed to evaluate significant (p < 0.05) differences between groups.

There were no statistically significant differences between critical thinking abilities (p > 0.08) or learning outcomes (p> 0.12) of nursing students when classroom instruction was utilized to deliver a learning activity. HESI exam scores were higher and statistically significant differences were detected between critical thinking abilities (p ≤ 0.002) and learning outcomes (p ≤ 0.001) of nursing students when simulation or a combination of classroom and simulation was utilized to deliver a learning activity.