JMIR RESEARCH PROTOCOLS Stenseth et al
Protocol
Simulation-Based Learning Supported by Technology to Enhance
Critical Thinking in Nursing Students: Protocol for a Scoping
Review
Hege Vistven Stenseth1, MSc; Simen Alexander Steindal1,2, MSc, PhD; Marianne Trygg Solberg1, MSc, PhD; Mia
Alexandra Ølnes1, BA, BSc; Andrea Mohallem3, MSc, PhD; Anne Lene Sørensen1, MSc; Camilla Strandell-Laine1,4,
MSc, PhD; Camilla Olaussen1, MSc; Caroline Farsjø Aure1, MSc, PhD; Fernando Riegel5, MSc, PhD; Ingunn Pedersen6,
MSc; Jaroslav Zlamal1, MSc; Jussara Gue Martini7, MSc, PhD; Paula Bresolin7, MSc; Silje Christin Wang Linnerud1,
MSc; Andréa Aparecida Gonçalves Nes1, MSc, PhD
1
Lovisenberg Diaconal University College, Oslo, Norway
2
Faculty of Health Studies, VID Specialized University, Oslo, Norway
3
Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
4
Faculty of Health and Welfare, Novia University of Applied Sciences, Turku, Finland
5
Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
6
Nord University, Namsos, Norway
7
Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
Corresponding Author:
Hege Vistven Stenseth, MSc
Lovisenberg Diaconal University College
Lovisenbergata 15B
Oslo, 0456
Norway
Phone: 47 93840197
Email:
Abstract
Background: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be
carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning
supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based
learning supported by technology to enhance critical thinking in nursing students.
Objective: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported
by technology to enhance critical thinking in nursing students.
Methods: The proposed scoping review will use the framework established by Arksey and O’Malley and will be reported
according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews.
A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and
Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and
extract data. The data will be analyzed and thematically categorized.
Results: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches
were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began
in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by
May 2023.
Conclusions: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research
on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research
may identify nursing students’ reported barriers and enablers for learning critical thinking skills through simulation-based learning
supported by technology, and the results may help educators enhance their educational approach through knowledge of students’
firsthand experiences and further development of successful teaching strategies in nursing education.
https://www.researchprotocols.org/2022/4/e36725 JMIR Res Protoc 2022 | vol. 11 | iss. 4 | e36725 | p. 1
(page number not for citation purposes)
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, JMIR RESEARCH PROTOCOLS Stenseth et al
International Registered Report Identifier (IRRID): DERR1-10.2196/36725
(JMIR Res Protoc 2022;11(4):e36725) doi: 10.2196/36725
KEYWORDS
simulation-based learning; technological supported simulation-based learning; critical thinking; nursing students; nursing education,
educational approach; education; nursing
In this proposed scoping review, the terms clinical
Introduction decision-making, analytical thinking, creative thinking,
Educational Approaches for Active Learning in problem-solving, reflective thinking, diagnostic reasoning, and
clinical judgment are all potential synonyms of CT. Teaching
Nursing Education
CT is the responsibility of nurse educators [16], and teaching
Active teaching methods are recognized as educational strategies and methodology must be carefully considered to
approaches by which teachers support students in the meet the purpose of preparing pre- and postgraduate nursing
development of critical thinking (CT) [1,2]. One strategy for students to think critically and manage the uncertainty of the
developing CT is to allow nursing students to actively participate nursing profession [10,12,17].
in the learning process with the support of technology.
Simulation-based learning (SBL) is a teaching strategy that may Simulation-Based Learning
enhance the integration of theoretical and practical knowledge Reflection and CT skills may be developed through learning
and the ability to reflect and to give and receive feedback [3,4]. activities with high-quality teaching strategies, such as SBL
Scientific evidence reveals that active learning strategies are [7,10]. SBL facilitates learning in a safe environment with the
more effective for developing CT skills for students in higher opportunity to gain experience and practice without the risk of
education than passive learning under traditional methods, such doing harm to the patient [3]. Bland et al [18] define SBL as “a
as lectures [2,5]. With the advent of the COVID-19 pandemic dynamic process involving the creation of a hypothetical
and its resultant social distancing requirements, the interest in, opportunity that incorporates an authentic representation of
demand for, and use of technological solutions have increased reality, facilitates active student engagement, and integrates the
in nursing education [6]. complexities of practical and theoretical learning with
opportunity for repetition, feedback, evaluation, and reflection.”
Critical Thinking in Nursing Education
SBL is commonly founded on social constructivism and learning
CT is a crucial skill and a fundamental component of nurses’ theory, which view knowledge as being constructed in a social
daily professional responsibilities. Nurses require CT skills to context [19]. Within this framework, the traditional
analyze, summarize, and evaluate information and initiate action. teacher-student relationship, in which knowledge is transferred
CT skills enable nurses to manage uncertainties in nursing from teacher to student, shifts to a learner-centered,
practice and contribute to safe and effective care across diverse teacher-guided approach [9,20]. SBL can potentially replicate
clinical settings [7-9]. Several definitions and terms for CT are clinical practice, in which the learner must employ clinical
used interchangeably in nursing studies, research, and nursing reasoning with cognitive, psychomotor, and affective skills [15].
curricula [10,11]. The core components of CT are to be able to According to the International Nursing Association for Clinical
analyze, evaluate, and investigate [12]. Because there is no Simulation and Learning (INACSL) Standards Committee [21]
consensus on the definition of CT in nursing education research, self-monitoring, conscious reflection, and insightfulness occur
research often looks to other disciplines like philosophy, in SBL through debriefing, feedback, and guided reflection.
psychology, and education for clear definitions [10]. A This process may help learners understand their own actual
frequently cited definition in nursing studies is the one by a practice; identify knowledge gaps; increase competence; and
consensus statement of the American Philosophical Association, support the transfer of knowledge, skills, and attitudes. Learners’
which defines CT as “a judgment which is purposeful and insights may be developed through conscious reflection that
self-regulatory and results in a process of interpretation, analysis, connects actions, thoughts, and beliefs.
evaluation, and inference, as well as explanation of the
evidential, conceptual, methodological, criteriological, or In traditional SBL, high-tech modalities, including advanced
contextual considerations upon which that judgment is based” simulators (eg, life-size patient manikins), replicate real patients
[13]. According to Riegel and Crossetti [14], CT is driven by and settings in health care [22]. In simulation research, the term
internal motivation, which is reflective in nature and involves fidelity traditionally describes the degree to which the advanced
self-monitoring and self-correction. This process develops a simulator looks, acts, and feels like a human being, with an
reflective judgment on what to do, believe, or make sense of in emphasis on technological features and advances that enhance
any context. the physical resemblance [23].
Several distinct terms are currently used in studies exploring Other simulation research focuses on different aspects of realism
the outcome of CT in SBL, such as clinical problem-solving, with a physical, semantic, and phenomenal dimension, but what
clinical decision-making, clinical reasoning, and handling constitutes realism depends on what makes sense for the
clinical deterioration [4,11,15]. individual in a given context or situation [24,25].
https://www.researchprotocols.org/2022/4/e36725 JMIR Res Protoc 2022 | vol. 11 | iss. 4 | e36725 | p. 2
(page number not for citation purposes)
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Protocol
Simulation-Based Learning Supported by Technology to Enhance
Critical Thinking in Nursing Students: Protocol for a Scoping
Review
Hege Vistven Stenseth1, MSc; Simen Alexander Steindal1,2, MSc, PhD; Marianne Trygg Solberg1, MSc, PhD; Mia
Alexandra Ølnes1, BA, BSc; Andrea Mohallem3, MSc, PhD; Anne Lene Sørensen1, MSc; Camilla Strandell-Laine1,4,
MSc, PhD; Camilla Olaussen1, MSc; Caroline Farsjø Aure1, MSc, PhD; Fernando Riegel5, MSc, PhD; Ingunn Pedersen6,
MSc; Jaroslav Zlamal1, MSc; Jussara Gue Martini7, MSc, PhD; Paula Bresolin7, MSc; Silje Christin Wang Linnerud1,
MSc; Andréa Aparecida Gonçalves Nes1, MSc, PhD
1
Lovisenberg Diaconal University College, Oslo, Norway
2
Faculty of Health Studies, VID Specialized University, Oslo, Norway
3
Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, Brazil
4
Faculty of Health and Welfare, Novia University of Applied Sciences, Turku, Finland
5
Federal University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
6
Nord University, Namsos, Norway
7
Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
Corresponding Author:
Hege Vistven Stenseth, MSc
Lovisenberg Diaconal University College
Lovisenbergata 15B
Oslo, 0456
Norway
Phone: 47 93840197
Email:
Abstract
Background: Critical thinking is a crucial skill in the nursing profession, so teaching strategies and methodology must be
carefully considered when training and preparing nursing students to think critically. Studies on simulation-based learning
supported by technology are increasing in nursing education, but no scoping reviews have mapped the literature on simulation-based
learning supported by technology to enhance critical thinking in nursing students.
Objective: The proposed scoping review aims to systematically map research on the use of simulation-based learning supported
by technology to enhance critical thinking in nursing students.
Methods: The proposed scoping review will use the framework established by Arksey and O’Malley and will be reported
according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) extension for scoping reviews.
A systematic, comprehensive literature search was performed in the LILACS, ERIC, MEDLINE, EMBASE, PsycINFO, and
Web of Science databases. Pairs of authors independently selected the articles by screening titles, abstracts, full-text papers, and
extract data. The data will be analyzed and thematically categorized.
Results: The development of a comprehensive and systematic search strategy was completed in June 2021. The database searches
were performed in July 2021, and the screening of titles and abstracts was completed in September 2021. Charting the data began
in February 2022. Analysis and synthesis will be performed sequentially, and the scoping review is expected to be complete by
May 2023.
Conclusions: The results of this proposed scoping review may identify gaps in the literature and provide an overview of research
on the topic of simulation-based learning supported by technology to enhance critical thinking in nursing students. The research
may identify nursing students’ reported barriers and enablers for learning critical thinking skills through simulation-based learning
supported by technology, and the results may help educators enhance their educational approach through knowledge of students’
firsthand experiences and further development of successful teaching strategies in nursing education.
https://www.researchprotocols.org/2022/4/e36725 JMIR Res Protoc 2022 | vol. 11 | iss. 4 | e36725 | p. 1
(page number not for citation purposes)
XSL• FO
RenderX
, JMIR RESEARCH PROTOCOLS Stenseth et al
International Registered Report Identifier (IRRID): DERR1-10.2196/36725
(JMIR Res Protoc 2022;11(4):e36725) doi: 10.2196/36725
KEYWORDS
simulation-based learning; technological supported simulation-based learning; critical thinking; nursing students; nursing education,
educational approach; education; nursing
In this proposed scoping review, the terms clinical
Introduction decision-making, analytical thinking, creative thinking,
Educational Approaches for Active Learning in problem-solving, reflective thinking, diagnostic reasoning, and
clinical judgment are all potential synonyms of CT. Teaching
Nursing Education
CT is the responsibility of nurse educators [16], and teaching
Active teaching methods are recognized as educational strategies and methodology must be carefully considered to
approaches by which teachers support students in the meet the purpose of preparing pre- and postgraduate nursing
development of critical thinking (CT) [1,2]. One strategy for students to think critically and manage the uncertainty of the
developing CT is to allow nursing students to actively participate nursing profession [10,12,17].
in the learning process with the support of technology.
Simulation-based learning (SBL) is a teaching strategy that may Simulation-Based Learning
enhance the integration of theoretical and practical knowledge Reflection and CT skills may be developed through learning
and the ability to reflect and to give and receive feedback [3,4]. activities with high-quality teaching strategies, such as SBL
Scientific evidence reveals that active learning strategies are [7,10]. SBL facilitates learning in a safe environment with the
more effective for developing CT skills for students in higher opportunity to gain experience and practice without the risk of
education than passive learning under traditional methods, such doing harm to the patient [3]. Bland et al [18] define SBL as “a
as lectures [2,5]. With the advent of the COVID-19 pandemic dynamic process involving the creation of a hypothetical
and its resultant social distancing requirements, the interest in, opportunity that incorporates an authentic representation of
demand for, and use of technological solutions have increased reality, facilitates active student engagement, and integrates the
in nursing education [6]. complexities of practical and theoretical learning with
opportunity for repetition, feedback, evaluation, and reflection.”
Critical Thinking in Nursing Education
SBL is commonly founded on social constructivism and learning
CT is a crucial skill and a fundamental component of nurses’ theory, which view knowledge as being constructed in a social
daily professional responsibilities. Nurses require CT skills to context [19]. Within this framework, the traditional
analyze, summarize, and evaluate information and initiate action. teacher-student relationship, in which knowledge is transferred
CT skills enable nurses to manage uncertainties in nursing from teacher to student, shifts to a learner-centered,
practice and contribute to safe and effective care across diverse teacher-guided approach [9,20]. SBL can potentially replicate
clinical settings [7-9]. Several definitions and terms for CT are clinical practice, in which the learner must employ clinical
used interchangeably in nursing studies, research, and nursing reasoning with cognitive, psychomotor, and affective skills [15].
curricula [10,11]. The core components of CT are to be able to According to the International Nursing Association for Clinical
analyze, evaluate, and investigate [12]. Because there is no Simulation and Learning (INACSL) Standards Committee [21]
consensus on the definition of CT in nursing education research, self-monitoring, conscious reflection, and insightfulness occur
research often looks to other disciplines like philosophy, in SBL through debriefing, feedback, and guided reflection.
psychology, and education for clear definitions [10]. A This process may help learners understand their own actual
frequently cited definition in nursing studies is the one by a practice; identify knowledge gaps; increase competence; and
consensus statement of the American Philosophical Association, support the transfer of knowledge, skills, and attitudes. Learners’
which defines CT as “a judgment which is purposeful and insights may be developed through conscious reflection that
self-regulatory and results in a process of interpretation, analysis, connects actions, thoughts, and beliefs.
evaluation, and inference, as well as explanation of the
evidential, conceptual, methodological, criteriological, or In traditional SBL, high-tech modalities, including advanced
contextual considerations upon which that judgment is based” simulators (eg, life-size patient manikins), replicate real patients
[13]. According to Riegel and Crossetti [14], CT is driven by and settings in health care [22]. In simulation research, the term
internal motivation, which is reflective in nature and involves fidelity traditionally describes the degree to which the advanced
self-monitoring and self-correction. This process develops a simulator looks, acts, and feels like a human being, with an
reflective judgment on what to do, believe, or make sense of in emphasis on technological features and advances that enhance
any context. the physical resemblance [23].
Several distinct terms are currently used in studies exploring Other simulation research focuses on different aspects of realism
the outcome of CT in SBL, such as clinical problem-solving, with a physical, semantic, and phenomenal dimension, but what
clinical decision-making, clinical reasoning, and handling constitutes realism depends on what makes sense for the
clinical deterioration [4,11,15]. individual in a given context or situation [24,25].
https://www.researchprotocols.org/2022/4/e36725 JMIR Res Protoc 2022 | vol. 11 | iss. 4 | e36725 | p. 2
(page number not for citation purposes)
XSL• FO
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