Simulation in nursing education has become a standard method of instruction to provide nursing students with a realistic and safe environment in which to practice and hone clinical skills. There are three components to a nursing simulation: prebriefing, the simulation experience, and debriefing. While there is a list of minimum criteria recommended for the prebriefing experience at the time of this dissertation there were no published frameworks or models for prebriefing. A quasi-experimental pretest/posttest study assessed the impact of a structured prebriefing method on sophomore level nursing students’ (N = 55) clinical judgment, perception of their ability to care for patients, and their perceptions of the prebriefing and simulation experiences when compared to a group that was exposed to only the standard prebriefing criteria. All participants had the same simulation scenario. Participants were placed in groups of four then groups were randomly assigned to the structured prebriefing (intervention) or standard prebriefing (control). The instruments used in this study were the Satisfaction and Confidence in Learning Scale (SCLS), Prebriefing Experience Scale (PES), Lasater Clinical Judgment Rubric (LCJR), and the Perception to Care in Acute Situations (PCAS). This dissertation includes two chapters based on the same study as well as a chapter of lessons learned with commentary on completing nursing education research with postpandemic nursing students. The first dataset reported are results from the SCLS and PES. These instruments are posttest only and were completed after the prebriefing and simulation experience. The second dataset reported are results from the LCJR and the PCAS. The LCJR was used by two faculty members to rate student demonstration of clinical judgment during the simulation scenario. The PCAS was implemented as pretest/posttest; participants completed it upon arrival to their scheduled simulation then again after the simulation scenario was finished. All data were collected prior to debriefing as the groups had different debriefing experiences. The findings of this study indicate that all participants were satisfied with the simulation and prebriefing experiences. No statistically significant differences were found between group perceptions of confidence, satisfaction, or prebriefing. There was a statistically significant increase from pretest to posttest scores on the PCAS on which participants rated themselves higher in their perceptions to care for patients. There was no interaction as there was not a statistically significant interaction between group and time. There were no statistically significant differences between groups for participant clinical judgment scores as rated by two faculty members. Unprecedented attrition and retention were seen in the participant cohort. Though not an aim of this study, this phenomenon is attributed to the changes being seen in the postpandemic learner. More students did not return after their first year than in previous years and 49% were unsuccessful in the Fundamentals of Nursing course compared to the usual 5%. These results show that while participants were satisfied with both interventions, and their confidence in their ability to provide care did increase after the simulation, there may not be a difference between structured and standard prebriefing. Additional studies are needed with different cohorts to determine if structured prebriefing has an effect on nursing student clinical judgment or if the unique variables caused by COVID-19 had lingering effects on these participants.

The purpose of this review of literature was to explore and critically analyze relevant literature regarding stress factors and the consequences of stress in nursing students. Findings from this review of literature aimed to provide a better understanding of stress factors and the physical and psychological impact of stress on nursing students. Information was collected from the Cumulative Index to Nursing and Allied Health Literature, PsycINFO, and MEDLINE- EBSCOhost databases to explore what research has been conducted and to assess the current knowledge base. Analysis of the literature indicated that nursing students reported experiencing increased levels of stress during the academic year. Nursing students reported higher levels of stress in conjunction with elevated external stressors, including increased responsibilities and course requirements. Analysis of the findings suggested that factors related to stress in nursing students arose from clinical sources, academic sources, and personal sources. Further analysis indicated that experiencing elevated levels of stress had a negative impact on the student. Increased levels of stress, combined with poor coping mechanisms, may lead to poor academic performance and burn-out among nursing students. Future research may evaluate means to reduce stress levels and mitigate stress in nursing students through targeting specific causative factors. Findings from this review of literature aim to influence student management of stress.

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The effectiveness of full-time and part-time faculty is an area of major interest in education, especially in light of the dramatic rise of part-time faculty on the nation's campuses. In the period between 1976 and 1994, the use of full-time faculty increased by 21% while the use of part-time faculty increased by 91% (Clery, 1998). The quality of instruction is the primary concern surrounding the use of part-time faculty (Clery, 1998; Fedler, 1989; Gappa & Leslie, 1997; Leslie, 1998; Mellander & Mellander, 1999; Spangler, 1990). One way of assessing quality of education is by assessing teacher effectiveness. The purpose of this study was to compare the teaching effectiveness of part-time and full-time clinical nursing faculty. To achieve this, the Nursing Clinical Teacher Effectiveness Inventory (NCTEI) (Knox & Mogan, 1985) was adapted for use in measuring student and faculty perceptions of part-time faculty and of full-time faculty. The NCTEI was designed to measure five categories important in clinical nursing instruction: teaching ability, nursing competence, evaluation, interpersonal relationships, and personality traits. The sample included two groups: clinical nursing students in Associate Degree Nursing programs at schools in a mid-Atlantic state and the part-time and full-time faculty who taught those students. There were three components of the study. First students completed questionnaires about the effectiveness of their part-time and full-time clinical nursing faculty. Second, part-time and full-time clinical nursing faculty completed questionnaires about their perceptions of their own effectiveness. Finally, results were compared with the percentage of first-time pass rates on the National Council Licensing Exam for Registered Nurses (NCLEX-RN). Results of the study indicate that students rank part-time faculty as significantly less effective than full-time faculty on each of the five categories measured by the NCTEI and on the overall scale. These results are supported by the finding that there is no significant difference in the ways that students rate the effectiveness of teachers and the self-ratings of the teachers themselves. / Ph. D.

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The focus for this study was ethical reasoning among baccalaureate female nursing students. This descriptive and correlational study examined the ethical reasoning of freshmen and senior students at a large southwestern university for women. The research instrument used was the Defining Issues Test developed by Rest. The senior nursing students differed significantly (p < ,05) from the freshmen nursing students in ethical reasoning. However, nursing majors did not differ significantly from the non-nursing majors. A multiple regression analysis was performed that identified two factors associated with ethical reasoning (viz., age and GPA), The correlation coefficients were r= .377 for age and P_ score and r= .315 for GPA and P score. Older students were found to be significantly more advanced in ethical reasoning than were younger students. Students with higher GPAs used principled reasoning significantly more often than did students with lower GPAs. Of interest are the findings related to demographic characteristics, ethnicity, and religious preference. The sample was predominantly white, but a significant difference in use of principled reasoning between whites and non-whites was found. In the sample, whites used ethical reasoning more often than did non-whites. The students in the sample who labeled themselves as Baptists were significantly different from Traditional Christians (Methodists, Episcopalians, Presbyterians, Lutherans, and members of the Church of Christ) and Other Christians (all others, excluding Baptists, Catholics, and the Traditional Christians). The Baptist group used principled reasoning less often than did the other two groups of Christians. The Catholics were not significantly different from the Baptist, Traditional Christian, or Other Christian groups. The results are ambiguous and may reflect only a conservative philosophy or a conservative theological ideology rather than cognitive processing.