Gina Palombo

Date Approved


Degree Type

Campus Only Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department or School

Teacher Education

Committee Member

Tsu Yin Wu, PhD, RN, FAAN

Committee Member

Michael McVey, Ed

Committee Member

Janean Monahan, PhD, RN

Committee Member

Michael Williams, PhD, RN, CCRN, CNE


Currently, the increase in critical patient care situations has challenged the education system to prepare nursing students with critical thinking skills vital for providing quality patient care as well as safety in practice. The purpose of the study was to examine the effect of human patient simulation (HPS) technology on enhancing critical thinking skills, increasing self-efficacy (SE), and preparing the associate degree nursing students (ADNS) with quality and safety education for nurses (QSEN) competencies. The null hypothesis posited that the ADNS engaged in the HPS scenario as a teaching modality will exhibit no differences in critical thinking, self-efficacy, or knowledge of quality and safety of education competencies. The concept of self-efficacy from Bandura’s social cognitive theory was the framework used to support the simulation learning. It was expected that students would learn the necessary knowledge and skills and begin to develop attitudes to improve their self-efficacy to increase safe and effective patient care. The National League of Nursing Jeffries simulation framework was used as the operational model that guided the simulation event. The design of the study was a one-group pretest-posttest design. A convenience sampling included students (n = 78) from the spring 2017 semester of a pre-licensure associate degree nursing program enrolled in a Midwestern community college. Instruments used for assessments included the Health Science Reasoning Test (HSRT) for critical thinking, New Self-General Efficacy (NGSE) for self-efficacy, and Nursing Quality and Safety Self-Inventory (NQSSI) for quality and safety education for nurses. These instruments were utilized for both pretest and posttest. There were significant improvements in NQSSI total score (t = 5.00, p < .0001); the three QSEN subscales: (a) knowledge (t = 4.68, p < .0001), (b) skill (t = 4.96, p < .0001), (c) attitudes (t = 3.71, p < .0001); and NGSE total score (t = 3.26, p = .002) from pre- and post-measures. The study did not show a significant change in critical thinking from pretest to posttest using the HSRT instrument. To conclude, this study supportsthat simulation was effective in improving the students’ self-rated quality and safety knowledge, and self-efficacy.