The relationship between virtual simulation, critical thinking, and self-directed learning abilities of nursing students in Riyadh, Saudi Arabia

Introduction

Recent developments in healthcare systems necessitate that nurses are well-prepared to handle complex clinical situations, particularly in the post-COVID-19 era. Recent developments in healthcare systems require that nurses are well prepared to decomplex situations, particularly in the post-COVID-19 era (Anders, 2021). So, it is necessary to prepare nursing students to be competent in advanced technology skills, critical thinking disposition, and self-directed learning (SDL) abilities (Arizo-Luque et al., 2022; Kim & Shin, 2021). It was found that self-directed leaning in more effective in knowledge acquisition among nursing student in Saudi Arabia (Ahmed, Alostaz & AL-Lateef Sammouri, 2016)

Previous studies, such as a study conducted by Shin & Kim (2014), have illustrated that using simulations in nursing education effectively improve critical thinking skills in various fields, including pediatrics, and the multiple exposures for simulation in the nursing education coursework results in the gain of critical thinking skills and its subcategories (Shin et al., 2015). Furthermore, virtual simulation allows nursing students to practice their skills in an environment that is close to a clinical setting without affecting patient safety. Literature indicates that virtual simulation is an efficient method that poses no risks to patient safety (Ezzeddine, 2017).

In nursing education, directed self-learning (DSL) allows learners to find significance and reason in their learning and to take responsibility for the preparation, execution, and assessment of their learning (Lee, Kim & Chae, 2020). It generates a significant improvement in the level of knowledge acquisition and overall performance (Ahmed, Alostaz & AL-Lateef Sammouri, 2016; Abdullah et al., 2018). A study conducted by Bodur et al. (2024) showed that nursing students expressed positive view regarding virtual learning and improved their self-directed learning skills.

Several methods have been used by nursing educators to grow critical thinking among students. Virtual simulation is one of these utilized methods (Blakeslee, 2020) and provides an exceptional learning opportunity for nursing students with the significant achievement of the learning outcomes (Foronda et al., 2020). It was reported by Song & Kim (2023) that nursing students satisfaction regarding virtual simulation in nursing students.

Virtual simulation in nursing education has provided an enhancement in nursing students’ learning abilities, as illustrated in an integrative review of the educational characteristics related to virtual simulation in the field of nursing education by Shin et al. (2019) and another study by Foronda et al. (2020) reported that virtual simulation is an excellent educational tool for encouraging the learning process to reach the desired outcomes. Still, the previous studies were limited to providing solid evidence to support the association between virtual simulation and students’ critical thinking or self-learning abilities (Cant & Cooper, 2010; Chang et al., 2022).

Through the use of virtual simulations, nursing students can hone their critical thinking skills and SDL abilities. These simulated environments provide those students with various challenges and scenarios to explore and analyze (Warren et al., 2016; Jin & Ji, 2021). Students are actively encouraged to think independently and creatively as they work through the simulations. This learning environment helps nurture their capacity to think critically and develop the skills necessary to face the real world (Chan, 2019; Yildirim, Özkahraman & Karabudak, 2011). Additionally, it allows students to create a sense of self-discipline and SDL, as they can work through the simulations independently. With virtual simulation, nursing students can develop the skills they need to become successful in the future (Thiagraj, Karim & Veloo, 2021; Bruce, Levett-Jones & Courtney-Pratt, 2019). Furthermore, a study conducted by Yeo & Jang (2023) showed that the virtual environment has developed confidence, achievement, and satisfaction among the learners in addition to correcting their errors from failure.

There are different studies conducted across the globe on simulation effectiveness in the medical field. However, there are not many studies done on virtual simulation effectiveness in the nursing field, including the Middle Eastern countries; therefore, this study aimed to assess the relationship between virtual simulation with critical thinking and the SDL of nursing students at the Academic Institution, Riyadh, Saudi Arabia.

Materials and Methods

Results

Discussion

Virtual simulation is becoming increasingly popular as a learning tool in nursing education. It can be used to teach and assess critical thinking disposition and SDL abilities in nursing students, as well as provide a safe environment to practice clinical decision-making. This study assessed the relationship between virtual simulation with critical thinking skills and SDL abilities of nursing students at the Academic Institution.

This study explored the relationship of virtual simulation with nursing students’ critical thinking disposition and SDL abilities. The findings indicate a significant correlation between virtual simulation and both the critical thinking and SDL abilities of nursing students. A similar study conducted in Indonesia investigated the impact of virtual simulation on critical thinking and found that critical thinking was strengthened and increased with virtual simulation (Ikhsan, Sugiyarto & Astuti, 2020), and the Spanish simulation environment has resulted in improvement in critical thinking abilities of nursing students (Arizo-Luque et al., 2022). On the other hand, a Korean study about the extent of the simulation effect on the self-learning ability of nursing students conducted by Cho & Hwang (2019) concludes that there are little to no differences and the same level of ability of self-learning among nursing students was maintained after the simulation (Cho & Hwang, 2019) and on the impact of virtual simulation on critical thinking and SDL which showed no statistically significant difference were observed after application of virtual simulation, and there is no increase or decrease with the existence of virtual simulation (Kang, Hong & Lee, 2020).

The simulation helps nursing students to gain confidence in their abilities and to learn how to respond to various situations. It can also help them to develop problem-solving skills and critical thinking skills, as well as to become better communicators (Goulding et al., 2020). It can also help reduce stress and anxiety in nursing students, allowing them to practice their skills and knowledge in a safe environment before facing real-life situations. Simulation is also an effective way to teach students tasks of prioritization and teamwork (O’Flaherty & Costabile, 2020). In the current study, the top-ranked item of simulation benefit was that it helped students to predict changes that may happen to a real patient; they learned the health assessments and performed them in laboratories in nursing schools. However, virtual simulations offer the possibility to practice with real cases (Sundler, Pettersson & Berglund, 2015; Abelsson & Bisholt, 2017). The virtual nursing simulation includes an assessment that students may have found useful for their assessment knowledge and skills (Padilha et al., 2019). The third-ranked item on simulation effectiveness was that participating in simulation helped students to develop a better understanding of the medication that was in the simulated clinical experience. The goals of planning and applying simulation education are to help students to better the content of the class and to become better in clinical practice (Dubovi, Levy & Dagan, 2017). In this sense, the application of virtual simulation to nursing science has been successful for the student learning experience (Sitterding et al., 2019).

The critical thinking skills and SDL abilities improved significantly in the current study, and scores on one sub-scale of SDL abilities, “gathering resources for learning”, also significantly correlated with virtual simulation. Those findings implicate that virtual simulation resources for nursing interventions could be a proactively effective approach in nursing education. This is a very relevant finding because of the need to exert continuous effort to seek nursing resources and knowledge to improve care for patients by nursing professionals. Furthermore, a similar study reported that nursing professionalism implicates searching and finding relevant information. The competence related to professional nursing ability was enhanced by virtual simulation in this current study (Ghadirian, Salsali & Cheraghi, 2014).

This study has several limitations; it was done only on female participants and in one university. Thus, the results cannot be generalized. More extensive research with different educational institutions and larger samples, including females and males, is warranted. It was also limited to examine the correlational relationship between virtual simulation with critical thinking disposition and SDL abilities among nursing students using descriptive design, which needs experimental study approach. Further, replication of this study using other nursing student samples, like those found in various universities and public higher education institutions, would aid in generalizing findings. Another limitation was that this study used non-probability convenience sampling techniques to select the students from one place, which restricts its generalizability.

Conclusion

In conclusion, the study showed significant relationships between virtual simulation with critical thinking disposition and SDL abilities among nursing students. Besides, virtual simulation affected nursing students and made them develop critical thinking and self-learning abilities so that they simulate events and try to seek out and solve the problems. Most of the students stated that it had benefited their learning and that they experienced an environment close to a clinical setting. Virtual simulation could be helpful to nursing educators to maximize learning among students due to its education characteristics, provision of opportunities to synthesize nursing knowledge, and effective learning environment.

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