Dissertations & Theses (Open Access)

Date of Award

Summer 8-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)


Cathy L. Rozmus, PhD

Second Advisor

Rebecca L. Casarez, PhD, RN

Third Advisor

Valerie M. Howard, Ed.D, MSN, RN

Fourth Advisor

Renato M. Silva, DDS, MS, PhD



Clinical Reasoning (CR) is the intellectual capacity to understand the value of patient data related to current knowledge, skills, and experiences within a dynamic domain of patient care with reflective analysis relating the new experience and understanding into new knowledge to be applied in future clinical situations. Poorly developed CR skills inhibit effective problem-solving abilities of nursing students producing levels of unexpected confusion and loss of confidence impeding their adaptability and effectiveness in dynamic healthcare environments. This study explored the effectiveness of human patient simulation (HPS) as an innovative method to facilitate the development of CR in undergraduate nursing students.


A two-group crossover experimental design testing the hypothesis that Baccalaureate Student Nurses (BSN) experiencing patient simulations will have higher Health Sciences Reasoning Test (HSRT) scores as compared to students without these experiences. The 33 item HSRT is a multiple choice test using health science situational mini-case vignettes assessing the takers clinical reasoning capacity. Participants were randomly assigned to treatment groups that received HPS or case studies. Pre and posttest HSRT scores were measured to measure CR of each participant. Data analysis through the Grizzle Model included a mixed linear approach that included fixed effects of treatment, sequence, period, base score, and experience.


The residual effect value was very large signifying the absence of carryover effect (p=0.840) indicating further analysis for treatment effects could continue. The best-fit final mixed linear model selected for analysis with the Grizzle Model produced insignificant treatment results with significant (p


There were no significant treatment effects of HPS on the acquisition of CR yet the outcome illuminated additional considerations to explore with further research adding to the understanding of this complex concept. Additional considerations for future research should include investigating an effective timetable for the development of CR through HPS and consider a more sensitive evaluation tool. New research designs should also consider increasing the realism and designing HPS through best practice methods while respecting the effect of academic, clinical, and external student stressors.


5th advisor: Geri L. Wood, PhD, RN, FAAN


Reasoning, nursing students, nurses, critical thinking, confidence-building, decision-making, judgment

Included in

Nursing Commons



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