Independent Simulation Observation and Reflection: A Feasibility Study

Abstract

Clinical reasoning is essential for safe and effective nursing practice, yet traditional strategies for fostering clinical reasoning development in prelicensure nursing students are often limited by scheduling constraints, faculty availability, and resource demands. As nurse educators seek flexible, student-centered approaches to strengthen clinical reasoning skills, independent learning strategies that can supplement existing methods are increasingly valuable. This feasibility study examined Independent Simulation Observation and Reflection (ISOR), a theory-informed, asynchronous learning strategy in which students observe recorded simulations and complete guided reflections. ISOR is designed to serve as a low-resource, flexible complement to traditional strategies that can reinforce clinical reasoning through repetition and reflection. The study employed a within-subjects, quasi-experimental design. Undergraduate students enrolled in a nursing leadership course were recruited for voluntary participation. Participants completed both the ISOR activity and a virtual case study control assignment. After each activity, students completed surveys assessing acceptability, feasibility, and usability. Quantitative survey data were analyzed to compare student perceptions across the two learning strategies, and qualitative feedback provided additional context about perceived benefits and barriers of each strategy. Findings demonstrated that ISOR was similar to the case study in terms of acceptability, feasibility, and usability. Students found ISOR to be flexible, low-stress, and engaging, and reported that observing and reflecting on a simulation helped them apply prior learning, bridging the theory-practice gap. Barriers to implementation were minimal and primarily centered around technological issues that should be addressed prior to broader implementation or further study. The results of this study indicate that ISOR is a viable teaching strategy which could be implemented into nursing curricula with minimal disruption. Qualitative results also suggest that ISOR provides an opportunity for students to practice clinical reasoning skills. Further research is needed to investigate the impact of ISOR on clinical reasoning outcomes, to explore how repeated use of ISOR may influence engagement and learning outcomes, and to validate these results in a larger multi-site study.