Using online exercises and patient simulation to improve students' clinical decision-making.

Faced with increasingly complex clinical situations, nurses must respond with accurate clinical judgment. But del Bueno (2005) reports that only 35 percent of new graduate nurses exhibit entry-level expectations of the necessary critical-thinking skills. Croskerry (2003) argues that clinicians' education should be directed at developing cognitive strategies that reduce errors in clinical decision-making. A challenge for nurse educators is finding activities to help students analyze their thinking as they address clinical problems. The author describes an assignment, given to third-year baccalaureate students, that used both online learning and high-fidelity patient simulation. Through discussions with instructors and peers, as well as personal reflection, students gained insight into both their sound and faulty critical thinking and clinical decisions.