THE EFFECTS OF SIMULATION ON 2ND YEAR NURSING STUDENTS’ CRITICAL

THINKING SCORES AT SOUTHWESTERN UNIVERSITY PHINMA: A

QUANTITATIVE STUDY

A Thesis Proposal

Presented to the Faculty of the College of Nursing

Southwestern University PHINMA

Cebu City

In Partial Fulfillment of the Requirements for Nursing Research

Genturalez, Angel Robles

Gimenez, Anne Feona May Mendoza

Gonzales, Angela Niña Sotto

Jayme, Aliza Gepiga

Jesoro, Brix Gallardo

Labayos, Tresha Kyla Fabre

Lopez, Ydiane Marlou Degamo

Bollozos, Mahinay Louise Dhanielle

Masecampo, Renee Babon

Matiga, Cheeneeh Kaye Reyes

Mayol, Chelsea Claire Mangao

Metante, Mary Junce Sunico

Nolasco, Frances Ann Canonigo

Pacina, Peach Jewel Abayan

Quilatan, Rosario Tañeca

 CHAPTER I

THE PROBLEM AND ITS SCOPE

INTRODUCTION

Rationale of the Study

From assessing patients, administering medications, planning patient care, and

exhibiting nursing interventions among other responsibilities, critical thinking abilities

and clinical skills are two essential qualities for a nurse to have. It is important, therefore,

that nursing education and training polish nursing students’ skills in both knowledge and

practice to produce quality and effective nurses in the future.

Nursing clinical education strives to assist students in improving their problem-

solving abilities by fusing theoretical information from textbooks with real-world

applications. Critical thinking, a long-standing result of nursing education and nursing

practice, has been identified as one of the criteria for nursing school

accreditation. Nurses must cultivate a high level of surveillance and clinical judgment

for initial recognition of changes in a patient's condition that indicate a need for action

(Rahman, 2019).

Simulation-based clinical education is a significant educational strategy that gives

nursing students opportunities to hone their clinical and decision-making abilities through

a variety of real-life situational encounters without jeopardizing the patient's well-being.

According to Juan et al. (2017), experiential learning, such as simulation, is commonly

used in teaching to engage learners in critical and evaluative thinking, as well as self-

directed learning (Pugh et al., 2020). It enables students to immediately apply what they

have learned to real-world situations.

 A national study conducted by Berdida et al. (2022) tested Filipino nursing

students’ use of low-cost simulators during the COVID-19 pandemic. Four low-cost

simulators were found and themed under a category: home and hardware, health and

beauty, creative articles, and entertainment. It was found that home equipment used as

low-cost simulators enabled students to practice online simulation of skills

demonstration. Moreover, in an article by Gaskin (2022), 31 representatives from the

University of the Philippines - Manila, Western Visayas State University, and Mindanao

State University attended a workshop on simulation-based learning in partnership with

the University of Adelaide, specifically at the Adelaide Health Simulation.

Based on these observations, the researchers decided to conduct a study that

would determine the correlation between the variables used. With the subjects’

simulation experience being the main variable, this research aims to identify the effects

of simulation on nursing students’ critical thinking abilities.

Theoretical Background

Figure 1. Theoretical Framework

Simulation-based nursing education is an increasingly popular pedagogical

approach through which numerous situational real-life experiences gives the students

the chance to hone their clinical and decision-making abilities. It is a learner-centered

approach, grounded in learning theories based on constructivism. This study will be

based on theories that show how the various variables in our study, most notably the

impact of simulation on the critical thinking scores of nursing students, are

interconnected and applied. Therefore, this study is anchored on Kolb's Experiential

Learning Theory (ELT), Jeffries Simulation Theory, Benner's Novice to Expert Model, and

Constructivist Learning Theory.

Experiential Learning Theory

Kolb’s theory is a four-stage cyclical theory that involves a holistic perspective that

combines experience, perception, cognition, and behavior. To start with, in concrete

experience “DO”, the learner actively experiences an activity such as a lab session or

field work wherein the medical simulation creates kinesthetic learning (learning by

physical actions). Simulation may evoke strong emotional responses that reveal cause-

effect relationships which will be remembered by the learners. Furthermore, in reflective

observation “OBSERVE”, the learner consciously reflects back on that experience.

Debriefing allows time for learners to reflect and analyze their own behaviors. For

abstract conceptualization “THINK”, the learner attempts to conceptualize a theory or

model of what is observed. Simulations allow learners to think critically about a given

situation. They will formulate concepts and plan behaviors for future events. Lastly, for

active experimentation “PLAN”, the learner is trying to plan how to test a model or theory

or plan for a forthcoming experience. Role-playing activities, internships, and other

hands-on tasks let learners apply the learning and thus truly “learn by doing.” Active

experimentation leads to concrete experiences, and the cycle of experiential learning

resumes.

The debriefing phase of medical simulation is a key component of nursing

simulation education. During this phase, learners should be guided (not lectured at) to

reflect back on their own behaviors, determine their own concepts and whether they are

correct or not and then plan changes for their future behaviors. With the help of an
experienced nurse, the debriefing session can be used to discuss the self-assessments

in the context of expert nursing practice and help students understand what they are

striving for.

Figure 2. Kolb’s Experiential Learning theory model

NLN/Jeffries Simulation Theory

It has six core elements which includes context, background, design, educational

practices, simulation experience, and outcomes (Cowperthwait, 2020). The purpose,

physical location, and evaluation standards of the learning experience are defined as the

context, which provides the necessary framework for each developed simulation. The

background, which is a part of the context, describes the SBE's support for the

curriculum, learner expectations, and overarching goals for the simulation. Specific

learning objectives, desired fidelity, learner role assignments, simulation flow, and pre

and post-briefing procedures are all included in the simulation design. The simulation

experience is defined as interactive, learner-centric, experiential, collaborative, and

trust-based on the side of both the facilitator and learners. The facilitator and

participants' dynamic interaction is woven into the simulation experience through

prebriefing, simulation progression, cues, and debriefing. Outcomes occur in three areas:

the system, the patient, and the participant. These elements lead to the simulation

experience itself, which includes a dynamic interaction between the facilitator and the

learner through the use of appropriate educational strategies.

Benner's Novice to Expert Model

The Novice to Expert Model offers the crucial conceptual framework to direct the

creation of simulation facilitators and aid in comprehending the learning trajectory. The

five stages of development are defined and operationalized by this theory-based

approach, which also provides direction for the infrastructure, educational programs, and

development resources required at various program levels. Since there is some

consensus that nurses should be educationally prepared to work at least at the advanced

beginner level and possibly at the competent level upon entering the nursing profession,

the first three levels of Benner's model could serve as a guide for the progression of

simulation experiences in nursing education.

Simulation at the Novice level. The employment of these trainers in conjunction

with practice on fellow students would be most beneficial for those operating at the initial

level of skill learning. Simple and straightforward learning settings are best for beginning

students so that the situation's specifics can be focused on. Evaluation could begin with

fellow students while learning fundamental assessment techniques like taking vital signs
or evaluating chest and bowel sounds. Additionally, it aids students in overcoming some

of the nervousness they have when speaking with actual patients.

Students could be exposed to abnormal findings such uneven/weak/thready pulses

and abnormal chest or bowel sounds by using medium-fidelity human patient simulators.

According to experiential learning theory, it is best for student learning if exposure to

anomalous findings occurs in context (i.e., if the simulated patient had a specific

diagnosis or health history).

Novices must have the chance to share their results with others and relate their

experiences to existing cognitive frameworks for simulation to be an effective learning

tool. Novices learn about the diversity in normal vital signs, for instance, by evaluating

their peers. They adjust and modify their cognitive framework in relation to the diagnostic

or health history supplied in the simulation by connecting the aberrant indicators to the

presented health history.

Simulation at the advanced beginner level. Learners begin using protocols to

direct their actions when they reach the advanced beginner or second level of skill

acquisition. High-fidelity human patient simulators that can depict the results of actions

can be used in simulations at this stage. Students could participate in simulations where

they evaluate pain, choose the right amount, kind, and route of pain medication, deliver

blood products, and create scenarios where the patient's condition changes and a

response is necessary. Advanced beginners can guide their activities with algorithms and

protocols, and simulators can display the results of those actions.

Advanced beginners can stop simulations to discuss evaluations and decisions in

progress, or this debriefing can take place subsequently because they are concentrated
on the current patient condition. Sessions that are videotaped serve to guarantee that

the scenario is remembered correctly and help to steer the conversation at the post

simulation debriefing. Students can evaluate and discuss their own performance as well

as that of their peers through group debriefing. Some students may want to go through

a certain situation multiple times. While conforming learners would choose to play with

the simulated scenarios, divergent learners may be able to convert experience into

knowledge by commenting on and debating the simulation experience.

Simulation at the competent level. The nurse begins to recognize the

limitations of protocols and algorithms in terms of specific case information at this stage.

No matter how sophisticated, it is challenging to demonstrate those particular

characteristics using a generic patient simulator. Although they "... have a sense of

mastery and the ability to cope with and handle the myriad eventualities of clinical

nursing," nurses functioning at the level of competency do (p. 27). A human patient

simulator, along with a range of actor patients, family members, coworkers, doctors, and

other elements that make a simulation experience complex, can be used to model these

"contingencies of clinical nursing.”

Constructivist Learning Theory

It is based around the idea that learners are active participants in their learning

journey, wherein knowledge is constructed based on experiences (2021). To illustrate

this, there are four key areas that are crucial to the success of a constructivist classroom:

the instructor takes on the role of a facilitator instead of a director; there are equal

authority and responsibility between the students and the instructor; learning occurs in

small groups; and knowledge is shared between both the students and the instructor. In
a nutshell, this theory suggests teachers to guide learning by implementing group

activities, creating collaborative dialogue, and facilitating interactive experiences. As a

result, students build on their prior knowledge and construct new understanding based

on the lessons taught.

Figure 3. This model was entrenched in learning theories by Dewey, Piaget, Vygotsky, Gagne, and

Bruner.

One important teaching method in healthcare courses is simulation, which is

defined as “the process by which we are trying to achieve results approximating clinical

practice as closely as possible”. In nursing education, it enables students to learn,

understand, and apply theoretical knowledge into practice (Koukourikos et al., 2021).

The popularity of simulation-based nurse training as a pedagogical strategy continues to

rise. Today's nurse educators must be prepared to create teaching methodologies that
incorporate elements of clinical simulation, whether they are employed as teaching

hospital staff or as faculty members of college nursing programs (Ohio University,

2021).

In nursing education, simulation is being used as a teaching technique more and

more frequently (Guererro et al., 2022). Various simulators are used, including an

anatomical model of the human body to carry out a straightforward method and an

artificial catheterization model or an intravenous injection model to create certain nursing

procedures. Human patient simulators have recently been employed to provide students

with the opportunity to examine, intervene, and evaluate patient outcomes. These

simulators have been reported to result in more realistic experiences (Kavanagh et al.,

2021). Simulation can supplement these different experiences and aid in the

development of critical thinking.

In a systematic review and meta-analysis on high-fidelity simulation (HFS), Tong

et al. (2022) focused on the three key steps which are prebriefing, simulation, and

debriefing, and how the length of sessions affects nursing students’ knowledge and skills.

It was found that shorter sessions improved the students’ knowledge while longer

sessions enhanced their skills.

La Cerra et al. (2019) also explored the effects of HFS based on life-threatening

clinical situations on the learning outcomes of both undergraduate and postgraduate

nursing students. The results revealed that HFS resulted in a better enhancement on

students’ knowledge and performance; however, such study did not attest to whether

HFS improves nursing students’ competence and patient outcomes.

 Nursing students' self-efficacy, perceived competence, and learning satisfaction

can all be improved by simulation-based learning (Hung et al., 2021). Furthermore, the

first simulation attempt is where the majority of the changes happen, but the learning

results of the students are improved by the cumulative multiple exposure sessions.

In a 2021 study entitled “Simulation in Clinical Nursing Education”, it was

concluded that the inclusion and further development of simulation might greatly

improve the quality of nursing training together with the use of other educational

methods. Moreover, simulation allows interactive learning where there is feedback

between the students and the clinical instructor, and it encourages clinical reasoning and

critical thinking (Waxman et al., 2019).

In line with this, the ability to think critically is one of the most important skills that

a nurse or an aspiring nurse must possess. Healthcare professionals constantly make

decisions that significantly affect patient outcomes, and as decision-making and critical

thinking go hand-in-hand, the quality of care greatly depends on how the healthcare

professional thinks and decides (Meinke, 2021). Furthermore, Morris (2022) posited that

critical thinking is not only used in decision-making situations in the healthcare setting,

but also in prioritization and organization of patients and nursing interventions.

A study by Gonzales et al. (2022), which focused on students’ perception of how

evidence-based skills intervention affects their critical thinking, indicated a positive

result. The respondents perceived that innovative, evidence-based skills intervention

increased their achievements and critical thinking development.

Macartney et al. (2021) also conducted a cross-cohort study on nursing students’

perceptions, but with regard to video simulation and critical reflection for developing
clinical reasoning skills. According to the findings of this study, using video simulation in

the revised multimodal assessment task appears to be a promising, pertinent, and

significant learning design technique to support peer collaboration and the acquisition of

critical thinking abilities.

Tseng and Hill (2020) showed the relationship of simulation and thinking in their

study about the impact of HFS on nursing students’ flexible and reflective thinking in

higher education. HFS can expose students to regulated and dynamic clinical settings,

enabling them to try to apply theory in reality, learn via collaborative and active learning

tasks, and be open-minded to many perspectives in a variety of situations. It was

indicated that the development of flexible thinking and reflective learning requires the

use of critical reflection.

Contrarily, a causal-comparative study on the effects of HFS on baccalaureate

students’ critical thinking skills revealed no significant difference in the participants’

critical thinking scores, indicating no support that HFS increases students’ critical thinking

abilities (Blakeslee, 2020).

In a study about strategies to develop critical thinking among first year students,

Thorington et al. (2022) revealed that simulation, together with oral presentations,

develops critical thinking and gains overall student learning. The active, hands-on

learning techniques used were successful in enhancing students' critical skills.

Meanwhile, Samaras et al. (2022) compared the effects of simulation versus case

studies in developing students’ critical thinking abilities and found that simulation fosters

recursive learning and may prompt higher critical thinking outcomes compared to case

studies which are a more passive method of learning.

 Highlighting the importance of critical thinking and self-confidence for clinical

practice success, an integrative review by Al Gharibi and Arulappan (2020) induced that

simulation increases nurses’ and nursing students’ competence, self-confidence,

knowledge, critical thinking, and satisfaction; therefore, repetitive simulation experience

is encouraged as a teaching method in nursing education.

In another study that utilized a science simulation-based learning method to

develop students’ active learning, self-confidence, and critical thinking in academic

writing, it was found that simulation promotes active learning, knowledge acquisition,

self-confidence development, and critical thinking in academic writing (O'Flaherty &

Costabile, 2020).

Kim (2018) studied the effect of simulation-based emergency cardiac arrest

education on nursing students' self-efficacy and critical thinking skills with regard to

roleplay versus lecture. It was deduced that simulation with role play is an effective way

to teach complex clinical and nursing situations.

Alamrani et al. (2018) compared the results of simulation and traditional teaching

methods on the critical thinking and self-confidence of nursing students. Contrary to the

aforementioned results from other studies, there were no significant differences

identified with the outcomes of simulator-based and traditional teaching methods.

Kang et al. (2020) posited in their study that nursing students' ability to learn

independently in several areas was improved through virtual simulation. Additionally, the

subjects said it helped their learning since they felt safe in their learning environment.

Nurse educators must stay up to date on how to deliver nursing education using rapidly

emerging technology because students are extremely adaptable to these changes.

 A literature review by Hanshaw and Dickerson (2020) evaluated 20 research

studies of the HFS method in nursing education and supported the use of HFS as an

educational method that increases higher level thinking knowledge, critical thinking, self-

efficacy, self-confidence, clinical judgment, and motivation.

The theories that are utilized capture the characteristics of the variables in the

context of the study and, as a result, serve as the foundation for how the variables will

be handled. On the other hand, the related literature and studies provided a chance for

a favorable perspective on the value of simulation in enhancing the critical thinking

abilities of nursing students. The theories, studies, and literature mentioned can be used

as a reference for comparison and contrast with the results of the present study.
 THE PROBLEM

Statement of the Problem

This study aims to determine the effects of simulation on the critical thinking skills

among 2nd year Nursing students in Southwestern University PHINMA.

Specifically, it seeks to answer the following questions:

1. What is the profile of the respondents in terms of:

1.1 age

1.2 gender

1.3 year level; and

1.4 simulation experience

2. What are the satisfaction and self-confidence levels of the students in terms of

their simulation experience?

3. What is the effect of simulation on Nursing students’ critical thinking skills?

4. Is there a significant relationship between:

4.1 the respondents’ demographic profile and satisfaction levels on simulation

experience; and

4.2 the respondents’ demographic profile and self-confidence levels on simulation

experience?

5. Based on the findings, what will be the research output?

Statement of the Null Hypotheses

HO1 There is no significant relationship between the demographic profile of the

respondents and their satisfaction levels in terms of simulation experience.

HO2 There is no significant relationship between the demographic profile of the

respondents and their self-confidence levels in terms of simulation experience.

HO3 Simulation has no significant effect on the critical thinking skills of Nursing

students.
Significance of the Study

This study is conducted with the aim to provide the effects of simulation on nursing

students’ critical thinking scores through recent studies/ thesis and related articles that

are needed for the expected outcome of the conducted thesis which will be significant to

the following:

Clinical Instructors. The results of the study will help the clinical instructors create

educational environments that incorporate simulation in a manner that could promote

the development of critical thinking scores in nursing students, thereby increasing

nursing students’ academic success.

Nursing Education Administrators. Data given will provide the dean with information

on the effects of simulation on nursing students’ critical thinking scores. With the rapid

increase of simulation education, there has been a vast increase in the attention paid to

its effective use. In other words, the data gathered will help the dean initiate

collaboration among faculty and chairpersons to help plan the advancement of nursing

education through simulation in relation to the new curriculum.

Nursing students. This research will benefit the nursing students’ critical thinking that

will impact their academic success in nursing education. Nursing students who possess

high critical thinking for a particular task or situation will be more likely to continue to

be successful with the task or a similar situation. Simulations that are effectively

designed and implemented will allow nursing students to experience first-hand the

complexities of the clinical setting in a learning environment where students utilize critical

thinking skills as they gain confidence in the ability to provide appropriate patient care.
Future Researchers. The knowledge obtained from this study will serve to stimulate

further research and discussion regarding the effects of simulation on nursing student's

critical thinking scores. This study will then provide them with the necessary information

that is essential for the development and success of future related studies.

Scope and Limitation

Scope of the study

This study will focus on the effects of simulation on second year students’ critical thinking

scores at Southwestern University PHINMA. The data collection will be done through a

soft copy questionnaire as survey and reference. The study shall have students who

experienced the return demonstrations required for Level 2.

Limitations of the study

This study will not cover simulations that are not included in the curriculum for Level 2

nursing students. The respondents should be enrolled in the school year 2022-2023

under College of Nursing in Southwestern University PHINMA.

 RESEARCH METHODOLOGY

Research Design

This study will utilize the correlational analysis of data. The flow of the study is shown in

Figure 4.

Figure 4. Research Flow of the Study

Research Environment

This study will be conducted at Southwestern University PHINMA, particularly in

the Nursing Department located at Urgello St., Cebu City.

The Southwestern University, officially the Southwestern University PHINMA (SWU

PHINMA), is a private university in Cebu City, Philippines. Founded and opened in the

summer of 1946 by two pharmacists, SWU originally started as Southwestern Colleges

and achieved University status on December 11, 1959. The university and its base

hospital were acquired by PHINMA Education, a subsidiary of PHINMA Corporation in

2015. The university was renamed to Southwestern University PHINMA and the hospital
from Sacred Heart Hospital to Southwestern University Medical Center. The university

changed the logo and closed its South Campus in Basak San Nicolas, Cebu City.

It has a large number of international students from different countries. It is widely

recognized as the most diverse institution in Cebu due to the various nationalities of

students that came from 34 countries in five continents.

Research Respondents

The participants of this study are 2nd year college nursing students at

Southwestern University PHINMA. The number of participants will be limited to 264.

Students who participated are fully aware of the purpose of the questionnaire that will

be given to them.

Sampling Design

Population, Sampling, and Sample

Population

Before the sample was collected, the researchers first determined the population

of the currently enrolled second year nursing students of Southwestern University

PHINMA. The population is geographic generalization, where there are objects/subjects

that have quality and certain characteristics that have been set by the researchers to

learn and make conclusions. There are currently 770 enrolled second year nursing

students in the school year 2022-2023. However, the researchers will reduce the number
of respondents to 264 students only, using Slovin’s Formula based on the 95%

confidence level of the population size.

Sampling

Simple random sampling will be utilized to gather the research respondents. In this

type of sampling, sample members are selected by chance, but with a known probability

of selection. Sampling was constituted to choose some individual process in research so

they or individual as a volunteer. The purpose of sampling is to use some individuals to

get information about the population.

Samples

This research gathered 264 respondents. Slovin’s formula is used in computing the

sample size of the study given the total population and margin of error.

Slovin’s formula:

n=Sample size, N=Population, e=Margin of error (0.05)

Selection of the sample is a very important step in conducting a research study. Sample

is a part of the population which will be analyzed. Sample must be a representative as

one is able to generalize the sample to population.

Research Instruments

The study used 2 sets of instruments: Student Satisfaction and Self-Confidence in

Learning and NCLEX-based questionnaire.

“Student Satisfaction and Self-Confidence in Learning” is the data-gathering tool

used as a standardized survey questionnaire adopted from a survey study found online

by National League for Nursing, published in 2005. The questionnaire will include

questions that will aid in the assessment of simulation experience among 2nd year

Nursing students of Southwestern University PHINMA.

The scale used for evaluating the level of satisfaction and confidence level on

simulation experience is the Likert-type Scale.

A Likert-type scale assumes that the strength/intensity of experience is linear,

i.e. on a continuum from strongly agree to strongly disagree, and assumes

that attitudes can be measured. The scale used for rating the respondents

are Strongly Disagree, Disagree, Agree, and Strongly Agree as shown in Table

1.
 Scale Interpretation Description

1 Strongly Disagree Strongly believes that the stated statement is false and can be ignored

2 Disagree Does not have the same opinion, belief, and understanding

3 Agree Has an understanding that the statement is correct

4 Strongly Agree Strongly believes that the stated statement is true.

Table 1. Four-Point Likert Scale for Rating the level of satisfaction and confidence level on simulation
experience of the respondents.

In interpreting the data, the scales to be used for rating evaluating the

level of understanding are very high, high, low, and very low. In this study,

the desired number of categories is 4. The highest possible score is 4 and the

lowest is 1. The range therefore is 0.75 for every scale. The interpretation is

as follows:

Mean Interpretation Description

Value

3.26 - Very Very satisfied in the simulation experience and has high confidence to correctly
4.00 High apply the learnings in the hospital settings in providing the best care to the patients.

2.51 - High Satisfied in the simulation experience and has confidence to apply the learnings in
3.25 the hospital setting; needs minimal guidance from the CI

1.76 - Low Not satisfied with the simulation experience; needs careful supervision from the CI
2.50

1.00 - Very High dissatisfaction in the simulation experience and has no confidence in
1.75 Low knowledge and skills; needs to have another simulation experience
Table 2. Mean Scale for the Level of Satisfaction and Confidence level on Simulation experience of the respondents.

Another instrument that is to be conducted is NCLEX-based questions. It is used

to measure the critical thinking skills of the students. The questions are based on the

simulations that 2nd year students had performed: handwashing, gloving, vital signs,

oral medication, preparing medication from a vial, intradermal, intramuscular, changing

IV fluid, post mortem care, leopold’s maneuver, perineal care, bathing an infant, applying

a dressing, assisting delivery, handling, and immediate newborn care.

The questionnaire consisted of 3 sets. The first set contained items pertaining to

the personal profile of the respondents, specifically their age, gender, year level, and

simulation experience. The second set consisted of the “Student Satisfaction and Self-

Confidence in Learning” simulation test survey, with two sub-parts: Satisfaction with

Current Learning; and Self-confidence in Learning. The third and last set is the NCLEX-

based questions which consists of 30 multiple choice items.

The results taken from the questionnaire were gathered, analyzed, and interpreted.

Research Procedure

Prior to a survey for gathering the data from the respondents of the study,

specifically, random volunteers of second year Nursing students, the researchers will be

making a letter of consent to conduct the study in a manner approved by the Dean of

the College of Nursing. It will then be checked by the adviser. The Institutional Review

Board will review and approve the study. Upon receiving the approval of the Dean, the

researchers will then initiate the survey through Google forms.

Gathering of Data

To begin, the researchers formulated a title that has been confirmed by the

professor and has the Dean of the College of Nursing’s approval to conduct the study

and administer the survey questionnaires. A quantitative method will be used by the

researchers.

Upon the research advisor’s approval, the researchers will be selecting two hundred

sixty-four (264) student nurses from level II to participate in the study. Data will be

collected from ______ of 2023. Researchers will use a structured survey questionnaire

that will be validated through Cronbach’s alpha which assesses the reliability, or internal

consistency, of a set of scale or test items. To do this, pilot testing will be conducted

wherein we are going to gather responses from 20 randomly selected students. The

statistician will then validate the research tool based on the result. After validation, the

research tool will be checked by 3 experts.

Moving forward, the researchers will explain the purpose of the study to the

selected respondents and the researchers’ will make sure that each participant

corresponds to their predefined criteria. The study will be conducted in an environment,

where respondents will be given privacy and enough time to compose their thoughts.

To ensure the freedom of choice and provide an avenue for the respondents to

voluntarily consent or decline participation in the study, the informed consent of each

respondent will be secured. Moreover, after gathering data, the researchers tallied and

presented the raw data of the study to the research statistician for the findings of the

survey.
 To protect each respondent’s identity, all data from the survey was coded. During

the discussion and reporting of data, no names or other identifying information will be

utilized. All files and data obtained by the researchers were maintained in an encrypted

(restricted) Google drive. The data and results will be destroyed when they have been

thoroughly analyzed, and all electronic files will be deleted.

Ethical Considerations

Ethical considerations in research are a set of rules that direct the study designs

and procedures. When gathering data from people, scientists and researchers must

always abide by a set of ethical principles. The integrity of science, respect for human

rights and dignity, and cooperation between science and society all depend on research

ethics. These guidelines guarantee that study subjects' involvement is voluntary,

informed, and safe (Bhandari, 2021).

Informed Consent. Informed consent means that the person participating is fully

informed about the survey being conducted. It is important to inform participants about

the study's goals, who or what organization is supporting it, how the results will be

utilized, whether their participation could have any negative effects, and who will have

access to the results. The basic goal of informed consent is to give the participant the

information necessary to decide for themselves whether or not to take part in the survey.

In the event that a person experiences any kind of distress while participating, additional

information should also be given.

Voluntary Participation. Voluntary participation means that people participate

in the evaluation free from coercion. Participants have the right to discontinue their
participation at any time without negatively impacting on their involvement in future

research and relationship with any of the researchers. No pressure should be applied to

individuals who decide not to continue because it is their right to choose not to continue

at any time. Additionally, justifications are not needed.

Risk/Benefit Assessment. It involves weighing a situation's risk against any

associated benefits. The researcher must ensure that the amount of benefit outweighs

the amount of risk in the study involving more than a minimal risk of harm to the

participants.

Risks. The following are the major potential risks which the researchers removed:

Boredom from answering the questionnaire, time consuming, and inconvenience.

Benefit. The following are the major potential benefits derived from the study:

Being able to assess their skills and knowledge from the simulation activities performed,

satisfaction that information they provide may help students, and confidence after

evaluating their critical thinking skills.

Confidentiality. Data privacy and confidentiality will be rigorously enforced. The

informed consent method creates a confidentiality agreement between the researcher

and participant that guarantees the participant's identity, personal information,

comments, etc. won't be revealed to anybody outside the research team unless

specifically agreed upon. Encrypting sensitive files, managing data access, managing

data use, and managing devices consuming the data are ways to preserve confidentiality.

Authorization to Access Private Information. No authorization shall be given

to those that are outside the group of researchers, other than those who are given

authorization. Setting up security measures to protect data is indeed necessary. A few

examples include installing anti-virus and malware protection, putting up a system that

enables the researchers to see who is forcibly copying data, and keeping an eye out for

questionable emails.

Compensation. No incentives or compensation will be given because the

respondents will answer only through a questionnaire and voluntarily. The only way to

return the favor of them answering the questionnaire is to express gratitude to the

responders.

Treatment of Data

The questions from the statement of the problem should be answered using the data

acquired, which should be appropriately understood and exploited using the statistical

methodologies listed below:

Frequency refers to the number of times an event or data occurred in a category of a

study. It is used to evaluate the respondents in terms of their demographic profile as to

age, gender, year level, and simulation experience.

Percentage is used to evaluate the respondents in terms of their demographic profile

as to age, gender, year level, and simulation experience.

Mean is the sum of all values divided by the total number of values. It’s the most used

measure of central tendency and is often referred to as the “average.” it is used to

summarize the respondents’ critical thinking scores and their level of self-confidence and

satisfaction experience.
Standard deviation is an index of dispersion and the most frequently used statistic for

measuring the degree of variability in a set score. It is the square root of the quotient of

the total squared deviation of the mean and the total number of the respondents.

Pearson’s Correlation Coefficient will be used to know if there’s correlation between

the independent (demographic profile and critical thinking scores) and dependent (self-

confidence level and simulation experience) variables of the study.

Chi-square test is a statistical test used to compare observed results with expected

results. The purpose of this test is to determine if a difference between observed data

and expected data is due to chance, or if it is due to a relationship between the variables

you are studying.

Definition of Terms

Simulation A teaching technique, specifically using return demonstration educational

strategy which enables nursing students to develop, hone, and apply information and

abilities in a realistic clinical situation.

Simulation-based education An education strategy or technique that allows nursing

students to practice their clinical and decision making skills through a range of real-life

scenario interactions.

Critical thinking Necessary for clinical judgment to initially identify changes in a

patient’s health that point to the need for intervention.

Novice Operating at the first level of acquisition.

Advanced beginner This is where learners start using ir applying protocols to direct

their actions.

Competent level The nurse begins to recognize the limitations of procedures and

algorithms when it comes to specifics of each particular case.

Medium-fidelity human patient simulators Utilized to expose students to abnormal

findings.

High-fidelity simulation An experience using full scale computerized patient simulators

that provides a high level of interactivity and realism for the learner.

Likert-scale A type of psychometric response scale in which responders specify their

level of agreement to a statement typically in four points: (1) Strongly disagree; (2)

Disagree; (3) Agree; (4) Strongly agree.

NCLEX-based questionnaire Used to measure the critical thinking skills of the students

while answering questions based on RLE assessment.

 BIBLIOGRAPHY

Aebersold, M. (2018). Simulation-Based Learning: No Longer a Novelty in Undergraduate

Education. OJIN: The Online Journal of Issues in Nursing Vol. 23, No. 2.
https://doi.org/10.3912/OJIN.Vol23No02PPT39

Al Gharibi M. & Arulappan Ms. (2020). Repeated Simulation Experience on Self-

Confidence, Critical Thinking, and Competence of Nurses and Nursing Students—An
Integrative Review. SAGE Open Nursing. 6. doi:10.1177/2377960820927377

Alamrani, M., Alammar, K., Alqahtani, S., & Salem, O. (2018). Comparing the Effects of
Simulation-Based and Traditional Teaching Methods on the Critical Thinking Abilities and
Self-Confidence of Nursing Students. Journal of Nursing Research 26(3):p 152-157, June
2018. | DOI: 10.1097/jnr.0000000000000231

Berdida, D. J. E., Elero, F. S. L., Donato, M. F. T., Dungo, M. K. S., Dunque, N. I. O., Dy,
K. J. E., Elarmo, R. A. G. F., Espineli, J. M. B., & Espineli, V. J. G. (2022). Filipino Nursing
Students' Use of Low-cost Simulators During the COVID-19 Pandemic: A Summative
Content Analysis of YouTube Videos. Teaching and learning in nursing : official journal of
the National Organization for Associate Degree Nursing, 10.1016/j.teln.2022.08.003.
Advance online publication. https://doi.org/10.1016/j.teln.2022.08.003

Bhandari, P. (2022, December 02). Ethical Considerations in Research | Types &

Examples. Scribbr. Retrieved December 28, 2022, from
https://www.scribbr.com/methodology/research-ethics/

Blakeslee, J. (2020). Effects of high-fidelity simulation on the critical thinking skills of

baccalaureate nursing students: A causal-comparative research study. Nurse Education
Today 2020 (92),104494. https://doi.org/10.1016/j.nedt.2020.104494

Brown, D., & Chronister, C. (2009). The effect of simulation learning on critical thinking
and self-confidence when incorporated into an electrocardiogram nursing course. Clinical
Simulation in Nursing, 5(1), e45-e52.

Gaskin, L. (2022). Health simulation partnership with Philippines. The University of

Adelaide. https://www.adelaide.edu.au/newsroom/news/list/2022/09/27/health-
simulation-partnership-with-philippines

Gonzalez, H., Hsiao, E., Dees, D., Noviello, S., & Gerber, B. (2022). Promoting Critical
Thinking through an Evidence-Based Skills Fair Intervention. Journal of Research in
Innovative Teaching & Learning 2022 (15), 41-54.
https://www.emerald.com/insight/2397-7604.htm

Guerrero, J. G., Ali, S. A. A., & Attallah, D. M. (2022). The acquired critical thinking skills,
satisfaction, and self-confidence of nursing students and staff nurses through high-
fidelity simulation experience. Clinical Simulation in Nursing, 64, 24-30.
https://www.nursingsimulation.org/article/S1876-1399(21)00138-9/pdf
Hanshaw, S. & Dickerson, S. (2020). High fidelity simulation evaluation studies in nursing
education: A review of the literature. Nurse Education in Practice 2020 (46), 102818.
https://doi.org/10.1016/j.nepr.2020.102818

Hung, C., Kao, H., Liu, H., Liang, H., Chu, T., & Lee, B. (2021). Effects of simulation-
based learning on nursing students' perceived competence, self-efficacy, and learning
satisfaction: A repeat measurement method. Nurse Education Today 2021 (97),104725.
https://doi.org/10.1016/j.nedt.2020.104725

Kang, S. J., Hong, C. M., & Lee, H. (2020). The Impact of Virtual Simulation on Critical
Thinking and Self-Directed Learning Ability of Nursing Students. Clinical Simulation in
Nursing (2022) 49, 66-72. https://doi.org/10.1016/j.ecns.2020.05.008

Kavanagh, J. M., & Sharpnack, P. A. (2021). Crisis in competency: a defining moment in

nursing education. Online J Issues Nurs, 26 (1).
https://doi.org/10.3912/OJIN.Vol26No01Man02

Kim, E. (2018). Effect of simulation-based emergency cardiac arrest education on nursing

students' self-efficacy and critical thinking skills: Roleplay versus lecture. Nurse
Education Today (61), 258-263. https://doi.org/10.1016/j.nedt.2017.12.003

Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I. V., Iliadis, C.,
Fratzana, A., & Panagiotou, A. (2021). Simulation in Clinical Nursing Education. Acta
informatica medica : AIM : journal of the Society for Medical Informatics of Bosnia &
Herzegovina : casopis Drustva za medicinsku informatiku BiH, 29(1), 15–20.
https://doi.org/10.5455/aim.2021.29.15-20

La Cerra, C., Dante, A., Caponnetto, V., Franconi, I., Gaxhja, E., Petrucci, C., Alfes, C.
M., & Lancia, L. (2019). Effects of high-fidelity simulation based on life-threatening
clinical condition scenarios on learning outcomes of undergraduate and postgraduate
nursing students: a systematic review and meta-analysis. BMJ open, 9(2), e025306.
https://doi.org/10.1136/bmjopen-2018-025306

Macartney, M., Namasivayam, P., & Cooper, J. (2021). Student Nurse Perceptions of
Video Simulation and Critical Reflection for Developing ClinicalReasoning Skills: A Cross
Cohort Study. Student Success Journal, 12(1), https://doi.org/10.5204/ssj.1653

Meinke, H. (2021, July 5). Why Critical Thinking Skills in Nursing Matter (And What You
Can Do to Develop Them). Rasmussen University.
https://www.rasmussen.edu/degrees/nursing/blog/understanding-why-nurses-need-
critical-thinking-skills/

Morris, G. (2022, August 9). The Value of Critical Thinking in Nursing. Nurse Journal.
https://nursejournal.org/articles/the-value-of-critical-thinking-in-nursing/

O'Flaherty, J. & Costabile, M. (2020). Using a science simulation-based learning tool to

develop students' active learning, self-confidence and critical thinking in academic
writing. Nurse Education in Practice (47). https://doi.org/10.1016/j.nepr.2020.102839
Ohio University. (2021). Simulation in Nursing Education: How Nurse Educators Use
Technology. Online Master of Science In Nursing.
https://onlinemasters.ohio.edu/blog/simulation-in-nursing-education/

Rahman, M. (2019). 21st-century skill problem solving': Defining the concept. Asian
Journal of Interdisciplinary Research, 2(1), 64-74.
https://files.eric.ed.gov/fulltext/ED593994.pdf

Samaras, S., Adkins, C., & White, D. (2022). Developing critical thinking skills:
Simulations vs. cases. Journal of Education for Business, 97:4, 270-276, DOI:
10.1080/08832323.2021.1932703

Thorington, K., Lenzo, A., Lyons, J., & Viscido, S. (2022). Strategies for Developing
Critical Skills in First-Year Students. Journal on Excellence in College Teaching, 33
(2),131-157.
https://eric.ed.gov/?q=simulation+critical+thinking&ff1=dtySince_2019&id=EJ134375
9

Tong, L. K., Li, Y. Y., Au, M. L., Wang, S. C., & Ng, W. I. (2022). High-fidelity simulation
duration and learning outcomes among undergraduate nursing students: A systematic
review and meta-analysis. Nurse Education Today, 116, 105435.
https://doi.org/10.1016/j.nedt.2022.105435

Tseng, H. & Hill, L. (2020). The Impact of High-Fidelity Simulation on Nursing Students’
Flexible and Reflective Thinking in Higher Education. Higher Learning Research
Communications, 10(2), 52-65. DOI: 10.18870/hlrc.v10i2.1196

Waxman, K. T., Bowler, F., Forneris, S. G., Kardong-Edgren, S., & Rizzolo, M. A. (2019).
Simulation as a Nursing Education Disrupter. Nursing administration quarterly, 43(4),
300–305. https://doi.org/10.1097/NAQ.0000000000000369

Kurt, S. (2021). Constructivist Learning Theory. Educational Technology. Retrieved

from https://educationaltechnology.net/constructivist-learning-theory/
 APPENDIX

Research Instrument - Questionnaire

Dear Ma’am/Sir,

We, the researchers, would like to have a reliable and effective participation from

you on our study entitled “The Effects of Simulation on 2nd Year Nursing Students’

Critical Thinking Scores at Southwestern University PHINMA: A Quantitative Study”. The

researchers would keep the respondents answers anonymously and with confidentiality,

so kindly fill it up with full honesty. When all of the participants’ responses have been

processed, the aggregate findings will be made available. We are looking forward to your

authentic responses.

Thank you very much for participating in our research survey.

- The Researchers
PART I. DEMOGRAPHIC PROFILE

Age: _____

Gender:

 Female

 Male

 Prefer not to say

Year Level:

 2nd year

Simulation experience:

 Handwashing  Post Mortem Care

 Gloving  Leopold's Maneuver

 Vital signs  Perineal Care

 Oral Medication  Bathing an Infant

 Preparing Medication from a Vial  Applying a Dressing

 Intradermal  Assisting Delivery

 Intramuscular  Handling Delivery

 Changing IV Fluid  Immediate Newborn Care

PART II. STUDENT SATISFACTION AND SELF-CONFIDENCE IN LEARNING

A. Satisfaction with Current Learning

Strongly Agree Disagree Strongly

Agree Disagree

The teaching methods used in this

simulation were helpful and effective.

The simulation provided me with a variety

of learning materials and activities to

promote my learning the medical surgical

curriculum.

I enjoyed how my instructor taught the

simulation.

The teaching materials used in this

simulation were motivating and helped me

to learn.

The way my instructor(s) taught the

simulation was suitable to the way I learn.

 B. Self-confidence in Learning

Strongly Agree Disagree Strongly

agree disagree

I am confident that I am mastering the

content of the simulation activity that my

instructors presented to me.

I am confident that this simulation covered

critical content necessary for the mastery of

medical surgical curriculum.

I am confident that I am developing the

skills and obtaining the required knowledge

from this simulation to perform necessary

tasks in a clinical setting.

My instructors used helpful resources to

teach the simulation.

It is my responsibility as the student to

learn what I need to know from this

simulation activity.

I know how to get help when I do not

understand the concepts covered in the

simulation.
 I know how to use simulation activities to

learn critical aspects of these skills.

It is the instructor’s responsibility to tell me

what I need to learn of the simulation

activity content during class time.

PART III. CRITICAL THINKING (NCLEX-BASED)

Choose the letter of the BEST answer.

1. A nurse in a delivery room is assisting with the delivery of a newborn infant. After
the delivery, the nurse prepares to prevent heat loss in the newborn resulting from
evaporation by:

a. Warming the crib pad

b. Turning on the overhead radiant warmer
c. Closing the doors to the room
d. Drying the infant in a warm blanket

2. A nurse is assessing a newborn infant following circumcision and notes that the

circumcised area is red with a small amount of bloody drainage. Which of the following

nursing actions would be most appropriate?

a. Document the findings

b. Contact the physician

c. Circle the amount of bloody drainage and reassess in 30 minutes

d. Reinforce the dressing

3. A nurse in a newborn nursery is performing an assessment of a newborn infant. The

nurse is preparing to measure the head circumference of the infant. The nurse would

most appropriately:
a. Wrap the tape measure around the infant’s head and measure just above the

eyebrows.

b. Place the tape measure under the infant's head at the base of the skull and wrap

around to the front just above the eyes

c. Place the tape measure under the infant's head, wrap around the occiput, and

measure just above the eyes

d. Place the tape measure at the back of the infant’s head, wrap around across the

ears, and measure across the infant’s mouth.

4. A nurse prepares to administer a vitamin K injection to a newborn infant. The mother

asks the nurse why her newborn infant needs the injection. The best response by the

nurse would be:

a. “Your infant needs vitamin K to develop immunity”

b. “Vitamin K will protect your infant from having jaundice”

c. “Newborn infants are deficient in vitamin K, and this injection prevents your infant

from abnormal bleeding.”

d. “Newborn infants have sterile bowels, and vitamin K promotes the growth of

bacteria in the bowel.”

5. Vitamin K is prescribed for a neonate. A nurse prepares to administer the medication

in which muscle site?

a. Deltoid

b. Triceps

c. Vastus lateralis

d. Biceps
6. When performing a pelvic examination, the nurse observes a red swollen area on the

right side of the vaginal orifice. The nurse would document this as enlargement of which

of the following?

a. Clitoris

b. Bartholin’s gland

c. Parotid gland

d. Skene’s gland

7. The clinical instructor asks her students the rationale for handwashing. The students

are correct if they answered that handwashing is expected to remove:

a. Transient flora from the skin

b. Resident flora from the skin

c. All microorganisms from the skin

d. Media for bacterial growth

8. While taking an adult patient's pulse, a nurse finds the rate to be 140 beats/min. What

should the nurse do next?

a. Report the rate to the primary care provider

b. Record the information

c. Check the blood pressure

d. Check the pulse again in 2 hours

9. The client is to receive a sedative via the buccal route. Which of the following is true?

a. The medication is placed under the tongue.

b. This route is probably more expensive than the intramuscular route.

c. The nurse should offer the client a glass of orange juice after taking the sedative.

d. This method of administration would be avoided in the event of facial injuries.

10. The nurse has opened the sterile supplies and put on two sterile gloves to complete

a sterile dressing change, a procedure that requires surgical asepsis. The nurse must:

a. Keep splashes on the sterile field to a minimum

b. Cover the nose and mouth with gloved hands if a sneeze is imminent

c. Use forceps soaked in a disinfectant

d. Consider the outer 1 inch of the sterile field as contaminated

11. A nurse is preparing a sterile field using a packaged sterile drape for a confused

patient who is scheduled for a surgical procedure. When setting up the field, the patient

accidentally touches an instrument in the sterile field. What is the appropriate nursing

action in this situation?

a. Ask another nurse to hold the hand of the patient and continue setting up the

field.

b. Remove the instrument that was touched by the patient and continue setting up

the sterile field.

c. Discard the supplies and prepare a new sterile field with another person holding

the patient's hand.

d. No action is necessary since the patient has touched his or her own sterile field.

12. A nurse assesses an oral temperature for an adult patient. The patient's temperature

is 37.5°C (99.5°F). What term would the nurse use to report this temperature?

a. Febrile

b. Hypothermia

c. Hypertension

d. Afebrile

13. A nurse is assessing the vital signs of patients who presented at the emergency

department. Based on the knowledge of age-related variations in normal vital signs,

which patients would the nurse document as having a normal vital sign? Select all that

apply.

a. A 4-month old infant whose temperature is 38.1°C (100.5°F)

b. A 3-year old whose blood pressure is 118/80

c. A 9-year old whose temperature is 39°C (102.2°F)

d. An adolescent whose pulse rate is 70 bpm

e. An adult whose respiratory rate is 20 bpm

f. A 72-year old whose pulse rate is 42 bpm

14. A nurse is providing postmortem care. Which of the following nursing actions is a

legal responsibility?

a. Placing ID tags on the shroud and ankle

b. Washing the body to remove blood and excretions

c. Placing the body in normal anatomic position

d. Removing tubes and soiled dressings

15. A recently graduated nurse is caring for a client who was just given the diagnosis of

pancreatic cancer. The client asks the nurse to help her understand this death sentence

and tell her why God did this to her, as she has lived a good life all along. The nurse, not

being comfortable as a spiritual counselor, should do which of the following?

a. Tell the client that she will talk about this later

b. Tell the client she does not want to talk about this because she is not comfortable

doing so

c. Suggest to the client that she can call her spiritual advisor to help give her counsel

d. Change the subject to avoid focusing on the new diagnosis

16. In preparing two different medications from two vials, the nurse must:

a. Inject fluid from one vial into the other

b. Uncap the syringe and wipe the needle with an alcohol preparation before inserting

into either vial

c. Discard the medication from vial number two if medication from vial number one

is pushed into it

d. Insert air into the first vial, but not the second vial

17. The nurse is preparing 10 units of regular insulin and 5 units of NPH insulin. Which

of the following statements is the most accurate?

a. The NPH insulin is the shortest acting form of insulin.

b. Air is injected first into the regular insulin, then into the NPH.

c. The insulin vial should be discarded if there are any bubbles in it.

d. This medication order is given via the subcutaneous route.

18. In the later part of the 3rd trimester. the mother may experience shortness of

breath. This complaint maybe explained as:

a. A normal occurrence in pregnancy because the fetus is using more oxygen

b. The fundus of the uterus is high pushing the diaphragm upwards

c. The woman is having allergic reaction to the pregnancy and its hormones

d. The woman maybe experiencing complication of pregnancy

19. In Leopold’s maneuver step # 3 you palpated a hard round movable mass at the

supra pubic area. The correct interpretation is that the mass palpated is:

a. The buttocks because the presentation is breech

b. The mass palpated is the head

c. The mass is the fetal back

d. The mass palpated is the small fetal part

20. In Leopold’s maneuver step #1. you palpated a soft. broad mass that moves with

the rest of the mass. The correct interpretation of this finding is:
a. The mass palpated at the fundal part is the head part.

b. The presentation is breech

c. The mass palpated is the back

d. The mass palpated is the buttocks

21. What is the best way for the nurse to make sure that the right patient is receiving a

prescribed drug when the patient is alert and oriented?

a. Ask the patient to state his or her name

b. Check the patient’s wristband

c. Look at the patient's chart

d. Have the patient state his or her name and birth date

22. When is it acceptable for the nurse to take a verbal order from the prescriber before

giving a drug to a patient?

a. During the night shift when the prescriber is not at the hospital

b. In an emergency situation such as a cardiac arrest

c. When a patient is experiencing severe pain

d. At any time it is necessary

23. A health care provider prescribes 1,200 mL of 0.45% normal saline solution to be

infused at 125 mL/hour. The drop factor is 12 drops/mL. How many drops per minute

should the nurse adjust the flow rate to safely administer the prescribed intravenous

solution?

A. 25 drops per minute

b. 10 drops per minute

c. 15 drops per minute

d. 12 drops per minute

24. Ethel is an 80-year-old woman who was admitted for dehydration. The nurse reports

that she is not making 30 mL/hr of urine and the physician orders a bolus of 250ml to

be infused within 30 minutes. What is the correct drip rate for Ethel's infusion?

a. 400 ml/hr

b. 1000 ml/hr

c. 250 ml/hr

d. 500 ml/hr

25. The nurse is preparing to administer an intramuscular (IM) injection to a 4.8 pound

infant. The nurse should position the needle at which angle?

a. 15 degrees

b. 50 degrees

c. 90 degrees

d. 45 degrees

26. The new pediatric nurse has just given a suppository to a 5-year-old boy. He has a

bowel movement 7 minutes post administration. Which action should the nurse take

next?

a. Consult pharmacy

b. Examine the stool for the suppository

c. Give another full dose of the suppository

d. Inform the physician that the child has has a bowel movement

27. What are we trying to reduce or eliminate when we are doing handwashing?

a. Viruses

b. Bacteria

c. Fungi

d. All of the above

28. The most common normal position of the fetus in utero is:

a. Transverse position

b. Vertical position

c. Oblique position

d. None of the above

29. A newborn whose mother has diabetes is at risk for this complication following birth.

a. Macrosomia

b. Pneumothorax

c. Microcephaly

d. None of these

30. A full-term newborn was just born. Which nursing intervention is important for the

nurse to perform first?

a. Remove wet blankets

b. Assess Apgar

c. Insert eye prophylaxis

d. Elicit the Moro reflex