Factors influencing critical thinking in simulation-based maternal-child nursing education among undergraduate nursing students: a mixed methods study

Abstract

Background: Critical thinking constitutes a multifaceted and dynamic process to make appropriate decisions and solve problems. In simulation-based learning, critical thinking can be influenced by personal factors, facilitators, and design. Objective: This study was conducted to investigate the experiences and factors associated with critical thinking in simulation-based maternal-child nursing education. Methods: This study utilized an explanatory sequential mixed-methods approach. In the quantitative phase, convenience sampling was employed to select 400 undergraduate nursing students who met the following inclusion criteria: no history of repeating the maternal-child nursing and midwifery practicum course and class attendance of at least 80% of the total instructional hours. Following the completion of quantitative data collection, purposive sampling was used to recruit 80 students who had participated in and completed the initial survey to participate in focus group discussions. Results: Half of the nursing students had moderate scores of critical thinking on maternal-child nursing simulation. The regression analysis revealed that perception of professional identity, a personal factor, was statistically significantly associated with a high level of critical thinking (Beta = 0.207, t = 4.607, p = 0.000). Additionally, the attitude toward simulation (Beta = 0.139, t = 2.731, p = 0.007) and perceived stress (Beta = -0.103, t = -2.269, p = 0.024) were statistically significantly associated with critical thinking level. In the simulation design, the support aspect toward simulation design (Beta = 0.265, t = 2.943, p = 0.003) and the problem-solving aspect toward simulation importance (Beta = 0.239, t = 2.288, p = 0.023) were statistically significantly associated with a high level of critical thinking. The multiple linear regression model accounted for 35% of the variance in critical thinking with maternal-child nursing simulated learning. Qualitative data revealed the following themes: (1) a well-planned approach enables me to optimize my learning; (2) allow me to make mistakes, but please don’t leave me with failure; and (3) emulating practice shapes my growth as a nursing professional. Conclusions: The personal factor and simulation design factors were important for increasing critical thinking level. Promoting effective learning strategies, such as the use of simulated experiences, is useful in enhancing midwifery and nursing students’ competencies.