Effect of simulation training on the development of nurses and nursing students' critical thinking: A systematic literature review.

OBJECTIVE: To gain insight into the existing scientific evidence on the effect of simulation on critical thinking in nursing education.

DESIGN: A systematic literature review of original research publications.

DATA SOURCES: In this systematic review, the papers published in English and Farsi databases of PubMed, Science Direct, ProQuest, ERIC, Google Scholar and Ovid, MagIran and SID, from 1975 to 2015 were reviewed by two independent researchers.

REVIEW METHODS: Original research publications were eligible for review when they described simulation program directed on nursing student and nurses; used a control group or a pretest post-test design; and gave information about the effects of simulation on critical thinking. Two reviewers independently assessed the studies for inclusion. Methodological quality of the included studies was also independently assessed by the reviewers, using a checklist developed by Greenhalgh et al. and the checklist of Cochrane Center. Data related to the original publications were extracted by one reviewer and checked by a second reviewer. No statistical pooling of outcomes was performed, due to the large heterogeneity of outcomes.

RESULTS: After screening the titles and abstracts of 787 papers, 16 ones were included in the review according to the inclusion criteria. These used experimental or quasi-experimental designs. The studies used a variety of instruments and a wide range of simulation methods with differences in duration and numbers of exposures to simulation. Eight of the studies reported that simulation training positively affected the critical thinking skills. However, eight studies reported ineffectiveness of simulation on critical thinking.

CONCLUSION: Studies are conflicting about the effect of simulation on nurses and nursing students' critical thinking. Also, a large heterogeneity exists between the studies in terms of the instruments and the methods used. Thus, more studies with careful designs are needed to produce more credible evidence on the effectiveness of simulation on critical thinking.