Date of Award
Winter 12-11-2025
Degree Type
Dissertation
Degree Name
DNP Doctor of Nursing Practice
Department
Nursing
Advisor
Mary Ellen Roberts, DNP
Advisor
Moira E. Kendra, DNP
Keywords
high-fidelity simulation-based training, simulation training, septic shock, knowledge, confidence, pre- and post-tests, nursing, nursing education
Abstract
The purpose of this quality improvement (QI) Doctorate of Nursing (DNP) project was to create and evaluate the impact of high-fidelity simulation-based training (SBT) on graduate nursing students’ knowledge and confidence in diagnosing and treating septic shock. Outcomes were measured with pre- and post-simulation tests featuring competency questions and Likert-scale confidence ratings.
Accordingly, the two research questions guiding this project were: (1) How effective is high-fidelity simulation training in improving students’ knowledge and competence in managing septic shock? (2) How effective is high-fidelity simulation training in enhancing students’ confidence when caring for patients with septic shock?
Septic shock was selected as the project focus following a needs assessment by the QI manager. Acute care nursing faculty, who also practice as Advanced Practice Nurses (APN), unanimously reported that graduate students and new APNs often struggle to recognize and manage shock. Further review identified septic shock as a leading cause of death; approximately1.7 million U.S. adults develop sepsis each year, with at least 350,000 dying in the hospital or being discharged to hospice (Centers for Disease Control and Prevention, 2025). Given its high mortality and relevance across all acute care settings, septic shock was chosen as the primary focus.
Simulation-based training (SBT) continues to be a focus of nursing education. The landmark 2014 National Simulation Study by the National Council of State Boards of Nursing (NCSBN) found that high-quality simulation training can substitute up to 50% of traditional clinical hours in nursing curricula (Alexander et al., 2015, p. 39). Similarly, the American Association of Colleges of Nursing (AACN) advocated for competency-based education (CBE) in its 2021 and 2024 white papers, emphasizing the role of evolving learning technologies and approaches (American Association of Colleges of Nursing [AACN], 2021, p. 4). These innovative approaches in education may reduce costs, reduce dependance on clinical sites and faculty, and improve educational outcomes, patient care, and student confidence. SBT has also been shown to improve teamwork, enhance communication skills, and foster better clinical decision making (Elendu et al., 2024). Thus, this QI pilot project aimed to create and implement high-fidelity SBT for acute care graduate nursing students to enhance their knowledge, competency, and confidence in diagnosing and managing patients in septic shock.
Twenty-three acute care graduate nursing students participated in the created SBT. They were divided into six groups, each consisting of three to four students. All participants took part in the pre-briefing and debriefing sessions and completed both pre- and post-simulation tests which measured knowledge gain and confidence levels. Results revealed that the largest improvements post-simulation occurred in self-reported confidence levels in managing patients with sepsis and septic shock. These results were statistically significant (p ≤ 0.05) and showed a medium effect size (Cohen’s d ≥ 0.5). Hence, there was a moderate, meaningful improvement in confidence levels post-simulation. In regard to knowledge gain, there were no statistically significant differences seen between the pre and post test scores (p-values > 0.05). All Cohen’s d values were small (≤0.3) hence suggesting minimal changes in knowledge post-simulation. Although the simulation did not result in a measurable improvement in knowledge, it may have helped participants to retain or reinforce their previously acquired knowledge, or at the very least, apply it more effectively in a critical situation. This project did not test for knowledge retention or reinforcement. However, during the debrief, participants mentioned the “realistic, continuous, real-time” complexity of the simulation and “challenges in putting all the clinical pieces together so quickly” which they verbalized would make them “better providers” in the long run.
Recommended Citation
Mustafa, Shaden, "The Impact of High-Fidelity Simulation on Graduate Nursing Students’ Knowledge and Confidence in Septic Shock Management" (2025). Seton Hall University Dissertations and Theses (ETDs). 4418.
https://scholarship.shu.edu/dissertations/4418
