Review Article| Volume 16, P48-61, March 2018

Simulation as a Tool for Clinical Remediation: An Integrative Review

Published:December 22, 2017DOI:


      Development of clinical competency is a critical component of undergraduate nursing education. However, often when students struggle in the clinical setting with skills such as critical thinking and clinical reasoning, evidence-based resources for remediation are lacking. Because simulation is a well-established nursing pedagogy, could it be a valuable tool in clinical remediation for such students? The aim of this integrative review of literature was to examine what was currently known about clinical remediation using simulation and how simulation contributes to clinical competency. A literature search of three data bases was conducted to identify pertinent research using keywords such as simulation, remediation, nursing, education, clinical reasoning, clinical safety, and clinical competence. A total of 1,645 total articles were retrieved from databases, and 76 were retrieved from additional sources. Ultimately, 24 articles met the inclusion criteria and three main themes emerged which were the use of simulation as a nursing pedagogy, simulation use in clinical remediation, and effectiveness of simulation for development of critical thinking and clinical reasoning skills. The current evidence supports simulation as an effective pedagogy for development of clinical competency skills, such as critical thinking and clinical reasoning, but there is a significant deficit of literature on the use of simulation as a tool for clinical remediation of undergraduate nursing students.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Clinical Simulation In Nursing
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Alexander M.
        • Kardong-Edgren S.
        • Morvant B.
        • Hayden J.
        • Smiley R.
        • Jeffries P.
        The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education.
        Journal of Nursing Regulation. 2014; 5: s4-s41
        • Aromataris E.
        • Fernandez R.
        • Godfrey C.
        • Holly C.
        • Kahlil H.
        • Tungpunkom P.
        Summarizing systematic reviews: Methodological development, conduct and reporting of an umbrella review approach.
        International Journal of Evidence Based Healthcare. 2015; 13: 132-140
        • Banning M.
        Clinical reasoning and its application to nursing: Concepts and research studies.
        Nurse Education in Practice. 2008; 8: 177-183
        • Bensfield L.A.
        • Olech M.J.
        • Horsley T.L.
        Simulation for high-stakes evaluation in nursing.
        Nurse Educator. 2012; 37: 71-74
        • Berragan L.
        Simulation: An effective pedagogical approach for nursing?.
        Nurse Education Today. 2011; 31: 660-663
        • Birkhoff S.D.
        • Donner C.
        Enhancing pediatric clinical competency with high-fidelity simulation.
        Journal of Continuing Education in Nursing. 2010; 41: 418-423
        • Blum C.A.
        • Borglund S.
        • Parcells D.
        High-fidelity nursing simulation: Impact on student self-confidence and clinical competence.
        International Journal of Nursing Education Scholarship. 2010; 7 (Article 18)
        • Brown Y.
        • Neudorf K.
        • Poitras C.
        • Rodger K.
        Unsafe student clinical performance calls for a systematic approach.
        Canadian Nurse. 2007; 103: 29-33
        • Chunta K.
        Ensuring safety in clinical: Faculty role for managing students with unsafe behaviors.
        Teaching and Learning in Nursing. 2016; 11: 86-91
        • DeBourgh G.A.
        • Prion S.K.
        Using simulation to teach prelicensure nursing students to minimize patient risk and harm.
        Clinical Simulation in Nursing. 2011; 7: e47-e56
        • Decker S.
        • Sportsman S.
        • Puetz L.
        • Billings L.
        The evolution of simulation and its contribution to competency.
        The Journal of Continuing Education in Nursing. 2008; 39: 74-80
        • Evans C.J.
        • Harder N.
        A formative approach to student remediation.
        Nurse Educator. 2013; 38: 147-151
        • Fisher D.
        • King L.
        An integrative literature review on preparing nursing students through simulation to recognize and respond to the deteriorating patient.
        Journal of Advanced Nursing. 2013; 69: 2375-2388
        • Gaba D.M.
        The future vision of simulation in healthcare.
        Simulation in Healthcare: Journal of the Society for Simulation in Healthcare. 2007; 2: 126-135
        • Gaberson K.B.
        • Oermann M.H.
        Clinical evaluation and grading practices in schools of nursing.
        Clinical Teaching Strategies in Nursing. 2010; 30: 371-414
        • Gallant M.
        • MacDonald J.A.
        • Smith-Higuchi K.A.
        A remediation process for nursing students at risk for clinical failure.
        Nurse Educator. 2006; 31: 223-227
        • Haskvitz L.M.
        • Koop E.C.
        Students struggling in clinical? A new role for the patient simulator.
        Educational Innovations. 2004; 43: 181-184
        • Hutton J.A.
        • Krull-Sutherland R.E.
        Clinical remediation in a nursing program.
        Teaching and Learning in Nursing. 2007; 2: 68-71
        • Kavanagh J.
        • Szweda C.
        A crisis in competency: The strategies and ethical imperative to assessing new graduate nurses' clinical reasoning.
        Nursing Education Perspectives. 2017; 38: 57-61
        • Killam L.A.
        • Luhanga F.
        • Bakker D.
        Characteristics of unsafe undergraduate nursing students in clinical practice: An integrative literature review.
        The Journal of Nursing Education. 2011; 50: 437-446
        • Koharchik L.
        • Weideman Y.L.
        • Walters C.A.
        • Hardy E.
        Evaluating nursing students' clinical performance.
        American Journal of Nursing. 2015; 115: 64-67
        • Lapkin S.
        • Levett-Jones T.
        • Bellchambers H.
        • Fernandez R.
        Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: A systematic review.
        Clinical Simulation in Nursing. 2010; 6: e207-e222
        • Lasater K.
        High-fidelity simulation and the development of clinical judgment: Students’ experiences.
        Journal of Nursing Education. 2007; 46: 269-276
        • Leach J.
        Using simulation to expose shortcomings in clinical learning outcomes.
        Nursing Education Perspectives. 2014; 34: 56-57
        • Lewallen L.P.
        • DeBrew J.K.
        Successful and unsuccessful clinical nursing students.
        Journal of Nursing Education. 2012; 51: 389-395
        • Lewis R.
        • Strachan A.
        • Smith M.M.
        Is high fidelity simulation the most effective method for the development of non-technical skills in nursing? A review of the current evidence.
        The Open Nursing Journal. 2012; 6: 82-89
        • Lockwood C.
        • Munn Z.
        • Porritt K.
        Qualitative research synthesis: Methodological guidance for systematic reviewers utilizing meta-aggregation.
        International Journal of Evidence Based Healthcare. 2015; 13: 179-187
        • Lynn M.C.
        • Twigg R.D.
        A new approach to clinical remediation.
        The Journal of Nursing Education. 2011; 50: 172-175
        • McArthur A.
        • Klugarova J.
        • Yan H.
        • Florescu S.
        Innovations in the systematic review of text and opinion.
        International Journal of Evidence Based Healthcare. 2015; 13: 188-195
        • McCaughey C.S.
        • Traynor M.K.
        The role of simulation in nurse education.
        Nurse Education Today. 2010; 30: 827-832
        • Mok H.T.
        • So C.F.
        • Chung J.W.Y.
        Effectiveness of high-fidelity patient simulation in teaching clinical reasoning skills.
        Clinical Simulation in Nursing. 2016; 12: 453-467
        • National Council of State Boards of Nursing
        Test plan for the national council licensure examination for registered nurses.
        2015 (Chicago, IL)
        • Oermann M.
        • Kardong-Edgren S.
        • Rizzolo M.A.
        Towards an evidenced-based methodology for high-stakes evaluation of nursing students' clinical performance using simulation.
        Teaching and Learning in Nursing. 2016; 11: 133-137
        • Phillips A.C.
        • Lewis L.K.
        • McEvoy M.P.
        • Gallipeau J.
        • Glasziou P.
        • Moher D.
        • Williams M.T.
        • et al.
        Protocol for development of the guideline for reporting evidenced-based practice educational interventions and teaching (GREET) statement.
        BMC Medical Education. 2013;
        • Rhodes M.L.
        • Curran C.
        Use of the human patient simulator to teach clinical judgment skills in a baccalaureate nursing program.
        Computers, Informatics, Nursing. 2005; 23: 262
        • Shearer J.E.
        High-fidelity simulation and safety: An integrative review.
        Journal of Nursing Education. 2013; 52: 39-51
        • Sullivan-Mann J.
        • Perron C.A.
        • Fellner A.N.
        The effects of simulation on nursing students' critical thinking scores: A quantitative study.
        Newborn and Infant Nursing Reviews. 2009; 9: 111-116
        • Tanicala M.
        • Scheffer K.
        • Roberts M.
        Defining pass/fail nursing student clinical behaviors phase 1: Moving toward a culture of safety.
        Nursing Education Perspectives. 2010; 32: 155-161
        • The Joanna Briggs Institute
        Joanna Briggs Institute Reviewers' Manual.
        2016 (edition. Australia)
        • Weaver A.
        High-fidelity patient simulation in nursing education: An integrative review.
        Nursing Education Perspectives. 2011; 32: 37-40
        • Wolfgram L.J.B.
        • Quinn A.O.L.
        Integrating simulation innovatively: Evidence in teaching in nursing education.
        Clinical Simulation in Nursing. 2012; 8: e169-e175