Enhancing competency and cue recognition through branching pathway simulation in prelicensure senior-level nursing students

Background: Final-semester undergraduate nursing students often face challenges demonstrating clinical judgment, particularly when prioritizing care in high-acuity, time-sensitive situations. Branching pathway simulation (BPS) immerses students in unfolding scenarios requiring sequential decision-making, real-time feedback, and reflection, making it well suited to address students’ learning needs. Method: This quality improvement project used a quasi-experimental design with nonrandomized group assignment and post-intervention comparison between two student groups: one with branching pathway simulation and the other with a traditional linear simulation. Outcomes included time to sepsis recognition, Creighton Competency Evaluation Instrument 2.0 (CCEI 2.0) scores, and Simulation Effectiveness Tool–Modified (SET-M) ratings. Results: Students in the branching pathway group demonstrated faster sepsis recognition (8.46 vs. 19.83 minutes; p = .011; g = 1.47) and higher competency scores (96.36% vs. 79.55%; p = .001; g = 2.13). SET-M scores were high overall (2.70-3.00), with strongest ratings in debriefing and clinical judgment. Conclusion: Branching pathway simulation enhances cue recognition, clinical judgment, and perceived simulation effectiveness among final-semester undergraduate nursing students.

Duke Scholars

Author Marilyn Haag Oermann School of Nursing