Educational innovation experience: virtual simulation to develop clinical reasoning in postgraduate nursing students
Main Article Content
Keywords
Nursing, Clinical Reasoning, High Fidelity Simulation Training, Computer Simulation
Abstract
Introduction: Virtual simulation has established itself as a pedagogical strategy for developing clinical reasoning in highly complex contexts. To systematize an educational innovation experience for postgraduate nursing students, a series of virtual simulation activities based on intensive care unit scenarios was designed and implemented.
Development: The innovation initiative comprised four modules—M1 (Cardiovascular), M2 (Respiratory), M3 (Neurological), and M4 (Infectious)—and was implemented within an e-learning certificate program for intensive care nurses, incorporating virtual simulation activities and interactive audiovisual resources. A descriptive analysis compared academic performance on formative assessments between a cohort (T0) that participated in a traditional virtual clinical case analysis workshop and a cohort (T1) that engaged in virtual simulation activities. Differences in average academic performance were identified between the two cohorts, particularly in the Cardiovascular (M1) and Respiratory (M2) modules.
Conclusion: Systematizing this educational innovation confirms that virtual simulation is a relevant training strategy for developing advanced clinical reasoning in postgraduate nursing students; furthermore, it fosters active participation, clinical reflection, and professional autonomy in complex care environments.
References
Alfaro-LeFevre. Pensamiento Crítico, Razonamiento Clínico y Juicio Clínico En Enfermería. Un Enfoque Práctico. 7a edición. Elsevier
España; 2021. Disponible en: https://dialnet.unirioja.es/servlet/libro?codigo=699111.
Guzmán-Valdivia Gómez G, Rodríguez-Gutiérrez G, Guzmán-Valdivia-Talavera P, et al. Razonamiento clínico: aspectos prácticos que
permiten la facilitación de su desarrollo. Rev Med Inst Mex Seguro Soc. 2022;60(6):708-714. Disponible en: https://pmc.ncbi.nlm.nih.
gov/articles/PMC10395931/
Daniel M, Rencic J, Durning SJ, et al. Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. Academic Med
icine. 2019;94(6):902-912. doi: 10.1097/ACM.0000000000002618
Simmons B. Clinical reasoning: concept analysis. J Adv Nurs. 2010; 66(5):1151-1158. doi: 10.1111/j.1365-2648.2010.05262.x
Rencic J, Schuwirth LWT, Gruppen LD, et al. Clinical reasoning performance assessment: using situated cognition theory as a con
ceptual framework. Diagnosis. 2020;7(3):241-249. doi: 10.1515/dx-2019-0051
Guzmán-Valdivia Gómez G, Domínguez-González AD. Estrategia didáctica con estudios de casos para el desarrollo del razonamiento
clínico en estudiantes de Medicina. Estudio preliminar. Educación Médica. 2025;26(1):100975. doi: 10.1016/j.edumed.2024.100975
Ferreira Bacciarini J. Enseñanza de razonamiento clínico a residentes de Medicina Interna mediante un modelo de aprendizaje ba
sado en casos. Educación Médica. 2019;20:67-73. doi: 10.1016/j.edumed.2018.03.021
Kaya İG, Zengin N. The effect of scenario-based high-fidelity simulation on midwifery students’ knowledge and self-efficacy in elec
tronic fetal monitoring: A randomized controlled trial. Clin Simul Nurs. 2026;113:101923. doi: 10.1016/j.ecns.2026.101923
Luecha T, Kidsamrong W, Poonthawe P, et al. Satisfaction, confidence and self-rated clinical judgment in simulation-based learning:
A mixed methods study of Thai nursing students. Clin Simul Nurs. 2026;114:101941. doi: 10.1016/j.ecns.2026.101941
Guerrero JG, Hafiz AH, Eltohamy NAE, et al. Repeated Exposure to High-fidelity Simulation and Nursing Interns’ Clinical Performance:
Impact on Practice Readiness. Clin Simul Nurs. 2021;60:18-24. doi: 10.1016/j.ecns.2021.06.011
Alshehri FD, Jones S, Harrison D. The effectiveness of high-fidelity simulation on undergraduate nursing students’ clinical reason
ing-related skills: A systematic review. Nurse Educ Today. 2023; 121:105679. doi: 10.1016/j.nedt.2022.105679
Ayed A, Khalaf IA, Fashafsheh I, et al. Effect of High-Fidelity Simulation on Clinical Judgment Among Nursing Students. INQUIRY The Journal of Health Care Organization, Provision, and Financing. 2022;59:004695802210819. doi: 10.1177/00469580221081997
Klenke-Borgmann L, Cantrell MA, Mariani B. Clinical Judgment in Nursing Students After Observation of In-Class Simulations. Clin Simul Nurs. 2021;51:19-27. doi: 10.1016/j.ecns.2020.11.006
Pardue KT, Holt K, Dunbar DM, Baugh N. Exploring the Development of Nursing Clinical Judgment Among Students Using Virtual Reality Simulation. Nurse Educ. 2023;48(2):71-75. doi: 10.1097/NNE.0000000000001318
Dadaczynski K, Okan O, Messer M, et al. Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study. J Med Internet Res. 2021;23(1):e24097. doi: 10.2196/24097
Zumba-Zuniga MF, Rios-Zaruma J, Pardo-Cueva M, et al. Impact of information and communication technologies in Higher Education
Institutions in times of COVID-19 : A look from collaborative work and study modality. In: 2021 16th Iberian Conference on Information
Systems and Technologies (CISTI). IEEE; 2021:1-6. doi: 10.23919/CISTI52073.2021.9476642
Escandell-Rico FM, Pérez-Fernández L. Simulación de realidad virtual en la formación de los estudiantes de Enfermería: una revisión
sistemática. Educación Médica. 2024;25(1):100866. doi: 10.1016/j.edumed.2023.100866
McCoy CE, Sayegh J, Alrabah R, et al. Telesimulation: An Innovative Tool for Health Professions Education. AEM Educ Train. 2017;1 (2):132-136. doi: 10.1002/aet2.10015
Padilha JM, Machado PP, Ribeiro AL, et al. Clinical Virtual Simulation in Nursing Education. Clin Simul Nurs. 2018;15:13-18. doi: 10.1016/j.ecns.2017.09.005
Sim JJM, Rusli KD Bin, Seah B, et al. Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Metaanalysis. Clin Simul Nurs. 2022;69:26-39. doi: 10.1016/j.ecns. 2022.05.006
Pinto-Santuber C, Aburto-Godoy R. Simulación virtual con vSim® for Nursing: percepción y experiencia de estudiantes de enfermería en la Universidad del Bío-Bío, Chile. Revista de la Fundación Educación Médica. 2024;27(6):221. doi: 10.33588/fem.276.1219
Bastías-Vega N, Pérez-Villalobos C, Reyes-Aramburu EP, et al. Aportes de la simulación al desarrollo del razonamiento clínico en estudiantes de pregrado de medicina. Revista Latinoamericana de Simulación Clínica. 2020;2(1):19-25. doi: 10.35366/92935
Westermeier-Castillo G, Monrroy-Uarac M, Barría-Pailaquilén M. Simulación clínica como estrategia educativa para el desarrollo
del razonamiento clínico en estudiantes de kinesiología. Investigación en Educación Médica. 2024;13(50):122-130. doi: 10.22201/fm.20075057e.2024.50.23573
Kang J. Development and Evaluation of an Online Oncology Nursing Septic Shock Simulation Module for Nursing Students: A Mixed
Methods Experimental Design. Asian Oncology Nursing. 2025;25 (3):169. doi: 10.5388/aon.2025.25.3.169
Kow FF, Chong MC, Lai LL, et al. Developing Hospital Nurses’ Clinical Reasoning Abilities in Assessing and Managing Clinical Deterioration Using a Virtual Patient Simulation: A Quasi-Experimental Study. Clin Simul Nurs. 2024;87:101489. doi: 0.1016/j.ecns.2023.101489
Brown KM, Swoboda SM, Gilbert GE, et al. Integrating Virtual Simulation into Nursing Education: A Roadmap. Clin Simul Nurs. 2022; 72:21-29. doi: 10.1016/j.ecns.2021.08.002
Pastuña-Doicela R, Segovia-Hernándeza R, Alvarado-Alvarado A, et al. Simulación clínica virtual en enfermería en tiempos de pandemia: Percepción de estudiantes. Investigación en Educación Médica. 2023;12(48):52-63. doi: 10.22201/fm.20075057e.2023.48.23521
Cant R, Ryan C, Kelly MA. Use and Effectiveness of Virtual Simulations in Nursing Student Education. CIN: Computers, Informatics, Nursing. 2023;41(1):31-38. doi: 10.1097/CIN.0000000000000932
Kim JH, Kim SH, Park EY, et al. Development and Application of Case-based Video Education for Oncology Nursing based on Clinical
Reasoning. Asian Oncology Nursing. 2021;21(2):120. doi: 10.5388/aon.2021.21.2.120
Inangil D, Dincer B, Kabuk A. Effectiveness of the Use of Animation and Gamification in Online Distance Education During Pandemic.
CIN: Computers, Informatics, Nursing. 2022;40(5):335-340. doi: 10.1097/CIN.0000000000000902
Wang Q, Wen Y, Quek CL. Engaging learners in synchronous online learning. Educ Inf Technol (Dordr). 2023;28(4):4429-4452. doi:
10.1007/s10639-022-11393-x
Duff E, Miller L, Bruce J. Online Virtual Simulation and Diagnostic Reasoning: A Scoping Review. Clin Simul Nurs. 2016;12(9):377-384.
doi: 10.1016/j.ecns.2016.04.001
Shorey S, Ng ED. The use of virtual reality simulation among nursing students and registered nurses: A systematic review. Nurse Educ Today. 2021;98:104662. doi: 10.1016/j.nedt.2020.104662
Sales L, Ferreira M, Pereira R, et al. Early Development of Clinical Reasoning Through Virtual Patient Simulation: Nursing Students’ Perceptions of Collaborative Decision-Making. Nurs Rep. 2026;16 (5):152. doi: 10.3390/nursrep16050152
Aucay-Aucay RM, Cabrera-Berrezueta LB, Hermann-Acosta EA. Genially como herramienta interactiva para mejorar la motivación de los estudiantes. Revista Metropolitana de Ciencias Aplicadas. 2024; 7(S2):254-263. doi: 10.62452/r5e81z05
Riemer N, Eidner S, Hermanns J. Laboratory Courses for Pre-Service Chemistry Teachers Between Acquisition of Skills and Didactic Double Decker. Laboratories. 2025;2(2):10. doi:1 0.3390/laboratories 2020010
Heo M, Jang H. Factors Influencing Nursing Performance of Intensive Care Unit Nurses: Role of Clinical Reasoning Competence, Positive Psychological Capital, and Nursing Work Environment. Journal of Korean Critical Care Nursing. 2024;17(2):83-95. doi: 10.34250/jkccn.2024.17.2.83
España; 2021. Disponible en: https://dialnet.unirioja.es/servlet/libro?codigo=699111.
Guzmán-Valdivia Gómez G, Rodríguez-Gutiérrez G, Guzmán-Valdivia-Talavera P, et al. Razonamiento clínico: aspectos prácticos que
permiten la facilitación de su desarrollo. Rev Med Inst Mex Seguro Soc. 2022;60(6):708-714. Disponible en: https://pmc.ncbi.nlm.nih.
gov/articles/PMC10395931/
Daniel M, Rencic J, Durning SJ, et al. Clinical Reasoning Assessment Methods: A Scoping Review and Practical Guidance. Academic Med
icine. 2019;94(6):902-912. doi: 10.1097/ACM.0000000000002618
Simmons B. Clinical reasoning: concept analysis. J Adv Nurs. 2010; 66(5):1151-1158. doi: 10.1111/j.1365-2648.2010.05262.x
Rencic J, Schuwirth LWT, Gruppen LD, et al. Clinical reasoning performance assessment: using situated cognition theory as a con
ceptual framework. Diagnosis. 2020;7(3):241-249. doi: 10.1515/dx-2019-0051
Guzmán-Valdivia Gómez G, Domínguez-González AD. Estrategia didáctica con estudios de casos para el desarrollo del razonamiento
clínico en estudiantes de Medicina. Estudio preliminar. Educación Médica. 2025;26(1):100975. doi: 10.1016/j.edumed.2024.100975
Ferreira Bacciarini J. Enseñanza de razonamiento clínico a residentes de Medicina Interna mediante un modelo de aprendizaje ba
sado en casos. Educación Médica. 2019;20:67-73. doi: 10.1016/j.edumed.2018.03.021
Kaya İG, Zengin N. The effect of scenario-based high-fidelity simulation on midwifery students’ knowledge and self-efficacy in elec
tronic fetal monitoring: A randomized controlled trial. Clin Simul Nurs. 2026;113:101923. doi: 10.1016/j.ecns.2026.101923
Luecha T, Kidsamrong W, Poonthawe P, et al. Satisfaction, confidence and self-rated clinical judgment in simulation-based learning:
A mixed methods study of Thai nursing students. Clin Simul Nurs. 2026;114:101941. doi: 10.1016/j.ecns.2026.101941
Guerrero JG, Hafiz AH, Eltohamy NAE, et al. Repeated Exposure to High-fidelity Simulation and Nursing Interns’ Clinical Performance:
Impact on Practice Readiness. Clin Simul Nurs. 2021;60:18-24. doi: 10.1016/j.ecns.2021.06.011
Alshehri FD, Jones S, Harrison D. The effectiveness of high-fidelity simulation on undergraduate nursing students’ clinical reason
ing-related skills: A systematic review. Nurse Educ Today. 2023; 121:105679. doi: 10.1016/j.nedt.2022.105679
Ayed A, Khalaf IA, Fashafsheh I, et al. Effect of High-Fidelity Simulation on Clinical Judgment Among Nursing Students. INQUIRY The Journal of Health Care Organization, Provision, and Financing. 2022;59:004695802210819. doi: 10.1177/00469580221081997
Klenke-Borgmann L, Cantrell MA, Mariani B. Clinical Judgment in Nursing Students After Observation of In-Class Simulations. Clin Simul Nurs. 2021;51:19-27. doi: 10.1016/j.ecns.2020.11.006
Pardue KT, Holt K, Dunbar DM, Baugh N. Exploring the Development of Nursing Clinical Judgment Among Students Using Virtual Reality Simulation. Nurse Educ. 2023;48(2):71-75. doi: 10.1097/NNE.0000000000001318
Dadaczynski K, Okan O, Messer M, et al. Digital Health Literacy and Web-Based Information-Seeking Behaviors of University Students in Germany During the COVID-19 Pandemic: Cross-sectional Survey Study. J Med Internet Res. 2021;23(1):e24097. doi: 10.2196/24097
Zumba-Zuniga MF, Rios-Zaruma J, Pardo-Cueva M, et al. Impact of information and communication technologies in Higher Education
Institutions in times of COVID-19 : A look from collaborative work and study modality. In: 2021 16th Iberian Conference on Information
Systems and Technologies (CISTI). IEEE; 2021:1-6. doi: 10.23919/CISTI52073.2021.9476642
Escandell-Rico FM, Pérez-Fernández L. Simulación de realidad virtual en la formación de los estudiantes de Enfermería: una revisión
sistemática. Educación Médica. 2024;25(1):100866. doi: 10.1016/j.edumed.2023.100866
McCoy CE, Sayegh J, Alrabah R, et al. Telesimulation: An Innovative Tool for Health Professions Education. AEM Educ Train. 2017;1 (2):132-136. doi: 10.1002/aet2.10015
Padilha JM, Machado PP, Ribeiro AL, et al. Clinical Virtual Simulation in Nursing Education. Clin Simul Nurs. 2018;15:13-18. doi: 10.1016/j.ecns.2017.09.005
Sim JJM, Rusli KD Bin, Seah B, et al. Virtual Simulation to Enhance Clinical Reasoning in Nursing: A Systematic Review and Metaanalysis. Clin Simul Nurs. 2022;69:26-39. doi: 10.1016/j.ecns. 2022.05.006
Pinto-Santuber C, Aburto-Godoy R. Simulación virtual con vSim® for Nursing: percepción y experiencia de estudiantes de enfermería en la Universidad del Bío-Bío, Chile. Revista de la Fundación Educación Médica. 2024;27(6):221. doi: 10.33588/fem.276.1219
Bastías-Vega N, Pérez-Villalobos C, Reyes-Aramburu EP, et al. Aportes de la simulación al desarrollo del razonamiento clínico en estudiantes de pregrado de medicina. Revista Latinoamericana de Simulación Clínica. 2020;2(1):19-25. doi: 10.35366/92935
Westermeier-Castillo G, Monrroy-Uarac M, Barría-Pailaquilén M. Simulación clínica como estrategia educativa para el desarrollo
del razonamiento clínico en estudiantes de kinesiología. Investigación en Educación Médica. 2024;13(50):122-130. doi: 10.22201/fm.20075057e.2024.50.23573
Kang J. Development and Evaluation of an Online Oncology Nursing Septic Shock Simulation Module for Nursing Students: A Mixed
Methods Experimental Design. Asian Oncology Nursing. 2025;25 (3):169. doi: 10.5388/aon.2025.25.3.169
Kow FF, Chong MC, Lai LL, et al. Developing Hospital Nurses’ Clinical Reasoning Abilities in Assessing and Managing Clinical Deterioration Using a Virtual Patient Simulation: A Quasi-Experimental Study. Clin Simul Nurs. 2024;87:101489. doi: 0.1016/j.ecns.2023.101489
Brown KM, Swoboda SM, Gilbert GE, et al. Integrating Virtual Simulation into Nursing Education: A Roadmap. Clin Simul Nurs. 2022; 72:21-29. doi: 10.1016/j.ecns.2021.08.002
Pastuña-Doicela R, Segovia-Hernándeza R, Alvarado-Alvarado A, et al. Simulación clínica virtual en enfermería en tiempos de pandemia: Percepción de estudiantes. Investigación en Educación Médica. 2023;12(48):52-63. doi: 10.22201/fm.20075057e.2023.48.23521
Cant R, Ryan C, Kelly MA. Use and Effectiveness of Virtual Simulations in Nursing Student Education. CIN: Computers, Informatics, Nursing. 2023;41(1):31-38. doi: 10.1097/CIN.0000000000000932
Kim JH, Kim SH, Park EY, et al. Development and Application of Case-based Video Education for Oncology Nursing based on Clinical
Reasoning. Asian Oncology Nursing. 2021;21(2):120. doi: 10.5388/aon.2021.21.2.120
Inangil D, Dincer B, Kabuk A. Effectiveness of the Use of Animation and Gamification in Online Distance Education During Pandemic.
CIN: Computers, Informatics, Nursing. 2022;40(5):335-340. doi: 10.1097/CIN.0000000000000902
Wang Q, Wen Y, Quek CL. Engaging learners in synchronous online learning. Educ Inf Technol (Dordr). 2023;28(4):4429-4452. doi:
10.1007/s10639-022-11393-x
Duff E, Miller L, Bruce J. Online Virtual Simulation and Diagnostic Reasoning: A Scoping Review. Clin Simul Nurs. 2016;12(9):377-384.
doi: 10.1016/j.ecns.2016.04.001
Shorey S, Ng ED. The use of virtual reality simulation among nursing students and registered nurses: A systematic review. Nurse Educ Today. 2021;98:104662. doi: 10.1016/j.nedt.2020.104662
Sales L, Ferreira M, Pereira R, et al. Early Development of Clinical Reasoning Through Virtual Patient Simulation: Nursing Students’ Perceptions of Collaborative Decision-Making. Nurs Rep. 2026;16 (5):152. doi: 10.3390/nursrep16050152
Aucay-Aucay RM, Cabrera-Berrezueta LB, Hermann-Acosta EA. Genially como herramienta interactiva para mejorar la motivación de los estudiantes. Revista Metropolitana de Ciencias Aplicadas. 2024; 7(S2):254-263. doi: 10.62452/r5e81z05
Riemer N, Eidner S, Hermanns J. Laboratory Courses for Pre-Service Chemistry Teachers Between Acquisition of Skills and Didactic Double Decker. Laboratories. 2025;2(2):10. doi:1 0.3390/laboratories 2020010
Heo M, Jang H. Factors Influencing Nursing Performance of Intensive Care Unit Nurses: Role of Clinical Reasoning Competence, Positive Psychological Capital, and Nursing Work Environment. Journal of Korean Critical Care Nursing. 2024;17(2):83-95. doi: 10.34250/jkccn.2024.17.2.83
Article Sidebar
Published
October 22 2026
Section
Experiencia de la Práctica
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
How to Cite
1.
Jara-Jara V, Castro-Sandoval J, Carrasco-Aldunate P. Educational innovation experience: virtual simulation to develop clinical reasoning in postgraduate nursing students. Rev Enferm Inst Mex Seguro Soc [Internet]. 2026 Oct. 22 [cited 2026 Oct. 23];34(4):e1612. Available from: https://revistaenfermeria.imss.gob.mx/index.php/revista_enfermeria/article/view/1612