Thus, many things are dependent on how well the nurses know their skills. Coming back to the major reason why this problem is so important. The way the nurses perform controls and actually decides how well a person recovers. The skills learnt during nursing school and how they are applied will be embedded for the nurse's entire career. Lofmark, Smide and Wikblad (2006) stated that final year nursing students believe their strongest areas are being aware of the ethics, communicating with patients, self knowledge, cooperation and being focused. Sadly, it is not the knowledge that is going to save the patients and heal them. Lofmark et al. (2006) has stated that the students say they have the lowest confidence in how much practical experience they have. Clearly, these students lack critical thinking and self-confidence. When these same nurses are placed in actual situations, they bail out and mess up. When it is a matter of seconds or minutes, nurses, doctors or any medical staff doesn't have room for mistakes. They have to be fast, active and be able to multi-task within seconds. The nurse should be confident enough to carry out his duty and know that he is doing the right thing. In case, the doctors cannot be with them at all times, these fresh graduates should be able to make right decisions and be able to think apart from what is present in the textbooks. The cases that come in the ER aren't always going to be like the ones that are written in textbooks. This shows that the problem is quite significant. These skills need to be instilled one way or another for the benefit of the nurses and the entire medical community.

As stated before, nurses are an important member of the medical community. This study is present so that their teaching would have the best possible strategy and plan. Carrying out simulation is not something simple. It requires complex technology that is quite costly and sophisticated. The teachers and the school staff need to properly know how to incorporate this sort of learning in the curriculum. Thus, there needs to be ample evidence to prove that incorporating simulation will in fact enhance the self-confidence and critical thinking. Apart from the cost, just the entire change of curriculum should be positive otherwise it can be counterproductive. Students are already in a new leaning environment and have a lot of new knowledge being taught to them. With such a crucial career, there is no room for mistakes or wrong grooming. The teaching strategy and any new ideas incorporated need to be checked and confirmed beforehand.

Apart from cost and strategy, it should also see whether simulation will take the nursing students away from the basics of nurses. There is always the apprehension that what if they learn critical thinking and confidence but go on to lose their ethical skills. Ethics and the basics of nursing education are quite essential in the healing of the mind and spirit. Nurses are known for their ability to react in emergency situation but also for their compassion and their ability to connect spiritually with the patient. Therefore, it needs to be researched whether incorporating simulation will not imbalance other aspects of the nursing education.

As mentioned earlier, there are some who think that simulation learning can even make the nurses less competent. This again presents the need to test this question and figure out whether it is the right way to go or not. There could be other ways to enhance these two skills like teaching these students better and having more tasks or requiring them to do more electives. Seeing the different range of ideas out there, this plan needs to be looked into in more detail. This study will therefore see whether simulation does in fact affect the critical thinking and self-confidence of the nursing students.

Purpose of the study

The basic purpose of this study is to discover whether simulation makes an impact on the development of self-confidence and critical thinking in nursing students. Thus by incorporating simulation studies in one group, we will analyze if simulation does in fact affect the development of crucial interpersonal skills and attitudes in the nursing students. We are looking more for the development of critical thinking and self-confidence in these students. Thus, we hope to discover whether simulation studies will affect these skills or not.

Research Questions / Hypothesis

The major objective of the study is to find out whether simulation really works or not. Simulation can be of different sorts....

Here the primary reaction and the management are being tested. In other cases, simulation can mean giving the nurse a patient with the physical signs as well. Of course, if the patient is a simulated patient, he or she cannot present with tachycardia or tachypnea. Therefore, in this instance the patient would actually be an automated patient such as a robot or a mannequin who shows the vitals that an actual patient would. Thus one major question that this study poses is what sort of simulation would be used? Will simulation mean use of technology and mechanical devices or would patient present and act out certain scenarios? As mentioned before, simulated studies are of different kinds. As we look deeper whether simulation improves clinical skills, it should be studied what exactly would the simulation be comprised of.
In the previous days, learning consisted of the students practicing in wards for a certain time in a week. During their time in the wards, the students were guided by their teacher or by their preceptors. They did carry out the tasks a nurse is suppose to know however they were kept under direct supervision for the safety of the patient. Even though the students did attain hands on experience, this sort of learning did have its limitations. With the idea of having a preceptor over your head, the students did not attain the degree of independence that a nursing student should have. Another query that should be looked into is why these skills weren't developed? These questions can be incorporated in the interview and in the survey that would be given to the nursing students. Even though we are looking at better techniques for teaching, we should know what reasons caused the previous strategy to fail.

Regardless, we do know that self-confidence and critical thinking skills were not quite developed in the nursing students. When the nursing students practice with actual patients, they knew they could turn to their facilitator standing in the back. In other words, they were never placed in a situation where they have to think fast, act fast and make a decision about the patient. This therefore hinders the development of critical thinking in these students. This shows that for the development of critical thinking and self-confidence, simulation is quite necessary. Therefore, the discussion merely leads to two hypotheses.

Hypothesis 1: The use of simulation does improve the performance of the nursing students.

As discussed above, the presence of simulated patients and scenarios will lead to the students getting more hands on experience. They will be presented with different situations and will have to deal with them alone. This will therefore cause an increased amount of self-confidence and critical thinking in the nursing students. Therefore, the use of simulation will lead to improvement in the performance of the nursing students.

Hypothesis 2: The use of simulation does not improve the performance of the nursing students.

This is a different side of the story that reveals that simulation actually has a negative impact on the learning of the nursing student. As discussed above, simulation can cause the student to be in a mindset where he or she doesn't really realize the importance of the life of the patient. Many a times, the students are so trained to think and act as if it was simulation all along. These sorts of perceptions will go on to hinder their progress in practical life.

Definition of terms

Critical Thinking

Critical thinking is basically defined as the process of inquiring, analyzing, synthesis, interpretation, inference, deductive and inductive reasoning, intuition, application and creativity. In simpler terms it is the ability of nursing students to act in any situation. Surely, when a nurse is presented with a medical emergency, he or she would have to look at and analyze the situation from their own perspective. In other words, a nurse needs to be able to correctly figure out what the underlying issue is and quickly analyze the situation and figure out the management plan for the situation. The symptoms and the diagnostic results might not mimic the pathology that has been taught to the students. In these instances, the nurses need to be able to use their reasoning skills, their creativity and their intuition and therefore act in the proper way.

Self-Confidence:

Lundberg (2008)…