Testing a diabetes keotacidosis simulation in critical care nursing: A randomized control trial

Melba Sheila d'Souza, Leodoro Jabien Labrague, Subrahmanya Nairy Karkada, Kader Parahoo, Ramesh Venkatesaperumal

Research output: Contribution to journalArticle


Background: Integrating high fidelity simulation while teaching diabetes ketoacidosis would ensure a controlled therapeutic milieu for nursing students to practice.
Purpose: To evaluate the effectiveness of simulation teaching intervention for diabetes ketoacidosis in critical care nursing for undergraduate students’ in a public university.
Methods: A simple, two-arm (parallel) randomized controlled trial was conducted in a national public university.
A total of 164 nursing students were recruited and randomly assigned to two groups. The simulation group (N = 82) participated in the diabetes ketoacidosis high-fidelity simulation teaching intervention compared to the control group (N = 82) who were exposed to patient assignments on a clinical day on an acute medical unit.
The primary outcomes were assessed using the Student Satisfaction and Self Confidence in Learning, Simulation Design Scale, Educational Practice Questionnaire, Critical Thinking Skills Tool and California Critical Thinking Skill Test from 2015 to 2016.
Results: The students in the randomized control trial have had significantly higher scores on Student Satisfaction, and Self Confidence in Learning, Simulation Design, Educational Practice, Critical thinking skills and Critical Thinking Skill post-test mean scores. Younger age groups who had higher satisfaction had better self confidence
and a positive perception of the simulation design and education practice, which reflected better learning outcomes in the simulation group compared to the control group.
Conclusions: /Implication for future practice. This study supports the use of high-fidelity simulation scenarios as a teaching-learning strategy that is useful for students to assess, plan, intervene and evaluate in emergencies like diabetes ketoacidosis.
Original languageEnglish
Number of pages8
JournalClinical Epidemiology and Global Health
Early online date19 Mar 2020
Publication statusE-pub ahead of print - 19 Mar 2020


  • Critical thinking
  • Diabetes ketoacidosis
  • High-fidelity simulation
  • Nursing
  • Satisfaction
  • Self-confidence

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