Enhancing Nursing Students' Critical Thinking and Clinical Reasoning Abilities in Post-Operative Care by Scenario-Based Simulation: A Randomized Controlled Trial

Background Simulation-based education is essential in nursing education to build clinical competencies. However, in Bangladesh, teaching remains mostly traditional with limited simulation-based learning. This gap hinders the development of critical thinking (CT) and clinical reasoning (CR), significant for safe patient care. This study aims to evaluate the effectiveness of scenario-based simulation in improving CT and CR among nursing students in post-operative care in Bangladesh. Methods This prospective, open-label, parallel (1:1) randomized controlled trial was conducted from January to March 2025 with second-year nursing students in a nursing college. After lectures, participants were randomly allocated into an intervention group (IG) or a control group (CG) based on knowledge pre-test scores. The IG received scenario-based simulation training for one week, while CG received traditional skills training. Post-test evaluations measured knowledge, skills, CT, CR, and reflection using the researcher-developed questionnaires. Quantitative data were analyzed with descriptive statistics, independent t-tests, and the Mann–Whitney U test. Quantitative data was done by content analysis. Results Out of 64 students, 58 (IG = 29, CG = 29) completed the study, mostly females aged 18 to 23 with no prior clinical and post-operative practice experience. The primary outcome as the overall total score of CT, CR and skill was statistically significant between the groups (p < 0.001). The IG showed statistically significant improvements in knowledge, skills, CT and CR (all, p < 0.001). Reflections highlighted that IG students reported more confidence, engagement, and were willing to apply their skills and knowledge during clinical practice, while CG students noted knowledge gain but struggled with skills development. Conclusions Scenario-based simulation significantly enhanced CT and CR among nursing students. Future studies should explore its impact across specialties and in long-term practice. With sufficient resources and institutional support, it recommended a significant strategy for nursing education in resource-limited settings such as Bangladesh. Trial registration: ClinicalTrials.gov, NCT06751446, 2024-12-20