Date of Award

December 2013

Degree Type


Degree Name

Doctor of Philosophy



First Advisor

Karen H. Morin

Committee Members

Barbara J. Daley, Rachel F. Schiffman, Julia A. Snethen, Suzie Kardong-Edgren


Epistemology, Nursing Students, Perspectives on Teaching, Q-Methodology, Simulation, Simulation Based Learning


Simulation based learning (SBL) is pedagogical method poised to innovate nursing educational approaches. Yet, despite a growing body of research into SBL, limited investigation exists regarding assumptions and beliefs that underpin SBL pedagogy. Even though key simulation design characteristics exist, the particular methods nurse educators use to operationalize simulation design characteristics and how these choices are viewed from the perspective of nursing students is unknown. Without understanding what motivates educators to design simulations as they do, it is difficult to interpret the evidence that exists to support chosen methods. Through the exploration of perspectives (points-of-view), underlying beliefs can be uncovered. Educators readily share their points-of-view on simulation design both formally (in literature) and informally (ordinary conversations). These conversations portray the subjectivity surrounding simulation design and become a vehicle for exploration. The purpose of this study was to describe and compare nurse educators' and nursing students' perspectives about operationalizing design characteristics within educational simulations. The National League for Nursing-Jeffries Simulation Framework guided this study by identifying the interaction of teacher, student, and educational practices on the five design characteristics (objectives, student support, problem solving, fidelity, and debriefing). It was from this interaction that perspectives were investigated. A Q-methodological approach was employed to investigate the subjectivity inherent in perspectives. Derived from 392 opinions on simulation design, a 60-statement Q-sample was rank-ordered into a quasi-normal distribution grid by 44 nurse educators and 45 nursing students recruited from two national organizations. Factor analysis and participants' explanations for statement placement contributed to factor interpretation. Factor analysis revealed nurse educators share a common, overriding Facilitate the Discovery perspective about operationalizing simulation design. Two secondary bipolar factors revealed that even though educators share a common perspective, there exist aspects of simulation design held in opposition regarding student role assignment and how far to let students struggle including when and if to stop a simulation. Factor analysis revealed nursing students hold five distinct and uniquely personal perspectives labeled Let Me Show You, Stand By Me, The Agony of Defeat, Let Me Think it Through, and I'm Engaging and So Should You. Second-order factor analysis revealed nurse educators share similar aspects of thinking with four of the five nursing students' perspectives. Results suggest ongoing and sustained educational development along with time for nurse educators to reflect on and clarify their perspective about simulation design is essential. Educators need to emotionally prepare and support nursing students prior to and during simulation activities. Further educational research is needed on how operationalizing simulation design characteristics differ based on a SBL activity with either a formative or a summative purpose.