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This qualitative descriptive study investigated the experiences and professional outcomes of novice registered nurses participating in professional development nursing simulations integrating worked examples, a cognitive load instructional design principle. Drawing upon cognitive load theory and the worked examples principle, the study addressed two key research questions: (1) How do novice registered nurses perceive their experience in professional development nursing simulations with integrated worked examples? (2) What are the professional outcomes described by novice registered nurses in these simulations? Semi-structured interviews were conducted with eighteen novice registered nurses from a Midwest hospital setting, supplemented by a focus group involving four participants. Using Braun and Clarke's six-phase reflexive thematic analysis approach, six themes emerged: "Immersive Learning Experience," "Supportive Learning Environment," "Cognitive and Emotional Domains," "Professional Confidence and Growth," "Skill Acquisition and Application," and "Critical Thinking and Reflection." This study provides insights into how cognitive load theory can inform instructional design in nursing simulation, optimizing learning outcomes and supporting the professional development of novice nurses. The findings underscore the potential effectiveness of worked examples as an instructional strategy in nursing professional development simulations, with implications for nursing education and research in simulation-based learning. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Clinical Reasoning (CR) integrates thinking and decision-making in clinical practice (Huhn et al., 2019). CR is an established area of research in Doctor of Physical Therapy (DPT) education (Musolino & Jensen, 2019; Jensen & Mostrom, 2012) and has been acknowledged as a core competency of physical therapist residency education (APTA Residency Competency Work Group, 2020). Despite the established research, the assessment of CR has emerged as a topic of importance due to the need for standardized assessment of CR in DPT education that can lead to high-quality research and implementation of evidence-informed teaching and learning (Reilly et al. 2021; Furze et al., 2022; Christensen et al., 2017). Simulation-Based Learning (SBL) is an area of recent focus amongst DPT educators that has demonstrated the ability to improve student clinical decision-making, CR, and critical thinking in the health professions (Macauley et al., 2017). SBL is "a technique that creates a situation or environment to allow persons to experience a representation of a real event for the purpose of practice, learning, evaluation, testing, or to gain understanding of systems of human actions" (Lioce et al., 2020, p. 44). SBL promotes active learning and emotional engagement of the learner and has been integrated into DPT education (LeBlanc & Posner, 2022). Need for the Current Research Despite the recognized benefits of SBL, the effects of Simulation-Based Learning Experiences (SBLE) on DPT student CR have yet to be investigated. Additionally, limited tools are available to assess student CR in DPT education. One recently developed assessment tool is the Clinical Reasoning Assessment Tool (CRAT), which can be used to evaluate CR in both didactic and clinical settings. The CRAT assesses three domains of CR by rating a student's foundational knowledge, psychomotor skills, and conceptual reasoning on a 0 to 16 Likert scale (McDevitt et al., 2019). The CRAT is designed to track student CR assessment and development longitudinally over time (Furze et al., 2015; McDevitt et al., 2019), but the reliability psychometrics of the CRAT have not been established. This three-article dissertation investigated CR development in DPT students following a SBLE. The results of this dissertation will inform subsequent research. The combination of the three articles provides needed insight into the development of CR in DPT students following a SBLE in a DPT education program. The three articles include the following: 1. Assess the reliability of the CRAT. 2. Perform a systematic literature review on the effects of high-fidelity SBL on DPT student learning and performance. 3. Assess the effect of a high-fidelity SBLE on DPT student CR as measured by the CRAT. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Introduction: Empathy is an essential trait for nursing. Empathy as a construct consists of a cognitive and affective domain. The construct is associated with decreased clinician burnout, reduced stress, and improved patient-centered care. Nursing education has recognized the clinical benefits of empathy and has implemented various educational interventions to foster empathy in students. Although there is evidence that nursing students' empathy can be improved through training, little research has been completed to identify if students' baseline empathy level affects their benefit from training. There have also been few studies that attempt to discover what domain of empathy is developed from participation in educational interventions. This study aimed to understand how nursing students' baseline empathy level affected their experience with a simulation, how students expressed their empathic responses after participating in a simulation experience, and whether there was a relationship between empathy level and empathic experience. Methods: A mixed-methods study consisted of 82 undergraduate nursing students who participated in a simulation from the patient's viewpoint. The Jefferson Scale of Empathy-Health Professions Student (JSE-HPS) captured empathy quantitative data one week before and immediately following the simulation. A hierarchical cluster analysis (HCA) was performed on the pretest JSE-HPS data to identify baseline empathy levels. Qualitative data were gathered using open self-debriefing questions. A two-way ANOVA was performed between the empathy level and the change in the JSE-HPS score. A chi-squared test for independence assessed for associations between qualitative themes and level of empathy determined. Results: The HCA revealed two clusters representing a high empathy group (n=47) and a low empathy group (n=35). The low empathy group had significantly higher empathy (p < 0.001), while there was no change (p=0.149) in the high empathy group following the training. Qualitative analysis revealed four themes: appreciating the patient's perspective, self-other awareness, personal distress, and empathic concern. The chi-square revealed no relationship (p=0.193) between empathy level and their empathic response. Conclusion: Students identified as having low empathy at baseline significantly benefited from empathy training, while high empathy students did not have a change. Students demonstrated cognitive and affective empathetic responses to the simulation regardless of baseline level. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The use of Simulation-Based Learning (SBL) has increased in Nutrition and Dietetic (N&D) programs, although the research supporting its usability in N&D students is lacking. There are limited quality SBL instruments available that have been validated and tested for reliability in N&D students preparing for clinical practice. This three-article dissertation was to test the reliability of three SBL instruments for N&D students completing the Nutrition Care Process (NCP) during SBL activities. During the first phase of this study, two instruments were developed, and one instrument was modified from another SBL instrument that had been previously validated and used for nursing and medical students to align with N&D professional language, and focus on the specific skills necessary to perform a nutrition assessment and complete the NCP. The next phase of the study was aimed at testing the reliability of the instruments. Students participated in two simulation activities that included a prebrief, SBL learning activity, and a debrief. Students were asked to complete two surveys: the Nutrition Simulation Effectiveness Tool-Modified to determine the effectiveness of the SBL activity and the Nutrition Effective Learning Instrument (NEL) to gain perspective of how students perceive SBL influences their learning, preparedness, and confidence in readiness for clinical practice. The Nutrition Simulation Effectiveness Tool- Modified (NSET-M) showed some level of agreement that SBL was effective for N&D students completing prebriefing, learning, confidence, and debriefing while practicing the NCP. The Assessment, Diagnosis, Intervention, Monitoring and Evaluation Simulation Facilitator Instrument (ADIME-SFI) was developed for simulation facilitators observing N&D students completing the NCP. There was moderate agreement between the two facilitators rating the students simultaneously during SBL activities. The Nutrition Effective Learning Instrument (NEL) was used to gain perspective on how SBL contributed to students learning, preparedness, and confidence using the NCP in readiness for clinical practice. Reliability testing determined that the three instruments can be effectively used for N&D students participating in SBL activities. This study contributes to the limited research of SBL in N&D students and offers reliable SBL instruments that can be used for educational purposes; thus, allowing educators to consistently and effectively evaluate student learning and competency in N&D students completing the NCP. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Interprofessional practice has become a key component of health professions training programs in recent years as health care has shifted to a more team-based approach to patient care. Because of this, health professions training programs have been tasked with ensuring that students receive adequate training prior to graduation. In the field of speech-language pathology, limited research has shown the best practices in measuring the interprofessional practice skills of speech-language pathology graduate students. Such scant evidence warrants the need for further research on viable measurement tools for interprofessional practice skill development in speech-language pathology. This dissertation presents a three-phase project focusing on the interprofessional practice skills of speech-language pathology graduate students. Phase one consisted of a scoping review of current literature to determine what measurement tools are currently used to evaluate the interprofessional practice skills of speech-language pathology graduate students. Results of this scoping review showed thirty-five included articles identifying both published measurement tools and author created tools as current methods of evaluation. Phase two and three provides the results of two studies regarding observational and perceptual evaluations of interprofessional practice skills following two simulated interprofessional education events conducted with physical therapy, physician assistant studies, and speech-language pathology graduate students. Phase two utilized the "Interprofessional Collaborator Assessment Rubric (ICAR)" to evaluate student performance on interprofessional practice competencies as rated by trained faculty raters. Phase three provides data regarding student self-assessment of interprofessional practice skills using the "Interprofessional Collaborative Competencies Attainment Survey (ICCAS)" following the same simulated interprofessional education event. Results of all three phases are presented in this dissertation and connections are made to the relevance for speech-language pathology faculty members engaged in interprofessional education. Findings from this dissertation provide further evidence of the need for continued research in the measurement of the interprofessional practice skills of speech-language pathology graduate students. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The use of simulation holds promise for the future of dietetics education in its ability to replace up to 30% of the 1,000 required supervised practice hours for the training of future Registered Dietitian Nutritionists. Even more so, simulation is a teaching tool. When done well, such alternate learning experiences can challenge students in a safe environment where they can receive constructive feedback from expert guides and meaningfully reflect on their learning. This practice can thus potentially rocket the student to higher levels of performance when they do enter the real clinical settings. Yet, while much literature exists in other health professions on the use of simulation in health education curricula, very little information is available in the field of dietetics. This is a critical gap in the knowledge base of dietetics as maximizing the use of simulation can benefit the quality and training of dietetics students as well as provide relief to an already saturated market: student site placements and preceptors. The goal of this study was to explore the attitudes and motivations of dietetic internship directors on the use of simulation in their programs, targeting the heavily program-congested states of Pennsylvania, New Jersey, and New York. Participating directors were interviewed using a semi-structured interview format. Results suggested that while real-life experiential learning is considered the "'gold-standard'" by most, program directors would consider using more simulation in their programs if it could benefit their interns. As all directors voiced ACEND and NDEP as their major source of information on using simulation, more resources should be made available to dietetics educators on best-practices in using simulation. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

In this thesis, I use a combination of simulations and empirical data to demonstrate that a small set of structural and functional principles - the basic tenets of predictive coding theory - succinctly accounts for a very wide range of properties in the language processing system. Predictive coding approximates hierarchical Bayesian inference via a biologically plausible mechanism of competition whose unique properties (i) allow it to capture important asymmetries in bottom-up and top-down processing and (ii) offer a critical insight into the functional relationship between behavioral and neural measures of word processing. In addition to accounting for well-known properties of the language processing system, this mechanism of competition allows us to formulate and test a novel empirical prediction - that N400 attenuation can be observed in the presence of behavioral interference - which challenges a widely held assumption that N400 attenuation is essentially synonymous with facilitated processing. Importantly, the computational model that we used to simulate the above psycholinguistic phenomena was tightly constrained by predictive coding principles and the particular class of algorithm we employed (PC/BC-DIM; Spratling, De Meyer, & Kompass 2009), emphasizing how a fundamental, biologically plausible perceptual mechanism that is shared across the cortex can also give rise to psycholinguistic phenomena. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

All chemistry students must develop competency in analyzing and making sense of data. However, there are many difficulties that chemistry students may experience while analyzing data. Many students may not use relevant prior knowledge to aid in making sense of data, or they may not form conclusions using all the data provided. Additionally, prior knowledge seems to influence one's data analysis, but little is known about how students use it to make sense of data. Thus, I interviewed undergraduate students as they analyzed graphical data for a task and characterized how they used their prior knowledge throughout. My findings suggest that students' prior knowledge helped to form a frame for students. This frame is then used throughout students' sensemaking to help search for and identify relevant data and evaluate data against their frame to aid in decision-making. Because there are limited classroom interventions designed to help develop undergraduate students' data analysis competencies, I designed a study in which undergraduate students compared their data analyses to pre-constructed sample responses via a simulated peer review. My findings suggest that providing students with the opportunity to compare their analyses against other responses, practice giving feedback, and reflect on their work may provide opportunities to generate internal feedback on their performance. Depending on the nature of the internal feedback (i.e., if it is critical or not), students may revise to improve their work. Finally, as part of contributing new knowledge to their field, chemistry graduate students must learn how to best respond to data that is discrepant with their expectations. Yet, there is little research on how chemistry graduate students analyze data, and none that explores how they respond to unexpected data. For this reason, I interviewed chemistry graduate students as they analyzed multiple data sets to explain a chemical phenomenon, and I characterized how students responded to unexpected data using Data-Frame Theory. My findings indicate that students respond to discrepant data in several ways, and each response is capable of progressing students' sensemaking to achieve the goals of the analysis. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Situation awareness (SA) is linked with actionable decision-making and clinical judgment in nursing practice. The cognitive processes used in developing SA, outlined in Endsley's (1995) model, is the framework underpinning this study and are interwoven into the National Council of State Boards of Nursing Clinical Judgment Measurement Model (NCJMM). Cultivating these cognitive processes through prebriefing and simulation designed to intentionally develop SA, is a recommended practice currently seen in aviation and military training. There is a lack of vigorous research testing whether a specific intervention during clinical simulation can develop SA in nursing students. In addition, fostering SA in the preparation and prebriefing phase of simulation has not been studied. The purpose of this study was to test the effectiveness of an intentional, structured prebriefing intervention designed to foster SA and implemented prior to high-fidelity manikin simulation. A quasi-experimental study was conducted with a convenience sample of 132 traditional baccalaureate prelicensure nursing students from a large Midwestern private university. SA was measured utilizing an objective, subjective, and performance SA measure. Group differences between the intervention and control group and associations between SA measures and prebriefing experience were examined. The SA-focused preparation and prebriefing intervention group reported statistically significant difference in satisfaction compared to the control group. However, there were no significant differences in SA between the intervention and control group. Future research is needed to examine differences in a larger population that utilizes the SA-focused preparation and prebriefing for a longer duration. Since SA is inexorably linked with making good decisions informed by and resulting in clinical judgment in nursing practice, these results contribute to the further testing of SA interventions and implementation of preparation and prebriefing best practices to foster the cognitive processes needed in SA. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

The purpose of this mixed methods study was to determine how communication evaluation by clinical faculty compared in a clinical setting versus a simulation setting for Bachelor of Science in Nursing (BSN) students. Fifty (50) BSN students from three different schools of nursing were scored using the Interprofessional Situation, Background, Assessment, Recommendation Nurse to Physician Rubric in both clinical and simulation settings by seven nursing faculty. Scoring for each student occurred in both settings during one semester. Following the evaluation, students and faculty were asked to participate in a focus group to discuss their experience. Results from this study showed that scores from both settings were statistically the same, implying that a rubric used in a simulation setting could also be used in a clinical setting. Both the faculty and student focus groups found the rubric beneficial for improving student skill with hand-off report. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

Teachers are subject to multiple stressors in their profession and often experience significant distress, which has been found to be linked with harsh and punitive behaviors. These behaviors have been found to influence students negatively, particularly those with vulnerable temperaments. Prior research has also found such negative teacher behavior to be associated with hierarchical social structures in classrooms. While many researchers have attributed this hierarchical structure to teacher modeling--normalizing negative displays of behavior or treating favored students preferentially--student personality may also be a factor. Students high in neuroticism have been found to be particularly vulnerable to stress and often withdrawn. Students high in extraversion, however, have been found to be sociable and to experience positive emotions more frequently. Some evidence suggests these students may also be more likely to form transitive friendships, in which person A is friends with person B, person B is friends with person C, and person A is also friends with C, creating more cohesive networks of friends. It is possible that one reason hierarchical classroom social structures emerge in classrooms in which teachers display negative behaviors is that students higher in extraversion support each other and help maintain each other's positive emotions, while students higher in neuroticism are more likely to withdraw and experience more negative emotions. Students higher in extraversion may be more likely to occupy higher-status positions in the classroom social structure both because they have more frequent contact with one another, and because other students are more likely to hope to befriend those who are happier and have more friends. The current study will simulate fourth- and fifth-grade classrooms to investigate the relationship between teacher behavior, student personality, student emotions, and student social network structure. Results suggest that extraversion is associated with a greater likelihood of being embedded in transitive triads and greater popularity in the friendship social network. However, there is little evidence that neuroticism is associated with students' position in the student social network or that teacher behavior is related to the structure of student social networks. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]

This dissertation compares the performance of equivalence test (EQT) and null hypothesis test (NHT) procedures for identifying invariant and noninvariant factor loadings under a range of experimental manipulations. EQT is the statistically appropriate approach when the research goal is to find evidence of group similarity rather than group difference; despite this, the conventional approach to measurement invariance analysis relies upon NHT. EQT has proved effective for invariance detection using global model-data fit statistics in simulated and real-world data (Counsell et al., 2020) but its use in partial measurement invariance (PMI) analysis for evaluation of factor loading differences between groups has not been previously investigated. A Monte Carlo simulation is used to investigate test performance under experimental manipulations of power, model complexity, degree of noninvariance, and choice of EQT bound. Jung and Yoon (2017) use a similar approach to demonstrate that the direct comparison of factor loading differences across groups using NHT confidence intervals effectively detect population patterns of invariant and noninvariant loadings. I compare the performance of NHT to EQT using both conventional benchmarks of factor loading equivalence inferred from the work of Counsell and Cribbie (2015), Nye, Bradburn, Olenick, Bialko, and Drasgow (2019), and Shi et al. (2019) as well as EQT bounds selected post hoc to maximize recovery of the population pattern of invariance or partial invariance. I also investigate the likelihood of false invariance detections for truly noninvariant loadings and false noninvariance detections for truly invariant loadings over a range of EQT bounds, sample sizes, and magnitudes of noninvariance. The results of this simulation indicate that EQT can detect population patterns of invariance or partial invariance, but requires high power (i.e., large sample sizes and strong communalities) as well as optimal selection of the EQT bound. In experimental conditions where these requirements are met, EQT recovers the correct population pattern of invariant and noninvariant factor loadings in more simulation replicates than the NHT approach (Jung & Yoon, 2017). Inspection of individual loading detection rates reveals that false noninvariance errors occur most frequently when power is low, while false invariance errors are common whenever the true magnitude of noninvariance is small and the selected EQT bound is larger than the loading difference. In the EQT framing, false invariance errors in the presence of minor noninvariance might also be interpreted as accurate detections of practically equivalent loadings. These findings support the use of EQT for PMI analysis and reinforce previous findings that EQT is an effective but power-intensive procedure in the multivariate context (Alter & Counsell, 2023). The choice of EQT bound has implications for both the power of the test and the consequences of accepting loading differences falling within the selected EQT bound as invariant. Researchers using EQT to detect PMI should collect large samples in order to maximize the likelihood of detection, and should consider how much misspecification their selected EQT bounds might tolerate. Future development of PMI simulation tools could support the selection and justification of EQT bounds in applied settings. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com/en-US/products/dissertations/individuals.shtml.]