Relationship between Simulation Design Characteristics and Clinical Reasoning Competence: Multiple Additive Moderating Effects of Teaching Effectiveness and Students' Anxiety on Nursing Students

Purpose: The purpose of this study was to identify the moderating effect of teaching effectiveness and students ’ anxiety in the relationship between simulation design characteristics and clinical reasoning competence among nursing students. Methods: The participants were 123 nursing students who underwent simulation practice. Data were collected from September 1 to October 30, 2020 using self-report questionnaires. The collected data were analyzed using descriptive statistics, independent t-test, Pearson ’ s correlation coefficient, and SPSS PROCESS Macro program (to study the multiple additive moderation effect). Results: Significant positive correlations were observed between clinical reasoning competence and simulation design characteristics (r=.57, p < .001), clinical reasoning competence and teaching effectiveness (r=.49, p < .001), while negative correlations were observed between clinical reasoning competence and students ’ anxiety (r=-.33, p < .001). Teaching effectiveness and students ’ anxiety had a multiple additive moderating effect on the relationship between simulation design characteristics and clinical reasoning competence among the nursing students (F=15.10, p < .001). Conclusion: The relationship between simulation design characteristics and clinical reasoning competence differed depending on the students ’ anxiety. To improve the clinical reasoning competence of nursing students in simulation practice, developing interventions and techniques to manage students ’ anxiety levels are important.