Introduction: Today’s healthcare is complex and the need for quick decisions and care can be crucial for the patient’s well-being. For the students, it is essential to develop clinical competence during their nursing education. Aim: The aim of the study was to explore how an individual written academic reflection as an examination after high-fidelity simulation can support student nurses’ learning experiences of clinical competence when a developed questionnaire was used to stimulate in-depth reflection. Method: After the intervention of using an academic reflection as an examination after high-fidelity simulation during the fourth semester of the nursing programme, 107 individually written academic reflections were collected from students during 2017-18. A questionnaire with seven open-ended questions was developed to stimulate the reflection of students’ learning experiences of clinical competence. Based on Kolb’s experiential learning cycle, a deductive content analysis was used with focus on the students’ learning experiences. Results: The students expressed that the performed simulated scenario in connection with the individual written academic reflection made them aware of the strengths and weaknesses in their ability to clinical reasoning and patient safety. Furthermore, the importance of communications skills emerged. The students highlighted the use of the closed loop structure for communication in the team, and the necessity to involve the patient more in clinical situations. During the simulation scenarios, the students appreciated in having the opportunity to be an observer for developing knowledge concerning clinical competence. Conclusion: By implementing an examination that provides an opportunity for time for an in depth-reflection, creates effectively professional development. The academic reflection as an examination appears to be a good learning experience such as the clinical competence became visible for the students. Integrating reflective writing continuously during the nursing education can contribute progression of students’ skills to write an academic reflection. Copyright © 2020 by authors and Scientific Research Publishing Inc.

In nursing education, in semester four of six, in the course of 10 weeks clinical practice the final individual exam has developed. The aim was to deepen the clinical reasoning and make it more visible. The aim was also to give the student the possibility to reflect on the learning objectives, to identify additional knowledge needs and progression, which is a kind of learning recommended by higher education in Sweden. The academic reflection should have a clear purpose and show evidence of learning. Such a reflection requires that the student can use theory from the education to describe, explain and discuss critical events and their importance to future professional practice.

 Two classes with 75 nursing students participated in the study. One pair of students conducted a complex scenario in simulated environment during one hour including feedback. Another pair observed the scenario for identifying clinical reasoning, patient safety and team work. Then the pairs changed roles. Afterwards the students were instructed to make an academic reflection on their learning and progression based on seven open questions in a learning platform survey. Qualitative content analysis was used for data analysis.

Students expressed that the scenarios trained the ability to manage acute situations, team communication, plan and prioritize nursing actions and prepare for future profession.

The students felt that it was an excellent form of examination as the academic reflection forced the student to be aware of individual strengths and weaknesses and on the basis of this identify lack of knowledge.© 2018 OMICS International