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All Journal Sriwijaya Journal of Internal Medicine Enigma in Education
Maria Rodriguez
Department of Biomedical Sciences, Bahon Institute, Bahon, Haiti
Humanities Biochemistry, Genetics & Molecular Biology Education Health Professions Immunology & microbiology Languange, Linguistic, Communication & Media Mathematics Medicine & Pharmacology Nursing Other

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Effectiveness of High-Fidelity Simulation on Creative Clinical Reasoning Among Nursing Students: A Quasi-Experimental Study Danniel Hilman Maulana; Karina Chandra; Maria Rodriguez
Enigma in Education Vol. 3 No. 2 (2025): Enigma in Education
Publisher : Enigma Institute

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.61996/edu.v3i2.118

Abstract

High-fidelity simulation has become a key pedagogical strategy in nursing education, yet its specific effect on creative clinical reasoning remains underexplored, particularly in Southeast Asian higher-education contexts. The aim of this study was to evaluate the effectiveness of high-fidelity simulation on creative clinical reasoning, clinical judgment, and self-efficacy among nursing students. This quasi-experimental pre-test/post-test control group study, conducted at a private university in Palembang, Indonesia, evaluated its effectiveness among ninety final-year nursing students allocated to a simulation group (n=46) receiving four structured high-fidelity simulation sessions over eight weeks or a control group (n=44) receiving conventional case-based learning. Outcomes were measured using the Health Sciences Reasoning Test, a Creative Clinical Problem-Solving Scale, the Lasater Clinical Judgment Rubric, and the General Self-Efficacy Scale, with all scores standardized to a 0–100 metric, and analyzed using paired t-tests, independent t-tests, and ANCOVA with pre-test covariates. The simulation group demonstrated significantly greater improvements than controls in clinical reasoning (mean difference 16.2, 95% CI 13.8–18.6, p<0.001, Cohen’s d=1.98), creative problem-solving (15.5, p<0.001, d=2.10), self-efficacy (14.5, p<0.001, d=1.73), and clinical judgment (16.3, p<0.001, d=2.12); ANCOVA confirmed significant group effects (partial η²=0.322–0.375), and a positive dose-response correlation was observed (r=0.72, p<0.001). High-fidelity simulation was highly effective in enhancing creative clinical reasoning and related competencies, with large effect sizes supporting its systematic integration into nursing education curricula.
The Impact of Uncontrolled Type 2 Diabetes Mellitus on Chronic Rhinosinusitis Severity and Treatment Outcomes: A Prospective Cohort Study in Bandung, Indonesia Zainal Abidin Hasan; Aisyah Andina Rasyid; Hasrita Soleiman; Alexander Mulya; Pham Uyen; Maria Rodriguez
Sriwijaya Journal of Internal Medicine Vol. 3 No. 1 (2025): Sriwijaya Journal of Internal Medicine
Publisher : Phlox Institute: Indonesian Medical Research Organization

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.59345/sjim.v2i2.176

Abstract

Introduction: Chronic rhinosinusitis (CRS) is a prevalent inflammatory condition, and type 2 diabetes mellitus (T2DM) is a known comorbidity that can exacerbate inflammatory processes. This study aimed to investigate the impact of uncontrolled T2DM on CRS severity and treatment outcomes in a cohort of patients in Bandung, Indonesia. Methods: A prospective cohort study was conducted at a private hospital in Bandung, Indonesia, from January 2020 to December 2022. Adult patients diagnosed with CRS (with or without nasal polyps) were enrolled and categorized into two groups: controlled T2DM (HbA1c ≤ 7%) and uncontrolled T2DM (HbA1c > 7%). CRS severity was assessed using the Sino-Nasal Outcome Test-22 (SNOT-22) and Lund-Mackay CT scoring. Treatment outcomes were evaluated at 3, 6, and 12 months post-initial treatment (medical and/or surgical) based on SNOT-22 scores, endoscopic findings, and the need for revision surgery. Results: A total of 240 patients were included (120 with controlled T2DM, 120 with uncontrolled T2DM). At baseline, the uncontrolled T2DM group had significantly higher mean SNOT-22 scores (58.5 ± 12.3 vs. 45.2 ± 10.1, p < 0.001) and Lund-Mackay CT scores (11.8 ± 3.5 vs. 8.2 ± 2.8, p < 0.001) compared to the controlled T2DM group. At 12 months, the uncontrolled T2DM group showed significantly less improvement in SNOT-22 scores (mean change: -15.4 ± 8.7 vs. -28.3 ± 9.2, p < 0.001) and a higher rate of revision surgery (18.3% vs. 5.8%, p = 0.002). Multivariate analysis revealed that uncontrolled T2DM (HbA1c > 7%) was an independent predictor of poorer treatment outcomes (OR: 3.45, 95% CI: 1.98-6.01, p < 0.001). Conclusion: Uncontrolled T2DM is associated with increased CRS severity and significantly poorer treatment outcomes in patients in Bandung, Indonesia. Effective glycemic control should be a crucial component of CRS management in patients with T2DM.
Co-Authors Aisyah Andina Rasyid Alexander Mulya Danniel Hilman Maulana Hasrita Soleiman Karina Chandra Pham Uyen Zainal Abidin Hasan