Cognitive load experienced by nurses in simulation-based learning experiences: An integrative review

Background: Simulation based learning experiences help nurses gain skills necessary for independent practice. However, increased cognitive load placed on learners in simulation may affect learning outcomes. Objectives: The purpose of this integrative review was to synthesize what is known about nurses? cognitive load in simulation and summarize measurement approaches. Data sources: A search of CINAHL, Medline, ProQuest Nursing and Allied Health, and ERIC databases was limited to peer-reviewed studies published after 2006 in the English language, using the key words nurse, simulation, and cognitive load. Review Methods: Whittemore and Knafl?s (2005) integrative review method was used. Studies investigating advanced practice nurses or interprofessional teams were excluded. Results: Database and reference lists searches identified a total of 3077 records, and 20 met inclusion criteria. Simulation fidelity, time pressure, dual-tasking, interruptions, task complexity, distractions, and mismatched simulation objectives to learner ability increase nurses? cognitive load. However, past experience, pre-briefing, repeated scenarios, and worked-out modeling optimize cognitive load. Subjective and objective cognitive load measures help researchers understand cognitive load and define its relationship with other variables. Conclusions: Simulation impacts nurses? cognitive load. Varying simulation designs to optimize cognitive load will improve learning outcomes. Future nursing simulation research should utilize well-validated cognitive load measures and measure cognitive load alongside other variables to further understand how cognitive load affects simulation outcomes.