Award Date

May 2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Reimund Serafica

Second Committee Member

Catherine Dingley

Third Committee Member

Karyn Holt

Fourth Committee Member

Joseph Morgan

Number of Pages



Introduction The adoption of simulation technologies in schools of nursing has increased significantly over the last 5 years. Results regarding the use of simulation technology have been positive. The use of simulation technologies has been developed to include complex nursing situations that resemble real clinical settings. Research has demonstrated that memory recall is better in an environment that is the same or similar to the environment in which the learning took place (Krokos et al., 2018). For this reason, educators have used simulation technologies to create realistic environments where students can learn. However, learning outcomes in simulations are affected by a multidimensional range of factors other than technology, such as cognitive load and anxiety (Josephsen, 2018; Yockey & Henry, 2019). Research has demonstrated that mastery of learning outcomes depends on whether extraneous and intrinsic cognitive load (CL) is maintained at a level at which students experience learning and knowledge transfer (Sweller et al., 2019). Research has also demonstrated that anxiety affects learning (Shearer, 2016). However, little research has investigated how simulation technology as an educational design element affects learning outcomes, CL, and anxiety in nursing students.Methods This quasi-experimental three-group comparison design, based on cognitive load theory examined the effects of technological complexity in simulation on learning outcomes in prelicensure nursing students performing cardiac assessment in a simulated environment. The NLN Jeffries simulation theory was used to construct the intervention and formulate discussion. Students were recruited from two schools of nursing in northern Colorado from a Bachelor of Nursing program, an associate of nursing program, and a second degree Bachelor of Nursing program (N=88). Students were randomly assigned to one of three groups representing three levels of technological complexity in a simulation scenario where students performed a cardiac assessment. Students completed 4 surveys measuring anxiety, cognitive load, technological acceptance, and demographic data. ANOVA, multiple regression, Chi square analysis and MANOVA were used to analyze relationships between variables. Results Three variables were found to be statistically significant; extraneous cognitive load was negatively correlated with CCEI scores (p=.028). Age (22-25 years) was positively correlated with CCEI scores (p=.005) and having a previous associate degree was negatively correlated with CCEI scores (p=.016). Discussion age of participant, and level of degree emerged as influencing factors, and that increased extraneous load decreased learning. Implications for nursing education, and several recommendations for future research were suggested. The findings of this research lay the foundation for a program of research into identifying the effects of increased technology use on learning outcomes.


Anxiety; Cognitive load; Undergraduate


Education | Nursing

File Format


Degree Grantor

University of Nevada, Las Vegas




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