Global Journal of Health Science; Vol. 13, No. 10; 2021 ISSN 1916-9736 E-ISSN 1916-9744 Published by Canadian Center of Science and Education 19 High Fidelity Simulation and the Development of Clinical Judgment in Senior Nursing Students: A Mixed Method Approach Warongrong Nilphet 1 1 Pediatric Nursing Department, Boromarajonani College of Nursing Songkhla, Songkhla, Thailand Correspondence: Warongrong Nilphet, Faculty of Pediatric Nursing Department, Boromarajonani College of Nursing Songkhla, Songkhla, Thailand. Tel: 66-74-311-890. Received: April 14, 2021 Accepted: August 21, 2021 Online Published: August 27, 2021 doi:10.5539/gjhs.v13n10p19 URL: https://doi.org/10.5539/gjhs.v13n10p19 Abstract Clinical judgment is defined as an understanding and interpretation regarding patient’s needs, health problems or concerns (Tanner, 2006). There are four interrelated processes in Tanner’s model that consist of noticing, interpreting, responding, and reflecting (Tanner, 2006). Because clinical judgment is extremely complex and encompasses many ways of thinking and types of knowledge, it requires a flexible capability to identify significant features of indeterminate clinical circumstances. Mixed methods study was conducted to describe senior nursing students’ experience in using high-fidelity simulation to evaluate the development of clinical judgment skills. A convenience sampling of 30 senior nursing students who signed the consent, met the inclusion criteria, and attend the selected school of nursing in the fall of 2020 were used for this study. All participants answered questionnaires regarding the quantitative survey. Participants interviewed face-to-face and video call using Zoom meeting program and recorded using an audio recorder. Both the quantitative and qualitative findings identified that learning through high-fidelity simulation supports the improvement in the participants’ clinical judgment skills. All participants reported their perceptions and experiences from using high-fidelity simulation develop and support their clinical judgment skills from the beginning through the end of the simulation, especially improving prioritizing data and working as a team with providing effective communication. Keywords: high-fidelity simulation, clinical judgment, senior nursing student 1. Introduction 1.1 Introduce the Problem NSI Nursing Solution (2021) reported that the turnover of registered nurses increased by 2.8 percent in 2020 and currently stands at 18.7%. The average hospital turnover for registered nurses rate is up to over 83 percent of the workforce since 2016. At present, lack of nursing experience has been identified as a major predictor of nurses’ turnover and is exacerbated by factors such as compassion fatigue in nurses working in clinical settings (ANA, 2016). In particular, some specialized clinical settings such as the Intensive Care Unit (ICU), Progressive Care Unit (PCU), Cardiac Care Unit (CCU), Pediatric Intensive Care Unit (PICU), or Newborn Intensive Care Unit (NICU) have been found to be the most challenging areas for newly graduated nurses (Jung et al., 2017). One of the significant factors that influence a newly graduated nurses’ decision to resign from a job is feeling stress from taking care of patients without sufficient level of nursing experience and clinical judgment skills (Lau et al., 2015). This issue is related to the current nursing shortage problem and will continue into the future. Ineffective nursing care without productive clinical judgment is harmful to patients and increases nursing care errors, near misses, and adverse events (Van Graan & Williams, 2017). This study focused on senior nursing students who are preparing to be professional nurses. To become a professional nurse, senior nursing students are required to develop critical thinking skills; especially, clinical judgment. Clinical reasoning is an essential part of nursing care. In recent years, clinical judgment skills have been identified as a crucial competency and integral component of professional nursing practice. Clinical judgment is an essential part of patient care (Tanner, 2006). Therefore, to perform effective and productive nursing care to patients, nursing students need to improve this skill. Clinical judgment is also grounded in the nurses’ knowledge and experience and is a crucial element of productive and safe nursing practice. Lack of clinical judgment among senior nursing students is an added stress for them,