ABSTRACT Background: Available models for designing the struc- ture of specifc simulation-based learning (SBL) activities need further analysis. Method: This retrospective study was conducted using independent samples t tests to ex- amine diferences in mean clinical nursing judgment de- velopment scores between students who completed a nursing program prior to the introduction of an experien- tial learning theory (ELT)-based simulation design and stu- dents who completed the program after the adoption of its use for all scenario-based SBL activities. Results: Results showed a signifcant increase in clinical nursing judgment at both the beginning and end of a baccalaureate pro- gram in which all scenario-based SBL used an ELT design. Conclusion: Consistency with International Nursing As- sociation for Clinical Simulation and Learning standards of best practice and the use of ELT in SBL can improve student outcomes by fostering the development of clinical nursing judgment. [J Nurs Educ. 2017;56(12):733-736.] I n 2014, a theory-based simulation design was developed, merging nursing process with Kolb’s model of experiential learning (1984) and Tanner’s model of clinical judgment in nursing (2006). This experiential learning theory (ELT)-based design for simulation-based learning (SBL) built on the tradi- tional design, which focused on the unfolding scenario and de- briefing. To engage students in all phases of experiential learn- ing and all components of the nursing process, a 10-question, computer-based quiz was added to stimulate cognition and a concept-based prebriefing was added to address planning and reasoning. Use of this four-phase ELT-based design resulted in a significant increase in the development of clinical judgment in prelicensure baccalaureate nursing students in their first clinical semester. It was suggested that the design be evaluated further to assess its impact on clinical nursing judgment development in other levels of nursing students (Victor Chmil, Turk, Adam- son, & Larew, 2015). This retrospective study compared two cohorts of preli- censure nursing students engaged in an SBL program that was fully integrated throughout their entire baccalaureate nursing program. Cohort A was engaged in an SBL cur- riculum in which all scenario-based SBL was designed us- ing ELT, and Cohort B was engaged in an SBL curriculum that did not integrate a theory-based design. Clinical nurs- ing judgment development for each cohort was analyzed and compared. BACKGROUND SBL experiences should be designed to progressively chal- lenge students so they can develop knowledge, skills, clinical reasoning, and clinical nursing judgment (Ashcraft et al., 2013). Although various theoretical and conceptual frameworks have been used to develop simulation experiences, simulation design in nursing is not adequately theory-based (Rourke, Schmidt, & Garga, 2010). Although the Jeffries model provides a middle- range theory for simulation as a concept and phenomenon, available models for designing the structure of specific SBL activities are in need of further statistical analysis (Adamson, 2016). Improving Clinical Nursing Judgment in Prelicensure Students Joyce Victor, PhD, RN-BC, CHSE-A Dr. Victor is Assistant Professor and Director, Clinical and Simulation- Based Learning, Passan School of Nursing, Wilkes University, Wilkes Barre, Pennsylvania. The author has disclosed no potential conficts of interest, fnancial or otherwise. Address correspondence to Joyce Victor, PhD, RN-BC, CHSE-A, Assistant Professor and Director, Clinical and Simulation-Based Learning, Passan School of Nursing, Wilkes University, 84 West South Street, Wilkes Barre, PA 18766; e-mail: Joyce.victor@wilkes.edu. Received: May 24, 2017; Accepted: July 10, 2017 doi:10.3928/01484834-20171120-05 733 Journal of Nursing Education • Vol. 56, No. 12, 2017