Effect of nursing simulation teaching information system based on HIS in comprehensive training course for senior nursing undergraduates: a randomized controlled trial | BMC Medical Education

Objectives

To verify the effect of the NSTIS on the comprehensive nursing training course.

To investigate students’ insights into the refinement of the NSTIS and teaching scheme.

Study design

A randomized controlled trial was conducted based on a COPD case simulation during comprehensive nursing training from April 2023 to June 2023.

Participants and randomization

Third-year undergraduate nursing students from the School of Nursing at a researcher-affiliated medical university were selected as the participants. The inclusion criteria required that participants be third-year undergraduate nursing students who agreed to participate in the study, excluding those who did not complete the intervention due to the COVID-19 pandemic or other unforeseen circumstances. A total of 119 third-year undergraduate nursing students were enrolled in the study. Participants were randomly divided into experimental (n = 59) and control (n = 60) groups. Due to epidemic prevention and control measures, 5 individuals were excluded, resulting in a final control group of 59 individuals and an experimental group of 55 individuals. Figure 2 shows the CONSORT flow diagram.

A double-blind design was employed, with both researchers and data analysts blinded to group allocation. The participating students were randomized into Groups 1 and 2 using a lottery method based on their student ID sequences. One researcher recorded the students’ IDs and the corresponding group numbers on a list, that was submitted to the course instructor. A second researcher, blinded to the allocations, designated one group as the experimental group and informed the instructor of the course. The instructor supplemented the list with the intervention assignments, sealed it in an envelope, and stored it securely. Class schedules were arranged according to group assignments, and students were notified of their class locations and times. The students were informed of their group assignments only after the intervention. Following data analysis, the instructor unsealed the envelope to reveal the group allocation.

Sample size

The sample size was determined using the formula for estimating means [19], with a significance level (α) of 0.05 and a target power of 0.90. Based on the findings of Baptista et al. [20], we used a mean difference of 4.49 with a standard deviation of 6.53. The resulting sample size was 34 participants per group, accounting for a 20% dropout rate, resulting in a total sample size of 86.

Intervention

Teaching scheme

The lesson consisted of a pre-class preparation task and three in-class modules, as illustrated in Fig. 3.

1. 1)

   Pre-class tasks (relevant knowledge previously learned and assessed through other courses).

   1. a)

      Review the health history collection, focus assessment, key points of nursing, and health education related to COPD.

   2. b)

      Review the arterial blood gas analysis, atomization inhalation, respiratory function exercises, chest percussion for sputum clearance, and sputum specimen collection.

2. 2)

   Practical Training Sessions.

   1. a)

      Module 1: Admission assessment and health education (50 min) based on the admission case scenario.

      1. i)

         Admission focus assessment: core symptom inquiry and completion of respiratory specialty assessment scales (COPD, and dyspnea quantification scales).

      2. ii)

         Admission health education: Introduction to the hospital environment, symptom relief methods, sample collection methods, nutritional and lifestyle guidance.

   1. b)

      Module 2: Executing medical orders and complete report interpretation (40 min) based on the case scenario on Day 1.

      1. i)

         Perform arterial blood gas analysis procedures and interpret the results of the blood gas analysis report.

   1. c)

      Module 3: Chest Percussion (30 min).

      1. i)

         Simulation Scenario: Nurses receive orders to administer atomization inhalation to the patient; upon assessment, it is discovered that the patient has difficulty expectorating sputum, necessitating the chest percussion for sputum clearance.

3. 3)

   Feedback and evaluation session.

After each module simulation, the students, guided by the teacher, engaged in reflective discussions on the simulation process and complete a self-assessment or peer assessment on a guided feedback form.

The experimental group

The experimental group adopted the NSTIS to conduct scenario-based simulation teaching integrated with PBL. Students in the experimental group completed the related pre-class tasks by reviewing EMR in the system and professional textbooks. During class, students used the system to perform assessment tasks, manage orders through the system modules, and carry out nursing procedures as required.

The control group

The control group used traditional printed materials to conduct scenario-based simulation teaching integrated with PBL. Students in the control group completed the related pre-class tasks using Microsoft Word versions of case summaries and professional textbooks and completed the simulation tasks through printed assessment sheets and orders during class.

The two intervention groups were divided into three classes and taught in separate laboratories. Each class conducted situational exercises in groups of 2–3 people. The nursing simulation teaching system guidance and case simulation teaching were conducted by professional teachers who received standardized training. Three teachers taught the control group in the morning and the experimental group in the afternoon to prevent the teaching experience of the experimental group from interfering with that of the control group.

Data collection tools

Self-designed classroom teaching effect questionnaire

The self-designed questionnaire included six aspects: (1) Basic characteristics including sex and birth date. (2) Satisfaction evaluation with five items was assessed using a 5-point Likert scale, where scores from 1 to 5 represented “strongly disagree,” “disagree,” “neutral,” “agree,” and “strongly agree,” respectively. (3) Achievement of teaching objectives with nine items rated on a 5-point Likert scale, with scores ranging from 1 to 5 indicating “not met,” “partially met,” “moderately met,” “largely met,” and “fully met.” (4) Learning outcomes were assessed using five items scored on a 5-point Likert scale, where ratings of 1 to 5 signify “ineffective,” “slightly effective,” “moderately effective,” “quite effective,” and “very effective,” respectively. (5) Suggestions for additional course content with six items rated on a 5-point Likert scale, with 1 to 5 representing “strongly disagree,” “disagree,” “neutral,” “agree,” and “strongly agree.” (6) Open-ended questions for main learning gains and suggestions aimed at capturing insights beyond the closed-ended items. The detailed descriptions and distributions of each item are presented in Table 2. The overall Cronbach’s α coefficient for the closed-ended items was 0.918, with individual section Cronbach’s α coefficients of 0.945, 0.920, 0.921, and 0.791 respectively. The closed-ended section was evaluated by three experts in the relevant field, and the S-CVI was 0.987. The closed-ended questions showed good internal consistency and content validity.

Case workshop scores

The case workshop scores were evaluated by the instructional faculty based on group performance during case training, including nursing assessment, health education, skill operation, cooperation, and communication skills, with three points awarded for each. Additionally, individual student participation and group performance were recorded, which may have resulted in bonus points or deductions based on group scores. The students’ total scores did not exceed 15 points.

Data collection and analysis

The two groups completed related questionnaires after class, which were collected by researchers who were not involved in the teaching. All responses were submitted anonymously, and confidentiality was maintained. Teachers were absent when the surveys were distributed to prevent evaluation bias from their presence. The researchers responsible for data collection labeled the original data for group comparisons during the data analysis.

SPSS 24.0 (IBM Corp., Armonk, NY, USA) was used to analyze quantitative data. Descriptive data are presented as numbers, percentages, means, and standard deviations. Sex composition was assessed using the chi-square tests. Age, scores on the self-developed classroom teaching effect questionnaires, and case workshop scores exhibited a skewed distribution; the Mann–Whitney U test was used to compare the differences between the two groups. The significance level was set at α = 0.05. NVivo 12 Plus was used to analyze the gains and suggestions gathered from open-ended questions. The researchers analyzed the data by group number while remaining blind to the students’ assignments in the experimental or control group.

Ethical consideration

This study was approved by the Southern Medical University Biomedical Ethics Committee (Approval [2023] No.6). Written informed consent was obtained from all the participating students.