Evaluation of the combination of virtual simulation and in-person simulation among undergraduate nursing students: A mixed methods study

This study aimed to evaluate the combination of virtual simulation and in-person simulation among undergraduate nursing students.At present, in-person simulation is the main form of simulation in China. With the development of computer technology, computer-based virtual simulation is gradually applied in simulation and has shown unique advantages. However, simulation format that combines virtual simulation with in-person simulation is rare in China.This was a mixed methods study, which applied a QUAN→qual sequential explanatory approach.In the quantitative phase, a non-randomized controlled trial (NRCT) was employed among 93 junior nursing students from nursing school of a university in China. Students from parallel classes 1, 2 and 3 (45 students) were selected as experimental group, while students from parallel classes 4, 5 and 6 (48 students) were selected as control group. The control group completed the in-person simulation, while the experimental group was required to complete both virtual simulation and in-person simulation. The students' performance in in-person simulation was evaluated by the teachers according to a demonstrating checklist. After simulation, Students were invited to answer the Students' Satisfaction and Self-confidence in Learning Scale (SSS), Educational Practices in Simulation Scale (EPSS) and Clinical Learning Environment Comparison Survey (CLECS). A descriptive qualitative study was conducted in qualitative phase. Ten students were recruited by a purposive sampling method from the experimental group and were interviewed by the researcher. A semi-structured interview method was used to conduct in-depth interviews with them.The mean score of the students' performance in the experimental group was higher than that in the control group (63.00 vs 57.67). There were no significant differences in learning satisfaction, self-confidence and simulated practice score (except cooperation dimension) between the two groups (P>0.05). For experimental group, the total CLECS score in in-person simulation was higher than that in virtual simulation, which was 84.98±12.50 and 72.58±13.04 respectively and the difference was statistically significant (t=5.270, p<0.001). Ten students were interviewed in the qualitative phase. Through the interview, we have learned that students believed that virtual simulation combined with in-person simulation is helpful to enhance their knowledge, improve their learning confidence and help them develop non-technical skills (i.e., decision-making and critical thinking).In-person simulation is the preferred form of simulation and virtual simulation is a beneficial supplement to in-person simulation. The combination of the two is suggested to be introduced into the simulation curriculum for undergraduate nursing students.