Efficacy of a Novel Simulation-Based Instructional Model in Enhancing Emergency Nursing Competence Among Nursing Students
Keywords:
Simulation-based education, Emergency nursing, Nursing competence, Nursing studentsAbstract
Emergency nursing education faces persistent challenges in bridging the theory-practice gap, particularly in preparing nursing students for high-stakes clinical situations. Although simulation-based education shows promise, there remains a critical need for evidence-based, comprehensive instructional models that can effectively cultivate and sustain emergency nursing competence. This quasi-experimental study pursued three primary objectives: (1) to develop and validate a novel simulation-based instructional model for emergency nursing education, (2) to evaluate the longitudinal impact of the model on knowledge and skills acquisition at 4, 8, and 12 weeks post-intervention, and (3) to examine the relationship between theoretical understanding and clinical performance throughout the intervention period. Using a one-group pretest-posttest design, 30 fourth-year nursing students at Boromarajonani College of Nursing, Uttaradit, participated in a 12-week intervention. The study employed multiple validated instruments including: (1) a 50-item emergency nursing knowledge assessment (Content Validity Index = 0.87, Cronbach's alpha = 0.85), (2) a structured clinical performance evaluation checklist (Inter-rater reliability ICC = 0.92), and (3) a standardized debriefing tool based on the Promoting Excellence And Reflective Learning in Simulation (PEARLS) framework. The instructional model, grounded in Kolb's (1984) Experiential Learning Theory and Jeffries, Rodgers, and Adamson's (2015) Simulation Framework, comprised three phases: preparation, implementation, and evaluation. An analysis of variance (ANOVA) for repeated measures revealed significant improvements in both knowledge (F(2.14, 62.06) = 1471.929, p < .001, partial η² = .981) and skills (F(2.32, 67.28) = 970.392, p < .001, partial η² = .971) across all time points. Post-hoc analyses indicated sustained learning gains, with the most substantial improvements occurring between baseline and week 4. Correlation analysis indicated a strong positive relationship between knowledge and skills scores (r = 0.72-0.85, p < .001). These findings suggest that the developed simulation-based model significantly enhances and maintains emergency nursing competence, offering a promising instructional approach for nursing education. Future research should investigate long-term retention and the transferability of acquired competencies to clinical practice.
References
Alharbi, A., Almarzuqi, A., Alghamdi, R., Alanazi, A., & Alharbi, F. (2024). The effectiveness of simulation-based learning on nursing students' knowledge and skill acquisition and retention: A systematic review. BMC Medical Education, 24, 1099. https://doi.org/10.1186/s12909-024-06080-z
Curtis, K., Munroe, B., Van, C., & Elphick, T. L. (2020). The implementation and usability of HIRAID, a structured approach to emergency nursing assessment. Australasian Emergency Care, 23(1), 62–70. https://doi.org/10.1016/j.auec.2019.10.001
Faul, F., Erdfelder, E., Lang, A. G., & Buchner, A. (2007). G*Power 3: A flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behavior Research Methods, 39(2), 175–191. https://doi.org/10.3758/BF03193146
Hamdi, A., & Al Thobaity, A. (2023). Enhancing disaster triage competencies through simulation-based training: A pre–post intervention study among nursing students. Sustainability, 15(21), 15513. https://doi.org/10.3390/su152115513
Hosseini, M. M., Farahani, M. A., Mohammadi, E., Haghani, S., Alavi-Majd, H., & Sharif Nia, H. (2023). Crossover design in triage education: The effectiveness of interactive guidelines on nursing students' disaster triage performance. BMC Medical Education, 23, 793. https://doi.org/10.1186/s13104-023-06596-5
Huai, P., Li, Y., Wang, X., Zhang, L., Liu, N., & Yang, H. (2024). The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis. Nurse Education Today, 138, 106189. https://doi.org/10.1016/j.nedt.2024.106189
INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM simulation design. Clinical Simulation in Nursing, 12(S), S5–S12. https://doi.org/10.1016/j.ecns.2016.09.005
Jang, J.-H., Kim, S.-S., & Kim, S. (2020). Educational simulation program based on the Korean Triage and Acuity Scale. International Journal of Environmental Research and Public Health, 17(23), 9018. https://doi.org/10.3390/ijerph17239018
Jeffries, P. R., Rodgers, B., & Adamson, K. (2015). NLN Jeffries Simulation Theory: Brief narrative description. Nursing Education Perspectives, 36(5), 292–293. https://doi.org/10.5480/1536-5026-36.5.292
Jung, M.-J., & Roh, Y. S. (2022). Mediating effects of cognitive load on the relationship between learning flow and clinical reasoning skills in virtual simulation learning. Clinical Simulation in Nursing, 64, 16–23. https://doi.org/10.1016/j.ecns.2021.12.004
Kiegaldie, D., & Shaw, L. (2023). Virtual reality simulation for nursing education: Effectiveness and feasibility. BMC Nursing, 22, 488. https://doi.org/10.1186/s12912-023-01639-5
Kolb, D. A. (1984). Experiential learning: Experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall.
Lee, H., Han, J.-W., Park, J., Min, S., & Park, J. (2022). Development and evaluation of a virtual reality mechanical ventilation nursing education program: A quasi-experimental study. BMC Medical Education, 22, 348. https://doi.org/10.1186/s12909-022-03834-5
Lee, H., Han, J.-W., Park, J., Min, S., & Park, J. (2024). Development and evaluation of extracorporeal membrane oxygenation nursing education program for nursing students using virtual reality. BMC Medical Education, 24, 92. https://doi.org/10.1186/s12909-024-05057-2
Liu, K., Zhang, W., Li, W., Wang, T., & Zheng, Y. (2023). Effectiveness of virtual reality in nursing education: A systematic review and meta-analysis. BMC Medical Education, 23, 300. https://doi.org/10.1186/s12909-023-04662-x
Mulyadi, M., Tonapa, S. I., Rompas, S. S. J., Wang, R. H., & Lee, B. O. (2021). Effects of simulation technology-based learning on nursing students' learning outcomes: A systematic review and meta-analysis of experimental studies. Nurse education today, 107, 105127. https://doi.org/10.1016/j.nedt.2021.105127
Nair, M. A., Muthu, S. S., & Abuijlan, S. A. (2024). Effectiveness of high-fidelity simulation in nursing education: A systematic review and meta-analysis. SAGE Open Nursing, 10, 23779608241249357. https://doi.org/10.1177/23779608241249357
Oh, W.-O., & Jung, M.-J. (2024). Triage—clinical reasoning on emergency nursing competency: A multiple linear mediation effect. BMC Nursing, 23, 274. https://doi.org/10.1186/s12912-024-01919-8
Ozata, K., & Dinc, L. (2025). Effects of high-fidelity simulation and e-learning methods on nursing students' self-efficacy in patient safety: A quasi-experimental study. BMC Nursing, 24, 904. https://doi.org/10.1186/s12912-025-03561-4
Park, S., Shin, H. J., Kwak, H., & Lee, H. J. (2024). Effects of immersive technology–based education for undergraduate nursing students: Systematic review and meta-analysis and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach. JMIR Medical Education, 10, e57566. https://doi.org/10.2196/57566
Polit, D. F., & Beck, C. T. (2017). Nursing research: Generating and assessing evidence for nursing practice (10th ed.). Alphen aan den Rijn, Netherlands: Wolters Kluwer.
Shorey, S., & Ng, E. D. (2021). The use of virtual reality simulation among nursing students and registered nurses: A systematic review. Nurse Education Today, 98, 104662. https://doi.org/10.1016/j.nedt.2020.104662
Sim, J. J. M., Acharya, A. S., & Sethi, S. (2022). Virtual simulation to enhance clinical reasoning in nursing: A systematic review and meta-analysis. Clinical Simulation in Nursing, 69, 26–39.
Tong, L. K., Li, Y. Y., Au, M. L., Ng, W. I., Wang, S. C., Liu, Y., Cheung, D. S. K., Chan, A. W. K., Pang, S. M. C., Chan, P. P. M., Ho, J. C. M., & Lau, Y. (2024). The effects of simulation-based education on undergraduate nursing students' competences: A multicenter randomized controlled trial. BMC Nursing, 23, 400. https://doi.org/10.1186/s12912-024-02069-7
Wang, L.-H., Lin, Y.-C., Chao, M.-C., Chang, S.-F., Goopy, S., & Han, C.-C. (2024). Effectiveness of a virtual reality triage simulation program for nursing students: A mixed-methods study. Nurse Education in Practice, 78, 104161. https://doi.org/10.1016/j.nepr.2024.104161
World Health Organization. (2020). State of the world's nursing 2020: Investing in education, jobs and leadership. Retrieved June 4, 2024, from https://www.who.int/publications/i/item/9789240003279
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Suan Dusit University
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
1 All articles will undergo a formal peer-review. A panel of experts from within or without the university will examine the article; approval from a minimum of two experts is required for publication. Revisions posed by the experts must be completed by the research prior to publication.
2 Once published in the ASEAN Journal of Education, the article becomes intellectual property of Suan Dusit University. Duplication, in full or part, requires permission from Suan Dusit University.
3 Excluding errors incurred during printing, author(s) are responsible for the content of their articles.
