Objects
This study began recruiting participants after obtaining approval from the ethics committee of Jiangxi Cancer Hospital (No.2022ky085). All volunteers joined the investigation after being informed of the study's purpose. The outcome of the test did not affect their final subject grades. The volunteers was conducted after obtaining signed informed consent from each participant. The nursing interns (nursing students) of three junior colleges who practiced in Jiangxi Cancer Hospital from July 2021 to April 2022 were enrolled, and the study objects were the nursing students who matched the inclusion criteria as follows: (1) nursing students studying in specialized colleges; (2) nursing students aged ≥18 years old; (3) nursing students who did not receive virtual training in nursing before; (4) all participants gave informed consent and participated voluntarily. The exclusion criteria included (1) nursing students who cannot participate in the complete investigation and training process, such as out-of-home training; (2) nursing students who do not cooperate with investigation or training. Students were randomly divided into traditional educational modalities (control group) and the vSim simulation training group (experiment group).
Teaching method
Both control and experimental groups received lectures on clinical pneumonia knowledge and nursing skills training on pneumonia. Nursing lectures and nursing skills training is conducted by experienced nurses in respiratory medicine (> 10 years of experience). The teaching time of nursing lectures is 2h, and the training time for skills training is 4h. After completing lectures and skills training, the experimental group received 4h vSim training. Each of the above pieces of training is separated by one week. The specific training process of the two groups is displayed in Figure 1.
The teaching method of the vSim platform
In addition to the same routine training as the control group, the experimental group adopted the vSim platform teaching method. The scenario data were translated into Chinese after the pneumonic patient vSim scenario was chosen. Teachers explain the features, functions, operation process, and precautions of the vSim platform before the training start. Then, teachers will arrange pneumonia cases and inform the specialized nursing students that the vSim training focuses on simulating the nursing tasks of clinical nurses, i.e., simulating the evaluation-diagnosis-implementation nursing procedures for "standardized patients." Accordingly, students can review related clinical knowledge about pneumonia and clinical basic nursing skills, and other course content. The presented scenario selected an experienced 27-year-old man with chest pain, trouble breathing, cough with phlegm, and fever symptoms for one week, and the patient was taken to the emergency room. The instructional content of the vSim included a respiratory examination of the pneumonic patient who entered the emergency room, diagnosis of respiratory issues, delivery of medications according to doctor's recommendations, and teaching regarding pneumonia prevention and treatment. After training, the students should write out the corresponding nursing procedures and reflections and communicate with the teacher. The teacher will give guidance and comments based on the evaluation information recorded and saved on the vSim training platform.
Evaluation
Knowledge and self-confidence assessments are conducted before starting the project and after training. After completing the training, the experimental group used a questionnaire to evaluate the students' satisfaction with the vSim® for the nursing platform. The specific assessment and evaluation contents are depicted in Figure 1.
Knowledge
According to the learning objectives of researchers (professors of respiratory nursing), the knowledge scale for pneumonia nursing care was established. It consisted of 20 questions in assessment (8 items) and intervention (implementation, 9 items; education, 3 items). The range of total scores was from 0 to 16, and 0 (incorrect) or 1 (correct) was the score per every item. Higher scores represent a greater knowledge level. Table S1 shows the subcategory’s specific details.
Confidence in practice (CP)
To assess CP, the confidence instrument for clinical performance created by Kim(12) was adjusted and supplemented to focus on pneumonia treatment which is the topic of the current study. To assess the ability to perform with confidence, the researchers established the CP scale, like performance, on the basis of simulation contents utilized in the current research. It comprised ten items, which were categorized into assessment (four items), planning (one item), intervention (implementation, two items; education, two items), and evaluation (one item); it is also graded on a 4-point Likert scale. The greater the score, the greater the confidence in caring for asthmatic children. The scale has a Cronbach's alpha of 0.892.
Students' satisfaction
On the basis of a prior investigation that focuses on students’ compliance with vSim® for nursing (9), the questionnaire design was generated. The questionnaire comprised nine open-ended questions asking students about their participation in the vSim® simulation to elucidate their positive and prospective outcomes.
Statistics
To examine the assumption of normality, a Kolmogorov-Smirnov test with Lilliefors correction was performed. Continuous variables were reported as medians and interquartile ranges (IQRs), whereas categorical variables were reported as numbers and percentages. The Mann-Whitney U test (non-normal distribution parameters) for continuous variables between experimental and control cohorts and the Pearson’s chi-square or Fisher's exact tests for categorical variables were utilized to compare the clinical variables. To compare the knowledge test and self-confidence test scores within the group after and before training, the Wilcoxon signed-rank test was utilized. Mann-Whitney U test was used to compare the difference between knowledge test and self-confidence test scores before and after training within the two groups.