Effects of a simulation-based nursing process educational program: A mixed-methods study
Abstract
Aims To examine the effects of a simulation-based nursing process educational program on nursing students' confidence in communication and foundational understanding of the nursing process.Background The nursing process is a core component of patient-centered nursing care that is underpinned by effective communication. However, learning how to engage patients and carry out the distinct steps of the nursing process can be challenging if students are not able to apply knowledge to practice. Simulation-based learning programs can provide an immersive opportunity for students to enhance their understanding of the nursing process as well as improve their communication skills.Design A mixed methods randomized controlled trial METHODS: Two Fundamentals of Nursing classes were recruited from a university in northern Taiwan. The experimental group (n = 58) engaged with the simulation-based nursing process educational program, which consisted of an online interactive animation and a standardized patient simulation. The control group (n = 49) was assigned a case-study. Confidence in Communication surveys, assignment and examination scores, satisfaction questionnaires and post-simulation reflection logs were used for data collection. Data were analyzed using SPSS 22.0 and qualitative content analysis.Results Both groups showed statistically significant improvement in Confidence in Communication (p < .001). The experimental group performed better on the assignment than the control group (p < .001). No significant difference was seen between either groups' examination performances. The animation's high usage rate (mean 5.91 interactions per-user) and the results of the satisfaction questionnaires indicate the program's positive reception from the experimental group. The following themes emerged: effective communication skills, problem solving, confidence, feeling prepared and novel learning experience.Conclusion The results demonstrate that the simulation-based nursing process educational program increased students' self-confidence in communication and non-verbal communication skills as well as foundational understanding of how to carry out the nursing process. The use of interactive simulation-based learning experiences is recommended to improve nursing students' understanding of how to apply abstract concepts into practice.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Students often encounter learning challenges during the traditional nursing process, including high cognitive load, limited ability to integrate knowledge across multiple databases, and unfamiliarity with database navigation and interface operations.
“However, scholars have indicated that students often encounter several learning challenges during the traditional nursing process [1].”
Cites
The Application of Content Analysis in Nursing Science Research
(2019) · Springer eBooks · doi:10.1007/978-3-030-30199-6 · Cited by 671 · see citing works
Virtual simulation in nursing education: a systematic review spanning 1996 to 2018
Foronda, C. L., Fernandez-Burgos, M., Nadeau, C., Kelley, C. N., & Henry, M. N. (2020) · Simulation in Healthcare The Journal of the Society for Simulation in Healthcare · doi:10.1097/sih.0000000000000411 · Cited by 505 · see citing works
Kyngäs, H. (2020) · The Application of Content Analysis in Nursing Science Research · doi:10.1007/978-3-030-30199-6_2 · Cited by 393 · see citing works
Curricula for empathy and compassion training in medical education: A systematic review
Patel, S. N., Pelletier‐Bui, A., Smith, S., Roberts, M., Kilgannon, H., Trzeciak, S., & Roberts, B. W. (2019) · PLoS ONE · doi:10.1371/journal.pone.0221412 · Cited by 373 · see citing works
The evolution of cognitive load theory and its application to medical education
Leppink, J., & Van den Heuvel, A. (2015) · Perspectives on Medical Education · doi:10.1007/s40037-015-0192-x · Cited by 299 · see citing works
Kyaw, B. M., Posadzki, P., Paddock, S., Car, J., Campbell, J., & Tudor Car, L. (2019) · Journal of Medical Internet Research · doi:10.2196/12967 · Cited by 257 · see citing works
Simulation-based training for nurses: Systematic review and meta-analysis
Hegland, P. A., Aarlie, H., Strømme, H., & Jamtvedt, G. (2017) · Nurse Education Today · doi:10.1016/j.nedt.2017.04.004 · Cited by 205 · see citing works
What is the Net Generation? The challenge for future medical education
Sandars, J. E., & Morrison, C. M. (2007) · Medical Teacher · doi:10.1080/01421590601176380 · Cited by 194 · see citing works
Vogel, D., Meyer, M., & Harendza, S. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1260-9 · Cited by 173 · see citing works
Clinical intuition in the nursing process and decision‐making—A mixed‐studies review
Melin‐Johansson, C., Palmqvist, R. R., & Rönnberg, L. (2017) · Journal of Clinical Nursing · doi:10.1111/jocn.13814 · Cited by 161 · see citing works
The effectiveness of training interventions on nurses' communication skills: A systematic review
Kerr, D. C., Ostaszkiewicz, J., Dunning, T. L., & Martin, P. (2020) · Nurse Education Today · doi:10.1016/j.nedt.2020.104405 · Cited by 159 · see citing works
Systematic Review of Effectiveness of Situated E‐Learning on Medical and Nursing Education
Feng, J., Chang, Y., Chang, H., Erdley, W. S., Lin, C., & Chang, Y. (2013) · Worldviews on Evidence-Based Nursing · doi:10.1111/wvn.12005 · Cited by 152 · see citing works
Self-citationUsing Cognitive Load Theory to Inform Simulation Design and Practice
Reedy, G. B. (2015) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2015.05.004 · Cited by 151 · see citing works
The implementation and evaluation of a communication skills training program for oncology nurses
Banerjee, S. C., Manna, R., Coyle, N., Penn, S., Gallegos, T. E., Zaider, T., Krueger, C. A., Bialer, P. A., Bylund, C. L., & Parker, P. A. (2017) · Translational Behavioral Medicine · doi:10.1007/s13142-017-0473-5 · Cited by 133 · see citing works
Herron, E. K., Powers, K., Mullen, L. K., & Burkhart, B. (2019) · Nurse Education Today · doi:10.1016/j.nedt.2019.05.015 · Cited by 126 · see citing works
What's in a Name? Clarifying the Nomenclature of Virtual Simulation
Cant, R., Cooper, S. J., Sussex, R., & Bogossian, F. E. (2018) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2018.11.003 · Cited by 123 · see citing works
High-fidelity Simulation in Teaching Problem Solving to 1st-Year Nursing Students
Burns, H. K., O'Donnell, J. M., & Artman, J. (2009) · Clinical Simulation in Nursing · doi:10.1016/j.ecns.2009.07.005 · Cited by 108 · see citing works
Twelve tips for medical curriculum design from a cognitive load theory perspective
Leppink, J., & Duvivier, R. (2016) · Medical Teacher · doi:10.3109/0142159x.2015.1132829 · Cited by 96 · see citing works
DiMattio, M. J. K., & Hudacek, S. (2020) · Nurse Education in Practice · doi:10.1016/j.nepr.2020.102901 · Cited by 84 · see citing works
How students choose E‐learning resources: The importance of ease, familiarity, and convenience
Bringman, L. R., & Hortsch, M. (2020) · FASEB BioAdvances · doi:10.1096/fba.2019-00094 · Cited by 64 · see citing works
Concerns of nursing students beginning clinical courses: A descriptive study
Cowen, K. J., Hubbard, L., & Hancock, D. C. (2016) · Nurse Education Today · doi:10.1016/j.nedt.2016.05.001 · Cited by 62 · see citing works
Relationship between communication skills and care behaviors of nurses
Kırca, N., & Bademli̇, K. (2019) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12381 · Cited by 58 · see citing works
Challenges nurse educators experience with development of student nurses’ clinical reasoning skills
Wyngaarden, A. V., Leech, R., & Coetzee, I. (2019) · Nurse Education in Practice · doi:10.1016/j.nepr.2019.102623 · Cited by 57 · see citing works
Sarabia‐Cobo, C., Alconero‐Camarero, A. R., Lavín-Alconero, L., & Ibáñez-Rementería, I. (2016) · Nurse Education Today · doi:10.1016/j.nedt.2016.08.014 · Cited by 51 · see citing works
Lin, M. F., Hsu, W.-K., Huang, M., et al. (2017) · European Journal of Cancer Care · doi:10.1111/ecc.12648 · Cited by 47 · see citing works
Educating for teamwork - nursing students’ coordination in simulated cardiac arrest situations
Husebø, S. E., Rystedt, H., & Friberg, F. (2011) · Journal of Advanced Nursing · doi:10.1111/j.1365-2648.2011.05629.x · Cited by 46 · see citing works
Nursing process education: A review of methods and characteristics
Mousavinasab, E. S., Kalhori, S. R. N., Zarifsanaiey, N., Rakhshan, M., & Ghazisaeedi, M. (2020) · Nurse Education in Practice · doi:10.1016/j.nepr.2020.102886 · Cited by 44 · see citing works
Jiang, X., Zhu, S., Feng, G., et al. (2013) · European Urology · doi:10.1016/j.eururo.2013.01.035 · Cited by 41 · see citing works
Leoni‐Scheiber, C., Mayer, H., & Müller‐Staub, M. (2019) · Nursing Open · doi:10.1002/nop2.299 · Cited by 37 · see citing works
A Scenario-Based Virtual Patient Program to Support Substance Misuse Education
Zlotos, L., Power, A., Hill, D. R. B., & Chapman, P. (2016) · American Journal of Pharmaceutical Education · doi:10.5688/ajpe80348 · Cited by 32 · see citing works
‘The future is old’: immersive learning with generation Y engineering students
Blashki, K., Nichol, S., Jia, D., & Prompramote, S. (2007) · European Journal of Engineering Education · doi:10.1080/03043790701334228 · Cited by 31 · see citing works
Predictors of fitness to practise declarations in UK medical undergraduates
Paton, L. W., Tiffin, P. A., Smith, D. T., Dowell, J. S., & Mwandigha, L. (2018) · BMC Medical Education · doi:10.1186/s12909-018-1167-5 · Cited by 31 · see citing works
Nursing Admission Assessment and Examination
Toney-Butler, T., & Unison-Pace, W. J. (2019) · StatPearls · Cited by 28 · see citing works
Contextualizing Instructional Technology to the Demands of Nursing Education
Smart, D. A., Ross, K., Carollo, S., & Williams‐Gilbert, W. (2019) · CIN Computers Informatics Nursing · doi:10.1097/cin.0000000000000565 · Cited by 27 · see citing works
Salvador, J. T., Alqahtani, F. M., Sauce, B. R. J., et al. (2020) · Journal of Nursing Management · doi:10.1111/jonm.12996 · Cited by 26 · see citing works
Navigating Communication Challenges in Clinical Practice: A New Approach to Team Education
Rachwal, C. M., Langer, T., Trainor, B. P., Bell, M. A., Browning, D. M., & Meyer, E. C. (2018) · Critical Care Nurse · doi:10.4037/ccn2018748 · Cited by 20 · see citing works
The Effect of Web-Based Nursing Process Teaching on Senior Nursing Students’ Care Planning Skills #
Basit, G., & Korkmaz, F. (2020) · International Journal of Nursing Knowledge · doi:10.1111/2047-3095.12283 · Cited by 18 · see citing works
Utilization of the Nursing Process to Foster Clinical Reasoning During a Simulation Experience
Lambie, A., Schwend, K., & Scholl, A. (2015) · SAGE Open · doi:10.1177/2158244015617516 · Cited by 15 · see citing works
Critical Thinking Tools for Quality Improvement Projects
Whiteman, K. F., Yaglowski, J., & Stephens, K. (2021) · Critical Care Nurse · doi:10.4037/ccn2021914 · Cited by 13 · see citing works
The design process of a multimodal module that synthesized knowledge across nursing courses
Wolf, L., Rutar, P., Delgado, C., et al. (2017) · Nurse Education Today · doi:10.1016/j.nedt.2017.02.010 · Cited by 11 · see citing works
[Construction and Application of Innovative Education Technology Strategies in Nursing].
Chao, L.-F., Huang, H.-P., Ni, L., et al. (2017) · PubMed · doi:10.6224/jn.000080 · Cited by 7 · see citing works
Self-citationHuang, Y.-C., Hsu, L., & Hsieh, S. (2011) · PubMed · Cited by 7 · see citing works
Meruvia-Pastor, O., Patra, P., Andres, K. M., et al. (2016) · International Journal of Medical Informatics · doi:10.1016/j.ijmedinf.2016.02.007 · Cited by 5 · see citing works
Importance of Healthy Work Environment Education in Nursing Schools
Blake, N. T., & Collins, M. (2017) · AACN Advanced Critical Care · doi:10.4037/aacnacc2017511 · Cited by 4 · see citing works
[Exploration of Recent Mobile Technologies Applied in Nursing Education].
Wu, T., Lu, Y., & Chang, L. (2017) · PubMed · doi:10.6224/jn.000079 · Cited by 4 · see citing works
Lambie, A., & Schwend, K. (2015) · Nurse Educator · doi:10.1097/nne.0000000000000105 · Cited by 1 · see citing works
Flagged first, then by citations
Cited by
Sorted by citations
Dwiarini, M., Hwang, G.-J., & Chang, C.-Y. (2026) · BMC Nursing · doi:10.1186/s12912-026-04840-4 · Cited by 1 · see citing works
“These include high cognitive load, limited ability to integrate knowledge across multiple databases, and unfamiliarity with database navigation and interface operations [2].”
- Authors
- Chang, Y.-Y., Chao, L.-F., Xiao, X., & Chien, N.-H.
- Affiliations
- Chang Gung University of Science and Technology (TW)
- Corresponding author
- Chao, Li-Fen
- Venue
- Nurse Education in Practice
- Publisher
- Elsevier BV
- Published
- 2021-10
- Volume
- 56
- Pages
- 103188
- ISSN
- 1471-5953 (ISSN-L)
- OpenAlex
- W3196422146
- Cited by
- 45
- References
- 46
- Citations by year
- 2026: 9 · 2025: 11 · 2024: 10 · 2023: 11 · 2022: 4
- FWCI
- 3.95
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Nurse Education in Practice (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Ministry of Education of the People's Republic of China (PMN1080134)
- Topics
- Health Sciences › Medicine › Physiology › Simulation-Based Education in Healthcare
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Innovations in Medical Education
- Health Sciences › Nursing › Research and Theory › Nursing education and management
- Keywords
- simulation-based training, nursing process, nursing students, communication confidence, nonverbal communication, standardized patients, interactive animation, nursing education, student satisfaction
- MeSH terms
- Clinical Competence, Education, Nursing, Education, Nursing, Baccalaureate, Humans, Nursing Process, Students, Nursing, Patient Simulation
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
