● Quantitative research
∙ General characteristics
The 20 experimental group participants used the mobile virtual nursing simulation training content for one week. The groups had no statistically significant difference in general characteristics (
Table 1).
Table 1
Homogeneity Tests between the Two Groups at Baseline (N=40)
Characteristics |
Categories |
Exp. (n=20) |
Con. (n=20) |
χ2/t (p) |
|
Mean±SD or n (%) |
Age (years) |
21.50±1.53 |
21.45±1.70 |
0.09 (.923) |
Sex |
Male |
1 (5.0) |
1 (5.0) |
1.00* (.999) |
Female |
19 (95.0) |
19 (95.0) |
Satisfaction on nursing major |
6.70±1.26 |
6.85±1.92 |
-0.29 (.772) |
Smartphone OS |
Android |
5 (25.0) |
8 (40.0) |
0.50* (.311) |
iOS |
15 (75.0) |
12 (60.0) |
∙ Homogeneity test of dependent variables
The mean pre-intervention satisfaction score in simulation-based learning was 4.32±0.31 points in the experimental group and 4.29±0.27 points in the control group. In contrast, the self-confidence score was 4.46±0.20 points in the experimental group and 4.30±0.35 points in the control group, with no statistically significant differences. The learning flow score was 4.30±0.24 in the experimental group and 4.09±0.42 in the control group. There were no statistically significant differences between the experimental and control groups in the three dependent variables. Therefore, the homogeneity test of the dependent variables showed no statistically significant differences between the experimental and control groups (
Table 2).
Table 2
Homogeneity Tests of the Outcome Variables at Baseline (N=40)
Outcome variables |
Exp. (n=20) |
Con. (n=20) |
t (p) |
|
Mean±SD |
Learning satisfaction |
4.32±0.31 |
4.29±0.27 |
0.32 (.751) |
Learning confidence |
4.46±0.20 |
4.30±0.35 |
1.71 (.094) |
Learning flow |
4.30±0.24 |
4.09±0.42 |
1.91 (.063) |
∙ Learning satisfaction, confidence, and flow
Table 3 compares the two groups’ learning satisfaction, confidence, and flow. The level of satisfaction in the experimental group increased from 4.32 to 4.80 points, while the control group stayed at 4.27. There was a significant difference between the two groups (t=3.53,
p=.001). The confidence level in the experimental group increased from 4.46 to 4.86 points, while the control group decreased from 4.30 to 4.23. There was a significant difference between the two groups (t=4.07,
p=.001). The level of learning flow in the experimental group increased from 4.30 to 4.68 points, while that in the control group decreased from 4.09 to 3.92. There was a significant difference between the two groups (t=3.78,
p=.001). Hypotheses 1, 2, and 3 of the present study were all supported.
Table 3
The Effects of Mobile Virtual Nursing Simulation on Learning Satisfaction, Confidence, and Flow (N=40)
Variables |
Group |
Pretest |
Posttest |
Difference |
t (p) |
|
Mean±SD |
Learning satisfaction |
Exp. (n=20) |
4.32±0.31 |
4.80±0.31 |
0.48±0.28 |
3.53 (.001) |
Con. (n=20) |
4.29±0.27 |
4.27±0.42 |
-0.02±0.56 |
Learning confidence |
Exp. (n=20) |
4.46±0.20 |
4.86±0.15 |
0.40±0.22 |
4.07 (.001) |
Con. (n=20) |
4.30±0.35 |
4.23±0.37 |
-0.08±0.47 |
Learning flow |
Exp. (n=20) |
4.30±0.24 |
4.68±0.32 |
0.38±0.21 |
3.78 (.001) |
Con. (n=20) |
4.09±0.42 |
3.92±0.42 |
-0.17±0.60 |
The effect size was calculated using the mean and standard deviation of the posttest learning satisfaction, learning confidence, and learning flow of the experimental and control groups [
21,
22]. The results indicated a large effect size for learning satisfaction (d=1.73), learning confidence (d=2.23), and learning flow (d=2.03). The results demonstrated a large effect size greater than 0.8 according to the criteria established by Cohen [
23], and learning satisfaction exhibited a vast effect size greater than 1.2 according to Sawilowsky’s criteria [
24]. Furthermore, learning confidence and engagement demonstrated a substantial effect size greater than 2.0.
● Qualitative findings: Learning experiences
The qualitative findings from this mixed methods study reveal the profound impact of a mobile-based virtual nursing simulation focused on the care of patients with breast cancer. Two overarching themes emerged from the student interviews, highlighting the educational value and authentic nature of the simulation-based learning experience.
Theme 1. Learning by simulating patient care in vivid detail
The virtual simulation enabled nursing students to engage deeply with the complexities of breast cancer care, enhancing their understanding and clinical competencies.
1.1 Understanding the complex situation of pre- and post-operative processes for patients with breast cancer
Students described how the simulation allowed them to comprehend the multifaceted patient journey, from diagnosis through surgical treatment and recovery.
“The simulation helped me understand the full journey that breast cancer patients go through, from their initial diagnosis to the different treatment options and the recovery process. It gave me a much more comprehensive view of their experience.” (G4-4)
“I was able to virtually walk through the various stages of care, from the pre-operative preparations to the post-op complications that can arise. This allowed me to anticipate the patients’ needs and concerns at each step.” (G1-5)
1.2 Learning about various aspects of nursing cancer care
The simulation allowed students to apply their knowledge and skills across various nursing interventions specific to oncology patients. This included managing symptoms, coordinating care, and educating patients-all within a safe, controlled environment.
“The simulation exposed me to a wide range of nursing interventions specific to oncology patients, such as pain management, wound care, and patient education. I felt like I was getting hands-on practice in these critical skills.” (G3-4)
“Being able to virtually interact with the breast cancer patient, provide treatments, and monitor their responses was invaluable. It helped me integrate my knowledge into real-time clinical decision-making.” (G2-5)
1.3 A complementary learning tool for clinical practice
Participants viewed the virtual simulation as a valuable supplement to their traditional clinical experiences. The simulation enabled them to practice critical nursing skills and refine their clinical judgment, better preparing them for real-world patient encounters.
“The virtual simulation was a great supplement to my clinical rotations. It allowed me to practice nursing care safely before applying those skills with real patients.” (G1-4)
Theme 2. Feeling like a real-world experience
In addition to enhancing their clinical competencies, the mobile-based virtual simulation fostered a sense of authenticity and investment in the patient’s care, as evidenced by the following subthemes:
2.1 Feeling responsible as if I were a nurse in the virtual world
Students described a profound sense of accountability and ownership over the virtual patient’s care, akin to caring for a real individual. This immersive experience cultivated heightened engagement and commitment to the patient’s well-being.
“I felt genuine responsibility for the virtual patient’s well-being. It was as if I was their nurse fully invested in providing the best possible care.” (G1-3)
2.2 A feeling of self-confidence emerged in caring for patients with breast cancer
Participating in the virtual simulation boosted students’ confidence in their ability to provide practical, compassionate nursing care for patients diagnosed with breast cancer.
“After going through the virtual simulation, I feel much more confident in my ability to care for breast cancer patients. I now better understand the nursing process and how to meet their needs effectively.” (G2-5)