This quasi-experimental study was conducted using a pre-test and post-test design in the Faculty of Nursing and Midwifery affiliated with Kerman University of Medical Sciences in 2021, the protocol for the study was approved by the ethics committee of Kerman University of Medical Science (IR. KMU. REC. 1400. 385). All nursing interns who had passed the pre-internship theory exam and OSCE[1] participated in the present study (N = 74). One student was excluded from the study, and finally, the data of 73 students (control = 39 and intervention = 34) were analyzed. First, the list of students and their student numbers was taken from the education department of the faculty. Afterward, two groups were formed in the WhatsApp application, and the students were randomly divided between two control and intervention groups (Fig. 1). The study objectives were explained to the students in both groups. Their informed consent to participate in the study had obtained, all students received information regarding the study and signed consent. Participation was voluntary, and students had the right to withdraw without adverse effects on their academic standing. The confidentiality and anonymity of personal data were maintained by coding students’ identity. Then the pre-test was taken by the participants in the two groups. The students in the intervention group attended the pediatric ward in groups of 8 people. On the first day of the internship, the head nurse of the ward, who was also responsible for students' clinical training, introduced the prevalent cases in the department to the students. They were required to obtain information about the presented cases (1- a child with seizures, 2- a child with a urinary infection, 3- a child with pneumonia). The students were required to check the clinical symptoms of the affected child, taking history, following up the process of diagnosis and treatment of the disease, and providing nursing care to the patients in the first ten days of the internship. During these ten days, a senior pediatric nursing expert was present in the department as a mentor for one hour and answered the student's questions regarding the documentation of the case and other questions. After ten days of internship in the pediatric ward, the students participated in the Skyroom course. Each scenario-based training session was held online for 2 hours for the students the intervention group. The course instructors were a pediatric nursing doctor and a nursing master's student. In designing the scenarios, the simulated cases were discussed from simple to complex.
At the beginning of the online classes, the information about the objectives, lesson plan, the duties of the students, and the title of the course was provided to the students. The scenarios were pre-written and approved by the professors of the pediatric department for content validity. Each case was discussed in a session. The scenarios were written in advance and were approved for content validity by the professors of the pediatrics department. In each scenario, a complete history of the patient was read by the senior student, and then questions were asked step by step about the proposed scenarios. Each student reported the actions they should take in dealing with this scenario, and then the professor examined and analyzed the answers to the students' questions one by one. Afterward, the videos prepared for each scenario were shown, and the necessary actions when facing each scenario were also explained. Then, one of the latest articles that presented new findings related to the problem in the scenario was reviewed. In the end, the teacher summarized the whole discussion presented in the class. The reason for conducting the scenario discussion sessions in the last four days of the internship was to familiarize the students with the cases of the ward and help them better analyze the simulated scenarios. This helped students to imagine the designed scenarios and analyze the designed situation effectively.
After completing the pre-test, the students in the control group attended the pediatric ward for 15 days according to the usual clinical training protocol in the faculty during the first three days. The rules and regulations were explained to the students and the conventional care protocol was implemented by the supervisor. Then, from the fourth day, the patient was handed over to students, and they provided care to the patient under the supervision of the supervisor. This process continued until the fifteenth day under the supervision of the head of the pediatric ward. The students in the control group provided routine clinical care for the patients using a case method form, and after one month, they were asked to complete the questionnaire again.
The data in this study were collected using a demographic information questionnaire and the Nursing Students' Core Competencies Questionnaire.
The demographic information questionnaire assessed the students’ age, sex, marital status, native status, year of entering university, residence status, whether they have completed a practical nursing course, their interest in the nursing profession, number of past units, grade point average (GPA), and whether they were familiar with the scenario-based training method or not?
The competencies of all students in two groups were evaluated after one month as a post-test using a questionnaire developed by Perng and Watson. The questionnaire had 48 items, which measured eight dimensions of competencies: critical thinking, general clinical skills, basic medical sciences, communication skills, care, ethics, responsibility, and continuous learning. Each domain was measured using six items on a 7-item Likert scale from completely disabled to completely capable (1 = completely not capable; 2 = disabled; 3 = relatively disabled; 4 = medium; 5 = relatively capable; 6 = capable; 7 = completely capable). Total scores for 48 items ranged from 48 to 336, with higher the score students indicating higher competencies (4).
The face validity of the original questionnaire had evaluated by an expert group including six senior lecturers, two assistant professors, and three senior clinical nurses. For this purpose, a 4-point Likert scale was used (1 = not relevant, delete the item; 2 = somewhat relevant, need much revision; 3 = quite relevant, need a little revision; and 4 = very relevant). The average content validity was equal to 0.96, and the its reliability was calculated using the internal consistency method, which Cronbach's alpha had reported to be more than 0.9 for all items (4).
The questionnaire was translated and retranslated into Farsi by the researcher, and its content validity was measured quantitatively and qualitatively by ten professors of the Kerman University of Medical Sciences. For this purpose, a 4-point Likert scale was used (1 = not relevant, delete the item; 2 = somewhat relevant, need much revision; 3 = quite relevant, need a little revision; and 4 = very relevant). Its content validity coefficient was obtained as CVI[2] = 1, and its reliability was measured by calculating the internal correlation coefficient and Cronbach's alpha in a group of 40 students, and Cronbach's alpha coefficient was 0.94. The results confirmed the reliability and validity of the instrument. The collected data were analyzed with SPSS26 software using the chi-square test, paired samples t-test, and independent samples t-test. The Kolmogorov-Smirnov test was used to check the normality of the data, and the significant level was considered p < 0.05.
Ethical approval
was granted by the Research Ethic Committee of University of Kerman (IR. KMU. REC. 1400. 385). Research team confirm that all methods were carried out in accordance with relevant guidelines and regulations. Also, informed consent was obtained from all subjects.
[1] Objective structured clinical examination
[2] Content validity index