Effectiveness of Scenario-Based Online Simulation in Chest Trauma in Nurses

Methods This randomized controlled trial evaluated teaching strategies for chest trauma education. The course was promoted via posters and conducted over two days, with two sessions per day. Sessions were randomly assigned to the control or experimental group via a lottery system before the course. This process was repeated on day two. A total of 67 participants per group were recruited, ensuring 50% random allocation. Control Group Participants received traditional classroom instruction with case discussions. Pretest: Collected demographic data and assessed baseline knowledge using the Chest Trauma Knowledge Scale (CTKS) and Nursing Clinical Decision-Making Scale (NCDMS). First posttest (1-week follow-up): Measured CTKS, NCDMS, and Learning Engagement Scale (LES). Second posttest (3-month follow-up): Assessed CTKS and Confidence in Nursing Clinical Reasoning Scale (CNCRS). Experimental Group Participants received traditional instruction plus "CARE! I-DECIDE" online simulation. Pretest: Same as the control group. First posttest (1-week follow-up): Measured CTKS, NCDMS, and LES. Second posttest (3-month follow-up): Assessed CTKS and CNCRS. Assessments were completed via Google Forms or paper-based questionnaires. This study compared traditional teaching with blended learning using online simulation, evaluating immediate and delayed outcomes.

Background In Taiwan, accidental injuries remain a major cause of death, with thoracic trauma being a significant contributor to severe cases. Nurses must develop rapid assessment, management, and clinical reasoning skills to improve trauma care. However, trauma training is often limited by spatial and financial constraints, restricting ongoing education. The "Care I Decide!" online simulation-assisted teaching provides a flexible, accessible solution for continuous thoracic trauma training, enhancing nurses' knowledge and clinical reasoning skills.

Purpose This study assessed the effectiveness of "Care I Decide!" in improving nurses' thoracic trauma knowledge and clinical reasoning skills.

Method This randomized controlled trial (RCT) used a two-group, repeated-measures design with 95 ER and surgical nurses from a regional teaching hospital in Northern Taiwan.

* Experimental group (n=49): Received classroom teaching + "Care I Decide!" online simulation.
* Control group (n=46): Received classroom teaching + case sharing.

Participants completed:

* Pre-test (before intervention)
* First post-test (1 week after intervention)
* Second post-test (12 weeks after intervention)

Instruments used:

* Thoracic Trauma Knowledge Scale (TTKS)
* Clinical Reasoning Skills Scale (CRSS)
* Learning Engagement Scale (LES) Results Pre-test scores showed no significant differences between groups.

After the intervention:

* The experimental group had higher thoracic trauma knowledge in both post-tests (p \< .01).
* Their clinical reasoning skills improved significantly in the second post-test (p \< .05).
* High learning engagement was observed in both groups but was not statistically significant (p \> .05).

Conclusion and Recommendations Both approaches improved nurses' knowledge and clinical reasoning skills. The "Care I Decide!" online simulation provided flexible training without time or location constraints. Scenario-based exercises enhanced clinical reasoning and decision-making, offering real-time feedback for concept clarification.

Additionally, interactive videos strengthened knowledge retention and clinical judgment by allowing nurses to apply reasoning in patient scenarios. This method is recommended for continuing education and could be expanded to other trauma scenarios for ongoing clinical training.

Eligibility Criteria:
Inclusion Criteria:

* Professional Setting:

Nurses working in emergency departments or specific surgical specialties, including thoracic surgery, neurosurgery, general surgery, and orthopedics.

Willingness to Participate:

Nurses who voluntarily agree to participate in this study.

Exclusion Criteria:

* Non-Surgical Nurses:

Nurses from non-surgical departments or those not meeting the inclusion criteria within other surgical specialties.

Non-Frontline Care Providers:

Nurses not directly involved in the clinical care of chest trauma patients, such as outpatient nurses or case managers.

Incomplete Participation:

Nurses who do not complete the full course of the study program.