• Alexis Borg Sapiano, Roberta Sammut, and Josef Trapani.
• Intensive Care Unit, Mater Dei Hospital, Msida MSD 2090, Malta. Electronic address: alexis.borg-sapiano.07@um.edu.mt.
• Nurse Educ Today. 2018 Mar 1; 62: 128-133.

BackgroundPreparing nursing students to perform competently in complex emergency situations, such as during rapid patient deterioration, is challenging. Students' active engagement in such scenarios cannot be ensured, due to the unexpected nature of such infrequent events. Many students may consequently not experience and integrate the management of patient deterioration into their knowledge and practical competency by the end of their studies, making them unprepared to manage such situations as practicing nurses. This study investigated the effectiveness of virtual simulation in improving performance during rapid patient deterioration.ObjectiveTo investigate the effectiveness of virtual simulation in improving student nurses' knowledge and performance during rapid patient deterioration.DesignA pre- and post-test design was used.SettingNursing students at a university in Malta were invited to participate in a virtual simulation program named FIRST2ACTWeb™, using their own computer devices.ParticipantsA total of 166 (response rate=50%) second and third year diploma and degree nursing students participated in the study.MethodsThe simulation included three scenarios (Cardiac-Shock-Respiratory) portraying deteriorating patients. Performance feedback was provided at the end of each scenario. Students completed pre- and post-scenario knowledge tests and performance during each scenario was recorded automatically on a database.ResultsFindings showed a significant improvement in the students' post-scenario knowledge (z=-6.506, p<0.001). Highest mean performance scores were obtained in the last scenario (M=19.7, median: 20.0, s.d. 3.41) indicating a learning effect. Knowledge was not a predictor of students' performance in the scenarios.ConclusionsThis study supports virtual simulation as an effective learning tool for pre-registration nursing students in different programs. Simulation improves both knowledge about and performance during patient deterioration. Virtual simulation of rare events should be a key component of undergraduate nurse education, to prepare students to manage complex situations as practicing nurses.Copyright © 2018 Elsevier Ltd. All rights reserved.

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