• Fiona E Bogossian, Simon J Cooper, Robyn Cant, Joanne Porter, Helen Forbes, and FIRST2ACT™ Research Team.
• The School of Nursing, Midwifery and Social Work, The University of Queensland, St. Lucia Campus, QLD Australia; The School of Nursing and Midwifery, Monash University, VIC, Australia. Electronic address: f.bogossian@uq.edu.au.
• Nurse Educ Today. 2015 Oct 1; 35 (10): e36-42.

BackgroundHigh-fidelity simulation pedagogy is of increasing importance in health professional education; however, face-to-face simulation programs are resource intensive and impractical to implement across large numbers of students.ObjectivesTo investigate undergraduate nursing students' theoretical and applied learning in response to the e-simulation program-FIRST2ACT WEBTM, and explore predictors of virtual clinical performance.Design And SettingMulti-center trial of FIRST2ACT WEBTM accessible to students in five Australian universities and colleges, across 8 campuses.ParticipantsA population of 489 final-year nursing students in programs of study leading to license to practice.MethodsParticipants proceeded through three phases: (i) pre-simulation-briefing and assessment of clinical knowledge and experience; (ii) e-simulation-three interactive e-simulation clinical scenarios which included video recordings of patients with deteriorating conditions, interactive clinical tasks, pop up responses to tasks, and timed performance; and (iii) post-simulation feedback and evaluation. Descriptive statistics were followed by bivariate analysis to detect any associations, which were further tested using standard regression analysis.ResultsOf 409 students who commenced the program (83% response rate), 367 undergraduate nursing students completed the web-based program in its entirety, yielding a completion rate of 89.7%; 38.1% of students achieved passing clinical performance across three scenarios, and the proportion achieving passing clinical knowledge increased from 78.15% pre-simulation to 91.6% post-simulation. Knowledge was the main independent predictor of clinical performance in responding to a virtual deteriorating patient R(2)=0.090, F(7, 352)=4.962, p<0.001.DiscussionThe use of web-based technology allows simulation activities to be accessible to a large number of participants and completion rates indicate that 'Net Generation' nursing students were highly engaged with this mode of learning.ConclusionThe web-based e-simulation program FIRST2ACTTM effectively enhanced knowledge, virtual clinical performance, and self-assessed knowledge, skills, confidence, and competence in final-year nursing students.Copyright © 2015 Elsevier Ltd. All rights reserved.

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