title: Designing and evaluating an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care: randomized controlled trial.
abstract: BACKGROUND
  Web-based learning is becoming an increasingly important instructional tool in nursing education. Multimedia advancements offer the potential for creating authentic nursing activities for developing nursing competency in clinical practice.
  
  
  OBJECTIVE
  This study aims to describe the design, development, and evaluation of an interactive multimedia Web-based simulation for developing nurses' competencies in acute nursing care.
  
  
  METHODS
  Authentic nursing activities were developed in a Web-based simulation using a variety of instructional strategies including animation video, multimedia instructional material, virtual patients, and online quizzes. A randomized controlled study was conducted on 67 registered nurses who were recruited from the general ward units of an acute care tertiary hospital. Following a baseline evaluation of all participants' clinical performance in a simulated clinical setting, the experimental group received 3 hours of Web-based simulation and completed a survey to evaluate their perceptions of the program. All participants were re-tested for their clinical performances using a validated tool.
  
  
  RESULTS
  The clinical performance posttest scores of the experimental group improved significantly (P<.001) from the pretest scores after the Web-based simulation. In addition, compared to the control group, the experimental group had significantly higher clinical performance posttest scores (P<.001) after controlling the pretest scores. The participants from the experimental group were satisfied with their learning experience and gave positive ratings for the quality of the Web-based simulation. Themes emerging from the comments about the most valuable aspects of the Web-based simulation include relevance to practice, instructional strategies, and fostering problem solving.
  
  
  CONCLUSIONS
  Engaging in authentic nursing activities using interactive multimedia Web-based simulation can enhance nurses' competencies in acute care. Web-based simulations provide a promising educational tool in institutions where large groups of nurses need to be trained in acute nursing care and accessibility to repetitive training is essential for achieving long-term retention of clinical competency.
authors.affiliation: National University of Singapore, Singapore, Singapore. nurliaw@nus.edu.sg.
authors.forename: Sok Ying
authors.identifier: http://orcid.org/0000-0002-8326-4049
authors.initials: SY
authors.lastname: Liaw
authors.forename: Lai Fun
authors.identifier: http://orcid.org/0000-0002-5208-2322
authors.initials: LF
authors.lastname: Wong
authors.forename: Sally Wai-Chi
authors.identifier: http://orcid.org/0000-0001-5484-4645
authors.initials: SW
authors.lastname: Chan
authors.forename: Jasmine Tze Yin
authors.identifier: http://orcid.org/0000-0001-9472-1543
authors.initials: JT
authors.lastname: Ho
authors.forename: Siti Zubaidah
authors.identifier: http://orcid.org/0000-0002-3005-3088
authors.initials: SZ
authors.lastname: Mordiffi
authors.forename: Sophia Bee Leng
authors.identifier: http://orcid.org/0000-0003-1916-6177
authors.initials: SB
authors.lastname: Ang
authors.forename: Poh Sun
authors.identifier: http://orcid.org/0000-0002-1531-2053
authors.initials: PS
authors.lastname: Goh
authors.forename: Emily Neo Kim
authors.identifier: http://orcid.org/0000-0002-1956-8427
authors.initials: EN
authors.lastname: Ang
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003198:Computer Simulation; D020375:Education, Distance; D004506:Education, Nursing / Q000379:methods*; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D019212:Multimedia; D009726:Nurses
keywords: Web-based simulation; acute nursing care; authentic learning; clinical competency; deterioration; instructional strategies; multimedia; simulation