Effectiveness of Virtual Simulation Game in Teaching Venous Blood Sampling Skills to Nursing Students

Simulation-based learning is essential in nursing education, especially for improving clinical decision-making and procedural skills in a risk-free environment. Virtual Simulation Games (VSGs), a form of digital learning environment, provide students with an opportunity to practice clinical scenarios in a professional role using a game-like structure. VSGs enable students to repeatedly attempt tasks, receive immediate feedback, and experience the consequences of their actions without compromising patient safety (Luctkar-Flude et al., 2021). Despite the widespread use of simulation-based training, there is a significant gap in the literature regarding the application of VSGs for fundamental nursing skills, such as venous blood sampling. Most previous studies have focused on simulations involving mannequins, and experimental designs evaluating human-based outcomes are scarce (Verkuyl et al., 2022; Keys et al., 2020).

The use of venous blood sampling procedures is a core part of healthcare services, yet errors in the process remain a significant issue. Preanalytical errors, which include hemolyzed samples, insufficient blood volume, and mislabeled samples, account for the majority (46-68%) of laboratory errors (Hammerling, 2012). These errors are preventable and often result from improper training or lack of adherence to standard protocols (Plebani, 2010). Preanalytical errors have a direct impact on patient safety, diagnostic delays, increased costs, and excessive resource use (Alcantara et al., 2022). For instance, studies have shown the average cost of a preanalytical error is $337.05 in outpatient care in the United States, while in Europe, it averages €107.62 (Green, 2013).

The training offered by this study aims to equip nursing students with practical skills to minimize such errors, emphasizing adherence to standard procedures and effective patient care practices. By combining traditional training with a VSG, this study offers a novel approach to improving education outcomes while addressing a critical need in healthcare education.

This study is a randomized controlled trial designed to assess the effectiveness of the Virtual Simulation Game (VSG) method in teaching venous blood sampling (VBS) skills to second-year nursing students. The trial uses a structured methodology to evaluate the impact of this innovative teaching tool on students' knowledge, practical skills, satisfaction, confidence, and comfort levels compared to the traditional teaching method.

Background and Rationale

Venous blood sampling is a routine yet critical procedure in healthcare, often prone to preanalytical errors that can impact patient safety and increase healthcare costs. Traditional methods of teaching VBS in nursing education focus on hands-on practice in laboratory settings, which may not adequately address the complexity of real-world challenges. The integration of virtual simulation games offers an innovative solution by providing an immersive, interactive, and repeatable environment for skill acquisition without compromising patient safety.

The Virtual Simulation Game (VSG) aligns with experiential learning theories, such as David Kolb's model, to provide nursing students with an engaging educational experience. By simulating real-life clinical scenarios, the VSG allows students to practice decision-making, receive instant feedback, and refine their skills in a low-risk environment.

Study Design

Type of Study: Randomized Controlled Trial Blinding: Single-blind (participants are aware of their assigned intervention; evaluators are blinded) Population: Second-year nursing students enrolled in the "Fundamentals of Nursing" course, who meet the inclusion criteria.

Sample Size: A total of 220 participants, with 110 students randomized to the experimental group (VSG) and 110 to the control group (traditional teaching).

Interventions

Experimental Group (VSG):

Students access the VSG platform using unique credentials. The platform includes interactive scenarios designed to mimic real-life challenges in venous blood sampling.

Students perform VBS procedures on peers after completing the virtual simulation training.

Control Group (Traditional Method):

Students receive standard instruction and practice VBS on peers in a laboratory setting.

The procedure follows conventional teaching methods without the use of virtual simulation.

Objectives

To evaluate the impact of the VSG method on nursing students' cognitive and psychomotor skills in VBS.

To assess the influence of VSG on student satisfaction, confidence, and comfort levels during VBS education.

To compare the effectiveness of VSG with the standard teaching method in reducing preanalytical errors during VBS procedures.

Hypotheses

VSG training will improve students' knowledge levels in VBS compared to traditional teaching.

VSG training will enhance students' practical performance in VBS procedures. VSG training will increase students' satisfaction with their educational experience.

VSG training will boost students' confidence in performing VBS. VSG training will improve students' comfort levels during VBS practice. Outcome Measures

Primary and secondary outcome measures include:

Primary Outcomes:

Knowledge improvement assessed using a validated questionnaire. Skill performance evaluated through a structured checklist.

Secondary Outcomes:

Student satisfaction measured using the Student Satisfaction and Self-Confidence in Learning Scale.

Confidence and comfort levels assessed via visual analog scales. Procedures

Randomization: Students will be randomized into experimental or control groups using a computer-generated sequence.

Training:

Both groups will receive a 45-minute theoretical lecture on VBS principles. The experimental group will complete VSG training before practicing on peers. The control group will directly practice on peers after the lecture.

Assessment:

Pre- and post-intervention evaluations will be conducted to measure knowledge, skill performance, satisfaction, confidence, and comfort.

Observations will be made for complications or adverse events during the practice.

Data Collection and Analysis

Data will be collected using structured forms, checklists, and validated scales. Statistical analyses will be performed using IBM SPSS Statistics, with tests including ANOVA, Kruskal-Wallis, and correlation analyses to evaluate differences and relationships between outcomes across groups.

Ethical Considerations

The study protocol has been approved by the ethics committee of Ege University Nursing Faculty.

Informed consent will be obtained from all participants. The study adheres to the Declaration of Helsinki and relevant guidelines for ethical research involving human subjects.

Significance and Innovation

The results of this study are expected to provide evidence supporting the integration of virtual simulation games into nursing curricula. This method offers a scalable and sustainable approach to enhancing nursing education, with potential benefits for improving patient safety and reducing healthcare costs through better-prepared healthcare professionals.