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Diabetes has placed heavy social and economic burdens on society and families worldwide. Insufficient knowledge and training of frontline medical staff, such as nurses, interns, and residents, may lead to an increase in acute and chronic complications among patients with diabetes. However, interns have insufficient knowledge about diabetes management. The factors that affect interns’ current level of diabetes-related knowledge are still unclear. Therefore, understanding the behavioral intentions of interns is essential to supporting the development and promotion of the use of virtual simulation teaching applications.
This study aimed to identify the determinants of nursing interns’ intentions to use simulation-based education applications.
From December 1, 2020, to February 28, 2021, the web-based survey tool Sojump (Changsha Xingxin Information Technology Co) was used to survey nursing interns in hospitals across China. Two survey links were sent to 37 partner schools in 23 major cities in China, and they were disseminated through participants’ WeChat networks. Multiple regression analysis was used to determine the association between demographic information and basic disease information and the use of the application for treating adult patients.
Overall, 883 nursing interns from 23 provinces in China responded to the survey. Among them, the virtual simulation utilization rate was 35.6% (314/883) and the awareness rate was 10.2% (90/883). In addition, among the interns, only 10.2% (90/883) correctly understood the concept of virtual simulation, and most of them (793/883, 89.8%) believed that scenario-simulation training or the use of models for teaching are all the same. Multiple regression analysis showed that the educational level, independent learning ability, and professional identity of the interns were related to use of the application (
The understanding and usage rate of diabetes virtual simulation teaching applications by Chinese nursing interns is very low. However, they have high requirements regarding this teaching method. Conducting high-quality randomized controlled trials and designing applications that are suitable for the needs of different nurse trainees will increase students’ interest in learning and help improve diabetes knowledge among nursing interns.
With the rapid development of the social economy, continuous changes in modern people’s behaviors and lifestyles, and the aging of the population, the incidence of diabetes is also increasing rapidly in all parts of the world. According to forecasts, from 1995 to 2030, the number of patients with diabetes worldwide will increase from 135 million to 472 million, among which more than 75% are in developing countries [
Effective diabetes education for patients is indispensable; it is a necessary means to ensure that patients receive effective therapies. Nurses are the most important providers of diabetes education in China. Due to China’s national conditions, there are no specialized diabetes educators that provide health guidance and dietary education to patients with diabetes. Such work is often undertaken by clinical staff (doctors, nurses, interns, etc). Nurses and interns have the most contact with patients with diabetes and are most likely to provide patients with diabetes-related knowledge [
The cultivation of self-learning ability by interns is inseparable from the application of self-learning methods and tools [
Interns’ apprenticeships have always constituted a challenge faced by the government, health educators, health managers, and the students themselves to ensure the quality and safety of learning and clinical practice [
A virtual simulation is a real-life reproduction depicted on a computer screen, and it involves a real person operating the simulation system. This type of simulation puts people at the center of a situation by exercising decision making, motor control, and communication skills [
This study aimed to assess the knowledge needs of nursing students for managing diabetes mellitus. By evaluating the self-learning ability of nursing students and the degree of demand for diabetes-related knowledge, the demand for virtual simulation teaching applications for nursing students was explored. Therefore, the purpose of this study was to evaluate the level of understanding of diabetes specialist knowledge and the demand for virtual simulation teaching among nursing students in China.
We aimed to investigate the use of virtual simulation teaching applications by nursing interns as well as their perspectives, attitudes, and associated factors regarding these teaching applications. We also aimed to investigate interns’ needs for these applications in order to provide information for the design of virtual simulation teaching applications and to learn how best to promote their use, which will help teachers to further improve their teaching methods and strengthen the willingness of nursing students to learn independently.
An expert group consisting of five nursing educators and five clinical nursing staff members searched for applications on the national, virtual simulation, education platform; they then designed a questionnaire based on the current diabetes guidelines and the problems encountered in clinical practice. These questions were presented in a selective format. If the respondent disagreed with the listed options, they could select “other options” and write their answer in the “remarks” column. The questionnaire collected information about respondents’ demographics and their views, attitudes, and needs for virtual simulation education applications.
To determine the validity of the questionnaire content, a total of 15 experts, consisting of 12 nursing education experts and three diabetes education nurses with at least 5 years of experience, rated the relevance and clarity of the items on a 4-point scale ranging from 1 (irrelevant) to 4 (highly relevant), with a content validity index of 0.91. Before administering the questionnaire survey, we conducted a pilot test on 18 interns at Xiangya Second Hospital in China. The Cronbach α value of the questionnaire was .83.
WeChat has become one of the largest mobile traffic platforms in China. It provides many services, including messaging, free phone calls, browsing and publishing for instant sharing of information, and mobile payments [
From December 1, 2020, to February 28, 2021, we used Sojump (Changsha Xingxin Information Technology Co), a web-based survey tool, to conduct snowball sampling through the WeChat contact network and to conduct convenience sampling through WeChat public accounts to recruit interns. The survey link was initially sent to 35 universities in 23 representative major cities in China. We asked the teachers at these universities to post the survey link on their WeChat account to reach their network contacts.
Survey respondents were all nursing trainees in China. Other nursing students who did not take part in internships at hospitals were excluded from our survey. Before administering the survey, we introduced the purpose of the survey, and the questionnaire was filled out by respondents voluntarily without any compensation.
This study was approved by the ethics committee of the Second Xiangya Hospital, Central South University, China (ID: 2020-S790).
The data were analyzed using SPSS, version 23.0 (IBM Corp). Quantile-quantile (Q-Q) charts were used to check the normality of all continuous variables and express them as the mean (SD) or median (IQR) where appropriate. Categorical variables were expressed as frequencies and percentages. The chi-square test was used to assess the differences between groups. The generalized logic model was used to obtain the odds ratio (OR) and its 95% CI at the same time. First, we conducted a univariate analysis to analyze the OR of the potential correlation between demographic factors and autonomous learning ability. Then, we inputted all important factors into the multivariate analysis to obtain the multivariate adjusted OR. Questionnaires with missing values were excluded from the multivariate analysis. Statistical significance was defined as
A total of 883 interns distributed among 26 provinces in China (
Distribution of the nursing intern sample in China by province. The numbers represent how many questionnaires were collected in each corresponding province.
Characteristics of nursing interns.
Characteristic | Respondents (N=883) | |
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Male | 89 (10.1) |
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Female | 794 (89.9) |
Age (years), mean (SD) | 20.64 (2.1) | |
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Middle school | 26 (2.9) |
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High school | 102 (11.6) |
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Technical college | 502 (56.9) |
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Bachelor’s degree | 242 (27.4) |
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Master’s degree or higher | 11 (1.2) |
Internship time (months), mean (SD) | 6.02 (1.6) | |
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I like nursing | 287 (32.5) |
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Parents’ suggestion | 247 (28.0) |
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Acquaintances’ recommendation | 55 (6.2) |
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The school transferred me | 99 (11.2) |
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Good employment | 195 (22.1) |
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I love the nursing career | 410 (46.4) |
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Not sure | 197 (22.3) |
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I can accept as a job, but not as a career | 260 (29.4) |
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I don’t like nursing | 16 (1.8) |
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Nurse | 747 (84.6) |
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Nursing-related industries | 115 (13.0) |
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Others | 21 (2.4) |
All of the interns (N=883) were able to fill out the self-learning ability scale. The Q-Q normality was the sum of the total scores of the self-learning ability of interns (
The normal quantile-quantile (Q-Q) chart for the score of autonomous learning ability.
The normal quantile-quantile (Q-Q) chart for the score of the learning strategy scale.
Correlation analysis of self-learning ability of interns (N=883).
Characteristic | Autonomous learning ability | Score of learning strategy scale | ||
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Age | –0.020 | .56 | –0.014 | .67 |
Gender | –0.101 | .10 | 0.018 | .59 |
Educational level | 0.008 | .81 | 0.008 | .81 |
Internship time | 0.410 | .22 | –0.044 | .19 |
Reason for choosing nursing | 0.993 | <.001 | 0.174 | <.001 |
Feelings about nursing | 0.595 | .02 | 0.298 | <.001 |
Employment intention | 0.011 | .75 | –0.175 | <.001 |
Nursing trainees believed that important functions of a diabetes virtual simulation application are to help them treat patients with hypoglycemia and the simulation of functional tests. Almost all respondents believed the listed functions were important or very important. However, most interns believed that oral administration, venofusion, and intramuscular injection were important (
Importance of different simulation scenes on a diabetes virtual simulation application as reported by interns.
Comparison of teaching methods with interns' expectations. PPT: PowerPoint.
In this study, out of 883 interns, 569 (64.4%) had never participated in virtual simulation teaching and 793 (89.8%) had not heard of the concept of virtual simulation before this survey.
Nurse interns’ usage and preferences of a diabetes virtual simulation application.
Question | Respondents (N=883), n (%) | |
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No | 569 (64.4) |
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Yes | 231 (26.2) |
Have you participated in similar activities? (yes) | 83 (9.4) | |
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No | 793 (89.8) |
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Yes | 90 (10.2) |
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Very good | 138 (15.6) |
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Good | 251 (28.4) |
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Neutral | 76 (8.6) |
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Bad | 7 (0.8) |
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Very bad | 2 (0.2) |
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Do not know | 409 (46.3) |
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Very good | 354 (40.1) |
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Good | 393 (44.5) |
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Neutral | 126 (14.3) |
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Bad | 7 (0.8) |
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Very bad | 3 (0.3) |
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Comprehension skills | 156 (17.7) |
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Analytical skills | 141 (16.0) |
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Judgment skills | 48 (5.4) |
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Clinical thinking ability | 534 (60.5) |
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Others | 4 (0.5) |
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0-10 | 209 (23.7) |
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11-30 | 483 (54.7) |
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31-60 | 169 (19.1) |
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61-90 | 22 (2.5) |
Among the interns, 26.2% (231/883) had participated in virtual simulation education, and 9.4% (83/883) had participated in similar activities. These rates are comparable to results from surveys conducted in New York [
The utilization rate of virtual simulation teaching applications in China is low because of the low awareness of this teaching method among interns. Only 10.2% (90/883) of interns had heard about virtual simulation teaching. In 2008, Tsinghua University launched a medical-related virtual simulation project for the first time to help doctors complete neurosurgery operations [
Through virtual simulation, clinical thinking was the ability that interns wanted to acquire the most (534/883, 60.5%); the second most desired ability was analytical skills (141/883, 16.0%). This result is consistent with a study in Canada [
Nursing trainees believed that the scenarios that should be included in the virtual simulation of diabetes care are the treatment of patients with hypoglycemia (626/883, 70.9%), functional test simulation (610/883, 69.1%), and blood glucose monitoring technology (485/883, 54.9%).
Several studies have also shown that nursing interns lack the knowledge to properly handle patients with hypoglycemia, especially elderly patients with diabetes, which could increase the risk of acute complications in these patients [
To the best of our knowledge, no large-scale survey on the use and demand of virtual simulation has been previously conducted among Chinese nursing interns. An Indian survey showed that the need for diabetes knowledge by interns is urgent, consistent with our research, but that study did not identify what kinds of teaching tools the interns wanted. The survey only investigated the needs of first-year nursing students in one city in regard to virtual simulation [
A strength of our research is that the initial survey links for patients and diabetes experts were sent to 37 partner schools in 23 representative major cities in China, and these were disseminated through their WeChat contact networks. In addition to this snowball-sampling method, the survey was also carried out through three convenience-sampling methods on WeChat Moments.
Our research also has some limitations. First, the sample of 883 nurse interns could not fully represent all interns in China. Our sample came from 23 provinces in China; thus, not all provinces were represented. Second, our sampling was not stratified by geographic area, urban or rural area, school level, or hospital level where internships were based. Certain selection biases were inevitable. Finally, our sampling was based on the WeChat network. Although WeChat has 1.04 billion monthly active users [
Chinese nursing interns’ awareness and usage of diabetes virtual simulation teaching methods are low. However, interns desire the knowledge they would gain by using these methods. Designing virtual simulations of diabetes that are suitable for the needs of different nurse trainees will increase students’ interest in learning and help improve diabetes knowledge among nursing interns. High-quality randomized controlled trials can be conducted to improve the effectiveness of virtual simulation teaching of diabetes, provide evidence for teachers to choose suitable teaching tools, and help with the promotion of the correct management of diabetes. China should improve people’s understanding of virtual simulation teaching in universities, and relevant policies and regulations should be published to support teachers in using virtual simulation teaching tools in schools or hospitals. Virtual simulation is a potentially effective supplement for teaching. It can be used anywhere and at any time to improve the self-learning methods of Chinese nursing interns.
information and communications technology
odds ratio
quantile-quantile
This work was supported by the Education and Teaching Reform Research Project of Central South University (2020jy166-11) and the Clinical Nursing Research Fund Project of the Second Xiangya Hospital, Central South University (2019-HLKY-25), the People’s Republic of China.
None declared.