WEB-BASED SIMULATION: A TOOL FOR TEACHING CRITICAL CARE NURSING
Sayonara de Fatima Faria Barbosa1 Heimar de Fatima Marin2
Barbosa SFF, Marin HF. Web-based simulation: a tool for teaching critical care nursing. Rev Latino-am Enfermagem 2009 janeiro-fevereiro; 17(1):7-13.
The objectives of this study were to develop, to implement and to evaluate a web-based simulation for critical care nursing, as a tool for teaching nursing students at the undergraduate level. An adapted methodology was used to develop teaching material in a web-based learning environment, consisting of three evaluation phases (ergonomic, pedagogical and usability), carried out by web-designers/programmers, nursing teachers/nurses, and undergraduate nursing students. The research tools used were three different evaluation forms, based on a five-point Likert scale, which were applied after using the simulation. The results garnered from the forms show positive analyses in every evaluation, with special emphasis on the encouragement of learning in the pedagogical evaluation period. In the usability evaluation, the highlight was on the students’ satisfaction in using the environment and how easy it was to navigate. This shows the feasibility of using this simulation to improve the learning process.
DESCRIPTORS: nursing informatics; internet; education, nursing
SIMULACIÓN UTILIZANDO LA WEB: UNA HERRAMIENTA PARA LA ENSEÑANZA DE
ENFERMERÍA EN TERAPIA INTENSIVA
Este estudio tuvo por objetivos desarrollar, implementar y evaluar una simulación de terapia intensiva, utilizando la tecnología web, para la enseñanza de graduación en enfermería. Fue utilizada una metodología adaptada para la construcción de material de instrucción en ambiente de enseñanza web, compuesta por tres fases de evaluación (ergonómica, pedagógica y utilización), realizadas por webdesigners/programadores, docentes/ enfermeros y alumnos del curso de graduación en enfermería. Como instrumentos de investigación, fueron aplicados tres diferentes formularios de evaluación, basados en la escala Likert de cinco puntos, después de la utilización de la simulación. Los resultados presentados en los formularios muestran análisis positivos en todas las evaluaciones, destacando en la evaluación pedagógica el estímulo al aprendizaje y en la evaluación de utilización la satisfacción de los alumnos al usar el ambiente y al constatar la facilidad del manoseo, traduciendo la indicación del uso de esa simulación en un proceso para mejorar la enseñanza y el aprendizaje.
DESCRIPTORES: enfermería informática; internet; educación en enfermería
SIMULAÇÃO BASEADA NA WEB: UMA FERRAMENTA PARA O ENSINO DE ENFERMAGEM
EM TERAPIA INTENSIVA
Este estudo teve por objetivos desenvolver, implementar e avaliar uma simulação em terapia intensiva, utilizando a tecnologia web, para o ensino de graduação em enfermagem. Foi utilizada metodologia adaptada para construção de material instrucional em ambiente de ensino web, composta por três fases de avaliação (ergonômica, pedagógica e usabilidade), realizadas por webdesigners/programadores, docentes/enfermeiros e alunos do curso de graduação em enfermagem. Como instrumentos de pesquisa, foram aplicados três diferentes formulários de avaliação, baseados em escala Likert de cinco pontos, após a utilização da simulação. Os resultados apresentados nos formulários mostram análises positivas em todas as avaliações, destacando na avaliação pedagógica o estímulo ao aprendizado e na avaliação de usabilidade a satisfação dos alunos na utilização do ambiente e a facilidade de manuseio, traduzindo a indicação do uso dessa simulação para melhoria do processo ensino-aprendizagem.
DESCRITORES: informática em enfermagem; internet; educação em enfermagem
1Ph.D. in Nursing, Adjunct Professor at Universidade Federal de Santa Catarina, Brazil, e-mail: sayonara.barbosa@uol.com.br; 2Free Lecture, Full Professor
at Universidade Federal de São Paulo, Brazil, e-mail: heimar@denf.epm.br.
INTRODUCTION
T
he popularity of internet use has triggered initiatives to developing new approaches to healtheducation. This allowed for implementing new
interactive media along with new teaching methods. Using computer tools in health teaching is
justified by the complex information, and often in
great amounts, that is required to be used in the decision-making process, and by the possibility that
these tools offer as new forms of educational
material, including sound, image, and video in an interactive manner.
The study of intensive care nursing is a
great challenge for students. Besides facing the complex health condition of patients in this health
c a r e s e t t i n g , t h e s t u d e n t s m u s t h a v e b a s i c
knowledge of monitoring with equipment that translates the patients’ clinical parameters, and
understand the complexity implied by the health
care demands, as well as to articulate a whole body of previously acquired and constantly increasing
knowledge. The patient’s characteristic of being in
a critical health condition implies that teaching in this area should include the development of sharper
perception skills and the ability to make fast and accurate decisions.
The clinical setting of critical care is usually
that of a place with an intense work rhythm, in which patients are clinically unstable. Nonetheless, despite
the various clinical situations that can occur in this
unit, it is not always the case that students have the opportunity to experience either a common or
critical clinical situation that would allow for a safer
professional practice in the future. Furthermore, the professor does not have control over the types of
experiences that the student will have, or the
conditions under which abilities can be observed, learned, or practiced, which, together with the lack
of the educational resources necessary for a deeper
k n o w l e d g e a c q u i s i t i o n , c a n c a u s e a l a c k o f appropriate theoretical and logical support for the
students’ decision-making process.
In regard to teaching, the internet is very promising; resources can and should be further
explored in nursing(1). Educators should, therefore,
b e a w a r e o f t h e p o s s i b i l i t i e s i n h e r e n t i n t h i s technology, such as favoring the development of
new products and processes, which could contribute
to insert nursing into other scenarios.
Hence, with the aim to incorporate new
t e a c h i n g - l e a r n i n g a p p r o a c h e s u s i n g c o m p u t e r
resources, developing clinical simulations could be an innovative and complementary proposal for
nursing education, allowing students to learn without
taking the risks that could emerge as a consequence of inaccurate actions(2). This development proposal
a l s o o f f e r s s t u d e n t s t h e o p p o r t u n i t y t o u s e
multimedia resources developed for this purpose. The concern with promoting safety in health
care has been continuously reinforced(3-4), since it
implies high costs for patients who sustain injury as a result of the health care process(5). In other words,
using computer technology can contribute in the
sense that it helps to improve practice and, thus, minimize the inherent risks, since there are no
p a t i e n t s i n v o l v e d i n t h i s p r o c e s s . A n o t h e r
consideration is the innovation of teaching-learning strategies, allowing for a more comprehensive
s t u d e n t e v a l u a t i o n , t h u s c o m p l e m e n t i n g t h e
practical education with a better cognitive evaluation. Taking these factors into consideration, the study
objective was to develop and analyze the application
of a clinical simulation environment in critical care nursing, through the internet, with a view to offering
the elements to improve educational quality in this area, and helping students to improve their critical
thinking and questioning of the practice itself.
MATERIALS AND METHODS
This is a descriptive, applied study in the
research field of Computers, Information Technology
and Nursing and Health Communication, developed at the Center for Nursing Informatics at the Federal
University of São Paulo (NIEn/UNIFESP). The project
was approved by the UNIFESP Research Ethics Committee, and each subject was properly informed
and signed the Free and Informed Consent Form,
as per Resolution 196/96 of the National Health Council (CNS – Conselho Nacional da Saúde).
In regard to intellectual authorship, the
a u t h o r s o f t h e t o o l s u s e d i n t h e p e d a g o g i c a l evaluation(6-7) and usability evaluation(8) phases were
contacted via e-mail to obtain their permission to
use and adapt the respective tools.
The selected application domain was part
Nursing Course at the Federal University of Santa
Catarina. The selected evaluation themes were the
evaluation of critical patients, acute respiratory insufficiency, mechanical ventilation, and thoracic
drainage. The simulation presented, in general
t e r m s , a p a t i e n t ’ s p r e l i m i n a r y d a t a f r o m t h e moment he was admitted to the Intensive Care
Unit, a victim of a stab wound injury to his right
hemithorax, causing acute respiratory failure and making mechanical ventilation necessary. With this
initial information, the students selected which data
they thought important for the evaluation, so that they could propose the nursing actions pertinent
to the data they took into consideration.
To develop the environment, methodology adaptation was used to construct the teaching
material in a web-based(9) teaching environment,
consisting of six phases.
In the teaching design phase, definitions
w e r e c r e a t e d r e g a r d i n g t h e e n v i r o n m e n t ’ s
pedagogical architecture, the educational goals, t h e t h e o r e t i c a l c o n t e n t o f t h e k n o w l e d g e
foundation, and the resources used, such as image
and audio files.
I n t h e c o m p u t e r m o d e l i n g p h a s e , t h e
requirements for developing and implementing the environment were determined, and this phase
i n c l u d e d t h e u s e o f v a r i o u s s o f t w a r e :
Dreamweaver® (HTML and PHP pages); Fireworks® (image edition), and Flash® (animations). The
s i m u l a t i o n c o n s i s t e d o f d y n a m i c w e b p a g e s
programmed in PHP (script 4.3) to construct the inference motor and the user’s research interface,
and a relational databank – MySQL 4.0. To execute
the dynamic pages, an Apache® 2.0 server with web interface was used.
For the ergonomic evaluation, a tool was
administered to make a technical evaluation of the developed environment. Four web-designers and
p r o g r a m m e r s p a r t i c i p a t e d i n t h i s p h a s e , w h o
performed the evaluation by filling out an online form after ending the access to the simulation, which
was done using a login and password created
s p e c i f i c a l l y f o r t h i s p u r p o s e . T h e e r g o n o m i c evaluation tool consisted of 15 items distributed in
three criteria: organization (4 items), presentation
(5 items), and technical criteria (6 items). Each item presented a value scale with five answer categories:
(1) bad, (2) regular, (3) good, (4) very good, and
(5) excellent.
The purpose of the pedagogic evaluation
phase was to validate the articulation of the theoretical
content with the proposed knowledge foundation, and was performed by filling out an online form adapted
and based on other tools(6-7). The form was
administered to a group of experts composed of four nursing professors and four intensive care nurses,
who filled them out after they finished using the
simulation. The evaluators had access to the website with the respective evaluation form, using a login and
password defined specifically for this use. The
pedagogical evaluation tool consisted of 44 items, distributed in three criteria: content evaluation (12
items), content organization and presentation (27
items), and evaluation of learning (5 items). Each item had five answer categories, in a Likert scale: (1)
strongly disagree, (2) partially disagree, (3)
undecided, (4) partially agree, and (5) strongly agree. The implementation phase of the environment
was performed after two previous evaluations and
the adjustment of proposed changes; the simulation was then made available on the web server of the
Nursing Department at the Federal University of São
Paulo (http://www.unifesp.br/denf/NIEn/simula). The simulation consisted of a group of web pages with
text and graphic descriptions of the clinical condition of a patient hospitalized in an Intensive Care Unit.
These pages were linked but dynamic, and had access
to a databank.
Finally, the purpose of the usability evaluation
was to determine the participants’ level of satisfaction,
motivation and difficulties when using the environment. To do this, an adapted tool(8) was used,
which the students filled out immediately after finishing
the simulation, using the online form available on the same site. Subjects in this phase were 25 students
from the 6th academic term of the Nursing Course at
the Federal University of Santa Catarina, who were enrolled in the Nursing in surgical and emergency incidents class.
RESULTS
The data collected by administering the
simulation evaluation tools were coded into an
electronic spreadsheet and treated using SPSS® for Windows® (Statistical Package for the Social Sciences). Descriptive statistical analysis was applied to the
students and professors), which included calculating
the means and standard deviations.
Ergonomic evaluation
The organization criteria achieved a 4.43 mean, in which its items concerning the easiness of
using the site, the layout logic and consistency in every
page presented a variation of 0.25 under the objectivity of the layout.
The presentation criteria showed balance.
Among its items, the harmony between the text and the pages’ background and the appropriate use of
graphic elements and animations achieved similar
means (4.5) and were considered satisfactory. The other criteria, such as adequate color and font use,
also achieved identical and higher means (4.75).
In regard to the technical criteria, its overall mean was 4.79. The items concerning adequate link
functioning, graphic optimization for different band
widths, working in different browsers, and page upload speed were considered excellent by the evaluators,
achieving a mean of 5. The connection with the
databank was considered very good (4.5), and so was multimedia resource functioning.
The ergonomic evaluation was extremely important because it allowed for the adjustment of
several aspects that had not been foreseen in the
preliminary version of the simulation, and were not part of the evaluation tool used.
The results achieved in this phase were
considered satisfactory and, after making the suggested adjustments, the next evaluation phase
was started.
Pedagogical evaluation
Most items in the content evaluation criteria (Table 1) received positive evaluations; that is,
presented means above four (partially agree). There
was unanimous agreement that the grammar used was appropriate, and the items with the highest means
were the items concerning the information
presentation at the appropriate level for students, the materials’ encouragement towards leaning, and the
website’s limitations do not exceed its value, all of
which achieved an identical mean (4.875±0.354). The only item with an unsatisfactory evaluation for the
adopted criteria was information clarity and
conciseness (mean 3.62±0.744).
Table 1 – Content evaluation criteria
As for content organization and presentation criteria (Table 2), the items concerning the text color
adequacy, balance of the number of colors on each
screen, and the quality of text, images, graphics, and
video achieved maximum means, showing there was
unanimous consensus.
Content division into small segments, using
font with appropriate style and size, text readability,
and the presentation of information that captured the
students’ attention were items that also achieved high
and equal means (4.75±0.46).
The page upload speed and the user-friendly
internet use (surfing) from page to page achieved
identical means (4.625±0.518). The students’
identification of the moment they had reached in the
simulation achieved a mean of 4.5±0.53. Immediate
feedback after the answer obtained a 4.375±0.518
mean. The item concerning the design overload on
the student’s memory did not receive a satisfactory
evaluation (3.625±0.916).
Paradoxically, although the item that
considered sound as an unnecessary alternative
presentation form received a low evaluation
(1.5±1.07), this result reinforced the importance of
using sound in the simulation, because the low mean
shows that most evaluators disagree that sound is an
unnecessary alternative medium. n o i t a u l a v e t n e t n o
C Mean Standard
n o i t a i v e d
e t a d -o t -p u s i t n e t n o c e h T .
1 4.75 0.46
d n a r a e l c a n i d e t n e s e r p s i n o i t a m r o f n i e h T . 2
r e n n a m e s i c n o
c 3.625 0.744
e s u r a m m a r g t c e r r o C .
3 5 0
d e z i n a g r o y ll a c i g o l s i t n e t n o c e h T .
4 4.125 0,991
e c n e i d u a -t e g r a t e h t h t i w t n e r e h o c s i t n e t n o c e h T .
5 4.625 0.518
e t a i r p o r p p a e h t t a d e t n e s e r p s i n o i t a m r o f n i e h T . 6
s t n e d u t s r o f l e v e
l 4.875 0.354
s l a o g d e s o p o r p e h t h t i w e c n e r e h o c s i e r e h T .
7 4.5 0.53
g n i n r a e l s e g a r u o c n e l a i r e t a m e h T .
8 4.875 0.354
d e n i f e d y l r a e l c e r a s l a o g g n i n r a e l e h T .
9 4.25 0.46
ll e w y t il a e r s e t a l u m i s l a i r e t a m e h T . 0
1 4.375 0.518
e u l a v s t i s s a p r u s t o n o d s n o i t a t i m il e t i s b e w e h T . 1
1 4.875 0.354
e c n e i r e p x e m o r f g n i n r a e l s t i m r e P . 2
1 4.625 0.518
s n a e m l a n i
Table 2 – Content organization and presentation criteria
In the learning evaluation criteria (Table 3),
using the simulation as an educational tool was
strongly indicated (mean 4.625±0.518) and the ease
of use and effectiveness in teaching achieved
identical means (4.375±0.518). The ability to retain
the simulation in the students’ memory was positively
evaluated (4.0±0.76). The simulation structure was
considered broad, favoring students with average
performance, who were able to fully understand and
follow (4.0±0.93).
Table 3 – Learning evaluation criteria
The results obtained in the pedagogical
evaluation were considered satisfactory for the
simulation to be implemented with students. Although
some of the proposed suggestions were important,
not all of them could be considered before applying
the tool with students, since they concerned making
deep conceptual changes in the developed model.
Usability evaluation
The usability evaluation consisted of a form
with 17 items, distributed in three criteria: general
reaction to simulation use (5 items), evaluation of
the screens (9 items), and learning (3 items). The
items were distributed on a scale with five answer
categories that varied according to the intensity of
the evaluated item.
All items related to the criteria concerning
the general reaction to the simulation (Table 4)
achieved good evaluations. With high means
(4.84±0.374), the students showed satisfaction
towards using the simulation. The overall simulation-a i r e t i r c n o i t a t n e s e r p d n a n o i t a z i n a g r o t n e t n o
C Mean Standard
n o i t a i v e d r e n n a m e l b i s n e h e r p m o c d n a r a e l c a n i d e t n e s e r p s i t n e t n o c e h T .
1 4.25 0.46
t n e i c i f f u s d n a r a e l c s i s t n e d u t s r o f n o i t a t n e m u c o d e h T .
2 4.25 0.46
s t n e m g e s ll a m s o t n i d e d i v i d s i t n e t n o c e h T .
3 4.75 0.46
s s e c o r p g n i n r a e l e h t t p u r r e t n i t o n o d t a h t s n o i t s e u q h t i w s t n e d u t s s t n e s e r p n o i t a l u m i s e h T .
4 3.875 0.641
y l d n e i r f -r e s u s i g n i f r u s t e n r e t n I .
5 4.625 0.518
e r a y e h t n o i t a l u m i s e h t f o t n e m o m h c i h w n i s w o n k s y a w l a t n e d u t s e h T .
6 4.5 0.53
r e w s n a e h t r e t f a d e d i v o r p s i k c a b d e e f e t a i d e m m I .
7 4.375 0.518
e c n a m r o f r e p r i e h t k c e h c o t s t n e d u t s s t i m r e p n o i t a l u m i s e h T .
8 4.5 0.53
e t a i r p o r p p a s i e c a f r e t n I .
9 4.125 0.835
r e n n a m e l b i s n e h e r p m o c d n a r a e l c a n i d e p o l e v e d e r e w s n e e r c s e h T . 0
1 4.5 0.53
n o i t n e t t a ' s t n e d u t s e h t s e r u t p a c n o i t a t n e s e r p n o i t a m r o f n i e h T . 1
1 4.75 0.46
y r o m e m e t a l u m i t s n a c n o i t a t n e s e r p n o i t a m r o f n i e h T . 2
1 4 0.53
y r o m e m ' s t n e d u t s e h t d a o l r e v o t o n s e o d n g i s e d e h T . 3
1 3.625 0.916
n e e r c s e h t n o d e t u b i r t s i d ll e w s i e c a p s e h T . 4
1 4.875 0.354
e l y t s d n a e z i s e t a i r p o r p p a f o e r a s t n o f e h T . 5
1 4.75 0.46
d a e r o t y s a e s i t x e t e h T . 6
1 4.75 0.46
r o l o c e t a i r p o r p p a n a n i s i t x e t e h T . 7
1 5 0
n e e r c s h c a e n o s r o l o c f o r e b m u n e h t n i e c n a l a b s i e r e h T . 8
1 5 0
d o o g e r a y t il a u q o e d i v d n a c i h p a r g , e g a m i , t x e T . 9
1 5 0
. t x e t e h t n i n o i t a m r o f n i e h t r o f t n a v e l e r e r a d e t n e s e r p s e r u t c i p e h T . 0
2 4.25 0.89
d e d i v o r p t x e t e h t d e t r o p p u s y l g n o r t s e s u e g a m I . 1
2 4 1.41
n o i t a t n e s e r p n o i t a m r o f n i d e v o r p m i o e d i v e h T . 2
2 4.25 1.16
n o i t a t n e s e r p n o i t a m r o f n i d e v o r p m i d n a y t il a u q d o o g s a h d n u o s e h T . 3
2 4 1.31
n o i t a m r o f n i e h t g n i t n e s e r p f o m r o f e v i t a n r e tl a y r a s s e c e n n u n a s i d n u o s e h T . 4
2 1.5 1.07
y r o t c a f s i t a s s i d e e p s d a o l p u e g a P . 5
2 4.625 0.518
d e s u t o n e r e w s r a b ll o r c s l a t n o z i r o h e h T . 6
2 4.25 0.89
s t i n u l a n o i t c n u f d n a ll a m s n i d e z i n a g r o s i n o i t a m r o f n i e h T . 7
2 4.25 0.71
s n a e m l a n i
F 4.319 0.937
n o i t a u l a v e g n i n r a e
L Mean Standard
n o i t a i v e d e s u o t y s a e s i n o i t a l u m i s e h T .
1 4.375 0.518
t n e i c i f f e -g n i h c a e t s i n o i t a l u m i s e h T .
2 4.375 0.518
e h t n i d e n i a t e r y l i s a e s i n o i t a l u m i s e h t f o e s U . 3 n r u t e r o t e l b a s i t n e d u t s l a u s a c e h t ; y r o m e m ' s t n e d u t s w o h n r a e l -e r o t g n i d e e n t u o h t i w e m i t e m o s r e t f a t i o t t i e s u o t
4 0.76
e g a r e v a h t i w s t n e d u t s d n a d a o r b s i e r u t c u r t s e h T . 4 t i w o ll o f o t e l b a e r a e c n a m r o f r e
p 4 0.93
n a s a d e s u e b o t d e t a c i d n i s i n o i t a l u m i s e h T . 5 l o o t l a n o i t a c u d
e 4.625 0.518
s n a e m l a n i
use experience achieved a mean of 4.8±0.408,
identical to the simulation usefulness (4.8±0.41), and
the item concerning the encouragement towards the simulation received a 4.6 mean. The simulation was
considered easy to use, with a 4.44 evaluation mean.
Table 4 – General simulation-use reaction criteria
In the screen evaluation criteria (Table 5),
the colors used in the simulation were unanimously
considered appropriate. The sound files were
considered adequate (4.84±0.374) and so were the
videos (4.48±0.77) and images (4.4±0.645). The
on-screen text readability was considered high (4.6±0.5).
Table 5 – Screen evaluation criteria
In the learning evaluation criteria, the item
concerning the contribution of learning to using the simulation achieved a mean of 4.72±0.458. A
satisfactory value was also observed for the level of
contribution to learning (4.2±0.408). Nevertheless, the item concerning satisfaction with the performance
in the simulation did not achieve a satisfactory value
(3.56±1.157).
DISCUSSION
In the pedagogical evaluation, the obtained
means show a positive contextualization of the
content, in tune with the contemporariness and
pertinence of its approach, considering the current
state-of-the-art, as well as content coherence with the target audience and the course curricula. This
shows the considerable proximity to the content of
on-site learning, but preserves the features of web-based teaching.
Positive aspects in the pedagogical evaluation
include the students’ opportunity to make a self-evaluation of data searching and proposing critical
patient care, in addition to encouraging learning. Other
points that were highlighted were the use of good-quality video and sound, sending out positive
encouraging messages to the user, and the simulation
being innovative, with the potential to augment learning. As to the negative aspects, one evaluator
reported that using a problem list is confusing and
can prevent establishing adequate interventions to meet each need. It was also noted that the simulation
was somewhat repetitive and long, and used
abbreviations. The inability to return to initial data and interrupt the study and come back again later
was also mentioned. Suggestions were made to
provide content and format reviews of the interventions, using the International Classification for
Nursing Practice, and developing a screen at the end of the simulation with the result from the three
evaluations, so that the student could make a more
visual evaluation of patient evolution.
Some of the positive aspects of the usability
evaluation were: easy visualization, which makes
students think and remember the content; easy to use and does not require advanced computer skills;
fast feedback to the questions provides continued
learning, encourages the perception of sounds and uses efficient sound and image resources for the
evaluation. The negative aspects reported include the
inability to ‘return’ to the previous evaluation to compare with the current one, and the presentation
of some data difficult to evaluate because of
forgetting reference values. The suggestions made were to create a help window (like literature
references) and include a link to check reference
values.
CONCLUSION
The ergonomic, pedagogic, and usability
evaluations reveal an overall satisfactory analysis, n
o i t a l u m i s e h t g n i s u o t n o i t c a e r l a r e n e
G Mean Standard
n o i t a i v e d
e c n e i r e p x e ll a r e v O .
1 4.8 0.408
e s u f o e s a E .
2 4.44 0.51
g n i s u f o n o i t c a f s i t a S .
3 4.84 0.374
e s u o t t n e m e g a r u o c n E .
4 4.6 0.65
s s e n l u f e s U .
5 4.8 0.41
s n a e m ll a r e v
O 4.696 0.496
s n e e r c
S Mean Standard
n o i t a i v e d
y t il i b a d a e r t x e t n e e r c s -n O .
1 4.6 0.5
e r u t c u r t s g n i f r u s -b e W .
2 4.76 0.435
n o i t a z i n a g r o n o i t a m r o f n I .
3 3.96 0.789
y c a u q e d a e l i f d n u o S .
4 4.84 0.374
y c a u q e d a e l i f o e d i V .
5 4.48 0.77
y c a u q e d a e g a m I .
6 4.4 0.645
y c a u q e d a r o l o C .
7 5 0
e c n e u q e s n e e r c S .
8 4.56 0.583
d e e p s d a o l p u e g a P .
9 4.8 0.408
s n a e m ll a r e v
indicating the validity of this simulation tool to improve
the teaching-learning process.
These study results were important to better understand the various aspects involved in the
process of developing and using alternative
educational technologies in undergraduate courses, as well as the students’ response to this process, which
showed the possible benefits, aspects that have been
previously reported in other studies (10-11).
Using computer technology resources in the
teaching-learning process implies the need to not only
incorporate knowledge that is pertinent to the area, but also the need to search and improve concepts
founded on software ergonomics and pedagogy with
a view to development and further improvements. Emphasis should be given to the pedagogic issue
rather than exclusively to technology per se(12). Developing and using new educational approaches via the internet contribute by
complementing on-site learning, as well as by creating
the possibility of enhancing the teaching-learning process and progressively incorporating new
technologies and resources into the teaching mode
that is more in-tune with the society’s educational
needs. The fact that there are still only a few experiences involving the use of computer technology
in nursing education shows that there is a need to
develop a greater number of studies that compare the results and perform a more in-depth research.
Simply using educational software will
certainly not solve every problem involved in the education aspects included in the teaching context.
In fact, to reach a solution for these problems, it is
necessary to make changes that do not only involve the professors, but also the educational process itself.
Hence, this study showed the viability of developing
a simulation primarily focused on web-based nursing undergraduate education, and it is a door to further
study. Nursing education is going through rapid
changes, which means it is necessary for educators to consider what is stated in the curricular guidelines,
and also to encourage students towards independent
study practices, with a view to their progressive intellectual and professional autonomy.
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