The effect of high-fidelity, web-based, and hybrid simulation methods on nursing students' advanced life support practice in adults

Introduction: Advanced life support (ALS) is a medical procedure performed in response to cardiac arrest. Considering the positive impact of early recognition of cardiac arrest and timely/effective intervention on patient survival, it is crucial for nurses to receive training in advanced life support. Aim: This study aimed to examine the effects of advanced life support training delivered through high-fidelity simulation, web-based simulation, and hybrid simulation (web-based simulation + high-fidelity simulation) methods on nursing students' knowledge and skills. Method: The study employed a randomized experimental design with three intervention groups and no control group, using a pretest–posttest approach. The sample consisted of 74 final-year nursing students distributed across the intervention groups. Data were collected using the Information Form, Advanced Life Support Knowledge Test, Advanced Life Support Skills Checklist, Simulation Design Scale, Student Satisfaction and Self-Confidence in 16 Learning Scale, and Education Evaluation Form, at three time points: pre-training, post- training, and 4 months after training. Data analysis involved descriptive statistics, chi-square, mixed-design ANOVA, paired-samples t-test, and one-way ANOVA. Results: Within-group comparisons showed significant differences in knowledge test scores across all three intervention groups between pretest and posttest, pretest and follow-up, and posttest and follow-up. No significant differences were found in pretest–posttest knowledge scores between groups; however, students in the hybrid simulation group achieved higher knowledge levels than those in the other groups. Regarding skill levels, significant improvements were observed within the high-fidelity and web-based simulation groups between pretest and posttest, pretest and follow-up, and posttest and follow-up. In the hybrid simulation group, no significant difference was observed between posttest and follow-up. Between-group comparisons revealed that posttest skill scores were higher in the high-fidelity and hybrid simulation groups compared to the web-based simulation group. In the follow-up test, students in the hybrid simulation group demonstrated higher skill levels than those in the other groups, while students in the high-fidelity group outperformed those in the web-based simulation group. All intervention groups reported high scores in simulation design, student satisfaction, and self-confidence in learning. Conclusion: Advanced life support training delivered through three different simulation methods had similar short-term effects on students' knowledge levels; however, follow-up results indicated that hybrid simulation had a more lasting impact on both knowledge and skill acquisition.