Development and quasi-experimental evaluation of a self-directed case-based digital learning model for emergency nursing competence

Abstract

This study developed and evaluated a self-directed, case-based digital learning model for emergency nursing education. A sequential research-and-development approach was used. Phase 1 comprised needs assessment and model development using questionnaires, interviews, and input from clinical educators and students. Phase 2 used a quasi-experimental pretest-posttest control-group evaluation. Total sampling included all 90 students in the Professional Nursing Program. Two existing classes were allocated at class level by random selection, with class A assigned to the intervention group (n = 43) and class B to the control group (n = 47). The intervention was delivered through Google Sites three times per week for four weeks. Each session included 10-15 minutes of reading, 5-10 minutes of instructional video, and 5-10 minutes of an interactive quiz. A 12-item competency instrument covering Emergency Nursing competencies was reviewed by two experts; content validity was strong (S-CVI/Ave = 1.00; mean Aiken's V = 0.92, range 0.83-1.00), with 100% expert agreement, although Cohen's kappa was not estimable because of zero variance. The intervention group increased from 49.19 ± 26.00 at pretest to 77.09 ± 21.66 at posttest, while the control group increased from 39.79 ± 11.93 to 58.83 ± 14.19. Paired improvements were significant in both groups (27.91 points, 95% CI 20.51-35.30, t(42) = 7.61, p < .001; and 19.04 points, 95% CI 14.10-23.98, t(46) = 7.76, p < .001, respectively). A supplementary gain-score comparison calculated from the supplied summary statistics showed an 8.86-point greater improvement in the intervention group, Welch's t(74.46) = 2.01, p = .048, Cohen's d = 0.43 (95% CI 0.01-0.85). Baseline scores were not equivalent between groups, which limits causal interpretation. The findings support the model as a feasible supplementary approach for emergency-nursing learning, while larger multi-site studies with stronger allocation procedures and objective clinical-performance measures are still needed.