Simulation Training for Adolescent Leukemia Care in Nursing Students

Simulation-based education is increasingly used in nursing programs to bridge the gap between theoretical knowledge and clinical practice. Pediatric oncology care requires specialized knowledge and clinical decision-making skills, particularly in managing complications such as chemotherapy extravasation. However, nursing students often have limited opportunities to encounter such situations during clinical placements.

This mixed-methods study will evaluate the effectiveness of an adolescent leukemia scenario-based simulation training program among third-year nursing students. The quantitative component will employ a single-group pretest-posttest quasi-experimental design. Participants will complete baseline assessments before the simulation intervention and follow-up assessments immediately after the simulation and debriefing sessions.

The simulation scenario focuses on the recognition and management of chemotherapy extravasation in an adolescent patient with leukemia. The intervention will be conducted in a simulation laboratory using a structured process including prebriefing, simulation implementation, and debriefing based on the Promoting Excellence and Reflective Learning in Simulation (PEARLS) framework.

Quantitative outcomes will include perceived stress, knowledge regarding extravasation management, and learning satisfaction. Qualitative data will be collected through semi-structured focus group interviews conducted after the simulation experience. The qualitative findings will provide a deeper understanding of participants' experiences, perceptions, clinical reasoning processes, and learning outcomes.

Data will be analyzed using appropriate descriptive and inferential statistical methods for the quantitative component and thematic analysis for the qualitative component. Findings from both components will be integrated to provide a comprehensive evaluation of the educational effectiveness of adolescent leukemia scenario-based simulation training in undergraduate nursing education.

• Scenario-Based Simulation Training (Other), also known as Simulation-Based Learning: A simulation-based educational intervention consisting of prebriefing (3 min), environmental orientation (3 min), scenario-based simulation on extravasation management in an adolescent leukemia patient (10 min), and structured debriefing using the PEARLS model (30 min). Pre- and post-tests were administered to assess perceived stress, knowledge level, and student satisfaction.

Primary outcomes

• Extravasation Knowledge Level [Baseline (pre-simulation) and immediately after simulation and debriefing (post-simulation, approximately 1 hour later)]: Change in nursing students' knowledge about extravasation management, assessed using a 10-item multiple-choice knowledge test developed by the researchers. Each correct answer scores 1 point (total: 0-10). Higher scores indicate better knowledge.
• Perceived Stress Level [Baseline (pre-simulation) and immediately after simulation and debriefing (post-simulation, approximately 1 hour later)]: Change in perceived stress measured with the Nursing Student Perceived Stress Scale (NSPSS; Karaca et al., 2015), a 29-item, 5-point Likert scale with 6 subscales. Total scores range from 0 to 116; higher scores indicate greater perceived stress.

Secondary outcomes

• Student Satisfaction and Self-Confidence in Learning [Immediately after simulation and debriefing (post-simulation only, approximately 1 hour after baseline)]: Student satisfaction assessed using the Student Satisfaction and Self-Confidence in Learning Scale (NLN; Turkish adaptation by Karaçay \& Kaya, 2017), a 13-item, 5-point Likert scale with 2 subscales. Scores range from 13 to 65; higher scores indicate greater satisfaction and self-confidence.

Other outcomes

• Students' Simulation Experiences (Qualitative) [Immediately after debriefing session (approximately 1-1.5 hours after baseline)]: Themes derived from semi-structured focus group interviews conducted after simulation, exploring students' experiences regarding stress, clinical decision-making, teamwork, and learning processes. Analyzed using thematic analysis with MAXQDA.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Third-year nursing students enrolled at Atılım University, Faculty of Health Sciences, Department of Nursing
* Voluntary participation in the study
* Not having previously taken the NURS302 - Child Health and Diseases course

Exclusion Criteria:

* Withdrawal from the study at any stage
* Incomplete completion of data collection forms

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• Didem Yüksel, PhD, Principal investigator, Atilim University School of Health Sciences, Department of Nursing