Research Studies

Social Validity of Simulation Training Among Nurses

Acute Care
Research Studies


Researchers are continuously striving to determine optimal teaching methods. The current study compared the effectiveness of a simulation course on heart failure readmissions titled, “What Would you Do?”, two traditional e-learning courses, and a blended learning approach combining the two, to improve knowledge and confidence in preventing heart failure patient readmissions among long-term care nurses.


62 nurses, including RNs and LVNs, were randomized to either a simulation only group, a traditional courses only group, or a combination group involving the simulation course and the traditional courses. Participants were assigned to a training plan consisting of a baseline assessment measuring knowledge and confidence, the intervention courses, and a post-test assessment measuring knowledge, enjoyment of the courses, and interest in taking similar courses. A post-test assessment measuring confidence was assigned a week after post-test, and a follow-up assessment measuring knowledge and confidence was assigned 40 days after post-test.

56 participants completed baseline, but only 39 participants had complete data at all 3 timepoints. Last observation carried forward was used to impute data for participants missing data.

All groups significantly increased their knowledge between pre- and post-assessment but there was no significant difference between the groups that received the courses only, the simulation only, or the combination of both, see Fig 1. Additionally, levels of confidence did not change significantly over time or differ by group.

Interestingly, the simulation only group was significantly more likely to strongly agree with the statement “I enjoyed taking this course/courses more than most online learning I have taken.” This group was also more interested in taking similar courses, although this did not reach statistical significance. See Figs 2 and 3.


Overall, these results indicate that learners enjoyed the simulation course and are interested in taking similar courses in the future. This suggests learners may look forward to training that includes simulations. Given the small final sample size and relatively low assessment scores across groups, we recommend future studies involving larger sample sizes and more rigorous assessments to determine which online training methods are most effective for improving knowledge and confidence in preventing readmissions.

Read more about this research


Elise Valdes PhD, MS

Director of Research, Relias

Emaley McCulloch M.Ed., BCBA

Vice President, Relias Institute, Relias

M. Courtney Hughes PhD, MS

Senior Researcher, Relias


November 2017


A Comparative Effectiveness Study: Comparing a Simulation-Based Online Training, Traditional Online Course, and a Combined Course on Health Care Professional’s Knowledge Regarding Preventing Rehospitalizations