Erna Rochmawati(1*), Fahni Haris(2), Resti Yulianti Sutrisno(3), Wulan Noviani(4)

(1) School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta – INDONESIA
(2) School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta – INDONESIA
(3) School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta – INDONESIA
(4) School of Nursing, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Yogyakarta – INDONESIA
(*) Corresponding Author


Background: Nursing student often experience anxiety and lack of motivation during their training program particularly during examination, and this may affect the achievement of learning outcomes. Teaching methods that might increase motivation and potentially increase learning outcomes have been developed, including video simulation and online learning. The purpose of the study was to investigate the effects of integrating video simulation into online learning on students’ motivation, anxiety level and competence.

Methods: A pre-test/post-test one group design was utilized. Two video simulations containing nursing skills were integrated into the e-learning system which can be accessed for three weeks by 76 respondents who took Basic Nursing course. The level of motivation and anxiety were measured before and after the intervention, while the competence was measured after the intervention.

Results: The majority of students passed the skills examination. This study indicates a significant increase of students’ motivation after the intervention (p value < 0.001), but the level of anxiety among respondents increased.

Conclusion: The integration of video simulation into e-learning system can enhance student’s skills performance and motivation. Although there is also an increase in anxiety, findings of the study can be applied to other subjects and nursing skills with attention to aspects that cause student anxiety.


anxiety; e-learning; motivation; nursing skills; nursing student; video simulation

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  1. Tuzer H, Dinck L, Elcin M. The effects of using high-fidelity simulators and standardized patient on the thorax, lung, and cardiac examination skills of undergraduate nursing students Nurse Educ Today. 2016; 45: 120–125.
  2. Boostel R, Felix JVC, Bortolato-Major C, Pedrolo E, Vayego SA, Mantovani MdF. Stress of nursing students in clinical simulation: a randomized clinical trial. Revista Brasileira de Enfermagem. 2018; 71(3): 967–974.
  3. Driscoll R, Evan G, Ramsey F, Wheeler S. High test anxiety among nursing students. Tenesse: University of Tenesse; 2009.
  4. Al-Ghareeb A, Cooper S, McKenna L. Anxiety and clinical performance in simulated setting in undergraduate health professionals education: An integrative review. Clinical Simulation in Nursing. 2017; 13: 478–491.
  5. Jeffries P. A framework for designing, implementing and evaluating simulations used as teaching strategies in nursing. Nursing Education Perspective. 2007; 26(2): 96–103.
  6. Voutilainen A, Saaranen T, Sormunen M. Conventional vs e-learning in nursing education: A systematic review and meta-analysis. Nurse Education Today. 2017.
  7. Gaba D. The future vision of simulation in healthcare. Simul Healthc. 2007; 2(2): 126–135.
  8. Alinier G, Harwood C, Harwood P, et al. Immersive clinical simulation in undergraduate health care interprofessional education: knowledge and perceptions. Clinical Simulation in Nursing. 2014; 10(4): e205–216.
  9. Lapkin S, Levett-Jones T, Bellchambers H. The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Clin Simul Nurs. 2010; 6(6): e207–e222.
  10. Blum CA, Borglund S, Parcells D. High-Fidelity Nursing Simulation: Impact on Student Self- Confidence and Clinical Competence. Int J Nurs Educ Scholarsh. 2010; 7(1).
  11. Kameg K, Howard VM, Clochesy J, Mitchell AM, Suresky JM. he Impact of High Fidelity Human Simulation on Self-Efficacy of Communication Skills. T Issues Ment Health Nurs. 2010; 31: 315–323.
  12. Fawaz MA, Hamdan-Mansour AM. Impact of high-fidelity simulation on the development of clinical judgment and motivation among Lebanese nursing students. Nurse Educ Today. 2016; 46: 36–42.
  13. Sharpnack PA, Goliat L, Baker JR, Rogers K, Shockey P. Thinking like a nurse: using video simulation to rehearse for professional practice. Clinical Simulation in Nursing. 2013; 9(12): e571–e577.
  14. Cardoso AF, Moreli L, Braga FTTM, Vasques CI, Santos CB, Carvalho EC. Effect of a video on developing skills in undergraduate nursing students for the management of totally implantable central venous access ports. Nurse Education Today. 2012; 32: 709–713.
  15. Da Silva C, Peisacovich E, Gal R, Anyinam C, Coffey S, Graham L. A Programmatic Approach to the Design of a Video Simulation Case Study. Clinical Simulation In Nursing. 2020; 41: 1–8.
  16. Pinar G, Abay H. The Effect Of Video Based Simulation Training On Neonatal Examination Competency Among Turkish Nursing Students. European Scientific Journal 2016; 12(15): 394–405.
  17. Dyer J, Spindler H, Christmast A, et al. Video Monitoring a Simulation-Based Quality Improvement Program in Bihar, India. Clin Simul Nurs. 2018; 17: 19–27.
  18. Shapiro AL. Test anxiety among nursing students: A systematic review. Teaching and Learning in Nursing. 2014; 9(4): 193–202.
  19. Beggs C, Shields D, Janiszewksi GH. Using guided reflection to reduce test anxiety in nursing students. J Holist Nurs. 2011; 29: 140–147).
  20. Nielsen B, Harder N. Causes of student anxiety during simulation: What literature says. Clinical Simulation in Nursing. 2017; 9(11): e507–e512.
  21. Parkin V, Cherney S, Soriano A. A preparatory workshop to reduce student anxiety prior to clinical testing. Teaching and Learning in Nursing. 2020; 15(1): 12–14.
  22. Xu J. Toolbox of teaching strategies in nursing Chinese Nursing Research. 2016; 3(2): 54–57.
  23. de Souza Teixeira C, Kusumota L, Pereira M, et al. Anxiety and performance of nursing students in regard to assessment via clinical simulations in the classroom versus filmed assessments. Invest Educ Enferm. 2014; 32(2): 270–279.
  24. Harandi SR. Effects of e-learning on students’ motivation Procedia-Social and Behavioural Sciences. 2015; 181: 423–430.
  25. Kala S, Isaramalai S-a, Pohthong A. Electronic learning and constructivism: A model for nursing education. Nurse Education Today. 2010; 30(1): 61–66.
  26. Barisone M, Bagnasco A, Aleo G, et al. The effectiveness of web-based learning in supporting the development of nursing student’s practical skills during clinical placements: A qualitative study. Nurse Educ Pract. 2019.
  27. Yang RJ, Lu YY, Chung ML, Chang SF. Developing a short version of the test anxiety scale for baccalaureate nursing skills test-a preliminary study. Nurse Education in Practice. 2014; 14(6): 586–590.
  28. Yuan HB, Williams BA, Fang JB. The contribution of high-fidelity simulation to nursing students’ confidence and competence: a systematic review. International Nursing Review. 2012; 59(1): 26–33.
  29. Poikela P, Ruokamo H, Teras M. Comparison of meaningful learning characteristics in simulated nursing practice after traditional versus computer-based simulation method: A qualitative videography study. Nurse Education Today. 2015; 35(2): 373–382.
  30. Botma Y. Nursing student’s perceptions on how immersive simulation promotes theory-practice integration. International Journal of Africa Nursing Sciences. 2014; 1: 1–5.
  31. Bravo E, Amante B, Simo P, Enache M, Fernandez V. Video as a new teaching tool to increase student motivation Paper presented at: Global Engineering Education Conference (EDUCON). 2011.
  32. Cato ML. Nursing student anxiety in simulation settings: A mixed-method study. Portland, Portland State University. 2013.
  33. Burbach BE, Struwe LA, Young L, Cohen MZ. Correlates of Student Performance during Low Stakes Simulation. J Prof Nurs. 2019; 35(1): 44– 50.
  34. Do ES, Seo YS. Factors influencing clinical competence in nursing students. Journal of Korean Academy of Fundamentals of Nursing. 2014; 21(3): 283.
  35. Hansen MM. Are nursing students’ clinical skills competency and self-confidence levels improved via video iPods? A randomized controlled pilot study. Journal of Nursing Education and Practice. 2011; 1(1): 32–42.


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