Technology-enhanced Simulation for Developing Nursing Competencies and Digital Intelligence

Abstract

In the context of digital disruption, nursing education requires approaches that integrate digital intelligence (DI) with professional competencies while addressing limitations of traditional simulation-based learning (SBL), which is often resource-intensive and constrained in large classes. This study developed and evaluated “Nurse Sims,” a progressive web application that integrates with an Internet of Things (IoT)-enabled humanoid manikin (ESP32) to support real-time clinical training and automated feedback for nursing students. A four-phase research and development design was employed. Phase 1 assessed learning needs among 462 nursing students in Thailand using questionnaires and PNIModified analysis. Phase 2 involved the development of the SBL model and technological system. Phase 3 evaluated the intervention with 31 nursing students and six instructors using repeated-measures analysis of variance across three assessment points (Situations 1, 3, and 5). Phase 4 involved expert validation of the innovation. Results show a high need for SBL (PNImodified = 0.796). Significant improvements were observed in professional competencies (ηp² = .911) and DI (ηp² = .933) (p < .001). Students reported high acceptance of the system (M = 4.52, SD = 0.49), while experts rated the innovation as highly appropriate (M = 4.76, SD = 0.20). Qualitative feedback indicated improved digital self-efficacy and engagement with technology-enhanced learning. The findings suggest that IoT-integrated simulation systems can enhance nursing competencies, and DI and may serve as a scalable model for nursing education in resource-constrained settings.