基于屏端交互的虚拟教学对护理专业学生临床推理能力影响的系统评价

doi:10.3761/j.issn.1672-9234.2026.05.008

摘要/Abstract

摘要：

目的系统评价基于屏端交互的虚拟教学(screen-based simulation,SBS)对护理专业本科生临床推理能力的影响。方法检索中国知网、万方、维普、PubMed、Web of Science、Scopus、Embase、CINAHL plus数据库,以及ProQuest学位论文数据库。检索时限为建库至2025年8月20日,检索语言为中文和英文,由2名研究人员使用乔安娜布里格斯研究所的随机对照试验质量评价标准、类实验研究评价标准对文献进行质量评价,采用无Meta分析的叙事性综合分析方法分析数据。结果共纳入12项研究,其中4项随机对照试验,8项类实验研究。其中11项(91.7%)研究表明SBS可以提升护理专业学生的临床推理能力。结论 SBS有利于提高护理专业学生的临床推理能力。未来随着研究数量的增加,还需进一步进行定量分析,以验证SBS对提升学生临床推理能力的有效性。

关键词: 基于屏幕的模拟教学, 护理,教育, 临床推理, 系统评价

Abstract:

Objective To systematically evaluate the effectiveness of screen-based simulation (SBS) in improving clinical reasoning ability among nursing undergraduates. Methods Databases including CNKI,Wanfang,VIP,PubMed,Web of Science,Scopus,Embase,CINAHL plus,and ProQuest Digital Dissertation & Theses were searched from inception to August 20,2025,for studies published in Chinese and English. Two researchers used the JBI’s evaluation criteria for RCTs research and JBI’s evaluation criteria for experimental research to independently evaluate the quality of the literature. Data were analyzed using narrative comprehensive analysis method without meta-analysis. Results A total of 12 studies were included in this study,including four RCTs and eight quasi-experimental studies. Among them,11 studies(91.7%) showed that SBS could improve the clinical reasoning ability of nursing students. Conclusion SBS contributes to the development of clinical reasoning ability among nursing students. As the number of studies grows,further quantitative analysis is warranted to validate its effectiveness of SBS in enhancing students’ clinical reasoning ability.

Key words: Screen-based Simulation, Nursing,Education, Clinical Reasoning, Systematic Review

张思, 顾怡薇, 金三丽. 基于屏端交互的虚拟教学对护理专业学生临床推理能力影响的系统评价[J]. 中华护理教育, 2026, 23(5): 560-567.

ZHANG Si, GU Yiwei, JIN Sanli. Effectiveness of screen-based simulation on clinical reasoning ability among nursing undergraduates:a systematic review[J]. Chinese Journal of Nursing Education, 2026, 23(5): 560-567.

图/表 3

参考文献 32

[1]	Huang HM, Huang CY, Lee-Hsieh J, et al. Establishing the competences of clinical reasoning for nursing students in Taiwan:from the nurse educators’ perspectives[J]. Nurse Educ Today, 2018, 66:110-116. doi: 10.1016/j.nedt.2018.04.007
[2]	Levett-Jones T, Hoffman K, Dempsey J, et al. The ‘five rights’ of clinical reasoning:an educational model to enhance nursing students’ ability to identify and manage clinically ‘at risk’ patients[J]. Nurse Educ Today, 2010, 30(6):515-520. doi: 10.1016/j.nedt.2009.10.020
[3]	Aiken LH, Clarke SP, Cheung RB, et al. Educational levels of hospital nurses and surgical patient mortality[J]. JAMA, 2003, 290(12):1617-1623. doi: 10.1001/jama.290.12.1617 pmid: 14506121
[4]	夏菁, 赵裕香, 孙艳, 等. 不同教学法对护生临床推理能力提升的贝叶斯网状分析[J]. 卫生职业教育, 2024, 42(13):96-100.
	Xia J, Zhao YX, Sun Y, et al. Bayesian mesh analysis on the improvement of nursing students’ clinical reasoning ability with different teaching methods[J]. Health Vocat Educ, 2024, 42(13):96-100.
[5]	O’Neill ES. The influence of experience on community health nurses’ use of the similarity heuristic in diagnostic reasoning[J]. Sch Inq Nurs Pract, 1994, 8(3):261-276. doi: 10.1891/0889-7182.8.3.261
[6]	Hsieh JY, Lin PC, Sun WN, et al. Effectiveness of immersive virtual reality in nursing education for nursing students and nursing staffs:a systematic review and meta-analysis[J]. Nurse Educ Today, 2025, 151:106725. doi: 10.1016/j.nedt.2025.106725
[7]	The Society for Simulation in Healthcare. Healthcare simulation dictionary[M]. 2nd ed. Rockville:SSH, 2020.
[8]	Cobbett S, Snelgrove-Clarke E. Virtual versus face-to-face clinical simulation in relation to student knowledge,anxiety,and self-confidence in maternal-newborn nursing:a randomized controlled trial[J]. Nurse Educ Today, 2016, 45:179-184. doi: 10.1016/j.nedt.2016.08.004
[9]	Foronda CL, Swoboda SM, Hudson KW, et al. Evaluation of vSIM for nursing^TM:a trial of innovation[J]. Clin Simul Nurs, 2016, 12(4):128-131. doi: 10.1016/j.ecns.2015.12.006
[10]	Phillips JM, Harper MG, DeVon HA. Virtual reality and screen-based simulation learner outcomes using Kirkpatrick’s evaluation levels:an integrative review[J]. Clin Simul Nurs, 2023, 79:49-60. doi: 10.1016/j.ecns.2023.02.008
[11]	Aromataris E, Lockwood C, Porritt K, et al. JBI manual for evidence synthesis[EB/OL]. (2024-11-01)[2025-07-01]. https://synthesismanual.jbi.global.
[12]	Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement:an updated guideline for reporting systematic reviews[J]. BMJ, 2021,372:n71.
[13]	Tufanaru C, Munn Z, Aromataris E, et al. Systematic reviews of effectiveness[M]//JBI manual for evidence synthesis. Adelaide,SA, Australia:JBI, 2020.
[14]	Barker TH, Habibi N, Aromataris E, et al. The revised JBI critical appraisal tool for the assessment of risk of bias for quasi-experimental studies[J]. JBI Evid Synth, 2024, 22(3):378-388.
[15]	Campbell M, McKenzie JE, Sowden A, et al. Synthesis without meta-analysis(SWiM) in systematic reviews:reporting guideline[J]. BMJ, 2020,368:l6890.
[16]	赵文晓, 刘艳丽. 虚拟病人联合模拟实践教学在护理本科生临床推理能力培养中的应用效果[J]. 护理研究, 2021, 35(19):3511-3513.
	Zhao WX, Liu YL. Application effect of virtual patient combined with simulated practice teaching in the training of clinical reasoning ability of undergraduate nursing students[J]. Chin Nurs Res, 2021, 35(19):3511-3513.
[17]	Padilha JM, Machado PP, Ribeiro A, et al. Clinical virtual simulation in nursing education:randomized controlled trial[J]. J Med Internet Res, 2019, 21(3):e11529. doi: 10.2196/11529
[18]	Blanié A, Amorim MA, Benhamou D. Comparative value of a simulation by gaming and a traditional teaching method to improve clinical reasoning skills necessary to detect patient deterioration:a randomized study in nursing students[J]. BMC Med Educ, 2020, 20(1):53. doi: 10.1186/s12909-020-1939-6
[19]	Han JW, Park J, Lee H. Development and effects of a chatbot education program for self-directed learning in nursing students[J]. BMC Med Educ, 2025, 25(1):825. doi: 10.1186/s12909-025-07316-2
[20]	周雯, 晋溶辰, 张艳, 等. 严肃游戏教学法在儿科实习护士临床推理与反思能力培养中的效果评价[J]. 中国实用护理杂志, 2023, 39(9):641-648.
	Zhou W, Jin RC, Zhang Y, et al. Evaluation of the effect of serious game teaching method in the cultivation of clinical reasoning and reflection ability of pediatric practice nurses[J]. Chin J Pract Nurs, 2023, 39(9):641-648.
[21]	Dubovi I. Designing for online computer-based clinical simulations:evaluation of instructional approaches[J]. Nurse Educ Today, 2018, 69:67-73. doi: 10.1016/j.nedt.2018.07.001
[22]	de Sá Tinôco JD, Santos Cossi M, da Conceição Dias Fernandes MI, et al. Effect of educational intervention on clinical reasoning skills in nursing:a quasi-experimental study[J]. Nurse Educ Today, 2021, 105:105027. doi: 10.1016/j.nedt.2021.105027
[23]	Havola S, Haavisto E, Mäkinen H, et al. The effects of computer-based simulation game and virtual reality simulation in nursing students’ self-evaluated clinical reasoning skills[J]. Comput Inform Nurs, 2021, 39(11):725-735. doi: 10.1097/CIN.0000000000000748 pmid: 33941719
[24]	Kim SH, Choi Y. Improving clinical reasoning competency and communication skills using virtual simulation-based learning focused on a pathophysiological approach in Korea:a quasi-experimental study[J]. J Korean Biol Nurs Sci, 2024, 26(4):363-372. doi: 10.7586/jkbns.24.026
[25]	Altmiller G, Jimenez FA, Wilson C. Screen-based patient simulation:an exemplar for developing and assessing competency[J]. Nurse Educ, 2024, 49(4):179-183. doi: 10.1097/NNE.0000000000001585
[26]	Williams R, Helmer B, Elliott A, et al. Navigating the virtual frontier:a virtual patient simulation pilot study in prelicensure baccalaureate nursing education[J]. Clin Simul Nurs, 2024, 94:101589. doi: 10.1016/j.ecns.2024.101589
[27]	Bahrami M, Hadadgar A, Fuladvandi M. Optimizing clinical reasoning:unpacking the impact of virtual patient educational duration in cancer care and nursing students’ experiences[J]. Iran J Nurs Midwifery Res, 2025, 30(1):92-96. doi: 10.4103/ijnmr.ijnmr_259_23 pmid: 40052036
[28]	Liou SR, Liu HC, Tsai HM, et al. The development and psychometric testing of a theory-based instrument to evaluate nurses’ perception of clinical reasoning competence[J]. J Adv Nurs, 2016, 72(3):707-717. doi: 10.1111/jan.2016.72.issue-3
[29]	俞杰, 王佳林, 王明钰, 等. 中文版临床推理与反思自评量表在护理学专业学生中的信效度测试研究[J]. 中华医学教育杂志, 2019, 39(7):539-544.
	Yu J, Wang JL, Wang MY, et al. Reliability and validity of the Chinese version of Self-Assessment of Clinical Reasoning and Reflection in nursing undergraduates[J]. Chin J Med Educ, 2019, 39(7):539-544.
[30]	Edelbring S. Research into the use of virtual patients is moving forward by zooming out[J]. Med Educ, 2013, 47(6):544-546. doi: 10.1111/medu.12206 pmid: 23662870
[31]	Dobber J, Harmsen J, Van Iersel M. Klinisch redeneren en evidence-based practice[M]. 1st ed. Houten,the Netherlands: Bohn Stafleu van Loghum, 2016.
[32]	Sandars J. The use of reflection in medical education:AMEE Guide No. 44[J]. Med Teach, 2009, 31(8):685-695. doi: 10.1080/01421590903050374 pmid: 19811204