BACKGROUND:

Well prepared nurses are the foundation of healthcare. Their role in providing care, comfort and compassion for their patients and patients’ families is indispensable in health care. For this preparation, a blend of theory and clinical teaching is required.¹

Clinical skill acquisition is vital part of the nursing curriculum. In the last few decades, tremendous changes are occurring in nursing education field from informal bedside hospital-based training to university-based graduate, postgraduate, and doctoral nursing education. Nurses needs to possess a number of exceptional technical skills as well as soft skills and attributes, to save patients' lives.²

Teaching is a unique human activity, and systematic selection of methods and materials for teaching & learning is essential to effectively impart knowledge. With the advancement of technology there are new teaching methods coming up to improve knowledge, skill as well as attitude.³ These teaching methods are the broader techniques used to help students achieve learning outcomes. A method of teaching is totally depending on practical aspects of implementation in hospital areas. To maintain standard nursing practices, the nursing education should focus on incorporating clinical competencies.² Furthermore, high proficiency in nursing care will help in increasing the safety and comfort of the patient within the clinical context. Therefore, nursing students should be guided based on a practice-oriented way, and it will help in building up confidence and empower them to actively participate in the care of patients.

A significant component of nursing education is clinical learning. A clinical demonstration is a technique for skill presentation that demonstrates how a certain procedure is carried out in a clinical environment.⁴ One of the most important elements influencing the teaching-learning process in clinical settings is the students' exposure to the clinical learning environment. Simulation creates a controlled environment to simulate real-life situations and help learners develop skills and knowledge and attitude. Simulation integrated teaching is often used in professional training programs to help learners practice and refine their skills. In this method, the teaching-learning process is carried in a systematic and step wise way. Simulation integrated demonstration helps in connecting theories to actual practice It assist in teaching a skill and efficiency with many steps and engages the students and encourage their participation. Finally, a structured demonstration with simulation is a way to engage the learner in a more complete way, rather than focusing on simply auditory or visual teaching methods. ⁵

As technology has improved the ability to record and edit video classes, video management applications, platforms to manage videos, the rationale to use videos have continually updating. In this YouTube era, video has become a preferred way for youth to learn. Video-assisted teaching learning is a well-informed strategic approach to using videos.⁶ Digital technology including video is being used more and more in nursing as a supplement to standard teaching methods and it has been shown to improve nursing students' problem-solving abilities ⁷

Research on effectiveness of video-assisted teaching program and traditional demonstration on nursing students learning skills of performing obstetrical palpation found both approaches were equally effective in improving nursing students' ability to perform obstetrical palpation, according to research on the subject. However, when post-test skills were compared, traditional demonstration performed significantly better than the video-assisted teaching program (t = 36.40, p = 0.001).⁸ However, another study on the effectiveness of these methods on mechanism of labor in undergraduate medical students revealed that the video-assisted teaching did not improve post-test intervention scores when compared to the traditional group. This suggests that traditional demonstration has an impact on skill improvement that is not inferior to that of video-assisted teaching⁹.

Among simulation based structured demonstration and video assisted teaching methods there is a need to study for analysing its effectiveness and its implementation for today’s generation leaning. To improve student performance and make a greater contribution to treatment skills, educators must find a more effective way to teach nursing procedures to develop skill especially for novice nursing students who are yet to develop confidence and competence in patient care.^1,9,10 Back care and back rub are the less harmful and low-cost intervention to prevent pressure ulcer and to reduce pain and increase comfort among patients. ^11,12Thus back care was selected as nursing procedure to compare the effectiveness of both teaching strategies. And this study aimed at assessing the effectiveness of video assisted teaching and simulation integrated structured teaching on knowledge, procedural skills of back care and perception of patient care by novice nursing students and to compare the outcome of video assisted teaching and simulation based structured demonstration.

METHODS:

This experimental study with two group post-tests only design was conducted on first year BSc (Hons) nursing students at clinical skill centre of xxxxx. All students were interested to participate in study. The study included first year students those who are willing to participate in study and who never studied the procedure back care. 40 students were selected by convenient sampling as it was accessible and only available group. Random allocation of students was done into SIT and VAT group by one member of the team. The evaluators were unaware of participants group while observing the return demonstration.

Method of data collection:

Permission from institution research cell and Institutional Ethics committee of AIIMS Nagpur was sought. The data collection process began with the identification of the students who are meeting sampling criteria. After explaining the purpose and nature of the study to the sample, informed consent was obtained and confidentiality was assured. The participants were randomly assigned into control and experiment group using computer generated number. The socio personal data was collected using questionnaire and knowledge of students on skin care pressure injury and comfort was assessed using questionnaire, The group VAT participants were administered video assisted teaching of back care and for group SIT simulation integrated structured demonstration including, setting learning objective, pre-briefing and performance, evaluation and debriefing respectively. Knowledge on back care was assessed using a questionnaire and skill of students was measured by checklist while they performed return demonstration of back care. The outcome of both groups was compared using descriptive and inferential statistics.

Outcome measurement:

The following outcome measures were included in study

Socio personal data questionnaire-The socio demographic data of students was assessed using a questionnaire consisted of multiple-choice questions.

Questionnaire on pressure injury and back care- Separate questionnaire to assess the knowledge of students regarding pressure injury & back care.

Procedure checklist on back care-After the teaching of back care the students were assessed for procedural skill using check list.

Patient care perception scale-A Likert scale to find out the perception of students regarding patient care was used.

All tools were found to be valid and reliable. Reliability of procedure checklist on back care was assessed by interrater reliability (Cohen’s Kappa=.70)

Ethical considerations:

Permission from institution research cell and Institutional Ethics committee of AIIMS Nagpur was sought. After explaining the purpose and nature of the study to the sample, informed consent was obtained and confidentiality was assured. For the better learning experience by all students, after the data collection both the groups were exposed to both the techniques i.e. video assisted and simulation based structured demonstration and feedback was taken.

Data analysis:

Data were analyzed using descriptive and inferential statistics. The statistical analysis was carried out on SPSS 30.0.0 at .05 level of significance

Total 40 students consented to participate in the study but later 1 from SIT group and 3 from VAT did not report for the study. The data analysis revealed that both experimental and control group were identical in socio demographic characteristics like age sex, batch, performance in the previous grade. None of the students had past exposure to the procedure.

Table 1: Socio-demographic data of the participants in Simulation integrated teaching and Video Assisted teaching group

		SIT Group Frequency (%)	VAT Group Frequency (%)		Chi Square	P value
Age in Years	17-20	12(63.15)		7(41.17)	1.8044.	0.179183.
	21-23	6(31.58)		9(52.94)
	>24	1(5.26)		1(5.88)
Gender	Female	19(100)		17(100)
Course	BSC (hons) Nursing	19(100)		17(100)
Year Of Study	I year	19(100)		17(100)
Grade in previous standard	>85%	17(89.47)		1694.11)	0.253	0.6148
Grade in previous standard	<85%	2		1	0.253	0.6148

As depicted in Table -1, participants 12(63.15%) in SIT group and 7(41.18%) in VAT group were between 17 to 20 years of age and 6(31.58%) in SIT group and 9(52.94%) in VAT group were between 21 to 23 years of age and 1 (5.26%) in each group was above 24. All the students were females studying in first year BSc (Honors) Nursing. There were 17 participants in SIT group and 16 in VAT group with above 85% score in previous standard. The chi-square computed was found to be nonsignificant with regard to age, previous grades or any other previous exposure to back care.

The result of independent t test (Table :2) shows that there was no significant difference in the background knowledge on skin care, pressure injury and comfort among SIT and VAT group (t=-1.436, p=.160*), Both groups were homogenous.

The mean knowledge of ST group was higher 17.05 than the VAT group regarding back care but the result of independent t test (Table :3) shows that there was no significant difference in the knowledge gain the SIT and VAT group(t=.291, p=<.773)

The result of independent t test (Table :4) shows that there was significant difference(P<.001) in the procedural skill of SIT and VAT group assessed after intervention (t=5.052, p=<.001*)

Table 2: Independent T test showing difference between groups regarding knowledge on pressure injury, skin care and comfort.

Group	N	Mean	Mean Difference	Std. Deviation	Std. Error Mean	Std. Error Difference	t	ds	p
SIT	19	16.05	-2.712	4.062	.932	1.889	-1.436	34	.160
VAT	17	18.76	-2.712	7.031	1.705	1.889	-1.436	34	.160

Table 3: Independent T test showing difference between groups regarding knowledge on Back care

Group	N	Mean	Mean Difference	Std. Deviation	Std. Error Mean	Std. Error Difference	t	ds	p
SIT	19	17.05	0.229	2.818	0.647	0.788	0.291	34	.773
VAT	17	16.82	0.229	1.704	0.413	0.788	0.291	34	.773

Table 4: Independent T test showing difference between groups in procedural skill

Group

Mean

Mean Difference

Std. Deviation

Std. Error Mean

Std. Error Difference

18.84

4.019

2.167

.497

4.019

5.052

<.001

14.82

2.604

.631

Table 5: Independent T test showing difference between groups regarding perception regarding patient care

Group	N	Mean	Mean Difference	Std. Deviation	Std. Error Mean	Std. Error Difference	t	ds	p
A	19	55.53	10.291	10.705	2.456	3.886	2.648	34	.012
B	17	45.24	10.291	12.607	3.058	3.886	2.648	34	.012

As shown in Table: 5 perceptions of participants about patient care measured on a Likert scale shows that the ST group had a higher mean score of 55.53 that VAT group (mean = 45.24). The result of independent t test shows that there was significant difference (P<.001) in the perception regarding patient care in the SIT and VAT group (t=2.648, p=.012*)

DISCUSSION:

In the present study two teaching learning methods simulation integrated teaching and video assisted teaching were compared for effectiveness in teaching nursing procedures like back care. The participants in both group after a brief classroom teaching were given teaching on back care either with simulation-integrated teaching or video-based teaching, the students were compared for the pre teaching knowledge and after the intervention both the groups were assessed for their knowledge on back care and procedural skill by observation. The participants from both the groups were also compared for perception regarding patient care.

Currently there are numerous teaching methodologies tried to increase the effectiveness of teaching and learning. The focus is on more on how to make teaching learning more in realistic setting and lifelike scenario especially when the objective is to improve the skill of student. Simulation based learning helps in achieving this objective thus many studies are targeted toward finding the efficacy of simulation.⁹ Studies show that simulation helps in improving hands-on skill, it provides immersive as well as interactive learning thus making student to improve knowledge and enhancement of skill¹³

A study on effectiveness of video instruction and simulation-based training was found to be effective as it helped to perform in more real life like situation, it also enhanced the confidence and also helped the participant to improve by quick feedback, opportunity to repeat the scenarios as well as hand on experience and active participation in teaching learning process improved students’ performance.¹⁴

In this study the groups had no significant difference regarding knowledge on pressure injuries, comfort and skin care. After teaching session on back care using SIT and VAT the SIT group had little higher knowledge that Vat group but there was no significant difference in the knowledge regarding back care in the SIT and VAT group (t=.291, p=<.773). The procedure skill score was significantly higher in SIT group compared to VAT group as demonstrated by the result of independent t test (Table (t=2.648, p=.012*)). The study results also demonstrated better perception regarding patient care in the SIT group than the VAT group.

As technology has improved the ability to record and edit video classes, video management applications, platforms to manage videos, the rationale to use videos have continually updating. video has become a preferred way for youth to learn. Study indicate online video-assisted teaching program is an effective and advantageous education tool that improves skills, knowledge, and confidence in fourth-year medical students while teaching a necessary and skill-demanding fractional curettage procedure.¹⁵ Though various studies demonstrate video assisted teaching programme was found effective in improving the knowledge of working lactating mothers regarding techniques of expression preservation and utilization of breast milk^16,prevention of oral cancer among participants¹⁷ care of dementia patients for nursing students,¹⁸ Polycystic Ovary Syndrome among adolescent girls¹⁹ ,Breast Self-Examination among School students²⁰ Neonatal Resuscitation protocol for staff nurses²¹, homecare of Schizophrenic Patients developed for Primary Caregivers²², Ozone Therapy on Knowledge Level among Staff Nurses²³, Alcohol Abuse among College Students²⁴. But the finding of this study indicates simulation integrated teaching is more effective than video assisted teaching.

A quasi-experimental research work with pretest, post-test, control group design on effectiveness of video-assisted teaching program and traditional demonstration on nursing students learning skills of performing obstetrical palpation found both the methods were equally effective in enhancing skill, traditional demonstration scored much better than the video-assisted teaching program when the post-test skills were compared⁷ (t = 36.40, p = 0.001).

Another study conducted on the effectiveness of video-assisted teaching program and traditional demonstration of mechanism of labour on undergraduate medical students The post- test intervention scores were not improved by the video assisted teaching as compared with the traditional group indicating that traditional demonstration has impact which is non-inferior to video assisted teaching in improving the skill⁸. (p- 0.35028). For practical skill learning sense of touch is essential and this cannot be imparted by videos alone though the classes may be made interesting. Females scored more compared with males in video assisted learning⁸

Simulation helps students to work in a setting similar to hospital or other clinical setting and it helps them to experience the real-life scenario as that of health care settings in a safe environment²⁵

Through simulation, nurses can improve their communication skills, confidence, and ability to take care of themselves while performing their tasks.²⁶ This technique minimizes errors, increases the satisfaction of students from the educational process, and enhances their self-confidence, self-esteem, and comfort in skill performance.²⁷ It makes students familiar with the successive steps required to acquire a skill, perfect their technique, and reach the optimal clinical outcome²⁸Effectiveness of traditional demonstration was found better than the video-assisted teaching while teaching obstetrical palpation (t = 18.35, p < 0.001)⁷

While comparing Simulation and Video assisted learning Video-assisted learning was mentioned as useful for simple devices for remote learning and enhance blended learning. No difference in knowledge was identified between the two groups. There was knowledge decay within the video-assisted group. Retention of procedural skills was found better in simulation group. The learning styles of students did not affect the outcome²⁹

In research though, a higher incremental improvement in the average score was recorded in the simulation group compared with the lecture group. Furthermore, students in the Simulation based learning group found their teaching modality more satisfactory compared with those in the lecture group. They ranked simulation higher regarding motivation, understanding, and gain of knowledge and skills like., problem solving, decision^30. In this study also students found Simulation integrated learning is effective and helps to build confidence.

LIMITATION AND STRENGTH:

This study sample size was very small which may limit the generalizability of findings to larger population and this also might not have allowed to fully capture the diversity of style of learning and other variables which may influence the attainment of nursing procedural skill. At the same time this study has several strengths like it was possible to conduct the study with limited resources and within limited timeframe. The single class helped to have a more controlled environment. Even with limited generalizability this study provides a preliminary understanding of effectiveness of both methos and provides a base for study on larger and diverse population.

CONCLUSION:

The findings of this study highlight the effectiveness of simulation integrated demonstration in improving learning clinical decision making and procedural skill development. Simulation helps better application of theory into practice than just classroom teaching or video-based teaching. Though teaching aids like video can be accessed anywhere according to convenience of student but simulation provide opportunity to practice and develop skill in real life like scenario. Thus, nursing educators’ and policy makers must find ways to integrate simulation-based teaching to improve procedural competence of students. Videos can be the source of review or preparation for the class.

FUNDING STATEMENT:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

COMPETING INTEREST:

The author declares no competing interest.

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Received on 29.09.2025 Revised on 17.12.2025

Accepted on 12.02.2026 Published on 30.04.2026

Available online from May 02, 2026

Asian J. Nursing Education and Research. 2026;16(2):113-118.

DOI: 10.52711/2349-2996.2026.00023

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.