A special online practicum: a mixed-methods study on how the Virtual Simulation System for Clinical Thinking in Obstetric Nursing enhances the learning outcomes of nursing undergraduates (Preprint)

BACKGROUND Virtual simulation technology can effectively address the growing complexity of obstetric teaching in China and enhance students' clinical thinking in nursing student. OBJECTIVE This study examines the effectiveness of the Virtual Simulation System for Clinical Thinking in Obstetric Nursing (VSSCTON), based on salutogenesis theory, in teaching nursing students through online training. METHODS The VSSCTON was developed, and 88 nursing students from four co-construction units affiliated with the Coastal Area Virtual Nursing Teaching and Research Office participated in the practical training. The study used a self-controlled before-and-after design. The evaluation included a general information questionnaire, the "Clinical Thinking Ability Evaluation Scale," and the "Virtual Clinical Case Application Effectiveness Evaluation Scale." Students wrote reflection diaries based on the Bass Model of Holistic Reflection within one week after training. Quantitative data were analyzed using SPSS version 22.0, and qualitative data were examined through thematic content analysis. RESULTS After practicum training, students showed significant improvements in clinical thinking, critical thinking, systems thinking, and evidence-based thinking abilities, all statistically significant (P < 0.001). Students rated the system’s design, technical performance, and content positively, especially its learning function, which received an “excellent” score. Qualitative findings indicated that the system enhanced students' clinical thinking and decision-making abilities, while also supporting their emotional development, attitudes, and values. CONCLUSIONS The VSSCTON can significantly improve students' clinical thinking and professional quality. Students rated the system highly, confirming its effectiveness. As a teaching tool, it supports clinical thinking development in obstetric nursing and helps students transition from theory to practice.