INSITU vs. INSIM: Mastering Nursing Competency of Chemotherapy Administration Among Newly Hired Oncology Nurses: A Mixed Method Study
This article is part of Special Issue:
Majeda A. AL-Ruzzieh,
Yahiya M. AL-Helih,
Sami AL-Yatim,
Bahaa Shtieah,
Majeda A. AL-Ruzzieh
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorCorresponding Author
Yahiya M. AL-Helih
School of Nursing , Middle East University , Amman , Jordan , meu.edu.jo
Search for more papers by this authorSami AL-Yatim
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorBahaa Shtieah
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorMajeda A. AL-Ruzzieh,
Yahiya M. AL-Helih,
Sami AL-Yatim,
Bahaa Shtieah,
Majeda A. AL-Ruzzieh
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorCorresponding Author
Yahiya M. AL-Helih
School of Nursing , Middle East University , Amman , Jordan , meu.edu.jo
Search for more papers by this authorSami AL-Yatim
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorBahaa Shtieah
Nursing Department , King Hussein Cancer Center , Amman , Jordan , khcc.jo
Search for more papers by this authorFirst published: 08 July 2025
Academic Editor: Dos Santos Julia
Abstract
Aim: To determine the effectiveness of two types of simulation in mastering the competency of chemotherapy administration with regard to the satisfaction level among newly hired oncology nurses.
Design: A mixed-methods design.
Methods: An explanatory sequential mixed methods design was used at a large cancer hospital, with convenience sample of 122 newly hired nurses. Two simulation types were compared: INSITU in which the simulation takes place in a clinical environment using a real setting and INSIM where the simulation takes place in laboratory environment. Quantitative data were collected using the Lippincott Procedures Competency Checklist and analyzed with paired t-tests. Qualitative data from semistructured interviews were analyzed thematically. Findings were integrated narratively.
Results: The results revealed a significant improvement in chemotherapy administration competency from pre- to postsimulation in both groups (p ≥ 0.001), with very large effect sizes of 3.10 for the INSITU group and 2.95 for the INSIM group, while the qualitative part identified three main themes: learning context, simulation burden, and satisfaction.
Conclusion: The results confirmed that both types of simulation enhance skills, confidence, empowerment, cognitive engagement, and satisfaction.
Conflicts of Interest
The authors declare no conflicts of interest.
Open Research
Data Availability Statement
The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.
References
- 1 Siegel R. L., Miller K. D., Wagle N. S., and Jemal A., Cancer Statistics, 2023, CA: A Cancer Journal for Clinicians. (2023) 73, no. 1, 17–48, https://doi.org/10.3322/caac.21763.
- 2 Debela D. T., Muzazu S. G., Heraro K. D. et al., New Approaches and Procedures for Cancer Treatment: Current Perspectives, SAGE Open Medicine. (2021) 9, https://doi.org/10.1177/20503121211034366.
- 3 Colciago R. R., Fischetti I., Giandini C. et al., Overview of the Synergistic Use of Radiotherapy and Immunotherapy in Cancer Treatment: Current Challenges and Scopes of Improvement, Expert Review of Anticancer Therapy. (2023) 23, no. 2, 135–145, https://doi.org/10.1080/14737140.2023.2173175.
- 4 Nurgali K., Jagoe R. T., and Abalo R., Editorial: Adverse Effects of Cancer Chemotherapy: Anything New to Improve Tolerance and Reduce Sequelae?, Frontiers in Pharmacology. (2018) 9, https://doi.org/10.3389/fphar.2018.00245, 2-s2.0-85044364584.
- 5
Gamal G. A.,
Gamal L. M.,
Eldessouki K. H. M., and
Abozied A. M., Chemotherapy Health Hazards Among Oncology Nurses and Its Possible Relation to Malpractice and Workplace Environment, Evidence-Based Nursing Research. (2019) 1, no. 3, https://doi.org/10.47104/ebnrojs3.v1i3.83.
10.47104/ebnrojs3.v1i3.83 Google Scholar
- 6 Luo J., Zheng Z., and Yu R., Analysis of Medical Malpractice Liability Disputes Related to Novel Antineoplastic Drugs and Research on Risk Prevention and Control Strategies, PLoS One. (2023) 18, no. 6, https://doi.org/10.1371/journal.pone.0286623.
- 7 Koulounti M., Roupa Z., Charalambous C., and Noula M., Assessment of Nurse’s Safe Behavior Towards Chemotherapy Management, Materia Socio Medica. (2019) 31, no. 4, https://doi.org/10.5455/msm.2019.31.282-285.
- 8 Fracica P. J. and Fracica E. A., Patient Safety, Medical Quality Management: Theory and Practice. (2021) 11, 53–90.
- 9
Hamdy Abd El-Salaheen M.,
Moustafa Hegazy M.,
Hamed Mahmoud M., and
Sobhy Omran E., Effect of an Educational Program for Nurses on Prevention and Management of Chemotherapy Extravasation, Journal of Nursing Science Benha University. (2022) 3, no. 2, 126–142, https://doi.org/10.21608/jnsbu.2022.244326.
10.21608/jnsbu.2022.244326 Google Scholar
- 10 Power L. A. and Coyne J. W., ASHP Guidelines on Handling Hazardous Drugs, American Journal of Health-System Pharmacy. (2018) 75, no. 24, 1996–2031, https://doi.org/10.2146/ajhp180564, 2-s2.0-85058463259.
- 11 Huang E. Y. and Lam S. C., Review of Frailty Measurement of Older People: Evaluation of the Conceptualization, Included Domains, Psychometric Properties, and Applicability, Aging Medicine. (2021) 4, no. 4, 272–291, https://doi.org/10.1002/agm2.12177.
- 12 Lawson C. C., Johnson C. Y., Nassan F. L. et al., CE: Original Research: Antineoplastic Drug Administration by Pregnant and Nonpregnant Nurses: An Exploration of the Use of Protective Gloves and Gowns, AJN, American Journal of Nursing. (2019) 119, no. 1, 28–35, https://doi.org/10.1097/01.NAJ.0000552583.69729.51, 2-s2.0-85059243200.
- 13 Hanafi S., Torkamandi H., Bagheri S., Tavakoli M., Hadav N., and Javadi M., Safe Handling of Cytotoxic Drugs and Risks of Occupational Exposure to Nursing Staffs, Journal of Pharmaceutical Care. (2015) 9, 11–15.
- 14
Eedes D. J.,
Bailey B., and
Burger H., Chemotherapy Administration Standards and Guidelines: The Development of a Resource Document, South African Journal of Oncology. (2018) 2, no. 1, 1–6, https://doi.org/10.4102/sajo.v2i0.48.
10.4102/sajo.v2i0.48 Google Scholar
- 15 Huff C., USP< 800 > Compliance: A Hazardous Drug Safe Handling PPE Toolkit for Infusion Nurses, 2020.
- 16 Friese C. R., Himes-Ferris L., Frasier M. N., McCullagh M. C., and Griggs J. J., Structures and Processes of Care in Ambulatory Oncology Settings and Nurse-Reported Exposure to Chemotherapy, BMJ Quality and Safety. (2012) 21, no. 9, 753–759, https://doi.org/10.1136/bmjqs-2011-000178, 2-s2.0-84866485559.
- 17 Friese C., Wong M., Fauer A., Mendelsohn-Victor K., Polovich M., and McCullagh M., Hazardous Drug Exposure: Case Report Analysis from a Prospective, Multisite Study of Oncology Nurses’ Exposure in Ambulatory Settings, Clinical Journal of Oncology Nursing. (2020) 24, no. 3, 249–255, https://doi.org/10.1188/20.CJON.249-255.
- 18
Srioetari S P., Chemotherapy Training Model to Improve Nurse Competence in the New Life Order Era, Journal of World Science. (2022) 1, no. 5, 260–272, https://doi.org/10.36418/jws.v1i5.39.
10.58344/jws.v1i5.39 Google Scholar
- 19
Sharour L. A., Oncology Nurses’ Knowledge about Exploring Chemotherapy Related-Extravasation Care: A Cross-Sectional Study, Clinical Epidemiology and Global Health. (2020) 8, no. 3, 780–784, https://doi.org/10.1016/j.cegh.2020.01.019.
10.1016/j.cegh.2020.01.019 Google Scholar
- 20 Nursing N. L., Excellence Initiatives: Hallmarks, Indicators, Glossary & References, 2004.
- 21 Coyne E., Northfield S., Ash K., and Brown-West L., Current Evidence of Education and Safety Requirements for the Nursing Administration of Chemotherapy: An Integrative Review, European Journal of Oncology Nursing. (2019) 41, 24–32, https://doi.org/10.1016/j.ejon.2019.05.001, 2-s2.0-85066501923.
- 22 Solarz M. K., Patel M. K., Struk A. M. et al., A Clinical Comparison of Triceps-Sparing and Triceps-Detaching Approaches for Revision Total Elbow Arthroplasty, The Journal of Hand Surgery. (2020) 45, no. 1, 66.e1–66.e6, https://doi.org/10.1016/j.jhsa.2019.05.002, 2-s2.0-85067292359.
- 23 Gilfoyle E., Koot D. A., Annear J. C. et al., Improved Clinical Performance and Teamwork of Pediatric Interprofessional Resuscitation Teams With a Simulation-Based Educational Intervention, Pediatric Critical Care Medicine. (2017) 18, no. 2, e62–e69, https://doi.org/10.1097/pcc.0000000000001025, 2-s2.0-85011573350.
- 24 Abulebda K., Lutfi R., Whitfill T. et al., A Collaborative In Situ Simulation-Based Pediatric Readiness Improvement Program for Community Emergency Departments, Academic Emergency Medicine. (2018) 25, no. 2, 177–185, https://doi.org/10.1111/acem.13329, 2-s2.0-85041916449.
- 25 Whitfill T., Gawel M., and Auerbach M., A Simulation-Based Quality Improvement Initiative Improves Pediatric Readiness in Community Hospitals, Pediatric Emergency Care. (2018) 34, no. 6, 431–435, https://doi.org/10.1097/pec.0000000000001233, 2-s2.0-85024472936.
- 26 Littlepge D., Using Simulation for Oncology Nursing Competency Evaluation in Hospitals, 2020.
- 27
Rutherford-Hemming T. and
Alfes C. M., The Use of Hospital-Based Simulation in Nursing Education—A Systematic Review, Clinical Simulation in Nursing. (2017) 13, no. 2, 78–89, https://doi.org/10.1016/j.ecns.2016.12.007, 2-s2.0-85014087683.
10.1016/j.ecns.2016.12.007 Google Scholar
- 28 Chan H.-Y., Chang H.-C., and Huang T.-W., Virtual Reality Teaching in Chemotherapy Administration: Randomised Controlled Trial, Journal of Clinical Nursing. (2021) 30, no. 13–14, 1874–1883, https://doi.org/10.1111/jocn.15701.
- 29 Keddington A. S. and Moore J., Simulation as a Method of Competency Assessment Among Health Care Providers: A Systematic Review, Nursing Education Perspectives. (2019) 40, no. 2, 91–94, https://doi.org/10.1097/01.nep.0000000000000433, 2-s2.0-85061988474.
- 30
Squires A. and
Dorsen C., Qualitative Research in Nursing and Health Professions Regulation, Journal of Nursing Regulation. (2018) 9, no. 3, 15–26, https://doi.org/10.1016/S2155-8256(18)30150-9, 2-s2.0-85054272604.
10.1016/S2155-8256(18)30150-9 Google Scholar
- 31 O’cathain A., Murphy E., and Nicholl J., The Quality of Mixed Methods Studies in Health Services Research, Journal of Health Services Research & Policy. (2008) 13, no. 2, 92–98, https://doi.org/10.1258/jhsrp.2007.007074, 2-s2.0-43949135833.
- 32 Nettina S. M., Msn A.-B., and Nettina S. M., Lippincott Manual of Nursing Practice, 2013, Lippincott Williams & Wilkins.
- 33 Miles M. B., Huberman A. M., and Saldana J., Qualitative Data Analysis, A Methods Sourcebook (Fourth), 2019, Arizona State University.
- 34 Alyateem S., AlRuzzieh M., Shtayeh B., and Alloubani A., Comparing the Efficacy of Single-Skill and Multiple-Skill Simulation Scenarios in Advancing Clinical Nursing Competency, Heliyon. (2024) 10, no. 9, https://doi.org/10.1016/j.heliyon.2024.e29931.
- 35
Costa R. R. D. O.,
Medeiros S. M. D.,
Coutinho V. R. D.,
Mazzo A., and
Araújo M. S. d., Satisfaction and Self-Confidence in the Learning of Nursing Students: Randomized Clinical Trial, Escola Anna Nery. (2020) 24, no. 1, https://doi.org/10.1590/2177-9465-ean-2019-0094.
10.1590/2177-9465-ean-2019-0094 Google Scholar
- 36 Lubbers J. and Rossman C., Satisfaction and Self-Confidence with Nursing Clinical Simulation: Novice Learners, Medium-Fidelity, and Community Settings, Nurse Education Today. (2017) 48, 140–144, https://doi.org/10.1016/j.nedt.2016.10.010, 2-s2.0-84994021936.
- 37 Carolan C., Davies C. L., Crookes P., McGhee S., and Roxburgh M., COVID 19: Disruptive Impacts and Transformative Opportunities in Undergraduate Nurse Education, Nurse Education in Practice. (2020) 46, https://doi.org/10.1016/j.nepr.2020.102807.
- 38 Kuokkanen L., Leino-Kilpi H., Numminen O., Isoaho H., Flinkman M., and Meretoja R., Newly Graduated Nurses’ Empowerment Regarding Professional Competence and Other Work-Related Factors, BMC Nursing. (2016) 15, no. 1, https://doi.org/10.1186/s12912-016-0143-9, 2-s2.0-84961994320.
- 39 Alrashidi N., Pasay An E., Alrashedi M. S. et al., Effects of Simulation in Improving the Self-Confidence of Student Nurses in Clinical Practice: A Systematic Review, BMC Medical Education. (2023) 23, no. 1, https://doi.org/10.1186/s12909-023-04793-1.
- 40
Cabrera T. A. A. and
Kempfer S. S., Clinical Simulation in Nursing Teaching: Student Experience in Chile, Texto & Contexto-Enfermagem. (2020) 29, no. spe, https://doi.org/10.1590/1980-265x-tce-2019-0295.
10.1590/1980-265x-tce-2019-0295 Google Scholar
- 41 Hustad J., Johannesen B., Fossum M., and Hovland O. J., Nursing Students’ Transfer of Learning Outcomes From Simulation-Based Training to Clinical Practice: A Focus-Group Study, BMC Nursing. (2019) 18, 53–58, https://doi.org/10.1186/s12912-019-0376-5.
- 42 Purva M., Baxendale B., Scales E. et al., Simulation-Based Education in Healthcare, Standards Framwork and Guidance. (2016) NHS Health Education England.
- 43 Johnsen H. M., Briseid H. S., Brodtkorb K., Slettebø Å., and Fossum M., Nursing Students’ Perceptions of Combining Hands-On Simulation With Simulated Patients and a Serious Game in Preparing for Clinical Placement in Home Healthcare: A Qualitative Study, Nurse Education Today. (2021) 97, https://doi.org/10.1016/j.nedt.2020.104675.
- 44 Koukourikos K., Tsaloglidou A., Kourkouta L. et al., Simulation in Clinical Nursing Education, Acta Informatica Medica. (2021) 29, no. 1, https://doi.org/10.5455/aim.2021.29.15-20.
- 45 Li S., Zheng J., and Lajoie S. P., The Relationship Between Cognitive Engagement and Students’ Performance in a Simulation-Based Training Environment: An Information-Processing Perspective, Interactive Learning Environments. (2023) 31, no. 3, 1532–1545, https://doi.org/10.1080/10494820.2020.1848879.
- 46 Munangatire T. and Indjamba L., Learning Engagement; Nursing Students’ Experiences in an Online Environment at a University, Nursing Open. (2023) 10, no. 5, 3145–3152, https://doi.org/10.1002/nop2.1564.
- 47 Gleek C., Understanding Student Engagement During Simulations in IB Global Politics, Ieva: Inquiry in Education. (2015) 7, no. 1.
- 48 Jesuit D. K. and Strachan J. C., Student Engagement and Learning Outcomes in the Model United Nations, Journal of University Teaching and Learning Practice. (2021) 18, no. 8, https://doi.org/10.53761/1.18.8.11.
- 49 Greenspan R. L. and Loftus E. F., What Happens After Debriefing? the Effectiveness and Benefits of Postexperimental Debriefing, Memory & Cognition. (2022) 50, no. 4, 696–709, https://doi.org/10.3758/s13421-021-01223-9.
- 50 Cabañero-Martínez M. J., García-Sanjuán S., Escribano S., Fernández-Alcántara M., Martínez-Riera J. R., and Juliá-Sanchís R., Mixed-method Study on the Satisfaction of a High-Fidelity Simulation Program in a Sample of Nursing-Degree Students, Nurse Education Today. (2021) 100, https://doi.org/10.1016/j.nedt.2021.104858.
- 51 Figueroa M. I., Sepanski R., Goldberg S. P., and Shah S., Improving Teamwork, Confidence, and Collaboration Among Members of a Pediatric Cardiovascular Intensive Care Unit Multidisciplinary Team Using Simulation-Based Team Training, Pediatric Cardiology. (2013) 34, no. 3, 612–619, https://doi.org/10.1007/s00246-012-0506-2, 2-s2.0-84879501704.
- 52 Omer T., Nursing Students’ Perceptions of Satisfaction and Self-Confidence With Clinical Simulation Experience, Journal of Education and Practice. (2016) 7, no. 5, 131–138.
- 53 Crowe S., Ewart L., and Derman S., The Impact of Simulation Based Education on Nursing Confidence, Knowledge and Patient Outcomes on General Medicine Units, Nurse Education in Practice. (2018) 29, 70–75, https://doi.org/10.1016/j.nepr.2017.11.017, 2-s2.0-85035031255.
- 54 Fraser K. and McLaughlin K., Temporal Pattern of Emotions and Cognitive Load During Simulation Training and Debriefing, Medical Teacher. (2019) 41, no. 2, 184–189, https://doi.org/10.1080/0142159X.2018.1459531, 2-s2.0-85046023551.
- 55 Lee W., Kim M., Kang Y. et al., Nursing and Medical Students’ Perceptions of an Interprofessional Simulation-Based Education: A Qualitative Descriptive Study, Korean Journal of Medical Education. (2020) 32, no. 4, 317–327, https://doi.org/10.3946/kjme.2020.179.
- 56 Dix S., Morphet J., Jones T. et al., Perceptions of Final Year Nursing Students Transer of Clinical Judgement Skills From Simulation to Clinical Practice: A Qualitative Study, Nurse Education in Practice. (2021) 56, https://doi.org/10.1016/j.nepr.2021.103218.
- 57 Yeo J.-Y. and Jang M. S., Nursing Students’ Self-Directed Learning Experiences in Web-Based Virtual Simulation: A Qualitative Study, Japan Journal of Nursing Science: JJNS. (2023) 20, no. 2, https://doi.org/10.1111/jjns.12514.
- 58 Ko E. and Choi Y.-J., Debriefing Model for Psychological Safety in Nursing Simulations: A Qualitative Study, International Journal of Environmental Research and Public Health. (2020) 17, no. 8, https://doi.org/10.3390/ijerph17082826.
