Evaluating the effect of hospital information system simulation-based training on nursing students\' informatics skills before internship: A quasi-experimental study

Copy igh © 2025 Zanjan Uni e si y o Medical Sciences. Published by Zanjan Uni e si y o Medical Sciences. This wo k is licensed unde a C ea i e Commons A ibu ion-NonComme cial 4.0 In e na ional license (h ps://c ea i ecommons.o g/licenses/by- nc/4.0/). Noncomme cial uses o he wo k a e pe mi ed, p o ided he o iginal wo k is p ope ly ci ed. E alua ing he e ec o hospi al in o ma ion sys em simula ion- based aining on nu sing s uden s' in o ma ics skills be o e in e nship: A quasi-expe imen al s udy Reza Abbasi1, Faezeh Gha a i2, Razieh Fa ahi3* , Malihe Ram4, Ma yam Mokh a i Seghaleh5 1Depa men o Heal h In o ma ion Technology, School o Pa amedical Sciences, To ba Heyda iyeh Uni e si y o Medical Sciences, To ba Heyda iyeh, I an 2Depa men o Heal h In o ma ion Managemen , School o Heal h Managemen and In o ma ion Sciences, I an Uni e si y o Medical Sciences, Teh an, I an 3Depa men o Heal h In o ma ion Technology, Fe dows Facul y o Medical Sciences, Bi jand Uni e si y o Medical Sciences, Bi jand, I an 4Facul y o Medical Sciences, Bi jand Uni e si y o Medical Sciences, Bi jand, I an 5Rasul-e-Ak am Hospi al, Fe dows, Bi jand Uni e si y o Medical Sciences, Bi jand, I an A icle in o Abs ac In oduc ion O e he pas wo decades, heal hca e In o ma ion Technology (IT) has de eloped signi ican ly. Heal h in o ma ion echnology (HIT) includes a b oad spec um o in o ma ion sys ems and ools ha enable elec onic s o age, e ie al, sha ing, and use o heal hca e da a, in o ma ion, and knowledge o communica ion and decision-making [1]. These echnologies include a a ie y o sys ems such as Elec onic Heal h Reco ds (EHR), disease egis y sys ems, elec onic p esc ibing, Hospi al In o ma ion Sys ems (HIS), Clinical Decision Suppo Sys ems (CDSS), and mo e [2]. HISs play an impo an ole in planning, implemen ing, o ganizing, and con olling he ope a ions o hospi al depa men s, such as labo a o y, adiology, admission and discha ge, inpa ien , and ope a ing oom [3]. Success ully implemen ing HIS in heal hca e se ings A icle his o y: Recei ed 4 No . 2024 Accep ed 12 May. 2025 Published 13 Jul. 2025 Abbasi e al. J Med Edu De . 2025; 18(2): 46-54 Jou nal o Medical Educa ion De elopmen Backg ound & Objec i e: Educa ional simula o s ha e been p oposed as e ec i e ools o enhancing lea ning and imp o ing s uden s' skills when p epa ing o he wo kplace. This s udy aimed o de e mine he e ec o simula ion-based aining in a hospi al in o ma ion sys em on nu sing s uden s' in o ma ics skills be o e hei in e nship. Ma e ials & Me hods: This quasi-expe imen al s udy was conduc ed in he i s semes e o he academic yea (2023-2024) wi h 26 hi d-semes e unde g adua e nu sing s uden s a he Fe dows Facul y o Medical Sciences. The s uden s we e andomly di ided in o con ol and in e en ion g oups. The educa ional con en ea u ed a simula ion o he inpa ien module o a hospi al in o ma ion sys em. S uden s in he in e en ion g oup we e gi en access o his module's de eloped aining and p ac ice sec ions o e wo weeks. A e one mon h, he es sec ion o his module was made a ailable o bo h he in e en ion and con ol g oups. Da a analysis was conduc ed using SPSS e sion 26, whe e desc ip i e s a is ics we e calcula ed, and he Mann-Whi ney es was u ilized. Resul s: A e he es , he mean sco es o s uden s in he in e en ion and con ol g oups we e 35.69 ± 3.9 and 29.85 ± 5.01 (ou o 41), espec i ely. The di e ence be ween he mean sco es o he wo g oups was signi ican (p = 0.003, E ec size = 0.59). Fu he mo e, he e was no signi ican co ela ion be ween sex, age, o g ade poin a e age and he mean es sco es in ei he g oup (P > 0.05). Conclusion: Simula ion-based aining can po en ially enhance nu sing s uden s' skills in u ilizing hospi al in o ma ion sys ems. Conside ing he emphasis on he ole o heal h in o ma ion sys ems in he managemen o heal hca e se ings, i is ecommended ha simula ed HIS aining be included in he educa ional cu iculum o nu sing s uden s. Keywo ds: e-lea ning, simula o sys em, hospi al in o ma ion sys em, skill, nu sing s uden s *Co esponding au ho : Razieh Fa ahi, Depa men o Heal h In o ma ion Technology, Fe dows Facul y o Medical Sciences, Bi jand Uni e si y o Medical Sciences, Bi jand, I an. Email: Fa ahi [email protected] O iginal A icle How o ci e his a icle: Abbasi R, Gha a i F, Fa ahi R, Ram M, Mokh a i Seghaleh M. E alua ing he e ec o hospi al in o ma ion sys em simula ion-based aining on nu sing s uden s' in o ma ics skills be o e in e nship: A quasi- expe imen al s udy. J Med Edu De . 2025; 18(2): 46-54. [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 1 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 47 depends on use s who ely on hese sys ems o pe o m hei du ies [4, 5]. The e o e, comp ehensi e use aining is a c ucial elemen in sys em de elopmen , as i os e s accep ance and enhances use s' speed and accu acy in comple ing asks and u ilizing he sys em e ec i ely [6]. In I an, ollowing he implemen a ion o he Heal h Sys em T ans o ma ion Plan in 2013, HIS ha e ecei ed g ea e a en ion han o he echnological ad ancemen s in in o ma ion echnology [5]. These sys ems play a pi o al ole in heal hca e se ice deli e y and a e ecognized as key ools o eco ding and managing pa ien da a and heal hca e se ices [7]. Nu ses, as he la ges use g oup o hese sys ems, play a key ole in ensu ing accu a e and comp ehensi e documen a ion o clinical da a [8]. Despi e his i al ole, nu sing s uden s do no ecei e he necessa y p ac ical aining o use HIS e ec i ely du ing hei s udies. As a esul , new p o essionals o en lack amilia i y wi h hese sys ems upon en e ing he wo k o ce, e en hough hey mus documen medical in e en ions. This lack o expe ience can lead o challenges such as spending excessi e ime on da a en y and an inc eased likelihood o documen a ion e o s. Due o conce ns o e pa ien in o ma ion con iden iali y, high wo k p essu e, and he s ess ul en i onmen o hospi als, clinical in e nships usually lack hands-on p ac ice wi h HIS. In mos cases, s uden s p ima ily obse e how heal hca e s a ope a e hese sys ems, missing he oppo uni y o engage di ec ly wi h he ac ual HIS en i onmen . This lack o p ac ical expe ience can lead o dec eased sel -con idence, low p oduc i i y, and e o s in da a en y [9]. Simula ion has eme ged as an inno a i e and e ec i e educa ional app oach in his con ex . Using HIS simula o s, especially o s uden s wi h limi ed expe ience wo king wi h in o ma ion sys ems, o e s an oppo uni y o p ac ice in a sa e en i onmen wi hou nega i e pa ien consequences. This me hod has nume ous ad an ages o e adi ional educa ional me hods by allowing epe i ion, ial and e o , ac i e lea ning, and immedia e eedback [10]. While simula ion is commonly employed in aining o clinical ac i i ies such as ca diopulmona y esusci a ion and wound ca e using mannequins and skill labo a o ies, and some s udies [11-15] ha e u ilized EHR simula ion o nu sing educa ion, he e has been less emphasis on comp ehensi e HIS aining ha mi o s eal hospi al wo k lows. A esea ch li e a u e e iew e eals signi ican gaps in in eg a ing HIS educa ion in o he nu sing cu iculum, pa icula ly in simula ed en i onmen s. Fo example, s udies by Zhang e al. [16] and Whi e al. [11] ha e iden i ied signi ican limi a ions. In esponse o his educa ional need, a p ac ical aining module o he Ti aje HIS nu sing sys em (inpa ien module)—used in o e 300 hospi als na ionwide—was de eloped using a compu e simula o . This s udy aims o e alua e he e ec i eness o a simula ion-based educa ional app oach in enhancing nu sing s uden s' skills and eadiness o using HIS. Ma e ials & Me hods Design and se ing(s) This quasi-expe imen al s udy was conduc ed a Fe dows Facul y o Medical Sciences du ing he i s semes e o he 2023–2024 academic yea . Pa icipan s and sampling The s udy popula ion comp ised 26 hi d-semes e unde g adua e nu sing s uden s om he Fe dows Facul y o Medical Sciences. A e ob aining e hical app o al (code IR.BUMS.REC.1402.445) om Bi jand Uni e si y o Medical Sciences and ecei ing implici consen om he s uden s in he class oom o pa icipa e in he esea ch, a b ie ing session was conduc ed o all pa icipan s. Du ing his session, he esea che s—who hold PhDs in heal h in o ma ion managemen wi h a backg ound in sys em design and applica ion and a mas e 's in nu sing wi h expe ience wo king wi h HIS— in oduced he scena io-based compu e simula o . They clea ly explained he s udy objec i es, i s signi icance, and how o use he aining, p ac ice, and es ing sec ions in he simula o . Adequa e ime was p o ided o add ess any ques ions o conce ns om s uden s ega ding he p ocess. A e he b ie ing session, a census sampling app oach was employed, including all s uden s in he class. Subsequen ly, 26 sealed en elopes we e p epa ed, wi h 13 labelled 'In e en ion' and 13 labelled 'Con ol.' To ensu e andom alloca ion, each s uden blindly selec ed an en elope, de e mining hei assignmen o one o he s udy g oups. Finally, s uden s' demog aphic cha ac e is ics, including sex, age, and G ade Poin A e age (GPA), we e eco ded on a checklis (Figu e 1). [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 2 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing 48 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 Figu e 1. CONSORT Flow diag am o he quasi-expe imen al s udy Tools/Ins umen s The web-based simula o sys em o eaching HIS includes se e al key unc ional capabili ies, such as in e ac i e aining cou ses, mul imedia con en , p ac ical exe cises, and assessmen s. Addi ionally, i p o ides help and eedback o use s o add ess hei po en ial e o s. This sys em's adminis a ion, communica ion, and con en managemen capabili ies can ex end he lea ning p ocess beyond o he educa ional simula o s. Addi ional ea u es, including in o ma ion dashboa ds, epo ing capabili ies, ques ion bank design, and messaging, ha e also been inco po a ed o c ea e a ully in eg a ed educa ional sys em. Da a collec ion me hods One o his sys em's simula ed educa ional con en s is he inpa ien module aining in he HIS. This module, one o he mos widely used modules by nu sing s a , was in oduced o nu sing s uden s in he in e en ion g oup. In his module, s uden s we e augh how o log in o he hospi al in o ma ion sys em, assign beds om di e en hospi al depa men s o pa ien s, egis e eques s o a ious se ices such as labo a o y es s, medica ions, and pa ien imaging, cancel o dele e o de s, and iew es esul s and medica ions assigned o he pa ien . S uden s we e g an ed access o he aining and, subsequen ly, he p ac ice con en o his module, allowing hem o ain and p ac ice any ime, anywhe e, and on any de ice—a mobile phone, able , lap op, o pe sonal compu e —o e wo weeks. To comple e he p ocess, s uden s needed o selec he "End o T aining" op ion a e inishing he aining and he "End o P ac ice" op ion a e comple ing he p ac ice o inalize hei p og ess. One mon h la e , bo h he in e en ion and con ol g oups comple ed he es sec ion o he module o e alua e he aining's impac on hei skills in using he Ti aje Hospi al In o ma ion Sys em. S uden s we e asked o comple e he es , which was designed in a scena io-based o ma aligned wi h he educa ional con en , and comple ed exe cises. The alidi y and eliabili y o he es (Supplemen a y 1), c ea ed by nu ses using his module based on eal pa ien s, we e [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 3 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 49 e iewed and app o ed by expe s in Heal h In o ma ion Managemen (HIM) and Medical In o ma ics (MI), who a e amilia wi h he design and use o his sys em. A scena io consis ing o 16 s eps was p epa ed, wi h each s ep sco ed acco ding o weigh ed impo ance analysis. The impo ance o each scena io s ep was de e mined based on expe opinion, and each s ep was sco ed based on i s impo ance. The s uden s eco ded hei sco es on he sys em a e comple ing he es . The simula o calcula ed he module-speci ic es sco e wi h a maximum sco e o 41, and he sco es ob ained by bo h g oups we e compa ed. Da a analysis A e ecei ing demog aphic in o ma ion and s uden s' es sco es h ough he simula o sys em, hese da a we e en e ed in o he SPSS so wa e e .26 o analysis. Fi s , he da a we e desc ibed using desc ip i e s a is ics ( equency, pe cen age, mean, and SD). Because he dependen a iable ( es sco e) did no ha e a no mal dis ibu ion, he Mann-Whi ney U es was used o compa e he sco es o he in e en ion and con ol g oups. Fu he mo e, Spea man's co ela ion coe icien es examined he associa ion be ween he demog aphic and dependen a iables. Resul s O he 26 pa icipan s, 13 (50%) we e male. A e sample alloca ion, se en emales (54%) and six males (46%) we e placed in he in e en ion g oup, and se en males (54%) and six emales (46%) we e placed in he con ol g oup. The dis ibu ion o he pa icipan s was no g oup. The dis ibu ion o he pa icipan s was no s a is ically signi ican (p = 0.695). The GPA o s uden s in he in e en ion g oup was 15.80 ± 1.18, and in con ol, i was 16.02 ± 0.61, wi h no signi ican di e ence be ween he wo g oups (p = 0.700). Also, he mean age o s uden s in he in e en ion g oup was 20.38 ± 1.26 yea s, and in con ol, i was 21.69 ± 2.95 yea s, and he e was no s a is ically signi ican di e ence be ween he wo s udy g oups (p = 0.370) (Table 1). Table 1. Demog aphic cha ac e is ics o in e en ion and con ol g oups Gende n (%) Sig. In e en ion Male Female 6 (46.2) 7 (53.8) 0.154 (0.695) Con ol Male Female 7 (53.8) 6 (46.2) GAP Mean ± SD U (Sig.) In e en ion Con ol 15.8 ± 1.18 77 (0.700) 16.02 ± 0.61 Age Mean ± SD U (Sig.) In e en ion 20.38 ± 1.26 65.5 (0.370) Con ol 21.69 ± 2.95 Abb e ia ions: n, numbe o pa icipan s; SD, s anda d de ia ion; U, Mann- Whi ney es ; Sig, signi icance le el. The mean es sco es o s uden s in he in e en ion and con ol g oups we e 35.69 ± 3.9 and 29.85 ± 5.01 (ou o 41), espec i ely. A s a is ically signi ican di e ence was obse ed be ween he g oups unde in es iga ion (U = 27, p = 0.003, E ec size = 0.59). This indica es ha simula ion-based educa ion o he Inpa ien module signi ican ly impac s nu sing s uden s' skills (Figu e 2). Figu e 2. Compa ison o s uden s’ es sco es be ween in e en ion and con ol g oups [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 4 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing 50 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 To assess he impac o demog aphic a iables on s uden s' es sco es, analyses we e conduc ed based on gende , age, and GPA wi hin bo h he in e en ion and con ol g oups. The Mann–Whi ney U es esul s showed ha he di e ence in mean sco es be ween emale and male s uden s was no s a is ically signi ican in ei he g oup. In he in e en ion g oup, he es s a is ic was 15 wi h a p- alue o 0.350; in he con ol g oup, he es s a is ic was 16.5 wi h a p- alue o 0.518. These esul s indica e ha gende did no signi ican ly a ec es sco es (Table 2). Addi ionally, Spea man's co ela ion es was used o examine he ela ionship be ween age and GPA wi h es sco es. The indings showed no signi ican co ela ion be ween GPA and es sco es in he in e en ion g oup ( = 0.122, p = 0.693) and he con ol g oup ( = -0.343, p = 0.252). Simila ly, no s a is ically signi ican co ela ion was ound be ween age and es sco es in he in e en ion g oup ( = -0.019, p = 0.952) o he con ol g oup ( = -0.177, p = 0.563) (Table 3). Table 2. Compa ison o es sco es be ween males and emales in each g oup using he Mann-Whi ney U es G oup Gende Mean ± SD U (p- alue) In e en ion Female 37.29 ± 1.11 15 (0.350) Male 33.83 ± 5.23 Con ol Female 31.17 ± 4.92 16.50 (0.518) Male 28.71 ± 5.19 Table 3. Spea man's co ela ion es esul s o he e ec o age and GPA on s uden s' es sco es Va iable G oup Co ela ion p- alue* GPA In e en ion 0.122 0.693 Con ol -0.343 0.252 Age In e en ion -0.019 0.952 Con ol -0.177 0.563 *Co ela ion is signi ican a he 0.05 le el (2- ailed). Abb e ia ions: p- alue, p obabili y alue. Discussion This s udy e alua ed he e ec o simula ion-based aining o he HIS inpa ien module on he in o ma ics skills o nu sing s uden s be o e hei in e nship. The esul s showed ha he HIS educa ion simula o inc eased nu sing s uden s' skills wo king wi h he hospi al in o ma ion sys em's inpa ien module. This s udy ound ha a iables such as gende , age, and GPA did no impac s uden s' in o ma ics skills. In he p esen s udy, s uden s in he in e en ion g oup acqui ed mo e skills in pe o ming asks in he inpa ien module o he HIS han hose in he con ol g oup, indica ing he use ulness o simula ion-based educa ion. In his ega d, he esul s o a sys ema ic e iew s udy by Nabo a i e al. [17] showed he posi i e impac o simula o s on a ious ou comes, such as use s' skills in using heal h in o ma ion sys ems. The esul s o a p e ious s udy [14] showed ha aining using an EHR simula o signi ican ly imp o ed he in o ma ics skills o nu sing s uden s. A s udy by Repsha e al. [15] showed a signi ican inc ease in sco es ela ed o nu sing s uden s' in o ma ics compe ency a e using a simula ed EHR. The esul s o ano he s udy also emphasized he enhancemen o nu sing s uden s' in o ma ics compe ency a e simula ion-based aining in EHR in he i s yea [18]. In oday's wo ld, as HIS use becomes widesp ead o enhance hospi al managemen , insu icien knowledge and skills among use s—pa icula ly nu ses and physicians—can lead o se e al nega i e consequences. These include dec eased e iciency and was ed ime, an inc eased likelihood o e o s (such as inco ec da a en y) [19], educed mo i a ion and job sa is ac ion [20], unde u iliza ion o he sys em's ull capabili ies [21, 22], and challenges in iden i ying and esol ing echnical issues [23]. These issues, in u n, lead o a decline in he quali y o ca e [24, 25], inc eased cos s [23, 26], educed in o ma ion secu i y [20], and epo ing p oblems wi hin he o ganiza ion [26]. The e o e, using hese sys ems wi hou su icien in o ma ics and compu e skills can esul in se ious p oblems o bo h he use and he o ganiza ion. The e o e, p ope aining o use s be o e hey begin wo king wi h he sys em, especially hose who a e mo e amilia wi h clinical p ocesses bu may ha e less compu e knowledge, is c i ical [27]. T aining in a sa e, low- isk en i onmen o pa ien s using in e ac i e and ac i e lea ning me hods, such as di ec sys em usage wi h immedia e eedback, is essen ial compa ed o adi ional eaching me hods [28, 29]. This app oach o e s lexibili y and accessibili y [30], pa icula ly o nu ses wo king in di e en shi s o hose wi h limi ed in-pe son aining esou ces. Fu he mo e, s anda diza ion o aining o ensu e uni o m lea ning, easy and e ec i e pe o mance assessmen , p ecise and objec i e e alua ion o nu ses, epea abili y o aining sessions, and ul ima ely cos educ ion p o ides g ea e con ol o e he lea ning p ocess [31]. This leads o educed s ess and anxie y [32], be e p epa edness o eal-li e si ua ions [33], and a mo e e ec i e imp o emen in in o ma ics skills compa ed o o he aining me hods [19]. Conside ing hese posi i e ou comes, i is ecommended ha simula ion-based HIS aining be in eg a ed in o he cu iculum o nu sing [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 5 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 51 s uden s, who will be u u e use s o hese sys ems. Addi ionally, om he ou se o hei educa ion, alongside p ac ical nu sing ca e skills, nu sing s uden s should be in oduced o in o ma ics compe encies, ecognizing he inc easing p ominence o new echnologies in heal hca e in he in o ma ion age. To maximize he e ec i eness o simula ion-based aining, i is ad isable o complemen i wi h o he educa ional me hods such as eal-wo ld exposu e and obse a ion o sys em use in p ac ice. To he bes o ou knowledge, his s udy is one o he i s o explo e he impac o an HIS educa ion simula o on nu sing s uden s' skills in using he inpa ien module o documen nu sing se ices as u u e sys em use s. Fu he mo e, he in e ac i e design o he sys em's use in e ace enabled s uden s o eco d da a esembling a eal sys em, guided by he de eloped scena ios, and na iga e h ough o he ela ed p ocesses. The limi a ions o his s udy include i s implemen a ion a a single academic cen e , he sho du a ion o he in e en ion, and he lack o an assessmen o nu sing s uden s' baseline in o ma ics skills. Consequen ly, he gene alizabili y and in e p e a ion o hese indings should be app oached wi h cau ion. Conclusion The s udy demons a ed ha a hospi al in o ma ion sys em aining simula o signi ican ly enhanced nu sing s uden s' skills in u ilizing he HIS inpa ien module be o e s a ing hei in e nship cou se. P epa ing s uden s as u u e end-use s o hese sys ems and inc easing hei skills and sel -con idence can imp o e he quali y o heal hca e se ice deli e y and pa ien heal h ou comes. The e o e, conside ing he emphasis on he ole o sys ems in he managemen o heal hca e se ings, i is ecommended ha simula ed aining o he HIS be included in he educa ional cu iculum o nu sing s uden s. E hical conside a ions This s udy was app o ed by he e hics commi ee o Bi jand Uni e si y o Medical Sciences (IR.BUMS.REC.1402.445). The e is no pa ien in his s udy; all pa icipan s we e s uden s. The s uden s' obse a ion o he aining and comple ion o es s we e conside ed implici consen o hei pa icipa ion in he s udy. A i icial in elligence u iliza ion o a icle w i ing No. Acknowledgmen The au ho s hank all he s uden s who pa icipa ed in he s udy. Con lic o in e es s a emen The au ho s decla e ha hey ha e no con lic o in e es . Au ho con ibu ions RF, RA, and FGH concei ed and designed he s udy, acqui ed and in e p e ed he da a, d a ed he manusc ip , and c i ically e ised i . RF and RA a anged he logis ics o his s udy. RF, MM, and MR. we e esponsible o collec ing and analyzing he da a. All i e au ho s ead and app o ed he inal e sion o he submi ed manusc ip . Funding The esea ch depu y a Bi jand Uni e si y o Medical Sciences unded his s udy wi h g an numbe 6420. Da a a ailabili y s a emen The da ase s used and analyzed du ing he cu en s udy a e a ailable in Pe sian om he co esponding au ho upon easonable eques . Re e ences 1. Manning SE, Wang H, Dwibedi N, e al. Associa ion o mul imo bidi y wi h he use o heal h in o ma ion echnology. Digi al Heal h. 2023;9:20552076231163797. [h ps://doi.o g/10.1177/20552076231163797] 2. Taneja D, Kulka ni SV, Sinha S, Dindigal RN. Digi al echnology in hospi al adminis a ion: a s a egic choice. The Jou nal o he Associa ion o Physicians o India. 2023;71(10):83-8. [h ps://doi.o g/10.59556/japi.71.0372] 3. Ismail A, Jamil AT, Rahman AFA, e al. The implemen a ion o hospi al in o ma ion sys em (HIS) in e ia y hospi als in malaysia: a quali a i e s udy. Malaysian Jou nal o Public Heal h Medicine. 2010;10(2):16-24. [h ps://api.seman icschola .o g/Co pusID:36478333] [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 6 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing 52 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 4. Theo L, Saue bo n R, Boda C. Design and implemen a ion o heal h in o ma ion sys ems. Gene a: Wo ld Heal h O ganiza ion. 2000. [h ps://i is.who.in /handle/10665/42289] 5. Shojaei Baghini M, Nase i Boo i Abadi T, Joodaki M, Mollaee S. P og ess o hospi al in o ma ion sys ems in Ke man eaching gene al hospi als in 2012. Jou nal o Mode n Medical In o ma ion Sciences. 2015;1(1):42- 50. [h p://jmis.hums.ac.i /a icle-1-28-en.h ml] 6. Geo ge NM, D ahnak DM, Sch oede DL, Ka ancha ED. Enhancing p elicensu e nu sing s uden s' use o an elec onic heal h eco d. Clinical Simula ion in Nu sing. 2016;12(5):152-8. [h ps://doi.o g/10.1016/j.ecns.2015.11.006] 7. P ob A, G iewing S, Sei z K, e al. Cu en landscape o hospi al in o ma ion sys ems in gynecology and obs e ics in Ge many: a su ey o he commission digi al medicine o he Ge man socie y o gynecology and obs e ics. A chi es o Gynecology and Obs e ics. 2023;308(6):1823-30. [h ps://doi.o g/10.1007/s00404- 023-07223-1] 8. Ahmed SS. The Rela ionship be ween nu sing knowledge abou documen a ion skills and audi ing e ospec i e o pa ien 's eco ds. Helwan In e na ional Jou nal o Nu sing Resea ch and P ac ice. 2024;3(5):213-28. [h ps://doi.o g/10.21608/hijn p.2024.252313.1091] 9. Zhang L, Wu J, Yang J, e al. De elopmen and applica ion e alua ion o a nu sing simula ion eaching in o ma ion sys em based on hospi al in o ma ion sys ems. In e na ional Jou nal o Clinical P ac ice. 2023;2023(1):6334967. [h ps://doi.o g/10.1155/2023/6334967] 10. Si anjali M. The e ec i eness o simula ion-based lea ning in clinical educa ion. Ba icaloa Medical Jou nal. 2024;18(1). [h ps://doi.o g/10.4038/bmj. 18i1.36] 11. Whi KJ, Allen CL, Hogg CW, e al. The use o elec onic heal h eco ds in ad anced p ac ice nu sing educa ion: a scoping e iew. Jou nal o P o essional Nu sing. 2024;50:83-94. [h ps://doi.o g/10.1016/j.p o nu s.2023.11.007] 12. McB ide S, Thomas L, Decke S, e al. Valida ion o a ool o e alua e nu sing s uden s’ elec onic heal h eco d compe ency in simula ion. Nu sing Educa ion Pe spec i es. 2021;45(3):161. [h ps://doi.o g/10.1097/01.NEP.0000000000001240] 13. Kobeissi MM. Enhancing simula ion: a oadmap o in eg a ing he elec onic heal h eco d in o he nu se p ac i ione cu iculum. Clinical Simula ion in Nu sing. 2023;85:101460. [h ps://doi.o g/10.1016/j.ecns.2023.101460] 14. Choi J, Bo e LA, Ta e V, Choi WJ. Impac o simula ed elec onic heal h eco ds on in o ma ics compe ency o s uden s in in o ma ics cou se. Heal hca e In o ma ics Resea ch. 2021;27(1):67-72. [h ps://doi.o g/10.4258/hi .2021.27.1.67] 15. Repsha C, Mo se B, Lee SE, Ka z J, Bu ows E, Tea es J. Use o a simula ed elec onic heal h eco d o suppo nu sing s uden in o ma ics knowledge and skills. Compu e s, In o ma ics, Nu sing. 2020;38(2):55- 9. [h ps://doi.o g/10.1097/CIN.0000000000000618] 16. Zhang L, Wu J, Yang J, e al. De elopmen and applica ion e alua ion o a nu sing simula ion eaching in o ma ion sys em based on hospi al in o ma ion sys ems. In e na ional Jou nal o Clinical P ac ice. 2023;2023:6334967. [h ps://doi.o g/10.1155/2023/6334967] 17. Nabo a i E, Jeddi FR, Gha a i F, Mi hoseini F. The e ec s o simula ion aining on lea ning o heal h in o ma ion sys ems: A scoping e iew. Jou nal o Educa ion and Heal h P omo ion. 2022;11:4. [h ps://doi.o g/10.4103/jehp.jehp_17_21] 18. Gosa LK. Imp o ing EMR Compe ency in Fi s Yea Nu sing S uden s. 2022. [h ps://doi.o g/10.57709/28700591] 19. Raghuna han K, McKenna L, Peddle M. Baseline e alua ion o nu sing s uden s’ in o ma ics compe ency o digi al heal h p ac ice: A desc ip i e explo a o y s udy. Digi al Heal h. 2023:20552076231179051. [h ps://doi.o g/10.1177/20552076231179051] 20. Alam o AA, Aljuma MS, Ala eeq SS, e al. Challenges o heal h in o ma ics sys ems in p ima y heal h ca e. Saudi Jou nal o Medical and Pha maceu ical Sciences. 2023;9(10):717-9. [h ps://doi.o g/10.53555/jp cp. 31i2.4536] 21. Choi J, Woo S, Ta e V. In o ma ics compe encies o s uden s in a doc o o nu sing p ac ice p og am: a desc ip i e s udy. Heal hca e In o ma ics Resea ch. 2024;30(2):147-53. [h ps://doi.o g/10.4258/hi .2024.30.2.147] 22. Belchez CA. In o ma ics and acul y in ap o essional assessmen and gap analysis o cu en in eg a ion o in o ma ics compe encies in a baccalau ea e nu sing p og am: Uni e si y o Kansas; 2019. [h ps://hdl.handle.ne /1808/29513] 23. Chikwa e AB, Roman NV, Da ids EL. Imp o ing heal h in o ma ics compe encies: a scoping e iew o he componen s o heal h in o ma ics academic p og ams. SAGE Open. 2024;14(4):21582440241293259. [h ps://doi.o g/10.1177/21582440241293259] 24. Al Najja RI, Sha ie ZM. Impac o nu sing in o ma ics on he quali y o pa ien ca e. In e na ional Jou nal o Medical Science and Clinical Resea ch S udies. 2022;2(5):418-21. [h ps://doi.o g/10.47191/ijmsc s/ 2-i5-19] 25. O oki i A. Using in o ma ics o imp o e heal hca e quali y. In e na ional Jou nal o Heal h Ca e Quali y Assu ance. 2019;32(2):425-30. [h ps://doi.o g/10.1108/ijhcqa-03-2018-0062] 26. Coppe smi h NA, Sa ka IN, Chen ES. Quali y in o ma ics: he con e gence o heal hca e da a, analy ics, and clinical excellence. Applied Clinical In o ma ics. 2019;10(02):272-7. [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 7 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 53 [h ps://doi.o g/10.1055/s-0039-1685221] 27. Au o e N, Valens M, Lune NJ, Nyssen M. Assessmen o heal h in o ma ics compe encies in unde g adua e aining o heal hca e p o essionals in Rwanda. Rwanda Jou nal. 2016;3(1):36-41. [h ps://doi.o g/10.4314/ j. 3i1.6F] 28. Je e y AD, Sengs ack P. Teaching da a science h ough an in e ac i e, hands-on wo kshop wi h clinically ele an case s udies. Applied Clinical In o ma ics. 2024;15(05):1074-9. [h ps://doi.o g/10.1055/a-2407-1272] 29. Ha e AJ, Soegaa d Balles e JM, Gab iel PE, Adusumalli S, Hanson III CW. T aining digi al na i es o ans o m heal hca e: a 5- ie ed app oach o in eg a ing clinical in o ma ics in o unde g adua e medical educa ion. Jou nal o he Ame ican Medical In o ma ics Associa ion. 2023;30(1):139-43. [h ps://doi.o g/10.1093/jamia/ocac209] 30. Chang H. Recen mo emen on educa ion and aining in heal h in o ma ics. Heal hca e In o ma ics Resea ch. 2014;20(2):79. [h ps://doi.o g/10.4258/hi .2014.20.2.79] 31. Wu H, Pa el MK, Tan CC. The cu en landscape o cybe secu i y aining in CAHIIM acc edi ed p og ams. In2024 IEEE 12 h In e na ional Con e ence on Heal hca e In o ma ics (ICHI) 2024 Jun 3 (pp. 750-752). IEEE. [h ps://doi.o g/10.1109/ICHI61247.2024.00120] 32. Sapci AH, Sapci HA. Digi al con inuous heal hca e and dis up i e medical echnologies: m-heal h and elemedicine skills aining o da a-d i en heal hca e. Jou nal o Telemedicine and Teleca e. 2019;25(10):623- 35. [h ps://doi.o g/10.1177/1357633X18793293] 33. Kleib M, Nagle L. Fac o s associa ed wi h Canadian nu ses' in o ma ics compe ency. Compu e s, In o ma ics, Nu sing. 2018;36(8):406-15. [h ps://doi.o g/10.1097/CIN.0000000000000434] [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] 8 / 9 Abbasi e al . : The E ec o Simula ion-Based T aining in Nu sing 54 Jou nal o Medical Educa ion De elopmen ¦ Volume 18 ¦ Issue 2 ¦ 2025 Supplemn a y 1. A schema ic ep esen a ion o he simula ed use in e ace o he inpa ien module o a hospi al in o ma ion sys em [ DOI: 10.61882/edcj.18.2.46 ] [ Downloaded om edujou nal.zums.ac.i on 2025-10-03 ] Powe ed by TCPDF (www. cpd .o g) 9 / 9