Effects of 3S business intelligence systems for nursing students: a repeated-measures randomized control trial

At the turn of the fourth Industrial Revolution, start-ups have emerged as a new growth engine for countries [1]. University curricula have also been changing to adapt to these changes, and entrepreneurship education has been actively spreading. The South Korean government has been promoting start-ups as a national policy project and has actively implemented relevant policies [2]. Moreover, in South Korea, the need for entrepreneurship education that can support decision-making, such as creation and innovation processes that reflect the ecosystem of each industry, entrepreneurship, problem-solving skills, and search for business opportunities, has been emphasized.

The healthcare industry is a rapidly growing market with a global popularity of start-ups in healthcare products [3], healthcare-related artificial intelligence businesses [4], and nursing services [5]. In South Korea, long-term care (LTC) insurance for the elderly was implemented in July 2008, and it laid the legal grounds for when nurses can establish an independent LTC facility [6]. The growing need for healthcare services as a result of a consistently rising prevalence of chronic diseases and rapid population aging [7] calls for a new set of activities and practices [8]. Nurses play key roles in preventive primary healthcare, and the importance of entrepreneurial competence will only increase among nurses [9].

According to Vannucci and Weinstein, the challenges that nursing professionals face in starting their business are primarily those pertinent to their inadequate managerial competencies, such as budget, finance accounting, and marketing [5]. Further, experiences in nursing start-up businesses, strong networking, and business-related education have been emphasized for nursing entrepreneurs to adapt to their changed roles [10]. For nursing entrepreneurship, the entrepreneurship education during undergraduate years has been extremely effective [10]. Newman et al. [11] and Salminen et al. [12] posit that entrepreneurship education should reflect the target population’s characteristics and use various teaching concepts and methods. Noh et al. [13] emphasized that both theoretical and practical education, such as the basics of entrepreneurship management and management strategy, were necessary subjects for nursing students to learn in entrepreneurship education.

Businesses must adapt quickly to survive amid rapidly evolving business environment in recent years. To this end, real-time processing and prompt decision-making are essential, for which an Enterprise Resource Planning (ERP) system and a business intelligence (BI) system are used [14]. Hence, it is important to ameliorate the management of home healthcare businesses by developing management support programs tailored to home health businesses, which may ultimately bridge the gap between the nursing profession and start-ups. To this end, BI software tailored to the features and environment of the home health industry is needed.

Consequently, the importance of entrepreneurship education is being emphasized from the undergraduate level so that nursing students can act as nursing entrepreneurs in the field of community nursing. However, there is still a lack of nursing entrepreneurship education curriculum or educational media based on BI that can support entrepreneurship education. Thus, this study develops and evaluates the effectiveness of a 3S (Simple, Smart, and Speed)-BI System (3S-BIS) among nursing students to encourage and prepare community-based home care nursing start-ups.

This section discusses the effects of the 3S-BIS program on various outcome measures among nursing students. To examine the effects of this program and the changes in the effects over time, we performed three post-tests after the program completion. The results showed that the experimental group had significantly improved simulation design assessment, evaluation of educational practices in simulation, education satisfaction, self-efficacy for learning, and entrepreneurship compared to the control group. Two participants were eliminated during the subject recruitment process because the program was not intended as education for technology start-up. Two participants were eliminated after the pre-test because of the overlap between department class hours and education hours. However, the elimination of the four participants was not regarded as having considerable impact on the results of this study.

Simulation design assessment and evaluation of educational practices in simulation evaluated by the experimental group, which participated in the 3S-BIS program, were significantly higher than those evaluated by the control group at T1 and T3. Currently, studies assessing simulation designs and educational aspects of simulation pertinent to start-up simulations are at an inchoate stage; thus, a direct comparison is difficult. Baek et al. reported that nursing students rated the design of a nasogastric tube management simulation as 4.33 and educational aspect of the simulation as 4.48 [17]. Han et al. employed a simulation education program to enhance forensic nursing competency and found that participants rated the simulation design as 4.42 points and simulation education as 4.78 points [23]. These are similar to scores of 4.67 and 4.43 for design and education, respectively, rated by the experimental group at T1 in the current study. These scores show that the simulation modules contain appropriate components and suggest that the quality of the simulation contents is crucial for start-up simulation education. Thus, start-up education should utilize a variety of teaching methods that include hands-on practices, as opposed to only using lectures that focus on imparting knowledge.

The experimental group showed a significantly higher education satisfaction and self-efficacy for learning than the control group at T1 and T3. Hung et al. provided simulation training involving emergency and critical care patients to nursing students and observed that students’ satisfaction and self-efficacy for learning significantly increased at six weeks after the simulation [24]. Saied also reported a positive correlation between simulation education and self-efficacy and education satisfaction [25]. These results suggest that the knowledge and experiences acquired from simulation training contribute to changing students’ behaviors and attitude. To boost nursing students’ self-efficacy and education satisfaction, various cases that emulate the actual cases in home-care nursing settings should be developed, and education should be provided with specific strategies that consider students’ current level.

The experimental group had significantly higher entrepreneurship at T3 compared to the control group. In a study on web-based start-up simulation education for nursing students, Lim et al. reported that entrepreneurship was significantly higher in the experimental group at T2 and T3 [15]. Entrepreneurship is an important determinant of the success of a start-up amid a rapidly evolving business environment, and start-up education can enhance individuals’ entrepreneurial attributes and foster an innovative start-up mindset [26]. A practical nursing start-up education that utilizes validated nursing start-up cases that impart practical information and tips for nursing start-up promotes successful nursing start-ups by increasing nurses’ entrepreneurship as well as their start-up competencies.

All of our study parameters—simulation design assessment, evaluation of educational practices in simulation, education satisfaction, self-efficacy for learning, and entrepreneurship—significantly improved immediately after the 4-week start-up nurses program intervention, and the improvement was retained until the 8-week follow-up. This result confirms that the effects of the 3S-BIS program are retained and that the simulation program is an appropriate practical training and educational tool that boosts nursing students’ nursing start-up competencies.

Simulation design assessment, evaluation of educational practices in simulation, education satisfaction, self-efficacy for learning, and entrepreneurship are inter-related. With start-up education being provided more frequently, there is a growing number of systematic studies on the development and designing of simulation curricula as well as studies investigating the effects of education [27]. Systematically designed simulation training enhances self-efficacy for learning, a belief on one’s ability to utilize newly learned contents [19], which increases students’ overall satisfaction. Facilitating learning through active interactions with students, as opposed to simply adopting the role of delivering knowledge, increases students’ satisfaction with learning [28]. Improved entrepreneurship as a result of learning serves as the psychological foundation that drives nursing start-ups. The findings of this study show that the 3S-BIS program is empirically effective in cultivating nursing start-up competency in nursing students.

The 3S-BIS program was designed to utilize simulation training to overcome the limitations of lecture-based learning. One key benefit of simulation is that students can practice a topic that otherwise cannot be practiced in an actual life setting in a safe and standardized environment, and that they can repeatedly practice it until they master it [29]. In recent years, simulation has been increasingly utilized in practicum courses in various aspects of nursing curricula in South Korea and abroad [17, 28]. In particular, hands-on education and training are essential for start-up education unlike other subjects that can be taught through methods that focus on imparting knowledge, further highlighting the importance of simulation in start-up education [27].

With the increased use of online learning because of the COVID-19 pandemic, there have been voices raising concerns about learning outcomes and instructor-learner interactions, and discussions about effective and efficient teaching and learning methods are ongoing. Moreover, a nursing curriculum includes both theory and practicum courses for third- and fourth-year students; thus, more student-friendly approaches are needed when providing nursing start-up education to third- and fourth-year students. The 3S-BIS involves a web-based simulation training that allows students to acquire knowledge about nursing start-ups and develop critical thinking and problem-solving skills through simulation training. Students generate results based on the simulation scenarios and are debriefed by their instructor, which helps them interact with their instructors and review their learning outcomes. A web-based self-study module that allows students to learn at their own pace without restrictions of time and space probably contributed to increasing the learning effects. These components of the program helped nursing students to be equipped with all knowledge and experience needed to start their own business, thereby fostering a positive attitude and confidence in nursing start-ups. However, start-up competency is not something that can be altered in a short period; hence, a mentoring system in which students are continually remotivated and supported should be incorporated to start-up education programs.

Kim stated that support for nursing start-ups is essential such that positive nursing experience, nursing competencies, and nursing start-up performance can lead to nurses’ starting a business [30]. Thus, nursing schools should continuously expose students to nursing start-ups through training and site tours and continue to attempt various experimental processes, such as development and implementation of diverse nursing start-up simulation curricula. Furthermore, scenarios that engage students and start-up learning activities and teaching strategies that allow students to collaborate with their colleagues should be developed.

Finally, since most participants in the current study are women, follow-up studies to confirm the difference in educational effects according to sex are needed in the future. Although the effect of 3S-BIS education was confirmed through repeated measurement, future studies should confirm the timing of booster education for the continuation of the educational effects. This study measured the effect of nursing start-up education using 3S-BIS on nursing students; however, since 3S-BIS was developed as an ERP, future research to measure the management effect of visiting nursing centers is needed.

The 3S-BIS program was designed to offer practical support for nursing students to start a nursing business and cultivate nursing leaders. The program was designed to teach about the basic structure of running a home healthcare service, and it accounted for the fact that the services are provided at client’s homes and that nurses are not management experts. Thus, the significance of this study is in structuring the program and developing an operating system to realize the three Ss—Smart, Speed, Simple. Furthermore, we used a sophisticated study design—a repeated-measures RCT—to analyze the effects of the 3S-BIS program on nursing students’ rating of simulation design and educational aspect of stimulation, education satisfaction, self-efficacy for learning, and entrepreneurship. The program can be utilized in various formats for nursing start-up education as part of the nursing curriculum, and we confirmed that the program is appropriate for achieving the learning objectives and resolving the anticipated problems that are encountered by home healthcare services.

This study had some limitations. The study subjects were limited to Korean nursing students, so caution needs to be exercised in generalizing the study results. Considering that the intervention period in this study was only one week, follow-up research comparing various study periods should be conducted in the future. In addition, the study does not discuss the effectiveness of various entrepreneurship competency enhancement programs such as entrepreneurship theory education courses, practical entrepreneurship courses, and entrepreneurship mentoring. Thus, we suggest that future studies should verify the effectiveness of these programs. Prospective cohort studies are needed to determine whether nursing students who complete the 3S-BIS program actually start a business, and the study sample should be expanded to nurses who operate or work in a home health care service to verify the effects of the program on these nurses.