Abstract: Objective To evaluate the effectiveness of screen-based simulation (SBS) as presimulation preparation for a lower leg fracture simulation for undergraduate nursing students. Methods A cross-sectional study was employed among 93 junior nursing students from nursing school of a university. They were required to complete SBS as presimulation preparation for a lower leg fracture simulation. The students' performance in in-person simulation were evaluated by facilitators according to a demonstrating checklist for simulation of lower leg fracture. After in-person simulation, students were invited to answer the Nurses Clinical Reasoning Scale (NCRS) and Clinical Learning Environment Comparison Survey (CLECS). Results Totally 85(91.4%) students believed that SBS was of great or very great help to in-person simulation. The mean score of the students' performance in in-person simulation was 72.83, which was higher than that of previous students (57.67). The total NCRS score was 62.28±6.94, indicating a high level of clinical reasoning ability. The total CLECS score in in-person simulation was higher than that in SBS, which was 87.14±13.36 and 77.77±16.79 respectively, and the difference was statistically significant (P<0.001). Conclusions The use of SBS as presimulation preparation was effective in improving the students' performance score in simulation and training their clinical reasoning ability. Further study is needed to determine best practices of using SBS before in-person simulation, and whether more SBS could be involved to enhance the learning outcomes.

Key words: Nursing, Screen-based simulation, In-person simulation, Clinical reasoning ability