The Development of an Interactive Deltoid Intramuscular Injection Simulator and Its Effectiveness

Abstract

Intramuscular injection in the deltoid muscle is a critical nursing procedure for vaccine administration and injectable medications in clinical settings. This procedure requires knowledge of human anatomy, principles of medication preparation, aseptic techniques, and appropriate injection methods to minimize complications arising from incorrect muscle layer injection, improper site selection, and inappropriate needle size.Practicing intramuscular injections on simulation models in nursing skills laboratories provides essential learning experiences for nursing students. However, conventional simulation models lack real-time feedback on the accuracy of the procedure. This research and development study aimed to develop an interactive shoulder intramuscular injection simulator that provides practice feedback and compares its effectiveness with traditional muscle part and upper-arm simulators. The conceptual framework integrated Dale’s Cone of Experience with anatomical principles and biomedical engineering techniques,emphasizing realistic learning experiences. The developed simulator replicates an adult deltoid muscle. It incorporates a feedback system using electronic sensors and auditory signals to indicate correct needle placement and depth, allowing learners to self-assess and build confidence. The study was conducted in four phases: 1) needs assessment and literature review, 2) development of the interactive shoulder intramuscular injection simulator, 3) evaluation of the simulator’s effectiveness, and 4) refinement and modification of the simulator.The samples included 60 second-year nursing students enrolled in a fundamental nursing course at a university and six nursing instructors, totaling 66 participants. The study utilized three types of simulators: the interactive shoulder intramuscular injection simulator, a muscle part simulator, and an upper-arm simulator with straps, light signals, and sound feedback. Data collection involved participants performing intramuscular injections using each of the three simulators in the following order: the muscle part, the upper-arm, and the interactive simulators. Each injection session lasted five minutes per simulator, totaling 15 minutes for all three simulators.Additionally, participants completed an evaluation form assessing the effectiveness of the simulators in four dimensions: 1) Realism: Skin and muscle anatomy, 2) Skill enhancement in muscle injection: site and depth, 3) Attitude improvement toward nursing practice: Safety and comfort, and 4) Practical application: Ease and suitability. The evaluation took five minutes, bringing the total data collection time to 20 minutes. Data were analyzed using descriptive statistics, repeated measures ANOVA, and pairwise comparison analysis using Bonferroni correction in nursing students, including the Friedman test, and Dunn-Bonferroni post hoc test in nursing instructors.The interactive shoulder intramuscular injection simulator was designed as a half-body male adult with a deltoid muscle molded from yellowish-white silicone,equipped with electronic circuits to detect the position and depth of the needle and a sound system that provides verbal feedback when the needle is inserted correctly at the appropriate location and depth. The overall effectiveness of three types of simulators among nursing students differed significantly in at least one pair (F_2,118 = 56.83,p < .001). significance level. The overall effectiveness of the interactive simulator for nursing students was significantly higher than that of the muscle part simulator and upper-arm simulator (MD = -1.15, SE = .13, p < .001, 95% CI = [-1.469, -.840];MD = -.86, SE = .11, p < .001, 95% CI = [-1.122, -.597]) The overall effectiveness of the upper-arm simulator for nursing students was significantly higher than that of the muscle part simulator (MD = -.29, SE =.10, p < .05, 95% CI = [-.546, -.045]).Furthermore, among nursing instructors, the overall effectiveness of three types of simulators differed significantly in at least one pair χ2 (2, N=6) = 9.65, p < .01).The overall effectiveness of the interactive simulator for nursing instructors was significantly higher than that of the muscle part simulator (z = -1.75, p < .01).The findings indicate that a realistic simulator with feedback mechanisms enhances intramuscular injection procedures' accuracy, convenience, and self-assessment. The interactive shoulder intramuscular injection simulator should be integrated  into  nursing education to improve injection skills, promote safety awareness, and ensure patient comfort. Future development and research should incorporate a palpable scapula bone and an acromion process, enhance muscle resistance upon needle withdrawal, extend the evaluation period, and increase the nurse instructor sample size for effectiveness comparison.
Keywords: Deltoid muscle, Interactive simulator, Intramuscular injection, Simulator-training effectiveness