Limitations of the Study
Several limitations of this study must be acknowledged. First, the study was based on a nonprobability convenience sample, which increases the risk of bias. However, the sample was consistent with educational level of the students (all were first year nursing students) and curriculum of the schools. Second, our results regarding the significantly higher scores of the students in the web-enhanced group should be interpreted with caution because the experimental group had easy access to computers, and internet and two opportunities to take the knowledge test and perform the skills. Third, the use of video in the web-based group might have positively influenced the scores and performances of students. Fourth, during the observations of student skills, inter-observer consistency was at a moderate level in some steps. Repeated observational measures within a short time interval (15 min per student) were tiring for observers, and they had to complete all observations within a few days. Such a tiring and long-lasting process of observation might have decreased the vigilance of observers and influenced inter-rater reliability. Finally, due to concerns of safety and privacy, we used a female mannequin for demonstration during lectures and observation of students' skill performances.