Effects of a Computational Fluid Dynamics‐Based Mobile Education Program on Syringe‐Based Wound Irrigation

ABSTRACT

The study aimed to develop a computational fluid dynamics‐based mobile wound irrigation education program and explore changes in irrigation pressure control, wound irrigation‐related knowledge and performance confidence in syringe‐based wound irrigation. This study used a single‐group pre–post design. A computational fluid dynamics‐based mobile wound irrigation program was developed following the Analysis, Design, Development, Implementation, and Evaluation model. The program enabled learners to manipulate irrigation variables and visualize pressure distribution in real time. Thirty‐four participants were recruited. Irrigation pressure was measured using a load cell‐based device, and knowledge and performance confidence were assessed pre‐ and post‐intervention. Data were analysed using paired t‐tests and content analysis. The mean irrigation pressure increased significantly, although the post‐intervention mean remained below the recommended pressure range and the proportion of participants achieving the recommended range rose from 0% to 44%. Knowledge and performance confidence also improved significantly. Qualitative findings indicated enhanced understanding of performance standards, improved technical awareness and reduced uncertainty during skill execution. Participation in the computational fluid dynamics‐based mobile education program was associated with improvements in irrigation pressure control, related knowledge and performance confidence in syringe‐based wound irrigation. These findings should be interpreted as preliminary because of the single‐group pre–post design. Numerical visualization and real‐time feedback may be useful educational strategies for facilitating the transition from experience‐based skill performance to data‐driven practice.

Trial Registration: Clinical Research Information Service (CRIS), Republic of Korea: KCT0011256.

Highlights

• A CFD‐based mobile education program for syringe‐based wound irrigation was developed and implemented.

• Irrigation pressure significantly increased after the intervention, with more participants achieving the target pressure range.

• Wound irrigation knowledge and performance confidence significantly improved following the program.

• Real‐time numerical visualization facilitated understanding of target irrigation pressure during wound irrigation.

• The program demonstrated potential as an educational strategy for wound irrigation training.

1. Introduction

The skin serves as a critical barrier that protects the human body from external environmental factors and microbial invasion. However, wounds occur when the structural integrity of healthy skin is compromised due to various causes, such as mechanical trauma, diabetes, burns and surgical procedures [1]. The incidence of wounds has risen with the increasing prevalence of older adults and individuals with chronic diseases, further highlighting the importance of evidence‐based wound management [2].

Among wound management interventions, wound irrigation is considered a key strategy for preventing infection and promoting an optimal healing environment [3]. Irrigation is particularly important in preventing the progression to chronic wounds by inhibiting biofilm formation and reducing bacterial load [4]. Consequently, maintaining an appropriate irrigation pressure is essential for effective wound cleansing [5]. Insufficient pressure may fail to remove contaminants effectively, whereas excessive pressure can cause tissue damage and pain [5, 6]. Accordingly, the Agency for Healthcare Research and Quality recommends an irrigation pressure of 8–15 psi to balance infection control and tissue protection [7]. Although various irrigation devices have been developed to maintain optimal pressure, syringe‐based irrigation remains widely used in clinical practice due to cost and maintenance considerations [8].

Previous studies have reported that syringe‐based wound irrigation can maintain recommended pressure levels comparably well compared to some commercially developed irrigation devices; however, significant variability in pressure has been observed depending on the operator [9]. Current clinical guidelines provide estimated pressure values based on specific syringes and needle combinations [10]. For example, a 35‐cc syringe with a 19‐gauge needle and a 12‐cc syringe with a 22‐gauge needle are estimated to generate approximately 8 and 13 psi, respectively. However, these estimations are primarily based on equipment specifications and theoretical calculations. In actual practice, limited guidance is provided regarding the speed at which the syringe plunger should be depressed (i.e., the flow rate of the irrigation solution) [8]. The plunger depression speed directly determines the flow rate, which consequently influences the actual pressure delivered to the wound surface.

Despite its critical importance, this physical principle has not been systematically addressed in clinical guidelines or educational curricula. Consequently, wound irrigation performance continues to rely largely on individual sensation and experience. Although recommended pressure ranges are available, maintaining consistent pressure control in clinical practice remains challenging. These limitations indicate that syringe‐based wound irrigation is not simply about selecting appropriate equipment but also requires understanding and regulating the dynamic physical variables during performance. Therefore, educational approaches should enable learners to immediately verify and adjust their performance outcomes [11]. However, conventional wound irrigation education does not visually present how variations in applied force, distance from the wound, or irrigation angle influence pressure, hindering learners' objective assessment of their performance [12]. Welsh [13] further highlighted that wound care practice still relies heavily on experiential traditions, with evidence‐based approaches insufficiently integrated into academic and clinical education. These findings underscore the need for educational strategies that integrate physical principles, performance standards and structured feedback mechanisms in wound irrigation training.

Computational fluid dynamics (CFD) offers a potential solution to these limitations. It enables quantitative simulation and visualization of pressure distribution under varying syringe‐based irrigation conditions, thereby clarifying the causal relationship between performance variables and pressure outcomes [14]. This technology can support repeated practice without temporal or spatial constraints and provide real‐time feedback to facilitate performance adjustment when integrated into a mobile‐based educational platform [15]. Such technological integration may serve as an educational strategy to transition from sensation‐based performance to data‐driven practice.

Therefore, this study developed a CFD‐based mobile wound irrigation education program and exploratively examined its effects on irrigation pressure control, wound irrigation‐related knowledge and performance confidence in syringe‐based wound irrigation.

2. Materials and Methods

2.1. Study Design and Setting

This study employed a single‐group pre–post design to develop and conduct a preliminary feasibility and usability evaluation of a CFD‐based mobile wound irrigation education program for optimal pressure control in syringe‐based wound irrigation.

2.2. Participants

This study involved two groups with different levels of wound care experience to examine the clinical and educational applicability of the CFD‐based mobile wound irrigation education program. The participants included clinical nurses with substantial exposure to wound care and fourth‐year nursing students with relatively limited clinical experience.

For clinical nurses, the inclusion criteria were (1) being currently employed at a university‐affiliated hospital in Seoul, (2) either being certified wound care nurses or nurses who had regularly performed wound‐related duties within the past year and (3) having provided written informed consent after receiving an explanation of the study's purpose and procedures.

The inclusion criteria for nursing students were (1) being fourth‐year undergraduate nursing students who had completed all required coursework and were preparing for graduation and (2) having voluntarily provided written informed consent after receiving an explanation of the study. The sample size was calculated based on a previous study measuring irrigation pressure during wound cleansing [16]. A minimum of 13 participants per group was required using a significance level of 0.05, statistical power of 90% and a two‐tailed test. Seventeen participants were recruited for each group, considering a potential dropout rate of 20%, resulting in a total sample size of 34.

2.3. Program Development

The education program was developed following the five phases of the Analysis, Design, Development, Implementation, and Evaluation model.

2.3.1. Phase 1: Analysis

A literature review was conducted during the analysis phase to establish foundational evidence for developing an education program aimed at regulating optimal pressure in syringe‐based wound irrigation. Eight databases were searched, including international (PubMed, Scopus, ProQuest and Cumulative Index to Nursing and Allied Health Literature) and domestic (DBpia, Korean studies Information Service System, the National Assembly Library and Research Information Sharing Service) databases.

The program incorporated findings from a prior CFD study [8] and additional CFD analyses conducted in the present study to reflect clinically relevant wound irrigation conditions. Variables such as needle inner diameter, irrigation solution type, height from the wound surface, spray angle and flow rate were modelled to derive corresponding pressure distributions in these analyses. The CFD analysis process applied in this study is as follows. We used Ansys SpaceClaim (Ansys Inc., USA) to define the fluid dynamics domain and analyse the pressure and spray characteristics as the irrigation solution exits the syringe and reaches the wound site.

The fluid dynamics domain was divided into two regions. The first was a cylindrical domain with a diameter of 2 mm, designed to simulate the flow disturbances and diffusion that occur when the liquid exits the syringe and interacts with air resistance. The second was a cylindrical domain with a diameter of 50 mm and a height of 1 mm, modelled to simulate the interaction between the cleaning solution and the wound surface. To apply the Navier–Stokes equations to the fluid dynamics domain, the region was divided into numerous small volume elements to generate a mesh. The Ansys Meshing program (Ansys Inc., USA) was used for this purpose. A relatively dense mesh was generated at the centre of the cylindrical domain where the fluid flows from the syringe to the wound surface to accurately model fluid motion and diffusion. Additionally, a uniformly dense mesh was applied to the wound surface to capture the flow characteristics at the point of impact. To improve accuracy and numerical convergence, both regions were composed of polyhedral elements. The total number of grid cells was approximately 290 000 for a height of 2 cm and approximately 550 000 for a height of 10 cm.

The simulation was performed using the Ansys CFX program (Ansys Inc., USA). The analysis was conducted under three‐dimensional, incompressible and unsteady‐state conditions, simultaneously solving the Navier–Stokes equations and the continuity equation. The physical properties of the irrigation fluid were specified, and a Dirichlet boundary condition with a flow rate ranging from 0.5 to 5.0 mL/s was applied at the inlet. A no‐slip condition was applied to the wound surface, and all other surfaces were set as open boundary conditions to allow for free inflow and outflow of the fluid. The simulation was run using available computer hardware. Based on the completed analysis files, data regarding fluid behaviour, pressure distribution on the wound surface and the effects of syringe angle, height and flow rate were extracted and analysed. Although mL/s was used as the standard unit for fluid flow rate in the CFD analysis, the results were converted to cc/min, a unit commonly used in clinical settings. Pressure values were reported in psi. The reliability of this analysis was verified using a pressure measurement device in a pilot study [17]. The integrated results were used as foundational data for designing the program's variable manipulation functions and pressure visualization features. For interface development, the practical experience of research team members with extensive clinical backgrounds and consultation from a nursing faculty member were incorporated. Key screen components were structured based on these inputs to enable learners to intuitively understand the process of variable selection, pressure monitoring and feedback‐based adjustment.

2.3.2. Phase 2: Design

Specific learning objectives were established during the design phase, and the structure and functional components of the mobile‐based education program were developed accordingly. The learning objectives included (1) understanding the recommended pressure range for wound irrigation, (2) interpreting pressure variations according to changes in irrigation conditions and (3) improving pressure regulation ability based on CFD‐generated visual feedback. Additionally, the instructional strategy was structured around visual feedback‐based self‐directed learning. Learners were designed to actively manipulate syringe specifications and irrigation‐related variables, observe the corresponding CFD‐based pressure distribution in real time and independently adjust pressure settings based on the feedback provided. The interface and workflow of the CFD‐based visualization screen and self‐learning modules were finalized in collaboration with a professional development company. This program adopted a cyclical learning structure comprising variable selection, pressure visualization, outcome confirmation and re‐adjustment. Program functions were aligned with the stated learning objectives to ensure consistency between instructional goals and evaluation components.

2.3.3. Phase 3: Development

During the development phase, the mobile‐based education program was implemented based on the results from the analysis and design phases. The program was developed in collaboration with a professional software development company and built on an Android platform to ensure compatibility with smartphones and tablets. User access was managed through a login system. Learners could select one of three pressure‐level scenarios (low, optimal or high pressure) upon entry, each representing a wound irrigation condition corresponding to a specific pressure range. The program comprised two main components as follows: (1) a condition‐setting stage where learners selected syringe size, needle gauge and irrigation solution type; and (2) a performance stage where learners specified spray angle and height, and manipulated a slider to adjust flow rate and irrigation duration in real time (Figure 1). Specifically, the CFD‐based pressure distribution on the wound surface was visually displayed according to these inputs. The recommended pressure range was simultaneously presented on the screen, enabling learners to immediately evaluate and modify their performance. Additionally, the developed program underwent expert review by one wound care specialist nurse and one nursing faculty member. Its applicability and usability in clinical and academic settings were evaluated, and suggested revisions were incorporated. A pilot test was subsequently conducted with five individuals who had characteristics similar to the target participants to assess system stability and user comprehensibility. Minor interface modifications and technical corrections were made based on pilot feedback. Research team members conducted a final usability check after the pilot test to identify any remaining technical issues before finalizing the program.

FIGURE 1.

Architecture and example screens of the syringe‐based wound irrigation mobile training system.

2.3.4. Phase 4: Implementation

The finalized CFD‐based mobile wound irrigation education program was implemented in a single session. Participants individually accessed the program using mobile devices and completed the theoretical learning and virtual practice components. Pre‐intervention measurements were conducted before program participation, and post‐intervention measurements were obtained immediately after completion using the same instruments.

2.3.5. Phase 5: Evaluation

During the evaluation phase, pre‐ and post‐intervention changes were assessed among clinical nurses and fourth‐year nursing students. Pre‐intervention assessments included irrigation pressure, wound irrigation‐related knowledge and confidence in wound irrigation and pressure regulation. Irrigation pressure was objectively measured using a load cell‐based pressure sensor device. After program completion, irrigation pressure, knowledge and confidence were reassessed using the same instruments. Post‐intervention measures included learning satisfaction and open‐ended responses regarding participants' experiences with the program.

2.4. Measurement

Wound irrigation pressure measured using a load cell‐based pressure sensor was the primary outcome, whereas the secondary outcomes included wound irrigation‐related knowledge, confidence in pressure control and educational satisfaction.

2.4.1. Irrigation Pressure

Irrigation pressure was objectively measured using a load cell–based pressure sensor device developed for this study to assess participants' ability to regulate optimal pressure during wound irrigation. The device was designed to detect the force generated by the syringe in real time and convert it into pressure units (psi), with a measurement range set to adequately encompass the clinically recommended pressure range. The measured values were automatically recorded in digital format, and the system was programmed to calculate the mean pressure across two trials. A 35‐cc syringe and 19‐gauge needle, as recommended in clinical practice guidelines, were used. The target pressure range was set at 8–15 psi. Participants performed wound irrigation twice at each measurement point. Although previous studies have reported either single or repeated measurements, this study adopted two trials to enhance measurement stability [16]. The device was calibrated against a standard manometer prior to data collection to ensure measurement accuracy. Pre‐ and post‐intervention assessments were conducted under identical conditions (Figure 2).

FIGURE 2.

Pressure measurement device for syringe‐based wound irrigation.

2.4.2. Wound Irrigation‐Related Knowledge

Wound irrigation‐related knowledge was assessed using the instrument developed by Campany et al. [16]. The tool consists of 18 items categorized into two subscales: general knowledge of wound irrigation (nine items) and knowledge of irrigation technique (nine items). Items were scored dichotomously (‘true’ or ‘false’). In the present study, reliability was confirmed with a Kuder–Richardson 20 coefficient of 0.78.

2.4.3. Confidence in Wound Irrigation

Confidence in wound irrigation was measured using a single‐item 10‐point scale, ranging from 1 (‘not confident at all’) to 10 (‘very confident’).

2.4.4. Learning Satisfaction

Learning satisfaction was assessed using a single‐item 10‐point scale, ranging from 1 (‘very dissatisfied’) to 10 (‘very satisfied’).

2.4.5. Learning Experience

Participants' experiences with the program were collected through a single open‐ended question, inviting overall reflections on program participation.

2.5. Data Collection

Participants were recruited from two groups comprising clinical nurses and fourth‐year nursing students. Clinical nurses were recruited from two university‐affiliated hospitals. Recruitment notices were posted in departments related to wound care, and nurses who expressed interest were provided with detailed information regarding the study's purpose and procedures. Those who voluntarily provided written informed consent were included. Fourth‐year nursing students who had completed all required coursework and secured hospital employment as clinical nurses were recruited through study announcements. The same procedures were followed, including an explanation of the study's purpose and procedures and obtaining written informed consent. Data collection was conducted from January 13 to 2 February 2026. All participants completed pre‐intervention assessments before participating in the mobile education program. Post‐intervention assessments were conducted immediately after program completion using the same instruments.

2.6. Data Analysis

Data were analysed using IBM SPSS Statistics for Windows, version 21.0 [18]. Descriptive statistics were used to summarize participants' general characteristics. Normality of the measured variables was assessed using skewness, kurtosis and the Shapiro–Wilk test. The intervention's effects were examined using paired‐sample t‐tests. Independent‐sample t‐tests were conducted to compare clinical nurses and nursing students at pre‐test and post‐test. Effect sizes were calculated using Cohen's d to evaluate the magnitude of observed changes and between‐group differences. Qualitative data collected through open‐ended responses were analysed using conventional content analysis. The researchers repeatedly reviewed the responses, identified meaning units and categorized them into cognitive, technical and psychological change domains. To enhance analytical rigour, categorization was reviewed and discussed among the research team to ensure consistency and appropriateness.

2.7. Ethical Considerations

This study was approved by the Institutional Review Board of Kyung Hee University [KHSIRB‐25‐576(NA)].

3. Results

3.1. General Characteristics of Participants

Thirty‐four participants were included in the study, comprising nine males (26.5%) and 25 females (73.5%). The mean ages of nursing students and clinical nurses were 24.06 and 29.24 years, respectively. Clinical experience among the clinical nurses (n = 17) was distributed as follows: < 5 (n = 9, 53.0%), 5–10 (n = 4, 23.5%) and > 10 (n = 4, 23.5%) years. Regarding prior wound care education experience, 26 participants (76.5%) reported no previous training, while eight (23.5%) had received wound care education.

3.2. Descriptive Statistics of Measured Variables

For wound irrigation‐related knowledge, the mean score was 10.71 ± 2.98, with a skewness and kurtosis of 0.087 and 0.816, respectively. The mean confidence score for wound irrigation and pressure regulation was 3.74 ± 1.78, with a skewness of 0.289 and kurtosis of 0.875.

Notably, the Shapiro–Wilk test indicated that wound irrigation‐related knowledge (W = 0.968, p = 0.418) and confidence (W = 0.937, p = 0.050) satisfied the assumption of normality.

3.3. Outcomes of the Mobile Education Program

The mean wound irrigation pressure significantly increased from 3.75 psi pre‐intervention to 7.71 psi post‐intervention in the pre–post comparison (t = 8.57, p < 0.001) (Table 1). Although the post‐intervention mean pressure approached the recommended range (8–15 psi), the overall mean did not fully reach the target range (Figure 3). Group‐level analysis showed that clinical nurses demonstrated an increase in post‐intervention pressure but did not reach the target range, whereas nursing students achieved pressure values within the recommended range at post‐test. Between‐group comparisons for wound irrigation pressure revealed no significant difference at pre‐test (p = 0.242) but a significant difference at post‐test (p = 0.001). The proportion of participants meeting the target pressure range increased from 0% at pre‐test to approximately 44% at post‐test (Figure 4). Wound irrigation‐related knowledge (t = 8.29, p < 0.001) and confidence in wound irrigation and pressure regulation (t = 9.81, p < 0.001) also significantly improved post‐intervention. Learning satisfaction was high, with a mean score of 9.68 out of 10.

TABLE 1.

Pre–post changes in wound irrigation pressure and educational outcomes by participant group (N = 34).

Variables	Clinical nurse (n = 17)	Nursing student (n = 17)	t (p b )	Effect size
	Mean ± SD	Mean ± SD
Wound irrigation pressure
Pre‐test	3.24 ± 2.29	4.26 ± 2.73	1.19 (0.242)	0.4
Post‐test	6.50 ± 1.64	8.91 ± 2.12	3.70 (0.001)	1.27
p value a	6.05 (< 0.001)	8.29 (< 0.001)
Effect size	1.64	1.90
Wound irrigation knowledge
Pre‐test	12.65 ± 1.96	8.76 ± 2.39	5.17 (< 0.001)	1.78
Post‐test	15.00 ± 1.06	16.41 ± 1.06	−3.87 (< 0.001)	1.33
p value a	5.28 (< 0.001)	11.71 (< 0.001)
Effect size	1.49	4.14
Confidence in wound irrigation performance
Pre‐test	4.29 ± 1.68	3.18 ± 1.74	1.91 (0.066)	0.65
Post‐test	7.12 ± 1.57	7.53 ± 1.00	−0.90 (0.371)	0.31
p value a	5.80 (< 0.001)	8.84 (< 0.001)
Effect size	1.74	3.07
Program satisfaction
Post‐test	9.41 ± 0.93	9.94 ± 0.24	−2.25 (0.037)	0.78

Note: Effect size = Cohen's d.

^a p value for within group comparisons.

^b p value for between groups comparisons.

FIGURE 3.

Pre–post changes in wound irrigation pressure (psi). (a) Total participants. (b) Clinical nurses. (c) Nursing students.

FIGURE 4.

Individual pre–post changes in wound irrigation pressure (psi).

3.4. Analysis of Participants' Learning Experiences

Open‐ended responses were analysed using content analysis and categorized into cognitive, technical and psychological change domains. Although changes across all three domains were identified in both groups, differences were observed in their specific meanings and emphases (Figure 5).

FIGURE 5.

Thematic analysis of participants' educational experiences.

3.4.1. Clinical Nurses

1. Cognitive Change: From Implicit Practice to Evidence‐Based Understanding

Clinical nurses reported reconsidering their previous wound irrigation practices, which had largely relied on experiential judgement without clear reference to recommended pressure standards. Many recognized that they had tended to maintain lower‐than‐recommended pressures due to concerns about patient pain or tissue damage. They became aware of specific pressure values and related influencing factors through the program, leading to reflective reconsideration of their clinical practice.

Before the training, I was unaware of the importance of appropriate pressure. I learned that the recommended range is 8–15 psi, which was higher than I expected. It made me realize that I need to apply sufficient pressure during wound irrigation in clinical practice. (Clinical nurse 5)

• 2 Technical Change: Integrating Sensory Experience with Physical Understanding

Participants reported that repeated virtual practice combined with numerical feedback helped them internalize the recommended pressure range and link tactile sensation with objective pressure values. They described gaining a clearer understanding of how variables such as needle diameter, irrigation solution characteristics, spray angle, height and flow rate influence pressure outcomes. This enhanced their ability to regulate performance more systematically.

I did not realize how much pressure changes depending on angle or height. Seeing the numbers immediately helped me understand how to adjust the force with my hand. (Clinical nurse 2)

I learned that syringe size and needle type must be selected appropriately during wound irrigation. Previously, I focused only on applying sufficient pressure to remove debris, but now I realize that multiple factors influence pressure. Practicing directly helped me develop a sense of what appropriate pressure feels like, which will be helpful in clinical settings. (Clinical nurse 6)

• 3 Psychological Change: Reduced Anxiety and Enhanced Performance Confidence

Clinical nurses reported decreased uncertainty and anxiety associated with wound irrigation performance. The opportunity to verify whether their performance met appropriate standards contributed to increased confidence. Participants indicated that re‐evaluating the efficiency of their previous practices while considering patient safety aspects led to greater psychological reassurance regarding future clinical performance.

I gained confidence in performing wound irrigation. The mobile program helped me learn the foundational knowledge and realize what I previously did not know. (Clinical nurse 17)

I had never considered irrigation speed or pressure before. This training helped me understand the concepts better, particularly through hands‐on practice. I also realized that irrigation typically requires higher pressure than I expected. If such programs were incorporated into training, they would greatly support standardization of nursing practice and enhance professionalism and confidence. (Clinical nurse 16)

I used to hesitate when irrigating wounds because I was unsure of the proper technique. After this training, I feel confident performing it independently without constantly consulting a senior nurse. (Clinical nurse 6)

3.4.2. Nursing Students

1. Cognitive Change: From Intuitive Guesswork to Data‐Based Understanding

Nursing students reported that concepts previously learned at a theoretical level became more concrete through numerical values and visualized simulation results. By examining CFD‐based outputs, they recognized how multiple variables influence irrigation pressure and began to view wound irrigation as an evidence‐based practice rather than an intuition‐guided task. This shift reflected a cognitive transition toward data‐informed nursing practice.

It was interesting to learn that 8–15 psi is the most appropriate pressure for wound irrigation and that research has identified which equipment should be used to achieve it. I had almost forgotten concepts such as debridement since my second‐year fundamentals course; however, this training reminded me that removing necrotic tissue is an important skill for promoting healing. The most helpful aspect was the application. The theoretical explanations were clear, and the simulation function allowed me to check how many cc per second were needed to reach the appropriate pressure. It was impressive that these results were derived from computational fluid dynamics. (Nursing student 3)

• 2 Technical Change: Integration of Physical Properties and Bodily Control

Participants reported that syringe‐based wound irrigation is not merely a mechanical action but a skill that requires understanding the interaction between equipment specifications and physical force regulation. They described increased awareness of how variables such as spray angle, distance and flow rate influence pressure outcomes, and reported improved ability to adjust these factors accordingly. This experience was perceived as complementing textbook‐based learning by providing a contextualized understanding of real‐world performance.

I had never learned about syringe‐based wound irrigation comprehensively in either theory or practice; therefore, I realized that I did not truly understand pressure, angle, or height. I was surprised that achieving 8–15 psi requires stronger and faster flow than I expected. Before the training, I hesitated, worrying that applying that level of pressure might irritate the tissue. However, learning with national and international standard references reduced this hesitation and gave me confidence in performing irrigation appropriately. I could sense that I had reached the correct pressure when the stream of solution was steady, and a consistent force was felt at the syringe tip. I believe improper irrigation may occur when nurses hesitate or are uncertain. (Nursing student 1)

• 3 Psychological Change: Reduced Clinical Anxiety and Development of Professional Self‐Efficacy

Nursing students reported decreased vague anxiety about making mistakes in clinical settings. They experienced increased confidence in performing wound irrigation through repeated practice and numerical feedback. Participants also noted that having access to a self‐directed learning environment enhanced their psychological readiness for their future role as novice nurses.

I might have performed the procedure without proper evidence if I had encountered a patient in the hospital without this training. However, I learned the appropriate pressure and its theoretical basis through this education. I felt more confident performing irrigation after the training. The mobile program made it easier to understand the concepts by providing visual examples, and the simulation highlighted key points to focus on at each step, which helped me remember them. Although I understood the theory and felt more confident, I still realized that regulating pressure precisely can be challenging. (Nursing student 4)

4. Discussion

This study explored changes in syringe‐based wound irrigation performance following participation in a CFD‐based mobile wound irrigation education program. These findings have several implications.

First, conventional wound irrigation education has limitations in enabling learners to quantitatively verify how variations in applied force, distance from the wound and spray angle influence actual irrigation pressure. Consequently, learners have typically relied on sensory judgement or experiential habits rather than clearly defined performance standards [11, 12]. In such educational contexts, recommended evidence‐based pressure ranges are not easily translated into actual performance behaviour. To address this limitation, the program developed in this study was designed to allow learners to directly manipulate syringe type, needle gauge, irrigation solution, spray angle and height, while visualizing the resulting pressure distribution in real time. Previous research has suggested that simulation‐ and technology‐based education may support the development of practical skills [19]. Similarly, the present program incorporated immediate feedback and iterative adjustment within the learning process, thereby operationalizing a performance–feedback–modification learning cycle. The qualitative findings further support this interpretation. Participants reported clearer recognition of performance standards and described changes in how they regulated pressure by integrating tactile sensation with numerical feedback. These findings suggest that participants may have restructured their performance strategies through engagement with pressure visualization, rather than merely increasing knowledge. Therefore, the findings suggest a potential shift from intuition‐based execution toward data‐informed performance regulation among participants.

Second, wound irrigation pressure increased significantly post‐intervention. Although the overall mean pressure did not fully reach the recommended range (8–15 psi), the increase in the proportion of participants achieving the target range suggests progress toward improved pressure regulation. Since the intervention was delivered in a single session, this change should not be interpreted as full skill mastery but rather as the initiation of performance recalibration. Prior research has emphasized that repeated practice and iterative feedback are essential for the consolidation of procedural skills [20]. Contextually, the present findings may be understood as early evidence of strategic performance adjustment. Group differences provide additional insight. Clinical nurses demonstrated significant increases in post‐intervention pressure; however, their mean values did not reach the recommended range. Nursing students achieved pressure levels within the target range at post‐test. One possible explanation is that clinical nurses, despite engaging in cognitive reflection on their prior practices, may have been influenced by previously internalized professional habits, which can constrain rapid modification of established performance patterns [21]. Nursing students, who have not yet been fully socialized into clinical routines, may have been more receptive to integrating data‐based standards directly into their performance. These findings suggest that changes in technical performance may be associated with skill acquisition and the influence of professional socialization and practice culture. Therefore, the findings suggest that implementing data‐driven feedback mechanisms may require differentiated educational strategies depending on learners' level of clinical experience.

Third, wound irrigation‐related knowledge significantly increased after the program implementation. This finding suggests that participation in the CFD‐based mobile education program was associated with improvements in learners' cognitive understanding. Although conventional wound irrigation education presents recommended pressure ranges as numerical standards, it offers a limited explanation of how these standards are operationalized in actual clinical performance. Consequently, learners may be familiar with the numerical values yet struggle to translate them into practical applications. In the present study, CFD‐based pressure distributions were visualized, transforming abstract numerical values into observable, performance‐linked information. This approach aligns with previous research suggesting that complex data visualization facilitates intuitive understanding and supports conceptual learning [22]. Learning may extend beyond memorization toward structural comprehension of underlying principles when numerical information is integrated with visual feedback.

Qualitative findings further supported this interpretation. Participants reported that concepts previously understood theoretically were reinterpreted within the context of actual performance, and that their awareness of the necessity of performance standards was strengthened. These findings suggest that the observed improvement reflects both an increase in factual knowledge and a process of conceptual restructuring. Although the intervention comprised a single session, a significant improvement in knowledge was observed, providing preliminary evidence that technology‐enhanced simulation learning may support cognitive development in clinical skill acquisition. These findings align with previous research indicating that simulation‐ and technology‐based education may contribute to improved understanding and clinical competence among healthcare learners [19].

Fourth, confidence in performing wound irrigation and regulating irrigation pressure significantly increased post‐program implementation. This finding suggests that the CFD‐based mobile education program was associated with improvements in both performance accuracy and learners' psychological readiness and performance assurance. Recent nursing education research indicates that structured feedback significantly improves students' knowledge, skills and confidence [23]. In the present study, learners were provided with real‐time visualization of pressure values and opportunities for repeated adjustment. Such an environment may have reduced uncertainty regarding performance outcomes. When learners can objectively verify the results of their actions, they are more likely to perceive their performance as controllable and adjustable. This perception may contribute to forming performance confidence.

Qualitative findings further supported this interpretation. Participants reported that the uncertainty associated with their previous practice decreased and that they could evaluate their performance according to explicit criteria. This reflects not merely emotional satisfaction but a sense of stability from having clear performance standards. Particularly, statements indicating that they were ‘performing with a clear standard in mind’ may suggest movement toward criterion‐based performance. This study is meaningful in that it developed a mobile education program based on CFD analysis and linked it to the objective measurement of actual wound irrigation pressure to explore its preliminary outcomes. It particularly differentiates itself from prior educational research by applying a numerical feedback system to a syringe‐based wound irrigation routine yet difficult‐to‐quantify clinical skill and directly measuring changes in performance outcomes. Furthermore, by integrating quantitative and qualitative data to interpret improvements in pressure regulation, knowledge and performance confidence, this study suggests that technology‐based education may support both performance accuracy and psychological readiness.

However, this study has some limitations. First, it employed a single‐group pre–post design, thereby limiting the ability to establish causal effects through comparison with a control group. Second, the relatively small sample size and recruitment from specific institutions require cautious interpretation regarding generalizability. Third, the intervention was conducted as a single session, preventing examination of the long‐term retention of pressure regulation skills. The fact that the overall mean pressure did not fully reach the recommended range further highlights the need for repeated practice and sustained feedback. Future studies should apply randomized controlled designs to more rigorously evaluate the program's effectiveness. Research incorporating repeated interventions and follow‐up assessments is also needed to determine whether improvements in pressure regulation are sustained and transferable to actual clinical settings. The development and validation of hybrid educational models that integrate pressure‐sensing devices with mobile platforms may further contribute to wound irrigation education standardization and evidence‐based practice dissemination.

5. Conclusion

This study identified preliminary improvements in syringe‐based wound irrigation performance following participation in a CFD‐based mobile education program. Wound irrigation pressure significantly increased after the intervention, although the mean pressure remained below the recommended range and the proportion of participants achieving the recommended pressure range increased. Improvements were also observed in wound irrigation‐related knowledge and performance confidence. Numerical feedback and real‐time visualization appeared to facilitate learners' understanding of performance conditions and pressure regulation. These findings suggest that CFD‐based mobile education may have potential as a strategy for supporting data‐driven wound irrigation practice. However, given the single‐group pre–post design, the findings should be interpreted cautiously. Future controlled studies with larger samples and repeated interventions are needed to establish effectiveness and evaluate the long‐term clinical applicability of this program.

Funding

This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (RS‐2025‐00563647).

Ethics Statement

This study was approved by the Institutional Review Board of Kyung Hee University [KHSIRB‐25‐576(NA)].

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Upon reasonable request, the corresponding author can provide the data sets generated and analysed in this study.