THE EFFECTIVENESS OF HIGH-FIDELITY SIMULATION IN ENHANCING CLINICAL DECISION-MAKING AMONG NURSING STUDENTS

Abstract

Background: High-fidelity simulation (HFS) has emerged as a powerful teaching strategy in nursing education, enabling students to engage in realistic clinical scenarios and develop essential decision-making skills. As the complexity of healthcare continues to grow, there is a critical need to evaluate the educational effectiveness of HFS in fostering clinical decision-making competence among nursing students.

Objective: This systematic review aims to assess the effectiveness of high-fidelity simulation in enhancing clinical decision-making skills among undergraduate nursing students.

Methods: A comprehensive literature search was conducted across PubMed, Scopus, ScienceDirect, and CINAHL databases, covering publications from January 2015 to March 2025. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Eligible studies were peer-reviewed articles evaluating HFS interventions in nursing education and their impact on clinical decision-making. Seven studies met the inclusion criteria. Data were extracted, quality assessed using appropriate appraisal tools, and synthesized narratively and graphically using a forest plot.

Results: All included studies demonstrated positive outcomes of HFS on nursing students’ clinical decision-making, with effect sizes ranging from moderate to large. Key findings included improvements in clinical judgment, critical thinking, confidence, and satisfaction. The forest plot showed consistent effectiveness, with no confidence intervals crossing zero. Qualitative data also highlighted students’ high satisfaction and perceived realism of HFS scenarios. Conclusion: HFS is an effective pedagogical tool for enhancing clinical decision-making skills among nursing students. It provides a safe, immersive environment that supports experiential learning and bridges the gap between theory and practice. Nursing education programs are encouraged to integrate HFS into curricula to better prepare students for clinical challenges and improve patient care outcomes.