Background Simulation-based assessment is widely used in nursing education, but structured tools may not fully capture educators’ judgments of readiness for safe practice. Method A qualitative descriptive study involved 17 nurse educators from a public university in Saudi Arabia. Semistructured interviews were analyzed using reflexive thematic analysis. Results Five themes described readiness as extending beyond observable performance to clinical reasoning, adaptability, communication, professional responsibility, and intuitive judgment. Trust and entrustment emerged as central to competency decisions, alongside tensions between standardization and individual learning trajectories. Conclusions Simulation-based competency assessment combines structured evaluation with professional judgment. Entrustment-informed educator judgment is essential for defensible decisions about clinical readiness.
Background Simulation-based experiences rely on skilled facilitation, yet few studies evaluate how structured debriefer feedback influences student-reported outcomes. Methods Participants included 136 first-year Bachelor of Science in Nursing students across two cohorts. Two participants, one from each cohort, had incomplete SET-M debriefing responses and were excluded from the outcome analysis, resulting in a sample of 134 students (preintervention n = 83, postintervention n = 51). Eight clinical teaching faculty facilitated debriefing across both the pre- and postintervention phases and participated in the structured feedback intervention. A quasi-experimental, nonrandomized cohort design examined whether structured Debriefing Assessment for Simulation in Healthcare (DASH©)-informed feedback was associated with changes in student-reported debriefing quality, measured using the Simulation Effectiveness Tool-Modified (SET-M). Results Mean SET-M debriefing scores were lower in the postintervention cohort (M = 2.67, SD = 0.51) than in the preintervention cohort (M = 2.81, SD = 0.39), but the difference was not statistically significant, Welch’s t (84.85) = 1.59, p = .115. In this setting, a single structured feedback intervention was not associated with measurable improvement in student-reported debriefing quality. Conclusion These findings should be interpreted within the context of one intervention, one setting, and student-reported outcomes.
Background OSCEs are increasingly used in graduate nursing education to evaluate evidence-based practice and clinical competency, but reported outcomes remain unclear. This review identified outcomes reported from Objective Structured Clinical Examinations (OSCE) in APRN education and described their characteristics. Method A scoping review was conducted using Joanna Briggs Institute methodology and included 54 studies reporting OSCE outcomes in APRN education. Results Clinical competence was the most frequently reported outcome (74.1%), followed by physical examination skills (64.8%) and communication skills (55.6%). Conclusion(s) Graduate nursing programs should adopt standardized reporting guidelines and simulation best practices to improve the quality of OSCE research.
Background Nurses and nurse practitioners often find themselves working together on teams, yet there is limited literature regarding intraprofessional education among these learners. Method This quasiexperimental quantitative study began with piloting a conscious sedation simulation with baccalaureate and graduate nursing students. Learners completed the Interprofessional Collaborative Competency Attainment Scale—revised (ICCAS-r) and the Simulation Effectiveness Tool—modified (SET-M). Results There was a statistically significant increase (p < .001) in total ICCAS-r scores from pre- to postsimulation and across all items (p < .01), most notably in students' abilities to communicate and collaborate. Participants recognized debrief as having the greatest impact on their learning. Analysis of open-ended questions revealed four themes, including collaboration and teamwork, realism, psychologically safe learning, and role clarity. Conclusion Simulation is an effective tool in fostering intraprofessional partnerships among undergraduate and graduate nursing students. Participants felt this experience improved their communication and collaboration skills and contributed to their learning. This scenario could be applied in both education and practice environments, having the capability to grow intraprofessional partnerships across multiple settings.
Background Maternal hemorrhage and neonatal emergencies are critical events that require rapid differential diagnosis, interprofessional teamwork, effective communication, and crisis management. In rural communities, where providers often practice with broad clinical responsibilities, preparedness for these emergencies is essential. Providers may enter practice without prior exposure to these critical events in the clinical setting. To address this gap, doctoral nursing faculty developed a joint obstetric hemorrhage and neonatal emergencies simulation designed to prepare Bachelor of Science in Nursing (BSN) students and Student Registered Nurse Anesthetists (SRNAs) for real-world crisis scenarios in the rural community. Methods After Institutional Review Board approval, 63 BSN and SRNA students voluntarily participated. Anonymous pre- and post-simulation surveys using Section I of the Casey–Fink Readiness for Practice Survey assessed practice readiness. Results Practice readiness scores increased significantly from pre- to postsimulation for both groups (p < .001). Improvements were comparable across readiness subscales. SRNAs scored higher than BSN students on one readiness subscale (p = .02), with no differences observed in the remaining subscales. Conclusion The simulation emphasized interprofessional collaboration, differential diagnosis, and readiness for practice.
Background Public Health Nurses (PHN) provide vital care to the community. There is a growing need to utilize checklists to ensure competencies are met for prelicensure nursing students; however, there are minimal public health resources with validated checklists to meet the requirements of accrediting bodies. Method Experts in public health validated a competency-based checklist that was mapped to the Essentials and public health competencies. Results A 26-item Simulated Public Health Competency Checklist was validated in a simulated environment with prelicensure nursing students. Conclusions The instrument can be used to demonstrate competency requirements and promote public health nursing in curricula.
Background Simulation-based learning enhances nursing education but may provoke anxiety that affects learning and well-being. Methods A cohort study examined self-reported anxiety, mean arterial pressure (MAP), heart rate variability (HRV), and post-simulation reflections during nursing students’ first high-fidelity simulation. Results Self-reported anxiety did not correlate with HRV; however, physiological and qualitative findings suggested anticipatory stress before simulation. Pre-simulation MAP predicted intra-simulation HRV. Conclusion Anticipatory stress may begin before simulation, highlighting the pre-simulation period as a critical opportunity for interventions that promote learner readiness, psychological safety, and effective simulation-based learning.
Background Early recognition of clinical deterioration is a core patient safety capability requiring knowledge, clinical judgement and contextual decision-making. Virtual reality (VR) simulation offers scalable, repeatable opportunities for deterioration learning; however, outcomes vary and are often insufficiently aligned with learning theory, simulation standards and implementation conditions. Method An integrative review was conducted using Whittemore and Knafl’s methodology and reported in accordance with PRISMA guidelines. Six databases (CINAHL, PubMed, MEDLINE, Scopus, Web of Science and Embase) and references were searched from January 2015 to December 2025. Study quality was appraised using the Mixed Methods Appraisal Tool. Results Twenty studies met the inclusion criteria. Four analytic functions were identified: (a) cognitive processing and clinical cue integration; (b) motivation, engagement and confidence calibration; (c) simulation standards and reflective practices operationalizing learning; and (d) implementation conditions influencing usability, feasibility, fidelity and adoption. Implementation conditions were reported inconsistently, limiting the interpretation of learning outcomes. Conclusion The framework links learning mechanisms, implementation determinants and outcomes to guide theory-informed simulation design, curriculum integration and evaluation of VR simulations for clinical deterioration. It also supports future empirical testing of VR-based educational interventions.
Background Final-semester undergraduate nursing students often face challenges demonstrating clinical judgment, particularly when prioritizing care in high-acuity, time-sensitive situations. Branching pathway simulation (BPS) immerses students in unfolding scenarios requiring sequential decision-making, real-time feedback, and reflection, making it well suited to address students’ learning needs. Method This quality improvement project used a quasi-experimental design with nonrandomized group assignment and post-intervention comparison between two student groups: one with branching pathway simulation and the other with a traditional linear simulation. Outcomes included time to sepsis recognition, Creighton Competency Evaluation Instrument 2.0 (CCEI 2.0) scores, and Simulation Effectiveness Tool–Modified (SET-M) ratings. Results Students in the branching pathway group demonstrated faster sepsis recognition (8.46 vs. 19.83 minutes; p = .011; g = 1.47) and higher competency scores (96.36% vs. 79.55%; p = .001; g = 2.13). SET-M scores were high overall (2.70-3.00), with strongest ratings in debriefing and clinical judgment. Conclusion Branching pathway simulation enhances cue recognition, clinical judgment, and perceived simulation effectiveness among final-semester undergraduate nursing students.
Objective This study aimed to compare the effectiveness of a pediatric escape room (ER) intervention versus traditional teaching in improving nursing interns' clinical skills, teamwork, and satisfaction. Background Traditional training often inadequately prepares nursing interns for dynamic pediatric settings, where communication challenges and rapid changes can cause anxiety. ER games offer immersive, collaborative learning under time pressure. Design A single-center, open-label, randomized controlled trial was conducted at a children’s medical center in Western China with 204 nursing interns. Methods Participants were randomized to traditional teaching (lecture, demonstration, practice) or an ER group (lecture plus 90-minute ER scenario). The ER integrated key pediatric procedures include IV placement and CPR within a high-fidelity narrative. Outcomes were assessed via OSCE, theory exam, CSAT, and satisfaction survey. Results The ER group scored significantly higher in practical skills (CPR, IV placement, overall procedures; all p < .01), teamwork, motivation, and reflection (p < .05), with 61.3% rating satisfaction as “Excellent” versus 29.6% in the traditional group (p < .001). Theoretical scores did not differ significantly. Conclusions A pediatric ER significantly enhances practical skills, collaboration, and satisfaction among nursing interns, offering an effective and engaging alternative to conventional training.
Background Digital twin technology, a virtual real-time representation of a physical entity, is gaining traction in healthcare, yet its potential in nursing practice remains underexplored. Objective This review examines current and potential applications of digital twins in nursing, including benefits, challenges, and integration pathways. Method An integrative review synthesised empirical and theoretical literature from PubMed, CINAHL, Scopus, IEEE Xplore, and Web of Science (2015 to 2025), alongside grey literature, with data extracted and analysed thematically. Results Digital twins show potential across patient monitoring, workflow optimisation, education, patient safety, and research, though challenges persist around data interoperability, privacy, consent, and workforce readiness. Conclusion Digital twins offer transformative opportunities for nursing, requiring interdisciplinary collaboration, curriculum integration, and robust regulatory frameworks.
