{"title":"Enhancing learning outcomes through AI-driven simulation in nursing education: A systematic review","authors":"Tuba Sengul RN, PhD, CWON, Seda Sarıköse RN, PhD","doi":"10.1016/j.ecns.2025.101797","DOIUrl":"10.1016/j.ecns.2025.101797","url":null,"abstract":"<div><h3>Background</h3><div>Artificial intelligence (AI) is increasingly integrated into simulation-based nursing education to enhance scalability, personalisation, and interactivity. This review systematically examined the impact of AI-driven simulations on learning outcomes in nursing education.</div></div><div><h3>Method</h3><div>This systematic review adhered to PRISMA guidelines and included empirical studies published between 2015 and 2025. A comprehensive search was conducted across six databases, and study quality was appraised using RoB 2, ROBINS-I, JBI, and MMAT tools. Methodological heterogeneity precluded meta-analysis; findings were instead synthesised through deductive categorisation to ensure a structured and critical integration.</div></div><div><h3>Results</h3><div>Sixteen studies met the inclusion criteria. AI-driven simulations were associated with improved communication, clinical reasoning, knowledge acquisition, self-efficacy, and empathy. Most studies reported high levels of learner satisfaction and engagement. However, limitations included challenges in interpreting nuanced emotional cues, limited cultural adaptability of AI systems, and technological constraints affecting responsiveness.</div></div><div><h3>Conclusions</h3><div>AI-driven simulation supports the development of diverse learning outcomes in nursing education. Further research is needed to explore long-term effects and optimise implementation strategies.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101797"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886973","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Student confidence and knowledge with electronic medical records through on-ward simulation: An evaluation study","authors":"Lyndall Mollart PhD, RN, RM , Michelle Stubbs PhD, RN , Danielle Noble RN , Noriko Koizumi RN , Gary Crowfoot PhD, RN","doi":"10.1016/j.ecns.2025.101792","DOIUrl":"10.1016/j.ecns.2025.101792","url":null,"abstract":"<div><h3>Background</h3><div>Registered nurses require digital health literacy to use patient electronic medical records. Incorporating on-ward simulation training for student Registered Nurses has the potential to improve engagement with electronic medical records. However, there is minimal evidence exploring this approach.</div></div><div><h3>Method</h3><div>Third-year nursing students (<em>n</em> = 30) completed seven on-ward simulations across 10 weeks of professional experience placement. Data were collected pre-intervention, mid-intervention and post-intervention. Differences in survey item scoring were analyzed across the intervention timeframe (Friedman’s) and between individual timepoints (Wilcoxon).</div></div><div><h3>Results</h3><div>A significant improvement in student knowledge documenting electronic observation charts (<em>p</em> = 0.024) and electronic medical records (<em>p</em> = 0.004) was observed between pre-and post-intervention timepoints. Student confidence in documenting in the patient’s electronic observation charts (<em>p</em> = 0.033) and electronic medical records (<em>p</em> = 0.002) was significantly improved pre- and post-intervention. Anxiety levels associated with documenting in the patient electronic medical records were significantly reduced between pre-and post-intervention timepoints (<em>p</em> = 0.005).</div></div><div><h3>Conclusion</h3><div>On-ward simulations show promise and appears to be efficacious in improving student-related outcomes associated with electronic medical record use. Future research is required to determine the effectiveness of this intervention.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101792"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886971","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A. Dana Ménard , Kendall Soucie , Jody Ralph , Sara Pratt , Laurie Freeman
{"title":"Simulation training to increase resilience of nursing groups (STRONG): Results from a multi-site trial","authors":"A. Dana Ménard , Kendall Soucie , Jody Ralph , Sara Pratt , Laurie Freeman","doi":"10.1016/j.ecns.2025.101802","DOIUrl":"10.1016/j.ecns.2025.101802","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare systems worldwide are undergoing increased staffing crises due in part to the impacts of the COVID-19 pandemic on the nursing workforce. Existing resilience-promotion programs for new graduate nurses were not designed to address the stressors seen in hospitals since 2020. Our aim was to create a training program that would prepare fourth year nursing students to successfully transition into hospital-based jobs.</div></div><div><h3>Methods</h3><div>A 10-week simulation-based online training program was developed; topics addressed included burnout and moral distress, mortality and trauma-informed care, self-advocacy, mental health, and resilience and coping strategies. Fourth-year students were recruited from across Canada and completed pre- and post-intervention questionnaires assessing resilience, self-efficacy, coping, and mental health components. Participants completed 10 training modules, including pre-simulation preparation materials, virtual simulation games, and self-debriefing questionnaires.</div></div><div><h3>Results</h3><div>In 94 participants, significant pre-to-post intervention increases were found for resilience and self-efficacy.</div></div><div><h3>Conclusion</h3><div>Our program was effective in improving several key metrics in fourth year nursing students and was well-received by participants. This program could be deployed as part of nursing program curricula or hospital onboarding.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101802"},"PeriodicalIF":2.5,"publicationDate":"2025-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144886972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Amy Nagle PhD, RN, CNE, CHSE, Ann Loomis PhD, RN, CNEcl, Christi Jones MSN, FNP-BC, CHSE, Karen Grammer MSN, CMSRN, ONC, CHSE, Mark Ailor MSN, RN, Amanda Ward DNP, RN, CNE, Deb Dye DNP, RN, CNE, AHN-BC
{"title":"Impact of a dedicated simulation faculty model on student learning outcomes and perceived self-efficacy in baccalaureate-prepared students","authors":"Amy Nagle PhD, RN, CNE, CHSE, Ann Loomis PhD, RN, CNEcl, Christi Jones MSN, FNP-BC, CHSE, Karen Grammer MSN, CMSRN, ONC, CHSE, Mark Ailor MSN, RN, Amanda Ward DNP, RN, CNE, Deb Dye DNP, RN, CNE, AHN-BC","doi":"10.1016/j.ecns.2025.101798","DOIUrl":"10.1016/j.ecns.2025.101798","url":null,"abstract":"<div><h3>Background</h3><div>Effective simulation requires a skilled facilitator to create an engaging learning environment. Becoming adept in facilitation demands training and experience..</div></div><div><h3>Purpose</h3><div>To evaluate the impact of a pilot of a dedicated simulation facilitator model (DSFM) on facilitator competency, student learning, and student clinical self-efficacy.</div></div><div><h3>Methods</h3><div>Five faculty were selected for the pilot DSFM and trained prior to facilitating five simulations with nursing students in two Medical-Surgical courses. Self-efficacy was gauged using the Self-efficacy in Clinical Performance (SECP) survey, while learning was evaluated by comparing exam scores. Faculty competence was measured through the Debriefing Assessment for Simulation in Healthcare (DASH) and Debriefing for Meaningful Learning Evaluation Scale (DMLES).</div></div><div><h3>Results</h3><div>Six of the ten exam scores showed improvements, with three demonstrating statistical significance. SECP scores demonstrated improved self-efficacy. Facilitators demonstrated slight improvements in DASH and DMLES scores.</div></div><div><h3>Conclusions</h3><div>These findings highlight the importance of training and evaluation in improving facilitation skills, particularly for novice facilitators. Implementing a DSFM with continuous training and evaluation can enhance student learning and self-efficacy.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101798"},"PeriodicalIF":2.5,"publicationDate":"2025-08-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144866996","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Effectiveness of the IPE-Sim based dementia management (IPE-SDM) program on community-dwelling elders for nursing and medical students","authors":"Sooyoung Jun RN, RhD","doi":"10.1016/j.ecns.2025.101790","DOIUrl":"10.1016/j.ecns.2025.101790","url":null,"abstract":"<div><h3>Background</h3><div>Although dementia management programs have been incorporated into nursing education to enhance knowledge and clinical skills, few programs are available for students in interdisciplinary curricula, particularly for managing dementia in home-based settings. This study aimed to evaluate the effectiveness of an Interprofessional Education Simulation-based Dementia Management (IPE-SDM) program to improve the competencies of nursing and medical students in community-dementia care for older adults with dementia.</div></div><div><h3>Methods</h3><div>A nonequivalent control group pretest-posttest design was employed. The participants were 39 students (experimental group: 20, control group: 19) from the nursing and medical schools at Keimyung Univeristy in South Korea. A 190-minute IPE-SDM program using standardized patients (SPs), structured into three sessions, was implemented for the experimental group. Data were analyzed using SPSS/WIN 25.0. Descriptive statistics, χ² test, Fisher’s exact test, independent <em>t</em>-test, and Mann-Whitney U test were used to assess pretest homogeneity. Repeated measures ANOVA with Bonferroni posthoc analysis was used to test the study hypotheses.</div></div><div><h3>Results</h3><div>Compared to the control group, the experimental group demonstrated statistically significant improvements in readiness for IPE (<em>p</em> = .044), self-efficacy for IPE (<em>p</em> = .030), teamwork attitude (<em>p</em> = .014), and the problem-solving process (<em>p</em> = .042).</div></div><div><h3>Conclusions</h3><div>The IPE-SDM program was found to be an effective intervention for enhancing interprofessional competencies. It holds potential for integration into formal interdisciplinary healthcare education curricula, contributing to the development of healthcare professionals equipped with the essential interprofessional skills required for community-based dementia care.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101790"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144831295","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Chaewon Kim MEd , Fengfeng Ke PhD , Veronica Brewer EdD
{"title":"Debriefing the escape: Sequential patterns in facilitator strategies for nursing simulations","authors":"Chaewon Kim MEd , Fengfeng Ke PhD , Veronica Brewer EdD","doi":"10.1016/j.ecns.2025.101789","DOIUrl":"10.1016/j.ecns.2025.101789","url":null,"abstract":"<div><h3>Background</h3><div>While widely studied in traditional simulations, research on debriefing practices in educational escape rooms remains sparse. This study leverages sequential pattern mining to investigate facilitators’ micro-debriefing in the escape rooms on a critical care scenario.</div></div><div><h3>Methods</h3><div>About 69 first-semester nursing students were randomly assigned to 32 groups with two to three participants per group. Transcripts of facilitator-student interactions were coded using Dreifuerst’s (2009) debriefing framework, expanded with new categories relevant to the escape room context. Sequential pattern mining was applied to identify patterns in the instructors’ debriefing sequences.</div></div><div><h3>Results</h3><div>Demonstration (26.3%), reflection (21.6%), and prompting (20.1%) were the most frequent debriefing strategies, while emotion and assimilation were infrequent. Salient sequential patterns included (reflection → integration → prompting), emphasizing knowledge scaffolding and guided decision-making.</div></div><div><h3>Conclusion</h3><div>Educational escape rooms demand adaptive debriefing approaches that blend traditional and game-specific methods. The study findings inform the design of flexible debriefing frameworks to enhance learning outcomes in escape room simulations for nursing education.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101789"},"PeriodicalIF":2.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Fulya Batmaz CNS, PhD, MSc , Havva Öztürk PhD , Şule Bıyık Bayram PhD , Ahmet Kağan Özkaya MD
{"title":"The simulation realism scale for healthcare professionals and students: A development, validity and reliability study","authors":"Fulya Batmaz CNS, PhD, MSc , Havva Öztürk PhD , Şule Bıyık Bayram PhD , Ahmet Kağan Özkaya MD","doi":"10.1016/j.ecns.2025.101788","DOIUrl":"10.1016/j.ecns.2025.101788","url":null,"abstract":"<div><h3>Introduction</h3><div>Realism in simulations significantly influences educational outcomes, yet there is no standardized tool to assess participants' perceptions. Developing a tool to measure how realistic they are will enhance the design of simulations, make them easier to evaluate and improve their quality.</div></div><div><h3>Aims</h3><div>This methodological study aimed to develop and validate the Simulation Realism Scale (SRS) for use by healthcare professionals and students.</div></div><div><h3>Methods</h3><div>A 21-item scale was developed using Morgado et al.’s (2017) three-stage approach. Three hundred and seventy-two participants participated in standardized simulations according to the INACSL guidelines. Language and content validity were ensured. Construct validity was tested with CFA; reliability was tested with Cronbach's alpha (α), item-total correlations, and test-retest.</div></div><div><h3>Results</h3><div>The CFA confirmed a five-factor structure explaining 65% of variance. The Cronbach’s α value was 0.91.</div></div><div><h3>Discussion</h3><div>The SRS is a reliable, valid tool for measuring perceived realism in simulation-based healthcare education.</div></div><div><h3>Conclusions</h3><div>Further validation across different cultures is recommended.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101788"},"PeriodicalIF":2.5,"publicationDate":"2025-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826338","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Xinran Peng BS, Xiaodan Wang MS, Ruojing Wang MS, Ying Li MS, Qi Zhang PhD, RN
{"title":"Empathy and emotional intelligence enhancement in geriatric nursing education: A multidimensional 4D strategy","authors":"Xinran Peng BS, Xiaodan Wang MS, Ruojing Wang MS, Ying Li MS, Qi Zhang PhD, RN","doi":"10.1016/j.ecns.2025.101793","DOIUrl":"10.1016/j.ecns.2025.101793","url":null,"abstract":"<div><h3>Background</h3><div>Enhancing empathy and emotional intelligence is a multifaceted process, and the multidimensional 4D strategy (Disability simulation, Dynamic unfolding case studies, Debriefing for meaningful learning and Deep empathy mapping) provides a comprehensive set of methods to cultivate these essential skills among nursing students. This approach better equips students to care for older adults who may face age-related functional challenges.</div></div><div><h3>Aim</h3><div>To evaluate the effects of multidimensional 4D strategy on enhancing empathy and emotional intelligence among nursing students.</div></div><div><h3>Design</h3><div>A mixed methods design.</div></div><div><h3>Setting</h3><div>A university in southern China.</div></div><div><h3>Participants</h3><div>Thirty-nine third-year undergraduate nursing students.</div></div><div><h3>Results</h3><div>Students' emotional intelligence abilities showed statistically significant improvement after the multidimensional 4D strategy. Emergent themes included ``emotional response to disability simulation,'' ``essential components of effective geriatric care,'' and ``empathic communication.''</div></div><div><h3>Conclusions</h3><div>This study demonstrates the potential of the multidimensional 4D strategy as a promising approach to enhance empathy and emotional intelligence in nursing students. Integrating this strategy into geriatric nursing education may better prepare students for the complex demands of elder care.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101793"},"PeriodicalIF":2.5,"publicationDate":"2025-08-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144826339","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Elisa D. Perez MSN, RN, CCRN, Courtnie N. Moore MSN, RN, CHSE, Heather A. Guest PhD, RN, CNE, CHSE
{"title":"Innovate, simulate and educate: An eight-hour simulation redefining undergraduate education","authors":"Elisa D. Perez MSN, RN, CCRN, Courtnie N. Moore MSN, RN, CHSE, Heather A. Guest PhD, RN, CNE, CHSE","doi":"10.1016/j.ecns.2025.101785","DOIUrl":"10.1016/j.ecns.2025.101785","url":null,"abstract":"<div><div>Simulation-based education is an essential component of nursing curricula, providing students with realistic experiences to enhance clinical reasoning and critical thinking in a safe environment. The sample consisted of second-semester, junior-level prelicensure nursing students across multiple campuses. Utilizing the Theory of Experiential Learning, nurse educators bring the hospital to the simulation center using a high-quality, evidence-based design to immerse students in opportunities for decision making and enhancing patient care through hands-on experience. Preparing students to care for a patient with complex medical needs is necessary to support the development of clinical reasoning required for safe nursing care.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101785"},"PeriodicalIF":2.5,"publicationDate":"2025-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772516","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Two important factors in virtual reality simulations: Nursing students' experiences of cybersickness and sense of presence","authors":"Atiye Erbaş RN, PhD , Elif Akyüz RN, PhD , Davide Giustivi RN , Daniele Privitera RN, PhD","doi":"10.1016/j.ecns.2025.101787","DOIUrl":"10.1016/j.ecns.2025.101787","url":null,"abstract":"<div><h3>Background</h3><div>With the increasing popularity of employing virtual reality simulations in nursing education comes the need for more research examining their effects on users besides learning outcomes. This study explored nursing students' perceptions of a sense of presence and experiences of cybersickness in virtual reality simulations.</div></div><div><h3>Method</h3><div>A descriptive-analytic research design was employed. Between March and July 2024, 102 second-year undergraduate nursing students participated in an immersive virtual reality simulation focused on postoperative colorectal surgery care. Data were collected using the Sociodemographic Characteristics Form, the Presence Questionnaire, and the Virtual Reality Sickness Questionnaire. Student’s t-test, Mann–Whitney U test, and Kruskal–Wallis test were used to compare variables.</div></div><div><h3>Results</h3><div>The study revealed that nursing students experienced high levels of presence and only slight symptoms of cybersickness. Additionally, a statistically significant difference was observed both between gender and the adaptation/immersion subdimension of sense of presence, and between the presence of vision problems and the disorientation subdimension of cybersickness.</div></div><div><h3>Conclusions</h3><div>Since virtual reality is anticipated to become the leading teaching method in future nursing education, and therefore to maximize its potential, efforts should focus on increasing the sense of presence and reducing cybersickness.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"106 ","pages":"Article 101787"},"PeriodicalIF":2.5,"publicationDate":"2025-08-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144772515","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}