The Experiences of Undergraduate Nursing Students with High-Fidelity Simulation in Nursing Education: A Systematised Literature Review.

Abstract

Abstract Background: High-fidelity simulation (HFS) is increasingly integrated into undergraduate nursing education to bridge the gap between theoretical learning and clinical practice. HFS uses advanced technology, such as computerised mannequins or standardised patients within realistic scenarios, to replicate complex clinical environments for students. Aim: This review aimed to synthesise qualitative evidence on undergraduate nursing students' experiences with HFS, focusing on students’ perceived benefits, challenges, and implications for educational practice. Methods: Adhering to the PRISMA 2020 checklist, a systematised review of qualitative studies and mixed-methods studies with relevant qualitative components was conducted. A systematic literature search was conducted in four electronic databases (CINAHL, MEDLINE, PubMed, and PsycINFO) through June 2025. Methodological quality was assessed using the CASP checklist. Thematic synthesis was employed to identify common patterns and analytical themes across studies. Results: Eight studies from diverse educational settings were included with the sample comprised 174 undergraduate nursing students across varied educational stages. Five themes emerged from the synthesis: fulfilling clinical learning needs with high realism, a safe space for learning through mistakes, empowerment, knowledge and skills gaps recognition, and group size as a learning barrier. Conclusion: HFS is a powerful approach in nursing education, supporting knowledge acquisition, skill development, and self-efficacy. Its structured approach, including debriefing, is crucial for maximising learning outcomes. Using small groups during HFS training maintains the realism of HFS and enhances students' participation. Nurse educators should integrate HFS thoughtfully to optimise student preparedness for clinical practice. Dissemination: The findings of this systematised review will be disseminated in the Journal of Nursing Education.