Effectiveness of Simulation Training in Nursing Education: A Systematic Review

Abstract

Background: Simulation training has become a widely used pedagogical tool in nursing education, offering a safe and controlled environment for students to develop clinical skills and decision-making abilities. Over the last five years, the effectiveness of simulation training in enhancing nursing education has been increasingly explored in various studies. Objective: To systematically review the effectiveness of simulation training in nursing education Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and involved a comprehensive search of PubMed, ScienceDirect, Web of Science, CINAHL, and Cochrane databases for studies published between 2019 and 2025. The review was also registered with PROSPERO (CRD420251012168). Relevant keywords such as ‘Simulation training’, ‘Nursing education’, ‘Effectiveness’, ‘Learning outcomes’, and Boolean operators were used to refine the search. The initial search yielded 875 articles, with 328 duplicates removed. After screening titles and abstracts, 465 studies were excluded, followed by 46 after full-text review. A total of 34 studies met the inclusion criteria, focusing on simulation-based nursing education, assessing outcomes such as clinical skills and decision-making. Excluded studies included grey literature, non-nursing topics, unclear interventions, and poor methodology. Data were extracted and critically appraised using Critical Appraisal Skills Programme (CASP) checklists. Results: Among the 34 included studies, 79.41% reported that simulation training had a positive impact on clinical competence, decision-making, and critical thinking. High-fidelity simulations that replicate real-life scenarios demonstrated the most effective outcomes. Students showed greater satisfaction with simulation-based learning compared to traditional methods and reported improvements in confidence, communication skills, and patient safety awareness. Variability in effectiveness was influenced by the type and length of simulation, student engagement, and instructor support. Challenges identified included limited access and high costs associated with advanced simulation technologies. Conclusions: Simulation training has proven to be an effective tool in nursing education, significantly improving clinical skills, critical thinking, and patient safety awareness. While high- fidelity simulations tend to produce the most positive outcomes, standardisation of simulation methods and further research into long-term effects on clinical practice are needed