Effectiveness of high versus mixed-level fidelity simulation on undergraduate nursing students: A randomised controlled trial

Abstract

Aim: This study evaluates the impact of high-fidelity simulation on the acquisition and retention of competències in nursing students. Background: High-fidelity simulation provides a realistic and risk-free environment allowing students to practice, which potentially enhances the acquisition and retention of required competencies. Design: A blinded, randomised clinical trial with three arms was conducted with a pretest and a follow-up at 6 months (post-test 1) and 12 months (post-test 2). Method: This study was conducted with 105 s-year nursing students, divided into three groups: control (6 lowfidelity simulations), intervention 1 (3 high-fidelity and 3 low-fidelity) and intervention 2 (6 high-fidelity simulations). Competencies were assessed using the Objective Structured Clinical Examination at baseline, 6 and 12 months. Student satisfaction was measured with the Simulated Clinical Experiences Scale. Results: Initial competency scores were similar across groups. At 6 months, both intervention groups showed significant improvements in critical thinking (6.2 and 6.0, p < 0.05), clinical skills (6.8 and 6.6, p < 0.05), communication (8.0 and 8.3, p < 0.05) and ethics (7.6 and 7.5, p < 0.05) compared with the control group. Intervention group 1 demonstrated better competency retention at 12 months. Overall satisfaction with highfidelity simulation was high (9.13/10), with particular praise for the practical dimension (8.95/10), realisme (8.02/10) and the cognitive dimension (9.43/10). Conclusions: High-fidelity simulation has the potential to enhance nursing competencies effectively. This approach supports long-term skill retention, highlighting the importance of a well-structured curriculum that integrates different simulation levels for optimal student preparation for clinical practice. .