Since the early twenty-first century, the function of nurses has changed dramatically. Nurses today do more than just offer care; they promote a holistic perspective to nursing practice with expanded duties to suit the requirements of today's complicated clinical setting. Nurses are required to respond quickly and correctly to more complicated cases, as well as keep up with the fast advancement in clinical technology. To address this transition, newly graduating nurses are required to be autonomous and capable of rendering high caliber practice, with a high degree of clinical reasoning judgment abilities [1].

Nurse educators are encouraged to empower students to enhance higher-order thinking abilities through clinical practicums under observation, which are largely utilized to achieve this goal. Nursing students may exercise not only clinical skills but also problem-solving and decision-making abilities through giving nursing care to patients in clinical training. Nevertheless, due to a scarcity of nurses, faculty members are having difficulty obtaining appropriate practicums for their trainees [2]. Simultaneously, increased nursing student enrollment in reaction to a labor shortage led to competitiveness among nursing professors for clinical placement of students [3]. Nurse training is thus restricted in terms of clinical posting to specialist areas and hands-on experience providing nursing care to actual patients. Furthermore, ethical concerns about practicing on real patients restrict nursing students' ability to gain hands-on training in critical circumstances. Several new instructional techniques have been employed in previous years to prepare proficient registered nurses. Nursing students are increasingly using interactive learning techniques such as high-fidelity simulation to prepare for the increasingly complicated clinical setting.

For instance, simulation has been utilized in nursing education for many years. Static manikins, a type of low-fidelity simulator, were originally used to develop basic care abilities. Nursing students learned the theory in lectures and then applied their nursing skills. Since the early twenty-first century, high-fidelity simulators have arisen as a result of technological advancements and have been used in nursing education. With computerized management, a high-fidelity simulator provides more lifelike biology and human-like reactions to a variety of illnesses and nursing treatments. High-fidelity simulation has been shown to offer a secure and realistic clinical, educational experience for nursing students to exercise procedural knowledge and essential components of nursing practice, including critical thinking, decision making, and prioritizing without endangering actual patients [4].

Considering the significance of developing reasoning skills and practicing clinical judgement among nursing students in order to satisfy the challenging health context, there are a growing number of studies looking into the usage of high-fidelity simulation in the advancement of self-confidence as well as clinical judgement and satisfaction [5]. High-fidelity simulation has been shown to increase nursing students' confidence and competence in a non- threat educational setting [6]. As per Im et al. (2018), one of the key variables that may impact nursing students' clinical judgement and problem-solving ability, as well as decision making and critical thinking, is confidence [7]. Several research works in the West found that high-fidelity simulations increased student nurses' satisfaction and self-confidence [8]. According to further research, high-fidelity simulation can help students improve critical thinking as well as clinical judgement and problem-solving skills [9]. Even though much research in the West has shown the advantages of utilizing high-fidelity simulation in nursing training, there are few studies evaluating the efficiency of HFS among Lebanese and Saudi students. Because of the differences in learning styles comparing Arab and Western nursing students, results from western research may not be applicable in the Arab setting. Therefore, there is a necessity to confirm the efficacy of HFS as a comparatively recent teaching method utilized in Lebanese and Saudi nursing education, and with scarce research demonstrating its impact on learning outcomes among nursing students in these two countries. Thus, this paper aims to evaluate the self-confidence, satisfaction, and clinical judgement of Lebanese and Saudi nursing students participating in high fidelity simulation.

Nurse student satisfaction with their learning and self-confidence may be used to create and implement educational programs for nurses that will help them enhance their education and patient care. The goal of this study was to find out how nursing students felt about simulation and how simulation could have impacted their clinical judgment formation. Despite the fact that simulation is used in nursing curriculum as a learning activity or as an alternative to clinical experience, few researchers have looked at bachelor's degree nursing students' conceptions of simulation and its impact on student satisfaction, confidence, and clinical judgment, particularly in Saudi Arabia and Lebanon.

The favorable impact of repeated simulation experiences on student learning, satisfaction, and self-confidence is supported by this investigation. Both the student satisfaction and self-confidence in Learning questionnaires showed that students enjoyed the exercise. The students that took part in the simulation unanimously agreed that it was a beneficial learning experience. These findings corroborate Power’s findings, which indicated that students thought the simulation was useful, productive, and inspiring; it aided learning and helped students develop confidence. Furthermore, numerous research investigations have shown that simulations with high-fidelity manikins improve student satisfaction. For instance, Herron et al. carried out a similar study and examined the impact of using high fidelity simulations on the development of self-confidence and students’ satisfaction with learning and have shown that students who took part displayed high scores [12]. In addition, Omer has conducted a similar study to ours, where they evaluated the perceptions of students participating in high fidelity simulation in regards to their satisfaction and self-confidence and found the simulation group had higher levels of satisfaction and self-confidence compared to their counterparts, thus establishing the results of our study [13].

The results of this study have shown that the participating students have displayed high clinical judgment scores upon their engagement with high-fidelity simulation experiences. This is consistent with a recent study by Hallin et al., which involved students who took part in simulation sessions and found that participating in the simulation was highly correlated with increased clinical judgement among student nurses [14]. Our findings were also in line with Lesa et al., who carried out a study to explore the perceptions of students participating in simulation and found that simulation has proven to enhance the critical thinking and clinical judgement of student nurses [15].

Moreover, the results of our study found that there was a highly significant difference in the level of self-confidence, satisfaction and clinical judgement between the different academic years, where the third year students were most satisfied, first year students were most confident, and internship students had the highest scores. In clinical judgment this is consistent with Zapko et al., where results of that study showed that higher academic levels had higher scores on the level of satisfaction and importance of active learning [6].

Finally, the results of this study have established that satisfaction and self-confidence are highly correlated with clinical judgement and are significant predictors of it. This is supported by the findings of Sarman & Pardi who conducted a study on using clinical simulation models among nursing students and documented a significant correlation between satisfaction and clinical judgement [16]. Similarly, Kaliyaperumal et al. reported that self-confidence and satisfaction are correlated with clinical judgement among nursing students [17]. Albagawi et al. comparably found that self-confidence is a predictor for clinical judgement in the application of simulation among nursing students [18, 19].

This study was done on a small group of Lebanese and Saudi nursing students, which may have hindered the development of more notable findings and reduced the generalizability of the results.

Simulation has been a common and vital technique in nursing clinical training, and its popularity is growing. Evaluating the benefits of this application has become popular research, and much information regarding student self-confidence and satisfaction with simulation experiences has been shared, but not much in the Arab world especially tackling clinical judgement. This study adds to the growing body of knowledge in simulation by revealing that students who participate in high-fidelity simulation have relatively high levels of satisfaction, self-confidence, and clinical judgment, with higher clinical judgment predicted by increased self-confidence and satisfaction.