• What are the perceptions of nursing students toward the clinical simulation program?

• Does simulation affect the students' clinical practice and critical thinking ability?

• Does the debriefing session help nursing students understand the clinical practice aspects?

The research has found that simulation teaching in nursing has advantages for performance, psychomotor skills, and clinical learning. The research indicates that simulation education has a moderate to high impact that may guide nurse instructors with regard to the conditions beyond which patient simulation is more practical than the traditional learning style [7]. In general, in nursing education, simulation should be incorporated at different levels by taking different learning approaches and using the proper methodologies necessary for learning [8]. The simulation can be a viable option for gaining clinical experience for nursing students. The research has found that sequent simulation experience is a valuable and an effective method as a learning tool [9, 10]. The study's findings showed that the majority of the students suggested that they were well prepared for their clinical training as a result of the simulation practice. In this study, the significant finding was that during the simulation scenario session, the clearer the learning objectives, the better were the chances for problem-solving and critical thinking abilities in students of nursing college [11].

A study aimed to evaluate whether simulation adds value to the training of nursing students for clinical practice. A voluntary purposeful sample of nursing college students was invited to participate in a focus group interview. The results of the data showed that simulation adds value in the training of students for clinical practice; the results have been grouped under the following themes: simulation preparation; experience and feelings of engaging in simulation; value for clinical practice; goals/outcomes of learning; and how to develop simulation to better prepare students for clinical practice. In conclusion, the purpose of this research was to know if simulation adds value to the clinical experience of nursing students in preparing them. While this was a small sample, the findings have shown simulation to add value to the clinical practice of students. Simulation participation builds their abilities, skills, and confidence, and prepares them for what to expect in the clinical setting. Simulation training seems to be directly transferable to clinical practice. Lecturers have a vital role to play in promoting simulation teaching and learning by maintaining a secure environment in which students can make mistakes and learn from them in a constructive manner. It is important to have direct, organized learning goals, and to use directed reflection in the debriefing to ensure that a safe learning environment is maintained [12]. In addition [13], simulation using standardized patients (SPs) in the learning of nursing students can have significant beneficial effects on their cognitive, affective, and psychomotor domains. A meta-analysis research has concluded that simulation-based learning using SPs may have a beneficial effect on self-efficacy and motivation for learning that impacts the development of information and clinical skills. Also, it indicates that, if properly applied, an SP instructional approach can be used as an active learning technique in academic settings.

In addition, the research is also aimed at exploring the effectiveness of simulation technology in nursing education from the point of view of students themselves. The study has found that most students express positive attitudes regarding utilizing simulation technology in nursing education. With great technical advancements, the ability to model patients has become more advanced, and virtual reality has transitioned to real-time with respect to training and education. Nursing training and education are developing remarkably and necessitate a high degree of attention in evaluation methods, such as critical thinking and problem-solving. Simulation provides opportunities in a secure and stable environment for education and training. Ongoing research is not adequate to justify that clinical education is repositioned by simulation, but simulation persists as an ideal bridge between the theoretical framework and implementation. In general, most nursing students have positive attitudes regarding using simulation in their training and teaching [14].

Moreover, a study was conducted to find out how simulation training affected nursing students' perceptions of including patient families' assessments in their treatment plans. A control group of 56 and an intervention group of 67 senior nursing students from the King Saud Bin Abdulaziz University for Health Sciences, College of Nursing, Jeddah, respectively, were randomly allocated as part of this quantitative, experimental research. The instrument was divided into three sections: a role-play survey, a Van Gelderen family rubric, and personal information. In this study, a total of 123 nursing students participated. Their ages ranged from 19 to 23 and from 23 and older, with the control group's mean age being 21.3 (1.3) and the experimental group's mean age being 22.2 (1.1). The mean scores in the experimental group increased post-training phase compared to the pre-training phase, with a statistically significant difference at p < 0.05. In contrast to the statistically significant difference between the two groups observed in the post-training phase, there were no discernible differences between the control and experimental groups in the pre-training period. In contrast to the statistically significant difference between the two groups observed in the post-training phase, there were no discernible differences between the control and experimental groups in the pre-training period. The study's conclusion showed scenario-based standardized patient-simulated exercises, supervised by committed faculty and combined with reflective debriefing activities, to be an efficient way to close the knowledge gap between theory and its practical application in clinical practice. In order to address and potentially close the theory-practice gap for graduates when they enter clinical practice, the study also recommended curriculum revisions to include family assessment in the practice of nursing as well as evidence-based strategies, like learning activities that use standardized clients or high-fidelity simulation technology [15].

On the other hand, both students and faculty agreed that critical thinking was enhanced by simulation. After introducing additional services and faculty development, faculty expectations of simulation learning have improved. The use of high-fidelity simulation is more favorable for faculty to simplify clinical learning. Moreover, alertness to the value of training and encouragement for faculty members who are less experienced with simulation learning style has improved. Students' perceptions remained overwhelmingly positive towards clinical simulation, which involved groups embracing the challenge, reality, and critical thinking that allow for technology. However, in simulation learning, some students remained cynical and anxious. Therefore, it is significant for faculty to be alert to differences in expectations of students and create secure and stable learning environments [16].

Besides, an investigation aimed to build a substantive theory of the high-fidelity simulation-based learning (HF-SBL) dynamics of nursing students by discussing the experiences of HF-SBL of nursing students and defining factors that affect HF-SBL. As a method of this study, the constructivist grounded theory was used. 23 semi-structured interviews were conducted among 16 undergraduate nursing students in memo writing. All of the data collected were handled using NVivo 11. A theoretical model of HF-SBL dynamics, containing process and four HF-SBL influencing factors, was constructed by this research. In addition, the students' perception during HF-SBL of a lack of psychological fidelity was established and highlighted. There is no argument that HF-SBL has advantages in nursing education. However, due to the disadvantages of HF-SBL, nursing educators should be careful to assume that HF-SBL is the ultimate alternative to clinical placements. However, the insufficiently realistic experience for students is one of the constraints (particularly of psychological aspects of care and communication). While HF-SBL can imitate clinical environments, real clinical contexts cannot be replicated completely and the practice of professional socialization cannot be achieved. In nursing education, clinical settings are irreplaceable, and HF-SBL is not a clinical placement panacea for learning problems. As a supplemental instructional technique, HF-SBL is more efficient in nursing education, along with formal clinical placements, which eventually leads to the conclusion that educators and health care practitioners can work together to develop clinical learning environments [17].

Ultimately, a research was conducted to evaluate students' perceptions related to satisfaction and self-confidence in high fidelity simulation (HFS) as a learning process. In this research, a cross-sectional descriptive correlation design was used that was performed at King Saud University (KSU) and Princess Nourah University (PUN) in Riyadh. At King Saud University (KSU) and Princess Nourah University (PNU), a total population of 404 students of levels 5 to 8 was identified from the Bachelor of Science in Nursing curriculum in the 1438-1439 academic year. This study found the most significant element in learning related to HFS to be fidelity (realism). In using HFS, the students were satisfied and self-confident. There was a significant relationship between the age profile of the participants and the academic level of students and the main features of the simulation. In conclusion, the findings demonstrated that students accepted simulation fidelity denoting real-life variables and situations. Students agreed that they were inspired to learn through instructional materials that have been used in the simulation. The findings also showed that the perception of satisfaction of students has shown no significant relationship with the participants' profiles. In terms of learning profile and self-confidence, it has been shown that only the level of the student did not substantially correlate with the level of confidence. Simulation is an effective way of teaching as a real-life instrument without threatening the patient's life and encouraging the students' performance. The simulation fidelity is the student's most important factor, and the students were satisfied and confident with existing HFS-related learning [18].

A quantitative study design was used in this study. A descriptive study was conducted using an adopted questionnaire in order to evaluate the perception of nursing students using clinical simulation at Prince Sultan Military College of Health Sciences (PSMCHS). Therefore, this study used the survey design to collect data from nursing students on their perceptions relating to the use of simulation in nursing education.

A convenient sample of nursing students studying at PSMCHS was used in this study. Bachelor nursing students from all levels and bridging nursing students typically holding a two-year college degree and have been working in clinical settings for years, who have been offered this program to seek and obtain a four-year or graduate degree, were also eligible to participate in this study. The exclusion criteria comprised students from other healthcare specialties. Finally, a total of 121 nursing students were eligible to participate in the study.

An adopted survey was used to conduct the study. It was initially designed by Howard, Englert [19], and then modified by Alhaykan [20]. The survey used in this study was also modified and adopted from an earlier study [21]. It involved two parts and the first part included demographic data. However, permission from the author was sought before using the survey instrument, and once obtained, a minor modification was done to the demographic data as the study has been focused on the nursing specialty alone. The second part consisted of 10 questions presented on a four-point Likert scale ranging from 1 (strongly disagree) to 4 (strongly agree). This survey has been done to evaluate the students’ perception of using simulation in nursing programs integrated with clinical courses in the curriculum.

The research team distributed the survey to nursing students at Prince Sultan Military College of Health Sciences after the IRB approval in March 2021. The survey included research information and confidentiality was reassured as the survey was anonymous. A reminder was sent to the potential participants to enhance their responses. The data collected was analyzed using the Statistical Packages for the Social Sciences (SPSS) program, version 25, by applying descriptive statistics of percentage, frequency, mean, and standard deviation.

Simulation is a safe environment creating an educational process that mimics clinical procedures. It is a technique that can be adjusted to reflect real-life situations and that offers the chance to apply it in situations that are more like the representation of real-life settings. Nursing students have the chance to practice their clinical and interview skills in a secure environment by participating in a simulation center. Also, they have the chance to practice some of the most difficult aspects of nursing care and make mistakes without hurting anyone because the experience normally consists of an actor playing a patient and a genuine scenario in a simulated clinical setting. As students, they will make mistakes, but it is better to do so in a simulation than in a real-life clinical setting. It should be recognized that every mistake they make is a chance for learning and that it reduces the number of mistakes they will make as a nurse practitioner in a real-life clinical setting. It can also assist in identifying a student's areas of strength and development while fostering confidence in their ability to put the knowledge they have acquired in the classroom into practice.

The simulation session was based on different scenarios that matched reality cases, helping the nursing students to recognize, analyze, and make decisions, and handle real patient cases. The scenarios of simulation were related to medical-surgical nursing, psychiatric-mental health nursing, and community health nursing, all with situations relevant to learning objectives. All the nursing students participated in each scenario; during a simulation, one group participated, while the others observed and evaluated the participating group. The observers were given specific tasks in accordance with the learning objectives specified for each scenario in order to learn about holistic nursing care. In one scenario, we used a simulator (manikin); in the others, we used a standardized client (a student who was given acting instructions). Each group consisted of around 15-20 students who took part in each session for 4-5 hours. Each simulation scenario involved a briefing session, the simulation scenario, and a debriefing, explaining the equipment needed for the specific scenario, reading the patient history, and distributing tasks for the exercise participants. The other students observed the main concepts listed in the learning objectives, while the students took turns participating in one simulation scenario. In this manner, each nursing student actively participated in each scenario, and they also trained, observed, and took part in the debriefing for scenarios. Based on nursing students’ responses in the survey, they showed the strongest agreement with the statement “simulation helped in better understanding concepts in the clinical setting” with a mean of 3.0. This means that simulation scenarios helped them to know how to handle such cases in real-life clinical settings. A simulation session followed a predetermined format and consisted of three distinct phases: prebriefing, simulation, and evaluation or debriefing.