The contribution of high-fidelity simulation to nursing students' confidence and competence: a systematic review

Background: High-fidelity simulation (HFS) has been proposed as a novel, supplemental teaching-learning strategy to enhance students' confidence and competence in nursing practice. Aim: To describe available evidence about the effects of HFS on students' confidence and competence within nursing educational programmes. Methods: A review of studies published between 2000 and 2011 was undertaken using the following databases: CINAHL, Proquest, MEDLINE, Science Direct, OVID and Chinese Academic Journal. The concepts of confidence and competence as they related to HFS in nursing education were used for screening the literature. Quantitative studies were assessed for methodological quality. Findings: Eighteen English and six Chinese studies addressed confidence and competence as outcomes of simulation and were retrieved in this review. The results of meta-analysis indicated a mixed contribution of HFS to confidence and competency with a lack of high-quality random control trials and large sample sizes. Conclusions: Although qualitative studies presented positive results, there was still insufficient evidence for supporting the notion that students' confidence and competency are enhanced through HFS. More quantitative studies are needed to demonstrate effectiveness. There was a deficit of formal measurement tools available to evaluate HFS. Most research pays no attention to validation of measurements. The increased confidence and competence after simulation may not be realized until the student experiences a real situation like the one in the simulation. More research is needed to examine the transferability of the simulation experience into real situations.