High-Fidelity Simulation’s Impact on Clinical Reasoning and Patient Safety: A Scoping Review


      Simulation-based learning is a recognized teaching approach in nursing education. However, research on the interplay of simulation and clinical reasoning development is limited. It is assumed that the opportunity to develop skills and clinical reasoning through simulation will contribute to patient safety.


      This scoping review aims to summarize the literature on the impact of high-fidelity simulation (HFS) on students’ clinical reasoning and patients’ safety in undergraduate nursing education and to use that information to provide recommendations to nursing educators.


      A scoping review of the literature published between 2011 and 2022 was conducted following the guidelines of the Joanna Briggs Institute Manual for Evidence Synthesis and a methodological framework for scoping studies.


      Of 155 studies identified, 21 were included in the final review. Based on these studies, HFS may affect patient safety by stimulating clinical reasoning in a safe environment for undergraduate nursing students. Exposure to HFS improves students’ readiness and alleviates “transition shock” and anticipatory anxiety in the clinical setting. HFS cannot replace but may be used in conjunction with real-life nursing practice to support the development of clinical reasoning in students.


      Simulation promotes active learning as students engage in lifelike scenarios. Repetitive practice of nursing skills in simulation contributes to students’ dexterity, leading to improved safety, clinical performance, and translation of theory to practice. In addition, prebriefing and debriefing sessions after the HFS activity provide opportunities for exploration of factors influencing patient safety.


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