Is high-fidelity simulation-based training in emergency nursing effective in enhancing clinical decision-making skills? A mixed methods study

Aim: To evaluate the effects of a high-fidelity simulation-based training in emergency nursing and the relationships between study outcomes. The objectives were to: (1) evaluate the effects of high-fidelity simulationbased training in emergency nursing on final-year nursing students' generic capabilities, self-confidence and anxiety during clinical decision-making; (2) examine the relationships between the outcomes of generic capabilities and clinical decision-making skills; (3) examine participants' satisfaction with the simulation experience; and (4) explore their experiences and opinions of the training module.Background: Following the emergence of coronavirus disease 2019, safety and other considerations have limited the clinical training opportunities available to nursing students. This has resulted in the increased use of highfidelity simulations to provide clinical training for nursing students. However, evidence of the effects of such training modalities on generic capabilities, clinical decision-making skills and learning satisfaction remains lacking. In particular, the effectiveness of high-fidelity simulations of emergency clinical situations in training has not been closely evaluated.Design: A mixed methods study incorporating quasi-experimental and qualitative components. Methods: We recruited a convenience sample of 255 final-year pre-registration nursing students (183 bachelor and 72 master students) from a government-funded local university in Hong Kong. Four case scenarios of emergency nursing were developed and simulated in the simulation wards of the study institution in May and June 2021. We assessed the pre- and post-intervention outcomes of generic capabilities and clinical decisionmaking skills. We also explored the participants' post-intervention satisfaction, experiences and opinions.Results: Post-intervention, the participants reported significant improvements in generic capabilities, selfconfidence and anxiety during clinical decision-making. They expressed a high level of satisfaction with the simulation experience. Additionally, we detected significant relationships between generic capabilities and clinical decision-making skills. Qualitative data analysis yielded four themes that either confirmed or complemented the quantitative findings.Conclusions: This study provides evidence of the effectiveness of high-fidelity simulation-based training in emergency nursing in enhancing students' learning outcomes. Further studies should include a control group, evaluate students' knowledge and skills, and retention of knowledge to confirm the true impact of such training.