Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter February 20, 2018

The State of Knowledge Regarding the Use of Simulation in Pre-Licensure Nursing Education: A Mixed Methods Systematic Review

  • Joanne K. Olson EMAIL logo , Pauline Paul , Gerri Lasiuk , Sandra Davidson , Barbara Wilson-Keates , Rebecca Ellis , Nichole Marks , Maryam Nesari and Winnifred Savard


This project is a mixed-methods systematic review on the use of simulation in pre-licensure nursing. This research question guided this review: What is the best evidence available upon which to base decisions regarding the use of simulation experiences with pre-licensure nursing students? Searches of CINAHL Plus with Full Text, MEDLINE, and ERIC were performed to identify relevant literature. These searches yielded 1220 articles. After duplicates were removed and titles and abstracts were reviewed for relevance to the inclusion criteria, the remaining 852 articles were independently assessed for quality by pairs of researchers. Forty-seven articles were retained. Findings were grouped into research using high-, medium-, and low-fidelity simulations and a group where researchers included several or all types of simulation. The conclusion is that insufficient quality research exists to guide educators in making evidence-based decisions regarding simulation. More rigorous and multi-site research is needed.

Funding statement: University of Alberta, Faculty of Nursing [Jack Kay Simulation Award in Nursing].


Adamson, K. (2015). A systematic review of the literature related to the NLN/Jeffries simulation framework. Nursing Education Perspectives, 36(5), 281–291. doi:10.5480/15-1655Search in Google Scholar PubMed

Aqel, A. A., & Ahmad, M. M. (2014). High-fidelity simulation effects on CPR knowledge, skills, acquisition, and retention in nursing students. Worldviews on Evidence-Based Nursing, 11(6), 394–400. doi:10.111/wvn.12063Search in Google Scholar

Baxter, P., Akhtar-Danesh, N., Valaitis, R., Stanyon, W., & Sproul, S. (2009). Simulated experiences: Nursing students share their perspectives. Nurse Education Today, 29(859-866). doi:10.1016/j.nedt.2009.05.003Search in Google Scholar PubMed

Blum, C. A., & Parcells, D. A. (2012). Relationship between high-fidelity simulation and patient safety in pre-licensure nursing education: A comprehensive review. Journal of Nursing Education, 51(8), 429–436.10.3928/01484834-20120523-01Search in Google Scholar PubMed

Bornais, J. A. K., Raiger, J. E., Krahn, R. E., & El-Masri, M. M. (2012). Evaluating undergraduate nursing students’ learning using standardized patients. Journal of Professional Nursing, 28(5), 291–296. doi:10.1016/j.profnurs.2012.02.001Search in Google Scholar PubMed

Bradley, P. (2006). The history of simulation in medical education and possible future directions. Medical Education, 40(3), 254–262. doi:10.1111/j.1365-2929.2006.02394.xSearch in Google Scholar PubMed

Bremner, M. N., Aduddell, K., Bennett, D. N., & VanGeest, J. B. (2006). The use of human patient simulators: Best practices with novice nursing students. Nurse Educator, 31(4), 170–174.10.1097/00006223-200607000-00011Search in Google Scholar PubMed

Canadian Association of Schools of Nursing (CASN). (2007). Inventory of the use of simulated clinical learning experiences and evaluation of their effectiveness. Available from in Google Scholar

Cangelosi, P. R. (2008). Accelerated nursing students and theatre students: Creating a safe environment by acting the part. Nursing Education Perspective, 29(6), 342–346.Search in Google Scholar

Cant, R. P., & Cooper, S. J. (2009). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3–15. doi:10.111/j.1365-2648.2009.05240.xSearch in Google Scholar

Choi, Y. J. (2012). Exploring experiences of psychiatric nursing simulations using standardized patients for undergraduate students. Asian Nursing Research, 6(91-95). doi:10.1016/j.anr.2012.07.001Search in Google Scholar PubMed

Chronister, C., & Brown, D. (2012). Comparison of simulation debriefing methods. Clinical Simulation in Nursing, 8, e281–e288. doi:10.1016/j.ecns.2010.12.005Search in Google Scholar

Cooper, S., Kinsman, L., Buykx, P., McConnell-Henry, T., Endacott, R., & Scholes, J. (2010). Managing the deteriorating patient in a simulated environment: Nursing students’ knowledge, skill and situation awareness. Journal of Clinical Nursing, 19, 2309–2318. doi:10.1111/j.1365-2702.2009.03164.xSearch in Google Scholar PubMed

Cordeau, M. (2010). The lived experience of clinical simulation of novice nursing students. International Journal for Human Caring, 14(2), 9–15.10.20467/1091-5710.14.2.8Search in Google Scholar

Critical Appraisal Skills Programme (2017). CASP Checklists. Available from in Google Scholar

Damassa, D. A., & Sitko, T. D. (2010). Simulation technologies in higher education: Uses, trends, and implications. (Research Bulletin 3). Boulder, CO: EDUCASE Center for Applied Research. Available from in Google Scholar

Ericsson, K. A., & Lehmann, A. C. (1994). Expert performance: Its structure and acquisition. American Psychologist, 49(8), 725–747.10.1037/0003-066X.49.8.725Search in Google Scholar

Feingold, C. E., Calaluce, M., & Kallen, M. A. (2004). Computerized patient model and simulated clinical experiences: Evaluation with baccalaureate nursing students. Journal of Nursing Education, 43(4), 156–163.10.3928/01484834-20040401-03Search in Google Scholar PubMed

Fisher, D., & King, L. (2013). An integrative literature review on preparing nursing students through simulation to recognise and respond to the deteriorating patient. Journal of Advanced Nursing, 69(11), 2375–2388. doi:10.1111/jan.1274Search in Google Scholar

Fluharty, L., Hayes, A. S., Milgrom, L., Malarnery, K., Smith, D., Reklau, M. A., … McNelis, A. M. (2012). A multisite, multi-academic track evaluation of end-of-life simulation for nursing education. Clinical Simulation in Nursing, 8, e135–e143. doi:10.1016/j.ecns.2010.08.003Search in Google Scholar

Foronda, C., Liu, S., & Bauman, E. B. (2013). Evaluation of simulation in undergraduate nurse education: An integrative review. Clinical Simulation in Nursing, Vol(x), e1–e8. doi:doi:org/10.1016/j.ecns.2012.11.003Search in Google Scholar

Gaba, D. M. (2004). The future vision of simulation in health care. Quality & Safety in Health Care, 13(Suppl 1), i2–10.10.1136/qshc.2004.009878Search in Google Scholar

Gordon, C. J., Frotjold, A., Fethney, J., Green, J., Hardy, J., Maw, M., & Buckley, T. (2013). The effectiveness of simulation-based blood pressure training in preregistration nursing students. Simulation in Healthcare, 8(5), 335–340. doi:10.1097/SIH.0b013e3182a15fa7Search in Google Scholar PubMed

Gore, T., Leighton, K., Sanderson, B. & Wang, C (2014). Fidelity’s effect on student perceived preparedness for patient care. Clinical Simulation in Nursing, 10 (6), e309– e315.10.1016/j.ecns.2014.01.003Search in Google Scholar

Grenvik, A., & Schaefer, J. (2004). From Resusci-Anne to Sim-Man: The evolution of simulators in medicine. Critical Care Medicine, 32(2 Suppl), S56–7.10.1097/00003246-200402001-00010Search in Google Scholar

Grimshaw, J. (2010). A guide to knowledge synthesis: A knowledge synthesis chapter. Available from in Google Scholar

Harder, B. N. (2010). Use of simulation in teaching and learning in health sciences: A systematic review. Journal of Nursing Education, 49(1), 23–28.10.3928/01484834-20090828-08Search in Google Scholar

Hayden, J. (2010). Use of simulation in nursing education: National survey results. Journal of Nursing Regulation, 1(3), 52–57.10.1016/S2155-8256(15)30335-5Search in Google Scholar

Hayden, J., Smiley, R., Alexander, M., Kardong-Edgren, S., & Jeffries, P. (2014). The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation, 5(2), Supplement, S3–S40.10.1016/S2155-8256(15)30062-4Search in Google Scholar

Heinrich, C., Pennington, R. R., & Kuiper, R. (2012). Virtual case studies in the classroom improve student knowledge. Clinical Simulation in Nursing, 8, E353–e361. doi:10.1016/j.ecns.2011.02.002Search in Google Scholar

Henneman, E. A., Cunningham, H., Roche, J. P., & Cumin, M. E. (2007). Human patient simulation: Teaching students to provide safe care. Nurse Educator, 32(5), 212–217.10.1097/01.NNE.0000289379.83512.fcSearch in Google Scholar PubMed

Hope, A., Garside, J., & Prescott, S. (2011). Rethinking theory and practice: Pre-registration student nurses’ experiences of simulation teaching and learning in the acquisition of clinical skills in preparation for practice. Nurse Education Today, 31(711-715). doi:10.1016/j.nedt.2010.12.011Search in Google Scholar PubMed

Ironside, P. M., Jeffries, P. R., & Martin, A. (2009). Fostering patient safety competencies using multiple-patient simulation experiences. Nursing Outlook, 57(6), 332–337. doi:10.1016/j.outlook.2009.07.010Search in Google Scholar PubMed

Kaakinen, J., & Arwood, E. (2009). Systematic review of nursing simulation literature for use of learning theory. International Journal of Nursing Education Scholarship, 6(1), Article 16. doi:10.2202/1548-923X.1688Search in Google Scholar PubMed

Kameg, K., Clochesy, J., Mitchell, A. M., & Suresky, J. M. (2010). The impact of high fidelity human simulation on self-efficacy of communication skills. Issues in Mental Health Nursing, 31(315-323). doi:10.3109/01612840903420331Search in Google Scholar PubMed

Kameg, K. M., Englert, N. C., Howard, V. M., & Perozzi, K. J. (2013). Fusion of psychiatric and medical high fidelity patient simulation scenarios: Effect on nursing student knowledge, retention of knowledge, and perception. Issues in Mental Health Nursing, 34(892-900). doi:10.3109/01612840.2013.854543Search in Google Scholar PubMed

Kaplan, B., & Ura, D. (2010). Use of multiple patient simulators to enhance prioritizing and delegating skills for senior nursing students. Journal of Nursing Education, 49(7), 371–377. doi:10.3928/01484834-20100331-07Search in Google Scholar PubMed

Kaplan, B. G., Abraham, C., & Gary, R. (2012). Effects of participation vs. observation of a simulation experience on testing outcomes: Implications for logistical planning for a school of nursing. International Journal of Nursing Education Scholarship, 9(1), Article 14. doi:10.1515/1548-923X.14Search in Google Scholar

Kardong-Edgren, S., Lungstrom, N., & Bendel, R. (2009). WitalSim versus SimMan: A comparison of BSN student test scores, knowledge retention, and satisfaction. Clinical Simulation in Nursing, 5, e105–e111. doi:10.1016/j.ecns.2009.01.007Search in Google Scholar

Kardong-Edgren, S. E., Oermann, J. H., Odom-Maryon, T., & Ha, Y. (2010). Comparison of two instructional modalities for nursing student CPR skill acquisition. Resuscitation, 81(1019-1024). doi:10.1016/j.resuscitation.2010.04.022Search in Google Scholar PubMed

Kastner, M., Tricco, A. C., Soobiah, C., Lillie, E., Perrier, L., Horsley, T., … Straus, S. E. (2012). What is the most appropriate knowledge synthesis method to conduct a review? Protocol for a scoping review. BMC Medical Research Methodology, 12(114). doi:10.1186/1471-2288-12-114Search in Google Scholar PubMed PubMed Central

King, J., & Reising, D. L. (2011). Teaching advanced cardiac life support protocols: The effectiveness of static versus high-fidelity simulation. Nurse Educator, 36(2), 62–65. doi:10.1097/NNW.0b013e31820b5012Search in Google Scholar

Kneebone, R. L., Scott, W., Darzi, A., & Horrocks, M. (2004). Simulation and clinical practice: Strengthening the relationship. Medical Education, 38(10), 1095–1102.10.1111/j.1365-2929.2004.01959.xSearch in Google Scholar PubMed

Lapkin, S., Levett-Jones, T., Bellchambers, H., & Fernandez, R. (2010). Effectiveness of patient simulation manikins in teaching clinical reasoning skills to undergraduate nursing students: A systematic review. Clinical Simulation in Nursing, 6, e207–e222. doi:10.1016/j.ecns.2010.05.005Search in Google Scholar

LeFlore, J. L., Anderson, M., Zielke, M., Nelson, K., Thomas, P. E., Hardee, G., & John, L. D. (2012). Can a virtual patient trainer teach student nurses how to save lives: Teaching nursing students about pediatric respiratory diseases. Simulation in Heathcare, 7(10-17). doi:10.1097/SIH.obo13e31823652deSearch in Google Scholar

Leigh, G. T. (2008). High-fidelity patient simulation and nursing students’ self-efficacy: A review of the literature. International Journal of Nursing Education Scholarship, 1(5), Article 37. doi:10.2202/1548-923X.1613Search in Google Scholar PubMed

Levett-Jones, T., Lapkin, S., Hoffman, K., Arthur, C., & Roche, J. (2011a). Examining the impact of high and medium fidelity simulation experiences on nursing students’ knowledge acquisition. Nurse Education in Practice, 11, 380–383. doi:10.1016/j.nepr.2011.03.014Search in Google Scholar PubMed

Levett-Jones, T., McCoy, M., Lapkin, S., Noble, D., Hoffman, K., Dempsey, J., … Roche, J. (2011b). The development and psychometric testing of the Satisfaction with Simulation Experience Scale. Nurse Education Today, 31, 705–710. doi:10.1016/j.nwsr.2011.01.004Search in Google Scholar

Lewis, D., O’Boyle-Duggan, M., Chapman, J., Dee, P., Sellner, K., & Gorman, S. (2013). Putting words into action project: Using role play in skills training. British Journal of Nursing, 22(11), 638–644.10.12968/bjon.2013.22.11.638Search in Google Scholar PubMed

Liaw, S., Rethans, -J.-J., Scherpbier, A., & Piyanee, K.-Y. (2011). Rescuing a patient in deteriorating situations (PRPEDS): A simulation-based educational program on recognizing, responding and reporting of physiological signs of deterioration. Resuscitation, 82(1224-1230). doi:10.1016/j.resuscitation.2011.04.014Search in Google Scholar PubMed

Liaw, S., Scherpbier, A., Rethans, -J.-J., & Klainin-Yobas, P. (2012). Assessment for simulation learning outcomes: A comparison of knowledge and self-reported confidence with observed clinical performance. Nurse Education Today, 32, e35–e39. doi:10.1016/j.nedt.2011.10.006Search in Google Scholar PubMed

Luctkar-Flude, M., Wilson-Keates, B., & Larocque, M. (2011). Evaluating high-fidelity human simulators and standardized patients in an undergraduate nursing health assessment course. Nurse Education Today, 32(448-452). doi:10.1016/j.nedt.2011.04.011Search in Google Scholar PubMed

McKeon, L. M., Norris, T., Cardell, B., & Britt, T. (2009). Developing patient-centered care competencies among prelicensure nursing students using simulation. Journal of Nursing Education, 48(12), 711–715. doi:10.3928/01484834-20091113-06Search in Google Scholar PubMed

Meyer, M., Connors, H., Hou, Q., & Gajewski, B. (2011). The effect of simulation on clinical performance: A junior nursing student clinical comparison study. Simulation in Healthcare, 6(269-277). doi:10.1097/SIH.0b013e18223a048Search in Google Scholar

Nehring, W. M., & Lashley, F. R. (2009). Nursing simulation: A review of the past 40 years. Simulation and Gaming, 40(4), 528–552. doi:10.1177/1046878109332282Search in Google Scholar

Neill, M., & Wotton, K. (2011). High-fidelity simulation debriefing in nursing education: A literature review. Clinical Simulation in Nursing, 7(5), e161–e168. doi:10.1016/j.ecns.2011.02.001Search in Google Scholar

Noone, J., Sideras, S., Gubrud-Howe, P., Voss, H., & Mathews, L. (2012). Influence of a poverty simulation on nursing student attitudes toward poverty. Journal of Nursing Education, 51(11), 617–622. doi:10.3928/01484834-20120914-01Search in Google Scholar PubMed

Norman, G., Dore, K., & Grierson, L. (2012). The minimal relationship between simulation fidelity and transfer of learning. Medical Education, 46(7), 636–647. doi:10.1111/j.1365-2923.2012.04243.xSearch in Google Scholar PubMed

Norman, J. (2012). Systematic review of the literature on simulation in nursing education (pp. 24–28). Spring: The ABNF Journal.Search in Google Scholar

Oermann, M. H., Kardong-Edgren, S., Odom-Maryon, T., Ha, Y., McColgan, J. K., Hurd, D., … Dowdy, S. W. (2010). Heartcode BLS with voice assisted manikin for teaching nursing students: Preliminary results. Nursing Education Perspectives, 31(5), 303–308.Search in Google Scholar

Onello, R., & Regan, M. (2013). Challenges in high fidelity simulation: Risk sensitization and outcome measurement. The Online Journal of Issues in Nursing, 18(3), 1–8.10.3912/OJIN.Vol18No03PPT01Search in Google Scholar

Paparella, S. R., Mariani, B. A., Layton, K., & Carpenter, A. M. (2004). Patient safety simulation: Learning about safety never seemed more fun. Journal for Nurses in Staff Development, 20(6), 247–252.10.1097/00124645-200411000-00001Search in Google Scholar PubMed

Parker, B. C., & Myrick, F. (2009). A critical examination of high-fidelity human patient simulation within the context of nursing pedagogy. Nurse Education Today, 29(3), 322–329.10.1016/j.nedt.2008.10.012Search in Google Scholar PubMed

Pawson, R., Greenhalgh, T., Harvey, G., & Walshe, K. (2005). Realist review--a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy, 10(Suppl 1), 21–34.10.1258/1355819054308530Search in Google Scholar PubMed

Pawson, R., & Tiley, N. (2004). Realist evaluation. Available from in Google Scholar

Pike, T., & O’Donnell, V. (2010). The impact of clinical simulation on learner self-efficacy in pre-registration nursing education. Nurse Education Today, 30(405-410). doi:10.1016/j.nedt.2009.09.013Search in Google Scholar PubMed

Piscotty, R., Grobbel, C., & Tzeng, H. (2011). Integrating quality and safety competencies into undergraduate nursing using student-designed simulation. Journal of Nursing Education, 50(8), 429–436.10.3928/01484834-20110429-04Search in Google Scholar PubMed

Power, T., Virdun, C., White, H., Hayes, C., Parker, N., Kelly, M., … Cottle, A. (2016). Plastic with personality: Increasing student engagement with manikins. Nurse Education Today, 38(126-131). doi:10.1016/j.nedt.2015.12.001Search in Google Scholar PubMed

Reid-Searl, K., Eaton, A., Vieth, L. & Happell, B (2011). The educator inside the patient: Students’ insights into the use of high fidelity silicone patient simulation. Journal of Clinical Nursing, 20 (19–20), 2752– 2760.10.1111/j.1365-2702.2011.03795.xSearch in Google Scholar PubMed

Reinhardt, A. C., Mullins, I. L., De Blieck, C., & Schultz, P. (2012). IV insertion simulation: Confidence, skill, and performance. Clinical Simulation in Nursing, 8, e157–e167. doi:10.1016/j.ecns.2010.09.001Search in Google Scholar

Rhodes, M. L., & Curran, C. (2005). Use of the human patient simulator to teach clinical judgment skills in a baccalaureate nursing program. Computer, Informatics, Nursing, 23(5), 256–262.10.1097/00024665-200509000-00009Search in Google Scholar PubMed

Ricketts, B. (2011). The role of simulation for learning within pre-registration nursing education: A literature review. Nurse Education Today, 31, 650–654. doi:10.1016/j.nedt.2010.10.029Search in Google Scholar PubMed

Robinson-Smith, G., Bradley, P. K., & Meakin, C. (2009). Evaluating the use of standardized patients in undergraduate psychiatric nursing experiences. Clinical Simulation in Nursing, 5, e203–e211. doi:10.1016/j.ecns.2009.07.001Search in Google Scholar

Rochester, S., Kelly, M., Disler, R., White, H., Forber, J., & Matiuk, S. (2012). Providing simulation experiences for large cohorts of 1st year nursing students: Evaluating quality and impact. Collegian, 19, 117–124.10.1016/j.colegn.2012.05.004Search in Google Scholar PubMed

Rogers, L. (2011). Developing simulations in multi-user virtual environments to enhance healthcare education. British Journal of Educational Technology, 42(4), 608–615. doi:10.1111/j.1467-8535.2010.01057.xSearch in Google Scholar

Rosen, K. R. (2008). The history of medical simulation. Journal of Critical Care, 23(2), 157–166.10.1016/j.jcrc.2007.12.004Search in Google Scholar PubMed

Rourke, L., Schmidt, M., & Garga, N. (2010). Theory-based research of HFS use in nursing education: A review of the literature. International Journal of Nursing Education Scholarship, 7(1), 1–14. doi:10.2202/1548-923X.1965Search in Google Scholar PubMed

Schiavenato, M. (2009). Reevaluating simulation in nursing education: Beyond the human patient simulator. Journal of Nursing Education, 48(7), 388–394.10.3928/01484834-20090615-06Search in Google Scholar PubMed

Schoening, A. M., Sittner, B. J., & Todd, M. J. (2006). Simulated clinical experience: Nursing students’ perceptions and the educators’ role. Nurse Educator, 31(6), 253–258.10.1097/00006223-200611000-00008Search in Google Scholar PubMed

Sears, K., Goldsworthy, S., & Goodman, W. M. (2010). The relationship between simulation in nursing education and medication safety. Journal of Nursing Education, 1(49), 52–55. doi:10.3928/01484834-20090918-12Search in Google Scholar PubMed

Shin, H., Sok, S., Hyun, K. S., & Kim, M. J. (2014). Competency and an active learning program in undergraduate nursing education. Journal of Advanced Nursing, 71(3), 591–598. doi:10.1111/jan.12564Search in Google Scholar PubMed

Sinclair, B., & Ferguson, K. (2009). Integrating simulated teaching/learning strategies in undergraduate nursing education. International Journal of Nursing Education Scholarship, 6(1), 1–11. doi:10.2202/1548-923X.1676Search in Google Scholar PubMed

Solnick, A., & Weiss, S. (2007). High fidelity simulation in nursing education. A Review of the Literature. Clinical Simulation in Nursing Education, 3, e41–e45. doi:10.1016/j.ecns.2009.05.039Search in Google Scholar

Teteris, E., Fraser, K., Wright, B., & McLaughlin, K. (2012). Does training learners on simulators benefit real patients? Advances in Health Science Education Theory and Practice, 7(1), 137–144. doi:10.1007/s10459-011-9304-5Search in Google Scholar PubMed

Tran, T., Scherphier, A., Van Dalen, J., & Wright, P. E. (2012). Teacher-made models: The answer for medical skills training in developing countries? BMC Medical Education, 12(98), 2–6. doi:10.1186/1472-6920-12-98Search in Google Scholar PubMed PubMed Central

Walton, J., Chute, E., & Ball, L. (2011). Negotiating the role of the professional nursing: The pedagogy of simulation: A grounded theory study. Journal of Professional Nursing, 27(5), 299–310. doi:10.1016/j.profnurs.201.04.005Search in Google Scholar

Weaver, A. (2011). High-fidelity patient simulation in nursing education: An integrative review. Nursing Education Perspectives, 32(1), 37–40.10.5480/1536-5026-32.1.37Search in Google Scholar PubMed

Williams, B., French, J., & Brown, T. (2009). Can interprofessional education DVD simulations provide an alternative method for clinical placements in nursing? Nursing Education Today, 29(666-670). doi:10.1016/j.nedt.2009.02.008Search in Google Scholar PubMed

Received: 2017-06-29
Revised: 2018-02-12
Accepted: 2018-02-12
Published Online: 2018-02-20

© 2018 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 7.12.2023 from
Scroll to top button