The influence of final-year undergraduate nursing students' participation in simulation on their critical thinking: A...

To synthesise recent evidence on the characteristics and effectiveness of simulation to support development of final-year undergraduate nursing students' critical thinking.

Critical thinking is fundamental to safe, effective nursing practice, particularly for final-year students transitioning to autonomous roles. Simulation-based education is widely used to foster critical thinking, yet simulation has transformed considerably in the last five years.

Mixed method systematic review.

Primary studies published from 2019 to 2025 were searched across MEDLINE, EMBASE, CINAHL Complete, ERIC and SCOPUS. Eligible studies reported on final-year nursing students' critical thinking outcomes following simulation participation. Methodological quality was appraised using the Mixed Methods Appraisal Tool. Data were integrated using convergent narrative synthesis.

Eighteen studies were analysed and synthesised to present the simulation interventions, critical thinking measures and outcomes according to simulation modality. Five simulation intervention modalities were used: standardised patient (5), high-fidelity (3), low-fidelity (1), virtual-reality (5) and mixed-reality (2). Eleven critical thinking measures were used, most commonly Yoon's Critical Thinking Disposition Scale. Most studies (n = 14) found simulation enhanced students' critical thinking. Standardised patient, virtual and mixed reality simulations positively influenced critical thinking and high and low fidelity showed mixed results. The modality's fidelity level did not predict effectiveness.

Various simulation modalities can support development of final-year nursing students' critical thinking particularly when incorporating structured debriefing. When designing simulation, educators should look beyond fidelity and intentionally align modality with learning goals. More longitudinal and qualitative research is needed to better understand simulations' impact on final-year nursing students' critical thinking.