Creativity in high-fidelity simulation-based nursing education: associations with learning outcomes and stress

Contemporary nursing education increasingly relies on evidence-informed teaching strategies that improve learning outcomes while supporting students' psychological well-being. High-fidelity simulation (HFS) is a well-established educational method; however, less is known about the role of individual learner characteristics, such as creativity, in shaping its effectiveness.

This study aimed to examine creativity in the cognitive and characterological domains and to analyze its relationship with satisfaction, self-confidence, perceived learning outcomes, and stress experienced during high-fidelity simulation classes among nursing students.

A cross-sectional study was conducted among 286 first-year undergraduate nursing students participating in HFS classes during the 2022/2023 and 2023/2024 academic years. Data were collected using an author-designed questionnaire, the Student Satisfaction and Self-Confidence in Learning Scale (SSCL), and the Creative Behavior Questionnaire (KAHN III). Statistical analysis included Spearman's rank correlation coefficient and the Mann-Whitney U test, with the level of significance set at p < 0.05.

Higher levels of creativity in both the cognitive and characterological domains were positively associated with students' satisfaction, self-confidence, and selected perceived learning outcomes. Characterological creativity was positively associated with perceived development of knowledge, practical skills, and social competencies, whereas cognitive creativity was associated with perceived development of knowledge and social competencies. Higher creativity was also associated with lower levels of stress related to independent task performance, patient communication, and procedural execution during simulation scenarios.

The findings suggest that creativity may be an important learner-related factor associated with more favorable educational experiences in high-fidelity simulation. Higher creative dispositions were linked to greater satisfaction and self-confidence, as well as lower stress during simulation activities. These results support the inclusion of creativity-supportive elements in the design of nursing simulation curricula.

Not applicable.