Effects of different technology-based simulation on nursing students' self-confidence and critical thinking: A...

As an indispensable teaching method in nursing education, technology-based simulation promotes the learning and practice of nursing students. Although evidence of the effectiveness of technology-based simulation for improving self-confidence and critical thinking among nursing students is expanding, the results remain inconsistent, and there is insufficient evidence to compare the relative effects of different simulations.

This study evaluated the relative effectiveness of different technology-based simulations on nursing students' self-confidence and critical thinking.

Systematic review and network meta-analysis.

A systematic search was performed in twelve databases to identify studies that were published up to December 2025. Randomized controlled trials evaluating the impact of technology-based simulation on the self-confidence and critical thinking of nursing students were included. Pairwise meta-analysis and network meta-analysis were used to compare the relative effects of different technology-based simulations and rank them according to SUCRA values.

A total of 47 randomized controlled trials were included, involving 10 types of technology-based simulations. High-fidelity simulation (SMD = 0.83, 95%CI = 0.34, 1.33) and immersive virtual reality (SMD = 0.81, 95% CI = 0.34, 1.28) had statistically significant effects on improving self-confidence. For critical thinking, computer-based simulation (SMD = 5.04, 95% CI = 0.58, 9.49) was a potentially effective option. However, this result should be interpreted with caution, as it was based on two direct comparative studies. For self-confidence, high-fidelity simulation had a SUCRA value of 74.0% based on 11 direct comparisons. For the secondary outcome of knowledge, serious game (SMD = 1.72, 95%CI = 0.21, 3.24), high-fidelity simulation (SMD = 1.01, 95%CI = 0.43, 1.59), and immersive virtual reality (SMD = 0.62, 95%CI = 0.03, 1.21) were effective. Serious game had a SUCRA value of 83.5%.

This study found that high-fidelity simulation had the potential to improve the self-confidence of nursing students. For critical thinking, computer-based simulation was a potentially effective option. Schools and educators should choose appropriate simulations according to specific training objectives and the strength of available evidence.