Immersive clinical learning using simulation and its impact on academic performance, satisfaction, self-confidence,...

Clinical education forms the foundation of nursing competence, yet access to equitable and high-quality pediatric clinical placements remains limited in many regions. Immersive clinical learning through simulation offers students a safe, authentic space to apply knowledge, build confidence, and manage anxiety before caring for real patients. This study examined the association between simulation-integrated clinical learning and academic performance, satisfaction, self-confidence, and anxiety among undergraduate pediatric nursing students, comparing it with traditional hospital-based training.

A cross-sectional study was conducted among 191 third-year undergraduate nursing and midwifery students enrolled in a pediatric nursing course. Students participated in either simulation-integrated clinical training (n = 148) or traditional hospital training only (n = 43). Data were collected using a structured survey that included academic indicators (GPA, theory, and clinical grades), the National League for Nursing's Satisfaction and Self-Confidence in Learning Scale, and the Generalized Anxiety Disorder-7 (GAD-7) tool. Analyses employed the Mann-Whitney U test, t-test, and correlation analyses. Logistic regression was used to examine predictors of group allocation, with effect sizes and 95% confidence intervals reported (p < 0.05).

Between-group comparisons showed no statistically significant differences in GPA (p = 0.066; r = 0.18), pediatric theory (p = 0.053; r = 0.19), or anxiety scores (p = 0.322, g = -0.17). Satisfaction and self-confidence were strongly correlated (r = 0.674, p < 0.001). Effect sizes for most academic outcomes were small, with confidence intervals indicating imprecision around group differences. Higher theory exam scores predicted lower anxiety (β = -0.186, p = 0.008). Students with higher GPAs were more likely to be allocated to simulation-integrated training (OR = 2.918, p = 0.047), indicating a potential for selection bias.

Immersive simulation-integrated clinical learning was associated with academic and psychological outcomes comparable to traditional hospital-based training within this institutional context. However, the non-randomized design, and evidence of GPA-related group allocation suggest the presence of selection bias, and findings should therefore be interpreted cautiously. Further randomized or longitudinal studies are required to establish causal relationships and evaluate the long-term impact of simulation-based clinical education.