Evaluation of high-fidelity simulation on clinical readiness among Thai undergraduate nursing-midwifery students: a...

To address the scarcity of clinical childbirth placements resulting from declining birth rates and pandemic disruptions, High-Fidelity Simulation-Based Education (HF-SBE) has emerged as a key pedagogical strategy. However, its effectiveness in enhancing knowledge, self-confidence, and learning experiences among undergraduate nursing-midwifery students remains limited. Hence, this study aimed to evaluate students' knowledge, self-confidence, and clinical performance quantitatively, while qualitatively exploring their learning experiences using HF-SBE within the Thai clinical education framework.

A sequential explanatory mixed-methods design was employed. The quantitative phase used a single-group, quasi-experimental repeated-measures design with 168 third-year nursing-midwifery students recruited. Data on knowledge and self-confidence were collected at three time points: baseline, post-simulation, and post-clinical placement, while clinical performance was observed during simulation. In the subsequent qualitative phase, 24 students participated in focus group discussions to provide a deeper exploration of their learning experiences. The Friedman test and Wilcoxon Signed Rank test were employed for statistical comparisons, while qualitative data were analyzed using thematic analysis.

Knowledge scores significantly improved from baseline to post-simulation (p < .001); although scores slightly declined following clinical practice, they remained significantly higher than baseline (p < .001). Self-confidence scores increased consistently across all time points (p < .001). Performance observations indicated that emergency-related tasks (including oxygen administration and SBAR-based notification for abnormal fetal heart rate patterns) as well as comfort promotion through facial wiping, were performed correctly. However, omissions were occurred in routine standards, specifically clinical documentation, self-introduction, and hand hygiene. Qualitative results generated two themes: (1) knowledge integration and application, and (2) confidence building and clinical preparedness.

HF-SBE is an effective and feasible approach for enhancing students' knowledge, self-confidence, and clinical readiness in childbirth care. However, future curriculum design should emphasize routine professional standards and procedural compliance alongside emergency management to ensure holistic midwifery practice.