Technology-Enriched High-Fidelity Simulation in Nursing Education: Learning Effectiveness and Mediating Model

Despite extensive research documenting high-fidelity simulation benefits, limited evidence exists regarding the effectiveness of simulation explicitly enriched with clinical technologies or the mechanisms through which simulation components influence learning outcomes.

To evaluate nursing students' learning effectiveness across multiple dimensions following high-fidelity simulation enriched with clinical technologies (HFSECT) and to test whether course arrangement, equipment resources, and clinical ability mediate the relationship between debriefing quality and problem-solving.

Eighty-one third-year undergraduate nursing students participated in a quasi-experimental one-group pretest-posttest study involving HFSECT with dual-component debriefing. The Simulation Learning Effectiveness Inventory assessed seven dimensions: course arrangement, equipment resources, debriefing, clinical ability, confidence, problem-solving, and collaboration. Learning satisfaction was assessed separately. A parallel mediation analysis was conducted using the PROCESS macro with 5,000 bootstrap samples.

Significant improvements occurred in six dimensions: course arrangement, equipment resources, debriefing, problem-solving, clinical ability, and confidence, with substantial satisfaction gains. Collaboration showed no significant change. Mediation analysis showed a significant indirect association through clinical ability, whereas the indirect associations through course arrangement and equipment resources were not significant. The direct association between debriefing and problem-solving remained significant.

HFSECT was associated with improvements in nursing students' perceived learning effectiveness and satisfaction. Clinical ability mediated the association between debriefing and problem-solving, suggesting that debriefing may support problem-solving partly through clinical ability.