TITLE:
The Use of High-Fidelity Simulation in Pre-Licensure Nursing Programs: A Systematic Review
AUTHORS:
Pius Omolewa, John Bressan, Feng Ping (Sarah) Lee
KEYWORDS:
Simulation, High-Fidelity, Prelicensure Nursing Program, Experimental Study, Quasi-Experimental Design, Systematic Review
JOURNAL NAME:
Open Journal of Nursing,
Vol.16 No.3,
March
12,
2026
ABSTRACT: Aim: This study aimed to evaluate the effectiveness of high-fidelity simulation in prelicensure nursing programs as it relates to the confidence, knowledge, and skills of student nurses. Background: Initiatives to improve the quality of prelicensure education in nursing programs include high-fidelity simulations, but research on their impact on student nurses’ confidence, knowledge, and skills remains limited. Nurses’ confidence in practical settings is essential for quality patient care and therapeutic use of self. Methods: Articles published between 2014-2025 that used experimental and quasi-experimental studies on high-fidelity simulations were searched in EBSCO host, Google Scholar, ProQuest, Medline, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Results: Six articles involving 402 participants who were undergraduate nursing students from various universities were included in this meta-analysis. Pooled results of the analyses showed that the effect of high-fidelity simulation on knowledge was statistically significant, a random-effects meta-analysis revealed a significant positive effect, 0.74, 95% CI [0.16, 1.31], P = 0.01, the forest plot on the impact of high-fidelity simulation on skills was statistically significant, a random-effects meta-analysis revealed a significant positive effect, 0.69, 95% CI [0.17, 1.21], P = 0.01, and based on five of the studies, the effect of high-fidelity simulation on confidence was statistically significant based on random-effects meta-analysis, 0.60, 95% CI [0.17, 1.02], P = 0.01. Conclusions: This review highlights the importance of high-fidelity simulation in pre-licensure nursing programs. High-fidelity simulation improves student nurses’ skills, knowledge, and confidence before graduation. Confidence is an important attribute for new nurses in the ever-changing highly stressful care settings. Relevance to Clinical Practice: The use of high-fidelity simulations in pre-licensure nursing programs improves student nurses’ skills, knowledge, and confidence, which are the essential traits for quality patient care in practical settings. Patient or Public Contribution: What does this paper contribute to the wider global clinical community? 1) Improved clinical reasoning skills essential for quality patient care. 2) Practical and demonstratively effective ways to inculcate confidence and knowledge among new nurses.