High-fidelity simulation and nursing students’ anxiety and self-confidence: A systematic review

Leodoro J. Labrague*, Denise M. McEnroe-Petitte, Ann M. Bowling, Chidozie E. Nwafor, Konstantinos Tsaras

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

107 Citations (Scopus)


Background: As a complementary teaching pedagogy, high-fidelity simulation remains as an effective form of simulation modality. Empirical evidence has additionally shown high-fidelity simulation (HFS) to be an effective contributor to students’ learning outcomes. Purpose: This paper critically appraised existing scientific articles that covered the influence of utilizing HFS on the effects of nursing students’ anxiety and self-confidence during undergraduate nursing education. Methods: This was a systematic review of scientific articles conducted from 2007 to 2017 on the topic of the influence of using HFS on students’ self-confidence and anxiety. The literature of six electronic databases (Proquest, SCOPUS, MEDLINE, PubMed Central, CINAHL, and PsychINFO) was reviewed. Results: Following the literature search, 35 articles were selected. This review provides updated evidence on the efficacy of HFS in reducing anxiety and enhancing self-confidence among nursing students when performing nursing duties or managing patients. Moreover, this review highlights the need for more research that examines the impact of HFS on students’ anxiety. Conclusion: As this form of simulation is found to be effective in the enhancement of nursing student self-confidence and the reduction of their anxiety when caring for patients and/or employing nursing skills, the inclusion of simulation-based activities in all clinical nursing courses is vital.

Original languageEnglish
Pages (from-to)358-368
Number of pages11
JournalNursing Forum
Issue number3
Publication statusPublished - 2019


  • anxiety
  • confidence
  • high fidelity
  • nursing student
  • simulation

ASJC Scopus subject areas

  • General Nursing


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