Table 2.

Characteristics of included studies

Primary author (Year)	Aim	Study design	Participants (sample size)	Simulation (intervention)	Results	finding Related to the review purpose
Araújo, Medeiros [34] Brazil	To identify the effect of clinical simulation on the immediate and retained cognitive performance of nursing students in a vocational course about their performance in emergencies.	RCT with repetitive test measure	46 nursing students	Practice in the scenario of experiencing a situation of cardiopulmonary arrest in adults, pregnant women, and a choking situation.	Students in the experimental group retained more knowledge than those in the control group.	Students who learned from the simulation methodology retained better cognitive performance than a traditional teaching strategy.
Arrogante, Rios-Diaz [29] Spain	To analyse the effects of deliberate practice using a feedback device (FD) on the CPR performance of nursing students before, immediately after, and three months after training.	RCT	60 nursing students	Structured CPR training.	The participants in the training group had an improved ability to perform chest compressions and ventilations and improve their overall quality of CPR than the control group.	Simulation has a positive effect on the acquisition of CPR skills by participants.
Charlier, Van Der Stock [43] Belgium	- To identify which basic life support skills of student nurses deteriorate in a period of four months. - To investigates the link between a specific cognitive skill and its corresponding motor skill in BLS.	Quasi-experimental repeated measure	169 nurse students	A standardised BLS-AED face-to-face course.	On BLS knowledge, 65% of students passed the overall post-test. 61% of all students passed the retention test. BLS skills were significant in skill performance between post and retention.	SBL was an effective method for teaching BLS knowledge and skills. There was a significant correlation between knowledge and skills in their acquisition and retention.
Chen, Yang [48] China	To evaluate the impact of a standardised simulation-based emergency and intensive care nursing curriculum on nursing students’ response time in a resuscitation simulation	Two-group, non-randomised quasi-experimental design.	39 third-year nursing students	Participated in standardised simulation-based in the following: clinical priorities (e.g. triage), basic resuscitation skills, airway/breathing management, circulation management and teamwork.	There was a significant decrease in the median ± IQR in seconds elapsed between the call for assistance and the initiation of chest compressions in the experimental group. Similar decrease from the call for help to successful defibrillation.	SBL methodology was associated with decreased response time in a resuscitation.
D’Cunha, Fernandes [44] India	To evaluate the effectiveness of a simulation-based training program for nursing students involved in simulated Code Blue resuscitation scenarios.	Interventional study, Pre and post	65 Nursing students	Hands-on stations on the crash cart and cardiac arrest algorithms using an electrocardiogram simulator.	A significant increase in mean% from pre-test to post-test (55.69–77.33%) following simulated drills.	Using simulation to train nurse students in Code Blue scenarios records greater satisfaction and improvement in clinical reasoning, knowledge, and skills.
Demirtas, Guvenc [26] Turkey	To examine the effectiveness of a simulation-based CPR training program on the knowledge, practices, satisfaction, and self-confidence of nursing students.	mixed-method design, with Pre and post-design (for quantitative).	89 fourth-year nursing students	Theoretical training for 45 min, then demonstrated CPR on a medium-fidelity CPR model according to the 2015 AHA guideline. 15 min performed CPR skills in the scenario.	The mean score of CPR knowledge score increased significantly after the simulation (p < 0.001). The mean post-test CPR skills score was significantly higher than the mean pre-test CPR skills score (p < 0.001).	SBL improved the level of knowledge and skills of nursing students. In addition SBL had a positive effect on students’ satisfaction and self-confidence.
Farsi, Yazdani [42] Iran	To evaluate the difference in educating nursing students on CPR when using the traditional simulation training with a mannequin versus a more novel serious game training on the smartphone platform.	RCT	56 Nurse students	A simulation-based CPR training, CPR training using a serious game on the smartphone platform, and a control group that received no CPR training.	The simulation and serious game intervention groups demonstrated better scores on the knowledge questionnaire and on the CPR skill demonstration.	CPR training for nursing students using simulation training and the novel serious game training on a smartphone platform both increased CPR knowledge and skill.
Filomeno, Renzi [45] Spain	To evaluate the effectiveness of SBL method, as an additional method to theoretical lectures, on improving critical care knowledge.	A non-experimental pre-test and post-test study	60 nursing students	Participating in four scenarios using simulation: ABCDE assessment, disturbance identification, prioritization and application of algorithms	Significance improvement of the intervention in the post-test: p-value 0.01 and the students improved on average by 1 point after the intervention, passing from 11.94 in the pre-test to 12.94 in the post-test.	Nursing students involved in the critical care course needed the simulated clinical scenarios to improve their abilities to solve questions or problems related to critical care.
Goldsworthy, Patterson [46] Canada	To evaluate the effects of SBL on nursing students’ confidence and competence in the recognition and response to rapidly deteriorating adult and paediatric patients.	Quasi-experimental design	63 undergraduates nursing students in final year	Participated in High-fidelity cases in six scenarios (angina/cardiac arrest, COPD/respiratory failure, post-op haemorrhage, paediatric sepsis, paediatric asthma, neonatal seizures)	Significant improvement in all items on the Clinical Self-efficacy tool was seen in the treatment group after the intervention. On the contrary, there was no significant improvement in any of the Clinical Self-efficacy items in the control group.	Simulation effective in improving confidence and competence in the recognition and response to deteriorating patients. Further, significant increases in knowledge (myocardial infarction, paediatric asthma, and septic shock).
Habibli, Ghezeljeh [31] Iran	To investigate the effect of SBL on the knowledge and performance of nursing students of adult essential life support cardiopulmonary resuscitation (BLS-CPR).	RCT	49 nursing students	The participants practice various BLS roles for 5 min, including heart compression, artificial respiration, and the use of AED.	The mean scores of students’ knowledge and performance in the intervention group immediately after (p < 0.001) and three months after the intervention (p < 0.05) were significantly higher than the control group.	SBL increased the knowledge and performance of nursing students in the field of BLS-CPR. Integrating conventional training with simulation-based education can be effective in learning BLS among nursing students.
Hardenberg, Rana [30] Australia	To assess the impact of HFS training on four vital skill areas: focused patient assessment, primary response, consultation with the doctor and emergency management interventions in postgraduate critical care nursing students	RCT	16 post-graduate nursing (Master of Nursing).	a 90-minute training in two stations. The first station with a human simulation manikin to resemble a critically ill patient. The second is the training simulation on airway management.	Focused patient assessment and emergency management intervention skills were improved and higher on training simulation group compared to the control group (p < 0.05).	HFS can impact the skills area of ‘‘focused patient assessment’’ and ‘‘emergency management intervention.’’
Ka Ling, Lim Binti Abdullah [33] Malaysia	To compare learning outcomes using an adult code blue resuscitation drill simulation, by using high fidelity patient simulation (HFPS) versus low fidelity patient manikins (LFPM).	RCT, pre-test and post-test double-arm intervention study.	409 third-year nursing students.	Participating in a code blue scenario to assess participants’ knowledge of CPR, administration of medication, identification of life-threatening arrhythmias, and team collaboration on a deteriorating patient.	A repeated-measures ANCOVA showed significant differences in knowledge levels and CT skills between control and intervention groups. The intervention group showed a significant improvement compared to control group.	Simulation-based education using HFPS can help increase knowledge and CT skills among nursing students in code blue management.
Kardong-Edgren, Oermann [50] USA	To compare the CPR psychomotor skills nursing students to assess their retention of skills post-BLS certification and following one training session using the RQI system.	Pre and post-design.	467 nursing students	Students initially completed 60 s of chest compressions and 1 min of bag, valve, and mask ventilation.	Overall compression and ventilation scores improved scores improved significantly from pre-test to post-test p < 0.0001 increase following a 10-minute RQI coached session.	SBL help Students to improve their skills in compression and ventilation.
Keys, Luctkar-Flude [32] Canada	To evaluate the effect of a resuscitation-oriented VSG (Virtual simulation gaming), when implemented as a pre simulation preparation adjunct, on the performance of nursing students during an advanced cardiac life support.	a parallel group randomised controlled trial (RCT) with a 1:1 intervention to control allocation ratio	26 nursing students	Each learner was required to complete one V-Fib arrest simulation, which focused on assessment and team roles during resuscitation. For participants allocated to the intervention group, the VSG is a 15-minute computer-based game that allows users to experience the role of a nurse caring for a patient in cardiac arrest.	Overall performance was greater for participants in the in- intervention group (mean = 12) than for the control group (mean = 8).	Virtual simulation gaming could serve as an effective pre simulation preparation tool
Kim, Issenberg [37] Korea	To identify the effects of simulation-based advanced life support education on nursing students’ knowledge, performance, self-efficacy, and teamwork.	RCT	60 fourth-year nursing students	Practised airway management and CPR (bag-valve-mask ventilation, chest compression, drug injection, and defibrillation), which were required in the high-fidelity simulation session.	The experimental group showed a higher mean score of knowledge, performance, and self-efficacy scores compared to the control group. There was no significant mean difference in the overall teamwork score.	SBL had positive effects on knowledge, performance, and self-efficacy among participants.
Lau, Chee [53] Singapore	To evaluate the team performance of students after Interprofessional simulation-based advanced cardiac life support (IPSACLS) training	Pre and post-design.	80 nursing and medical students	The simulation experience comprised nine different simulation scenarios, and each group needed to finish nine stations in two days. Simulation sessions involved using a high-fidelity simulation manikin in a team approach.	The total scores of the Clinical Teamwork Scale and Communication and Team Skills Assessment were improved substantially after the IPS-ACLS (p < 0.001).	IPS-ACLS training could augment teamwork performance among nursing and medical students.
Li, Lv [40] China	To explore the impact of integrating online virtual simulation with interactive exercises and offline low fidelity simulation on CPR (cardiopulmonary resuscitation) skills of first-year nursing students.	RCT	72 first-year nursing students	Teaching cardiopulmonary resuscitation (CPR). Blended learning approach integrating virtual simulation with interactive exercises and offline low-fidelity simulation	The experimental group exhibited significantly greater improvement in their self-directed learning (SDL) abilities and significantly better performance in their CPR skills. There were no statistical differences in terms of their critical thinking abilities.	The simulation was effective in improving the students’ CPR skills and self-directed learning abilities
Meneghesso, Marcatto [55] Brazil	To verify the contributions of using the “blindfolded” technique on nursing students’ self-confidence and knowledge in critical patient care in simulated clinical scenarios.	Quasi-experimental design	25 Nursing students	Blindfolded leader to the simulated ACLS scenario using High fidelity manikin	There was a mean increase of 4.04 correct answers in the sample when compared to their baseline knowledge. The students in leadership roles exhibited a significant rise in their self-confidence during the care provided in critical scenarios.	Using the “blindfolded” simulation technique led to a significant increase in nursing students’ knowledge.
Padilha, Machado [35] Portugal	To evaluate the effect of clinical virtual simulation with regard to knowledge retention, clinical reasoning, self-efficacy, and satisfaction with the learning experience among nursing students.	RCT with repetitive test measure.	42 nursing students in the second year.	A 45 min of class in the field of the respiratory process about ineffective airway clearance and hypoxia with recourse to a clinical virtual simulator scenario	The experimental group had better outcomes in knowledge after the intervention (P = 0.001), retention two months later (P = 0.02) and learning satisfaction (P < 0.001) than the control group.	SBL improves knowledge retention and clinical reasoning over time and improves student satisfaction with learning.
Requena-Mullor, Alarcón-Rodríguez [51] Spain	To evaluate the effects of the BLS clinical simulation course on Undergraduate Nursing Students’ Learning.	A pre-post intervention study.	479 nursing students.	30 min of BLS simulation session, including and proper use of the automated external defibrillator (AED).	statistically significant differences in the total score of the pre-test and after completing the BLS course (pre-test (12.61), post-test (15.68), p < 0.001). A significant increase in the mean scores was observed in each of the four parts of the assessment protocol (p < 0.001).	SBL was an effective method of teaching and learning BLS skills, and it is recommended that nursing students repeat BLS training throughout their education.
Roh, Kim [54] Korea	To identify the effects of a nursing simulation program with team-based learning (TBL) on Korean nursing students’ knowledge, team performance, and teamwork.	A one-group pre and post-test design	229 fourth-year nursing students.	Participate in three patient scenarios (hyperglycaemia, breathing difficulty, and cardiac arrest) using the human patient simulator. The fourth session for communication skills was a handover simulation performed by the students in pairs using scenarios that had been conducted previously.	The median post-test rank on team performance was significantly higher than the median pre-test rank (z = − 10.09, P < 0.001). Participants achieved higher scores in the Group Readiness Assurance Test than they did in the Individual Test	A simulation program positively affected nursing students’ knowledge, performance, and teamwork.
Saeidi and Gholami [36] Iran	To assess the effect of SBE on nursing students’ knowledge	RCT	80 s year nursing students	A 5-hour neonatal resuscitation session, according to NRP 2016 was used for the SBE group.	The pre-test analysis did not show any significant differences in knowledge between the two groups, but the post-test analysis showed that the SBE group had significantly higher knowledge.	SBL was significantly more effective than traditional in the students’ knowledge of neonatal resuscitation education.
Sapiano, Sammut [52] Malta	To investigate the effectiveness of virtual simulation in improving student nurses’ knowledge and performance during rapid patient deterioration.	A pre- and post-test design.	166 undergraduate nursing students.	The students took part in three virtual scenarios in which they had to assess and manage rapid patient deterioration. They had to complete each scenario within 8 min, prompting them to act quickly and prioritise care appropriately.	The mean pre-scenario knowledge scores were 6.71 out of 11, the mean post-scenario knowledge scores were 7.61, indicating an improvement in the students’ knowledge in cardiac, shock respiratory scenario.	Virtual simulation programs may improve knowledge and improve performance in deterioration management.
Seo and Eom [39] Korea	To assess the effect of a simulation nursing education program on clinical reasoning, problem-solving process, self-efficacy, and clinical competency using the Outcome-Present State-Test (OPT) model in nursing students.	RCT	45 nursing students.	The simulation session comprised gastrointestinal tract bleeding and acute myocardial infarction to reflect the opt model.	A significant improvement in clinical reasoning (p = 0.002), problem-solving process (p < 0.001), and self-efficacy (p < 0.001) and clinical competency in the experimental group as compared to the control group.	SBL effectively improved clinical reasoning, problem-solving process, self-efficacy, and clinical competency in undergraduate nursing students.
Seol and Lee [49] Korea	To identify the effects of CPR training among nursing students in Mozambique.	A one-group pre-test and post-test repeated-measures quasi-experimental design.	32 nursing students.	Practical training for CPR was conducted for 2 h using two CPR manikins (Little Anne, Laderal®).	Attitude and self-efficacy scores of students on CPR significantly increased immediately after CPR training but decreased 20 weeks after the intervention.	SBL positively affected attitude and self-efficacy in CPR among RN-BSN nursing students immediately, but not at 20 weeks, after the training.
Svellingen, Forstrønen [28] Norway	To assess the effect of multiple simulations on the students’ self-reported clinical decision-making skills and self-confidence.	RCT with two arms (double scenario simulations as intervention and single scenario simulations as control) and three follow-up time points.	146 nursing students	One day of simulation during the first academic year, two simulation days the second year, and one during the third year.	No significant differences between double vs. single scenario sessions on clinical decision-making scores or self-confidence scores.	The overall self-confidence scores increased significantly over time after simulation intervention.
Sarvan and Efe [41] Turkey	To determine the impact of integrating serious game simulation (SGS) into neonatal resuscitation training on the neonatal resuscitation related knowledge, skills, satisfaction with training, and self-confidence in learning of nursing students.	RCT with pre and post-test measure.	90 nurse students.	A neonatal resuscitation algorithm and employed a neonatal resuscitation serious game simulation (SGS) method to allow students to engage in neonatal resuscitation scenarios in a simulated, game-based environment.	The intervention group showed significantly better ventilation and chest compression skills, with p-values of 0.011 and 0.020, respectively. Both groups demonstrated a significant increase in neonatal resuscitation knowledge and skills post-training (p < 0.05), and High scores in satisfaction and self-confidence	The serious game simulation method used in neonatal resuscitation training effectively enhanced the students’ ventilation and compression performing skills.
Tucker, Urwin [56] UK	To investigate the impact of unsuccessful resuscitation and manikin death during simulation on nursing student’s resuscitation self-efficacy.	A quasi-experimental design.	120 s year nursing student	The simulation session was split into two groups, with one group being assigned to the scenario where the patient was successfully resuscitated and the other group going into the unsuccessful resuscitation scenario.	Overall, both groups showed improved self-efficacy because of the simulation session and the death of the manikin in the experimental group did not result in a reduced level of self-efficacy related to resuscitation	Skills and AED used significantly improved between pre- and post-simulation.
Tawalbeh [38] Jordan	To examine the effects of simulation modules on students’ knowledge and confidence in performing critical care skills.	RCT with repetitive test measure.	76 nurse students.	Three scenarios were implemented for each system and 18 h of simulation were provided for each group in the experimental group. A high-fidelity simulator was used with features including ventilation, hemodynamic monitoring, electrocardiogram analysis, medication administration, and chest tube.	A statistically significant difference between the control and experimental, the students in the experimental group scored significantly higher p < 0.001 than the control group in both knowledge and confidence regarding performing critical care skills.	Simulation significantly impacts nursing students’ knowledge and confidence in implementing critical care nursing skills.
Tseng, Hou [58] Taiwan	To determine the impact of combining clinical simulation scenario training and Information Technology Integrated Instruction (ITII) on the teaching of nursing skills.	A quasi-experimental design.	120 fourth year nursing student	Clinical scenario based on five cardiac topics: (PTCA) and (AMI); (BLS) and (AED) (SDH) care; applications Simulator for patients with septic shock; and acute respiratory distress syndrome (ARDS) care.	Experiment group significantly better OSCE performance, lab scores and improvements from the previous year’s grades.	SBL showed better in summative evaluation of knowledge components, OSCE formative evaluation and clinical nursing internship scores.
Tuzer, Inkaya [47] Turkey	To compare the effect of training with high-fidelity and medium-fidelity simulator cardiopulmonary resuscitation manikins on nursing students’ knowledge and performances.	Quasi-experimental design.	90 third-year nursing students who completed the “First Aid and Emergency Care”	Perform CPR on a Medium (experimental group 2) and high (experimental group 1) Fidelity CPR manikin.	Knowledge scores in both groups demonstrated significant increases in scores. According to log reports of the Medium Fidelity CPR manikin, correct compression rate and wrong hand position rate were found to change significantly over time in both groups.	Both HFS and MFS groups increased their level of CPR knowledge after training.
Yang and Oh [57] South Korea	To examine the effects (neonatal resuscitation nursing knowledge, problem-solving and clinical reasoning ability, self-confidence in practical performance, degree of anxiety, and learning motivation) using virtual reality.	A quasi-experimental study with a pretest-post-test design.	83 nursing students from two universities in South Korea	Virtual Reality Group received neonatal resuscitation gamification program using virtual reality. Simulation Group received high-fidelity neonatal resuscitation simulations in addition to online neonatal resuscitation program lectures.	The virtual reality and simulation groups had significantly higher scores in neonatal resuscitation knowledge and learning motivation scores compared to the control group. The virtual reality group show a significantly higher problem-solving ability, Self-confidence and exhibited significantly lower levels of anxiety compared to both the simulation and control groups.	The neonatal resuscitation gamification program using immersive virtual reality was effective in improving neonatal resuscitation knowledge, problem-solving ability, self-confidence, and learning motivation among nursing students.
Zieber and Sedgewick [27] Canada	To examines the relationship between competence, confidence, and knowledge retention in undergraduate nursing students.	A mixed quantitative and qualitative approach. The quantitative component comprised a repetitive test design.	24 students in the third or fourth undergraduate nursing.	One-day seminar similar in content to the AHA, Advanced Cardiac Life Support (ACLS) program. A three-hour knowledge session followed by a three hour high fidelity simulation activity.	The intervention was effective in improving perceptions of competence and confidence both immediately and at a three-month timeframe. Knowledge retention also was statistically significant at a three-month timeframe.	SBL effectively impact in confidence, competence, and knowledge both immediately and at a three-month interval.