Facilitators, barriers, and future direction of high-fidelity simulation in nursing education: a qualitative descriptive study

Abstract

Background

As simulation-based education has emerged as a crucial alternative for developing integrated practical skills in a safe environment, several foundations have been established in recent years. Now that simulation education has become more established, researchers have identified the need to explore the barriers, facilitators, and future directions of high-fidelity simulation education. The purpose of this study was to enhance our understanding of the barriers and strategies in utilizing high-fidelity simulation in nursing education, specifically regarding its facilitators, barriers, and future directions from the perspective of a nursing educator.

Methods

A qualitative descriptive study was utilized using semi-structured interviews. The participants included 10 nursing faculty members from various institutions. Data were collected from October 23 to November 1, 2024, and analyzed using Elo and Kyngäs’s inductive content analysis method.

Results

Twenty-six themes and 9 theme clusters were identified based on 96 meaningful statements related to the facilitators, barriers, and future direction of high-fidelity simulation education. The theme clusters were “realistic and secure educational setting,” “learner satisfaction,” “certain constraints,” “discrepancy with clinical practice,” “lack of staff expertise,” “absence of a supportive system,” “improved reflection of clinical reality,” “collaboration and sharing,” and “sustained institutional support.”

Conclusions

The findings underscore the importance of developing scenarios that reflect current clinical environments to enhance student engagement in simulation education. However, challenges such as high costs, technical limitations, and resource constraints still exist. Overcoming these barriers requires additional institutional support, collaboration, and information sharing among stakeholders. Specific strategies for promoting high-fidelity simulation in nursing should be explored further.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-025-03541-8.

Background

The goal of nursing education is to prepare nursing students to become competent professionals capable of effectively addressing patients’ health problems after graduation [1]. This entails not only acquiring extensive knowledge but also developing intellectual skills that can be actively applied in healthcare settings and clinical placements [2]. Accordingly, the Korean Accreditation Board of Nursing Education [3] mandates that nursing programs include a minimum of 1,000 h of clinical placement, emphasizing essential nursing skills, integrated clinical application, therapeutic communication, and critical thinking. However, the rising awareness of patients’ rights and consumer protection has made patients increasingly reluctant to receive care from nursing students [4]. Consequently, opportunities for hands-on practice have diminished, leaving students to engage primarily in observation-based training or low-risk tasks such as measuring vital signs and patient transfers.

Clinical settings consistently demand nurses to make quick, accurate judgments and well-rounded, comprehensive decisions. Therefore, nursing education must prioritize the development of critical thinking and clinical competency in nursing students. Undergraduate simulation-based learning has been proven effective in achieving this goal [5]. By addressing the limitations of clinical placement opportunities, simulation-based education effectively enhances nursing students’ practical skills [6]. Simulations replicate clinical scenarios, allowing students to acquire nursing knowledge and skills in a safe and controlled environment [7]. It also facilitates repeated practice and fosters the development of essential non-technical skills, including clinical judgment, problem-solving, critical thinking, communication, and teamwork [8].

In nursing, simulation involves using simulators to artificially reproduce patient scenarios that might occur in clinical practice [9]. Simulators are categorized by their fidelity, which reflects the level of realism and interaction they provide to learners [10]. High-fidelity patient simulators are life-size patient mannequins programmed with physiological responses that interact with trainees’ actions. Through voice commands, these mannequins also allow communication with instructors administering the program, and with trainees [11]. Simulation also encompasses the use of standardized patients, who are trained actors portraying real patients with specific medical histories, personalities, emotional responses, and physical findings [12]. This approach allows trainees to learn by addressing realistic clinical challenges in a safe and simulated clinical environment [7].

Simulation-based education offers a safe and structured environment that mimics real-world clinical settings. Through clinical case-based scenarios designed and supervised by instructors, students develop adaptability and practical skills without risking harm to patients [13]. However, the effective implementation of simulation education requires developing appropriate programs, advanced equipment, trained personnel, and small-group learning environments [14].

Furthermore, approaches using standardized patients (actors) and high-fidelity simulation mannequins have faced limited acceptance [15]. In addition, the adoption of novel educational methodologies, including simulation-based education, encounters a variety of challenges [12].

Since 2018, the Korean Ministry of Health and Welfare has supported simulation-based education by providing financial aid to nursing colleges. Each year, funds ranging from 200 to 600 million KRW have been allocated to build simulation infrastructure at nursing schools. Currently, 61 of approximately 200 nursing colleges nationwide have implemented such infrastructure. As such, it is beneficial to examine the factors associated with the implementation of high-fidelity simulation across these nursing schools. Related previous studies have primarily focused on the effectiveness of high-fidelity simulation education for nursing students [16, 17], with little research dedicated to exploring nursing educators’ perspectives. While qualitative studies have analyzed nursing students’ experiences with simulation [18], studies targeting educators remain scarce.

Against this backdrop, the aforementioned research gap is filled by exploring the barriers, facilitators, and future direction of high-fidelity simulation from the perspective of nursing faculty, to provide foundational insights for promoting the use of high-fidelity simulation in nursing education. Therefore, the aim is to expand our understanding of the barriers and strategies in using high-fidelity simulation in nursing education, specifically its facilitators, barriers, and future direction, from a nursing educator perspective.

Methods

Design

This was a qualitative descriptive study using in-depth interviews and Elo and Kyngäs’s [19] inductive content analysis method to explore the barriers, facilitators, and future direction of the use of high-fidelity simulation, as viewed by nursing faculty currently teaching in universities.

Participants

Participants were selected using convenience sampling of nursing faculty members currently teaching in university nursing programs. Those from colleges funded for simulation education by the Ministry of Health and Welfare were contacted via email regarding the study’s objectives and participation procedures. Participation was voluntary, with inclusion limited to those who expressed interest. Following literature that recommends 6–10 participants as an appropriate sample size for focus group interviews [20], data were collected through interviews with 10 nursing faculty members. This process continued until data saturation was reached, ensuring no new information emerged [21]. The inclusion criteria required participants to (1) be actively teaching in university nursing programs and (2) have experience implementing simulation-based education in their courses. Faculty members working at institutes without high-fidelity simulators were excluded. Of the 11 participants contacted, one participant was unable to attend due to exclusion criteria.

Data collection

Data were collected from October 23 to November 1, 2024. Before the interviews, participants completed a 10-item survey on demographic characteristics. The study involved 10 female participants aged 33 to 47, with clinical experience between 19 and 102 months. Nine worked at universities and one at a college. Their nursing faculty experience ranged from 8 to 84 months, while simulation experience varied from 12 to 80 months. Annual simulation utilization worked hours spanned from 8 to 240 h. Semi-structured interviews were conducted by two experienced PhDs in nursing with qualitative research training.

The questions were organized into introductory, transition, key, and wrap-up questions as shown in Supplementary file. Interviews were conducted on a one-on-one basis in a quiet, private setting. Participants provided informed consent for audio recordings of the interviews, which lasted approximately 50 min on average. Immediately following each interview, the recordings were transcribed, and the transcripts were reviewed by the participants to ensure accuracy of the content and nuances of their responses.

Ethical considerations

This study was approved by the Institutional Review Board (IRB) of the researcher’s affiliated institution (no. DGU 20240019). Nursing faculty participants were recruited through an informational document outlining the study’s purpose, methods, confidentiality, and their right to withdraw at any time. Participants received a stipend as compensation for their time upon completing the interview.

Data analysis

The collected data were analyzed using Elo and Kyngäs’s [19] inductive content analysis method. This process involved repeatedly reading the transcriptions to develop an overall understanding, followed by open coding, the creation of thematic categories, and conceptual abstraction of the data. The two researchers independently conducted open coding by repeatedly reading the data to identify meaningful units and assigning codes based on their content. These codes were then organized into initial themes, which were further grouped into theme clusters and broader categories through a data-driven inductive process. Any discrepancies between the researchers’ coding and categorization were resolved through multiple discussions involving all three members of the research team until consensus was reached.

Rigor

The study’s rigor and trustworthiness followed Guba and Lincoln’s [22] criteria. Interview transcripts were created immediately after each session, and non-verbal communication was noted in field notes. Participants confirmed their transcripts to ensure accurate representation of their intent. Two participants reviewed the findings for relevance. Researchers shared their initial assumptions about the topic and remained reflexive during the study, which minimized bias and accurately represented participants’ perspectives. Researchers held multiple discussions to ensure consistency in the data analysis, and two nursing professors provided feedback on concepts and categories. To maintain neutrality, researchers refrained from influencing responses and consistently compared data to eliminate bias.

Results

The analysis yielded 26 themes, grouped into 9 clusters and 3 categories. The relationships among the themes, clusters, and categories are outlined in Table 1.

Table 1.

Themes and theme clusters

Themes	Theme clusters	Categories
Ease of creating realistic scenarios	Realistic and secure educational setting	Facilitators
Safe learning environment
High-quality education	Learner satisfaction
Observation of student engagement
Observation of diverse educational effects
Difficulty in implementation	Certain constraints	Barriers
Lack of consumable supplies
Lack of dedicated spaces
Limited use due to high cost
Outdated simulation technology	Discrepancy with clinical practice
Insufficient scenarios
Lack of multilingual functionality
Time-consuming setup and operation	Lack of staff expertise
Insufficient stimulator operational skills
Difficulty in understanding and operating the equipment
Large class sizes	Absence of a supportive system
Lack of support staff
Disproportionally low recognition of simulation class hours
Need for functional improvements: communication and artificial intelligence integration	Improved reflection of clinical reality	Future Directions
Need to develop more realistic scenarios including multiple patients
Collaboration in scenario development	Collaboration and sharing
Promotion of information sharing among educators
Curriculum, class size, and recognition of class hours	Sustained Institutional support
Inclusion of essential equipment standards in accreditation
Minimum competency requirements for simulation educators
Formal educational support

Facilitators

1. Realistic and secure educational setting.

Participants viewed simulation-based education as a stable method of teaching, as it allows students to safely engage with scenarios, which they might not encounter during clinical placements, through simulators that provide realistic clinical experiences.

a) Ease of creating realistic scenarios.

The use of simulation was found to enhance students’ engagement by allowing them to experience realistic situations in a controlled environment.

I prefer SimMan because it generates realistic scenarios and allows students to perform skills, creating educational benefits. (Participant 4)

Because simulators can efficiently express patient responses, using more of their features seems to increase students’ engagement. (Participant 5)

b) Safe learning environment.

Simulation education significantly contributed to enhancing students’ confidence and focus by providing diverse experiences in a safe and controlled environment. This was particularly valuable in the context of increasing student enrollment and the limited availability of institutions offering clinical placements.

Because simulation classes pose no risk to patients in clinical training scenarios, students were able to build confidence and concentrate more effectively while engaging in a variety of learning experiences. (Participant 10)

2. Learner satisfaction

Participants observed positive responses and high levels of engagement from students using high-fidelity simulators during classes. These experiences highlighted the importance of prioritizing quality education over merely covering a lot of material.

a) High-quality education.

Using simulators in classes allowed participants to recognize the value of focusing on the quality of education rather than the breadth of content.

At first, I was overwhelmed by the quantity and diversity of material I thought I had to teach, but seeing the students’ enthusiasm with my first attempt, I realized that in education, quality is more important than quantity. (Participant 6)

b) Observation of student engagement.

Participants noted a significant increase in student engagement when using simulators, which provided them with a sense of fulfillment as educators.

When I used simulators with students, they enjoyed the new experience. Seeing their positive reactions made me feel proud, leaving me with many positive memories. (Participant 2)

c) Observation of diverse educational effects.

Participants emphasized the role of simulation in allowing students to experience real-life dynamics and engage in meaningful learning processes.

Through simulation, students learn how to communicate, collaborate, and engage in real-world dynamics. They learn through hands-on practice. (Participant 8)

Barriers

1. Certain constraints.

Participants expressed concerns about the high cost of equipment and software associated with high-fidelity simulators, identifying this as a significant barrier to implementation. They also pointed out the lack of consumables and dedicated simulation spaces, which further restricted their use in educational settings.

a) Difficulty in implementation.

Participants expressed that the high cost of equipment and software made implementation challenging, negatively impacting the effectiveness of education.

The equipment is expensive, and the software is extremely costly. Because of these high expenses, schools are often reluctant to provide full support. Every two years, we have to submit lengthy proposals, sometimes comprising ten pages, just to secure one or two simulators. (Participant 3)

Because simulators are expensive, limitations on the number [of stimulators we can afford] naturally occur. This leads to longer waiting times for students and reduced class hours. (Participant 5)

b) Lack of consumable supplies.

Participants reported that a lack of essential consumables in the educational environment is a barrier to the use of simulators.

Honestly, even if we asked for it, I doubt it would have been approved. It makes me think… if only there were a greater variety of consumable supplies. (Participant 2)

What we felt utterly lacking was consumable items that could be used with the simulators, making their use restrictive. (Participant 9)

c) Lack of dedicated spaces.

The absence of properly equipped spaces to implement simulators was felt as a barrier to their use, signifying restrictive use of the educational environment.

Our space is quite small compared with the equipment we have. As such, not many students can enter, and not everyone gets to use it adequately. (Participant 3)

It is difficult to implement for many reasons, and the space issue is definitely one of them. (Participant 4)

d) Limited use due to high cost.

Participants expressed hesitancy because of the high cost of simulators, citing concerns about potential damage and associated expenses.

High-fidelity simulators are really expensive, you know. Therefore, I am extremely cautious when handling the kids (laughter). The concern is, what if a student punctures it and we need to send it in for repairs? I cannot help but think about how much that would cost the school. (Participant 2)

2. Discrepancy with clinical practice.

Participants expressed concern that the current simulation systems do not adequately reflect the latest medical equipment and technological advancements, leading to a discrepancy with clinical practice. They emphasized the need for scenarios that incorporate diverse clinical situations to provide students with a realistic sense of clinical environments.

a) Outdated simulation technology.

Participants perceived that the current simulation systems lag behind the realities of modern clinical environments.

The current simulation systems do not fully reflect modern clinical settings. I felt that they are a bit behind the time. (Participant 4)

b) Insufficient scenarios.

Participants observed that the existing scenarios do not adequately incorporate recent advancements in medical devices and technologies. They emphasized the need for scenarios that reflect a broader range of clinical situations to enhance realism and relevance.

I think we could benefit from more scenarios that cover a wider range of clinical situations. It would be great to have scenarios that feel more like real-life patient interactions. Patients are all different, you know. (Participant 3)

c) Lack of multilingual functionality.

The simulators predominantly use English for their audio output, which detracts students from being immersed in the learning environment unless the instructor prepares pre-recorded Korean audio files.

Currently, the simulator … I mean the one I operated yesterday has English audio recordings. Unless the instructor prepares Korean audio files in advance, the use of English prevents students from being immersed in the scenario. (Participant 6)

3. Lack of staff expertise.

Participants reported experiencing fatigue due to the significant time required to set up and operate the simulators. They also emphasized the importance of professional expertise and certification in improving the quality of simulation-based education.

a) Time-consuming setup and operation.

The preparation, setup, and troubleshooting required for simulator use were perceived as time-consuming and exhausting tasks.

It takes a lot of time. Preparing it, dealing with glitches during the session, and reconnecting when it lags … All this takes place in a virtual environment, which makes the process even more time-consuming. (Participant 1)

b) Insufficient simulator operational skills.

Participants highlighted the importance of instructors’ stimulator operational skills in simulation-based education, believing that improving faculty expertise and providing certification would enhance the quality of simulation classes.

We have 21 faculty members, but only some of them can operate the simulators. Hence, their use is primarily restricted to specific classes, and those who are not familiar with the technology tend to avoid using it. (Participant 3)

c) Difficulty in understanding and operating the equipment.

Participants shared experiences where their insufficient understanding of the equipment’s features disrupted the flow of classes.

When I did not fully understand the equipment or was not skilled at handling it, I could not resolve issues quickly. This caused the scenario to go off track, and I had to explain it verbally instead. (Participant 9)

4. Absence of a supportive system.

Participants raised concerns about large class sizes and limited time, which hinder their ability to provide adequate training. They also highlighted issues with insufficient faculty staffing, particularly the lack of simulator operators, forcing instructors to learn independently. Additionally, they emphasized the need to increase recognition and allocation of class hours for simulation-based education.

a) Large class sizes.

Participants noted that large class sizes, combined with limited time, hindered the effective and sufficient use of simulation resources.

Simulators have many potential uses, but because of large class sizes and limited time, we tend to focus on specific areas rather than using them more broadly. (Participant 6)

c) Lack of support staff.

Participants pointed out that the lack of staff on campus created challenges such as the need to train new staff with each turnover, limited availability of staff for other courses, and difficulties when faculty had to travel between classes. They also highlighted the lack of operators for simulators, which forced faculty to learn the operation methods on their own.

Simulation is used in multiple ways across various courses, but the lack of operators has been the most challenging issue. I had to learn the operation methods myself. (Participant 10)

d) Disproportionally low recognition of simulation class hours.

Participants suggested that as the demand for simulation-based education increases, the recognition and allocation of simulation class hours must be expanded.

It seems inevitable that simulation will continue to grow, especially considering the current field conditions. I think we need to have simulation class hours more formally recognized and expanded. (Participant 8)

Future Direction

1. Improved reflection of clinical reality.

Participants highlighted the need for realistic responses in simulators to enhance educational effectiveness. They noted current limitations in replicating clinical reality and its impact on students’ decision-making. To create a more immersive experience, they emphasized developing diverse scenarios and realistic situations.

a) Need for functional improvements: communication and artificial intelligence integration.

Participants mentioned the compelling need to upgrade the simulator’s ability to provide realistic responses and pointed out its current limitations, highlighting how the simulator’s responses impact students’ decision-making processes.

With GPT [generative pre-trained transformer], you can program various inputs and get diverse responses. (Participant 1)

Although the technology has advanced and simulators can replicate many patient responses, I still feel there are limitations. (Participant 5)

b) Need to develop more realistic scenarios—including multiple patients.

To maximize the effectiveness of simulation-based education, participants stressed the importance of developing diverse scenarios and constructing realistic, dynamic situations.

The stability of the simulation environment can be an advantage, but to provide a wide range of experiences, it is essential to develop diverse scenarios. (Participant 6)

I just want… maybe more realistic scenarios? Or more diverse scenarios, for that matter. Anyway, rather than focusing on a single illness, it would be better to present more complex scenarios. (Participant 9)

2. Collaboration and sharing.

Participants expressed a desire to collaborate with clinical professionals to enrich simulation scenarios and share teaching methods with educators from other institutions to improve the efficiency of simulation-based education. They also highlighted the need for continuous technological upgrades and collaboration with simulator manufacturers.

a) Collaboration in scenario development.

Participants emphasized the importance of collaborating with clinical experts to create richer and more realistic scenarios.

To enrich the scenario content, I think collaboration with healthcare providers working in clinical settings is necessary. (Participant 3)

I think it would be good if students and clinical professionals could develop scenarios together. (Participant 10)

b) Promotion of information sharing among educators.

Participants suggested enhancing the efficiency of simulation education by fostering collaboration with simulator manufacturers, sharing teaching methods among educators, and reviewing the curricula of other institutions.

Collaboration among schools to share scenarios and teaching methods for high-fidelity simulation is essential. Observing the curricula of other institutions and developing new methods based on these insights would also be highly beneficial. (Participant 7)

3. Sustained institutional support.

Participants emphasized the need for institutional support to enhance student engagement in simulation education. Key measures include differentiated instruction, small-group classes, increased practical hours, and budget allocation for essential equipment. They also emphasized setting minimum competency requirements for simulation educators and ensuring ongoing training in high-fidelity simulation to maintain educational quality.

a) Curriculum, class size, and recognition of class hours.

Participants highlighted the need for differentiated curricula by grade level, smaller class sizes, and increased recognition of simulation class hours to improve student engagement.

As students advance to higher grades, their exposure to simulations increases, which can sometimes reduce their sense of immersion and realism. To address this point, it is essential to develop scenarios with clear distinctions at each level. (Participant 8)

I think smaller class sizes would make lessons more focused and engaging. (Participant

b) Inclusion of essential equipment standards in accreditation.

Participants suggested establishing standards for essential equipment in simulation courses to help schools secure budgets for necessary tools.

For example, specific standards in certifications state that certain equipment is mandatory for basic nursing practice. Similarly, if simulation courses had standards for minimum required equipment, schools or relevant institutions could allocate the necessary budget to meet those standards. I believe this would solve the problem. (Participant 1)

c) Minimum competency requirements for simulation educators.

Participants emphasized the importance of establishing minimum competency standards for simulation educators, including clinical experience and regular theoretical training, to ensure the quality of simulation education.

Currently, when hiring professors, at least three years of clinical experience is required, right? I believe we need to establish clear standards for career requirements. There should be a defined clinical experience criterion and a foundational alignment with the relevant module. I am unsure if this is just the case at my school, but I suspect that faculty members are sometimes assigned to simulation courses outside their area of expertise, simply because they are required to manage them. (Participant 1)

d) Formal educational support.

Participants highlighted the need for continuous training to strengthen instructors’ capabilities in simulation setup and operation. Participants highlighted the need for sustainable support in education, stressing that it should be institutionalized at the policy or ministerial level.

Even during offline training sessions, the primary focus was on scenario development rather than on mastering the operation of the machines. Discussions were also centered around scenarios. Since I needed to enhance my operational skills, I felt that this aspect was lacking. (Participant 3)

National-level institutional support, including securing spaces for simulations, could significantly enhance the use of simulation. Proper education for nursing students is directly connected to public health; therefore, institutional standards and support would be beneficial. (Participant 4)

Discussion

This study explored nursing educators’ experiences with high-fidelity simulation through in-depth interviews. Analysis of data collected from ten participants identified 3 major categories, 9 theme clusters, and 26 themes. The analysis revealed three major categories, nine theme clusters, and 26 themes.

Nursing educators identified “Realistic and secure educational setting” and “learner satisfaction” as key facilitators of high-fidelity simulation use. These theme clusters emerged from the following themes: ease of creating realistic scenarios, safe learning environment, high-quality education, observation of student engagement, and observation of diverse educational effects.

These findings align with previous research indicating that high-fidelity simulation that closely replicates real-life scenarios enhances the realism of clinical situations in simulation-based education. Additionally, by enabling repetitive practice in a controlled environment, it provides students with positive experiences such as reduced anxiety, increased confidence, and greater satisfaction while also being effective in developing knowledge, skills, and attitudes [7, 18]. Thus, expanding the use of high-fidelity simulation is essential for improving nursing students’ understanding of real patients and for strengthening their clinical competencies. Simulation-based education should be widely implemented as a strategic approach to enhancing nursing skills.

Overall, nursing educators expressed more barriers than facilitators in the use of high-fidelity simulation in nursing education. They identified “certain constraints,” “discrepancy with clinical practice,” “lack of staff expertise,” and “absence of a supportive system” as barriers. These theme clusters were derived from the following themes: difficulty in implementation, lack of consumable supplies, lack of dedicated spaces, limited use due to high cost, outdated simulation technology, insufficient scenarios, lack of multilingual functionality, time-consuming setup and operation, insufficient stimulator operational skills, difficulty in understanding and operating the equipment, large class sizes, lack of support staff, and disproportionally low recognition of simulation class hours.

These findings support a previous study in which limited time for simulation sessions, fear of operating the equipment due to lack of training, and insufficient resources were identified as common challenges in high-fidelity simulation education; and the need for faculty training, administrative support, and dedicated simulation coordinators were proposed to ensure effective operation of simulation programs [23].

Significant investment in equipment, facility development, faculty skill enhancement, and comprehensive operational resources all demand substantial costs and time commitments [12]. Therefore, concrete strategies are needed to overcome these barriers and support the sustainable expansion of simulation education.

Given that current high-fidelity simulators are primarily configured in English, simulation-based education—tailored to Korean nursing students and incorporating diverse scenarios with varying difficulty levels in Korean—must be developed. Additionally, with the increasing enrollment of nursing students, institutional measures are urgently needed to expand simulation equipment and space and formally recognize simulation class hours. These measures will also be essential for establishing benchmarks for quality assurance in simulation-based nursing education.

Nursing educators suggested several future directions for the use of high-fidelity simulation, which were categorized into three theme clusters: “improved reflection of clinical reality,” “collaboration and sharing,” and “sustained institutional support.” The interviewees particularly emphasized the “need for functional improvements”, “need to develop more realistic scenarios including multiple patients”, “collaboration in scenario development”, “promotion of information sharing among educators”, “curriculum, class size, and recognition of class hours,” “inclusion of essential equipment standards in accreditation,” “minimum competency requirements for simulation educators,” and “formal educational support.”

As highlighted in previous research, the successful implementation of high-fidelity simulation-based education requires not only the establishment of equipment and facilities but also the recruitment of specialized personnel, scenario development, use of assessment tools, and cost-effectiveness evaluation, all of which necessitate a phased and continuous review [24]. Consistent with the findings of this study, collaboration with clinical experts is essential for developing scenarios that enhance realism and accurately reflect clinical practice. Furthermore, standardized assessment tools should be adopted through improved information sharing among educators to ensure consistency and effectiveness in simulation-based education. Nursing educators emphasized that future directions should not be left solely to the discretion of individual institutions. They argued that relying on one-time government-funded projects has only resulted in temporary equipment acquisition and limited educational support. Therefore, support must be sustainable, embedded within the accreditation standards for nursing education, and ensured through government agencies or policy-level initiatives.

Efforts should be made to enhance the overall environment for simulation-based education; however, it is essential to recognize that high-fidelity simulators may not be suitable for every training scenario. A more strategic approach is needed—one that carefully aligns the level of simulation fidelity with specific learning objectives and educational contexts [25]. This study involved interviews with nursing faculty from institutions with high-fidelity simulators, limiting its representation of a wider range of educators. The study recruited participants from only 72 government-funded nursing schools in Korea, out of 200 nursing schools nationwide [26, 27]. All participants were female, reflecting the estimated less than 5% male faculty in Korean nursing schools [28]. Due to these factors and the use of convenience sampling, the findings may not be representative of all nursing faculty in Korea and should be interpreted cautiously. Since the use and functionality of these simulators vary by institution, further analysis is necessary to address these differences. Nevertheless, the study offers valuable foundational data for improving simulation-based nursing education and suggests future directions. Based on the study’s findings, three recommendations for future research are proposed: (1) Develop and implement educational programs to assess the effectiveness of high-fidelity simulation across various nursing domain, (2) Conduct an in-depth exploration of the experiences of nursing educators responsible for simulation training of newly licensed nurses in clinical settings, and (3) Analyze the current state of high-fidelity simulation education at national and international levels to devise institutional strategies for improving the quality of simulation-based education.

Conclusion

This study was important as it examined the current state of high-fidelity simulation education from the perspective of nursing educators. It identified key facilitators and barriers, as well as future directions, during a time when simulation-based education is rapidly growing. High-fidelity simulation education has the potential to enhance teaching methods, improve learning outcomes, and strengthen nursing competencies, ultimately contributing to patient safety and the overall quality of nursing education. Despite existing challenges, it is vital to reinforce the factors that facilitate this education and engage in clear strategic planning for its successful integration. Sustainable support at both the institutional and policy levels is crucial, extending beyond the efforts of individual educators. The findings of this study provide a valuable foundation for developing strategies to expand and optimize high-fidelity simulation education, as well as informing effective policies and implementation frameworks for simulation education.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Author contributions

Study conception and design: Y.H.; Data collection: Y.P., Y.H. S.L.; Data analysis and interpretation: Y.P., Y.H. S.L.; Drafting of the article: Y.P., Y.H. S.L.; Critical revision of the article: Y.H. All authors reviewed the manuscript.

Funding

This work was supported by the Dongguk University Research Fund of 2024.

Data availability

The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.

Declarations

Ethical approval and consent to participate

This study was approved by the Institutional Review Board designated by Dongguk University (IRB No. DGU 20240019) and conducted in accordance with the Declaration of Helsinki. All participants were fully informed about the study and provided written consent, with the understanding that participation was voluntary and could be withdrawn at any time.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.