Exploring the use of low-cost simulation in nursing education: a scoping review

Abstract

Objectives

This scoping review aims to assess low-cost simulation methods used in nursing education, evaluating how they balance educational effectiveness with budget constraints.

Design

Scoping review conducted in accordance with Arksey and O’Malley’s methodological framework and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines.

Data sources

PubMed, Embase and CINAHL were systematically searched for relevant studies published between January 2000 and October 2023.

Eligibility criteria

We included peer-reviewed primary studies involving nurses or nursing students, focused on the use of low-cost simulation in any healthcare setting. Studies had to describe the simulation strategy and its educational application.

Data extraction and synthesis

Two reviewers independently screened titles, abstracts and full texts and extracted data using a standardised form. Findings were synthesised narratively and categorised by type of simulation, educational context and competencies addressed.

Results

Out of 3332 records, 39 studies met the inclusion criteria. The reviewed studies covered various clinical areas, including critical care, emergency, neonatal, paediatric and obstetric nursing, as well as transversal competencies such as communication and clinical reasoning. Low-cost methods included task trainers, mannequins, computer-based tools, hybrid models and serious games. Only 38% of studies reported detailed cost information.

Conclusions

Low-cost simulation offers promising opportunities in nursing education but suffers from inconsistent cost reporting and a lack of standardisation. Further research is needed to evaluate its long-term effectiveness and support broader implementation.

STRENGTHS AND LIMITATIONS OF THIS STUDY.

• The study followed Arksey and O’Malley’s established five-step framework for scoping reviews.

• The review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines to ensure methodological rigour and transparency.

• A broad and systematic search strategy was applied across three major databases without language restrictions.

• Two independent reviewers conducted screening and selection, with a third reviewer resolving disagreements.

• The heterogeneity of included study designs and reporting may have limited comparability across studies.

Introduction

Simulation is widely recognised as an effective teaching methodology in healthcare, particularly in nursing education,^{1 2} as it provides a safe environment for skill development and enhances knowledge, critical thinking, satisfaction and confidence.³ Simulation offers benefits to nursing students from basic skill acquisition to the management of complex clinical scenarios.² Effective simulation-based education is grounded in adherence to established guidelines, provision of timely feedback and debriefing, opportunities for deliberate practice and seamless integration into the broader educational programme.⁴

In healthcare education, simulation enables learners to gain knowledge through experiential and social learning processes.¹ Learning outcomes are frequently assessed through students’ perceptions, knowledge acquisition, self-confidence and observational evaluations of their core competencies. Initially, simulation in healthcare was primarily applied in emergency medicine with a strong focus on resuscitation and airway management. However, since the mid-2000s, advancements in simulation technologies have significantly broadened their application, leading to their adoption across various medical specialities.⁵ Consequently, simulation has become an integral component of nursing education.⁶

Several studies have demonstrated the positive impact of simulation-based training on healthcare professionals’ knowledge, skill development and clinical decision making.^{7 8} A comprehensive meta-analysis revealed that technology-enhanced simulation training consistently produces large effects on knowledge, skills and behaviours, and moderate effects on patient-related outcomes when compared with traditional methods or no intervention.⁹ Simulation provides healthcare professionals with opportunities for deliberate practice and experience with rare, high-consequence events, balancing educational goals with patient safety.¹⁰ Despite these advantages, challenges such as cost-effectiveness, staff training and student anxiety remain barriers to its widespread adoption.⁸ These challenges include the financial investment required for simulation technologies, the need for adequate training for both educators and learners, and potential stress or discomfort that some students experience during simulation exercises.

Despite these obstacles, simulation-based training has proven to be invaluable in healthcare education, with evidence supporting its positive impact on patient outcomes beyond traditional educational methods.¹⁰ Although simulation-based education offers significant benefits, its implementation is often hindered by the high costs of advanced simulators.^{11 12} In this context, low-cost alternatives have been proposed as feasible and scalable options, particularly in low-resource settings or for foundational skill development.

However, the concept of ‘low-cost simulation’ is not uniformly defined in the existing literature. Rather than applying a fixed economic threshold, studies generally describe low-cost simulation as any strategy or modality perceived as cost-effective or feasible in resource-limited contexts. These approaches are typically positioned in contrast to high-fidelity simulation methods, which are associated with significant financial, technological and human resource investments, even if there could be some exceptions, as in the case of scenarios involving simulated patients without the need for moulage, where low cost and high fidelity can align. For the purposes of this review, low-cost simulation was operationalised as any intervention that was explicitly referred to by the authors as low-cost, affordable, economical or feasible in constrained-resource settings, even in the absence of formal economic evaluations.

These considerations highlight the need to understand how simulation practices can be adapted to resource-constrained contexts and what methods are already being used. Rather than conducting formal cost-effectiveness analyses, this review focuses on identifying and describing examples of simulation strategies labelled as low-cost in the literature.¹²

The existing literature on simulation in healthcare is extensive, but often fragmented. Although simulation has been widely adopted across various healthcare disciplines, its application in nursing education deserves specific attention. Nursing simulation encompasses a wide range of activities, from foundational skills training such as basic patient care techniques to complex clinical decision-making in critical care scenarios.¹³ Given the interdisciplinary nature of healthcare, nursing simulation often overlaps with other professions, further highlighting its multidisciplinary potential.¹⁴ However, the distinctive needs and applications of simulation in nursing education underscore the importance of a comprehensive review that focuses on this area. Such a review would provide valuable insights into the current state of simulation practices and their integration into the nursing curricula.

These considerations underscore the importance of a mapping review that aims to systematically explore the availability and application of low-cost simulation methods and their potential to democratise healthcare training across diverse settings. Addressing these gaps is essential to establishing a clearer foundation for understanding the costs and outcomes of simulation-based education, specifically within nursing. This review also assesses the accessibility and effectiveness of these methods in various geographical and resource-constrained contexts, where high-fidelity simulation tools may not always be feasible. By systematically mapping the available evidence, this study aimed to offer actionable insights for educators, policymakers and healthcare institutions, supporting the adoption and scaling of cost-effective simulation programmes in nursing education. Such analyses are crucial for promoting equitable access to high-quality training and ultimately enhancing nursing competence and patient care across diverse settings.^{12 15}

Aim

This scoping review aimed to explore and map evidence addressing the use of low-cost simulation methods in nursing.

Methods

This scoping review followed the methodological framework developed by Arksey et al,¹⁶ which involves a five-step process to ensure rigour and transparency. This approach was selected based on the objective and nature of the review, which aimed to map the existing evidence on low-cost simulation strategies in nursing education. A scoping review was deemed appropriate to address exploratory research questions and to accommodate the methodological and conceptual heterogeneity of the included studies. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines,¹⁷ and a systematic approach was employed to ensure the inclusion of all relevant types of literature. The five-step process included (1) Defining the research question, (2) Searching for relevant studies, (3) Selecting studies, (4) Charting data and (5) Collating, summarising and reporting the results.

Formulating the research question

The initial step of this review was to develop a broad research question: what are the existing typologies of low-cost simulation-based training regarding the knowledge, skills and competencies of nurses across various healthcare settings?

The following research sub-questions were addressed: (1) What examples of low-cost simulation methods in nursing education have been documented in the literature? (2) What are the main strategies used for low-cost simulations in nursing education and training? (3) What cost factors should be considered when implementing low-cost simulation methods in nursing education? (4) What specific technical and non-technical competencies in nursing are addressed through low-cost simulation methods? (5) What are the key challenges and barriers to implementing low-cost simulation in nursing education?

The research question was framed using the PCC model: population—Nurses and nurses included in multi-professional healthcare teams; Concept—Training with low-cost simulation; Context—Healthcare training settings.

In this review, we operationalised ‘low-cost simulation’ as any simulation-based strategy that was explicitly described by the authors as affordable, low-cost, cost-effective or feasible in constrained-resource settings. This included not only low-cost simulators (such as task trainers or mannequins made with inexpensive materials), but also broader simulation strategies—such as remote simulations, hybrid models or use of serious games—that reduce implementation costs through innovative design or delivery.

As the literature lacks a standard cost benchmark, no specific economic thresholds were applied. Rather, we relied on the descriptions and justifications provided within each study. Our goal was not to conduct a cost-effectiveness analysis, but to identify and map how low-cost simulation was conceptualised and implemented in the literature.

The categories of low-cost simulation strategies (eg, task trainers, computer-based tools and hybrid forms) were inductively derived from the data during the data charting process, consistent with the scoping review methodology. This allowed the review to capture a wide range of typologies and educational approaches as they emerged from the included studies.

This broader scope aimed to capture all articles addressing nurses, even when considered in conjunction with other healthcare professionals, as it reflects the interdisciplinary nature of simulation-based training. This approach aligns with the typical application of simulation in healthcare, which often involves diverse professional groups working collaboratively.

This scoping review encompasses articles published from January 2000 to October 2023, reflecting the increasing adoption and development of simulation techniques in healthcare professional education over the past two decades.^{9 18 19}

Identifying relevant studies

Eligibility criteria

This scoping review included a diverse range of study types to comprehensively capture research on low-cost simulation for healthcare training involving nurses. We included experimental, observational and mixed-method studies as well as systematic and scoping reviews, technical reports and studies involving nurses (whether students or professionals) and multiprofessional teams that included nurses. We also included studies reporting simulation sessions conducted by nurses and other healthcare professionals, such as doctors and allied health professionals.

The following types of publications and studies were excluded to maintain relevance and focus: (1) Letters, (2) Editorials, (3) Comments, (4) Newspaper articles, (5) Diaries, (6) Narrative reviews, (7) Studies focused on developing simulators for surgical, laparoscopic, anaesthesiological, urological or gynaecological competencies, (8) Studies related to pharmacological, veterinary or economic-statistical simulation and (9) Articles on simulator development for nursing practices without a clear research on a sample.

Search strategy

Three electronic databases were searched, namely PubMed, Embase and CINAHL. The complete search strategy for each database is shown in online supplemental table S1. No filters were applied, except for the publication date range from 1 January 2000 to 11 October 2023. No language restrictions were applied during the search process. Additionally, a manual search for potentially eligible studies was conducted by reviewing the references of full-text articles. Search strings for each database were developed in collaboration with a research librarian.

Selecting studies to be included in the review

Duplicate articles were removed using EndNote (V.x9-2022 Clarivate). Titles and abstracts of retrieved records were independently screened for eligibility by two reviewers (DF and SB) to identify relevant studies on low-cost simulations. The full texts of the remaining articles were retrieved and independently assessed for inclusion based on eligibility criteria by the same two reviewers. In case of disagreement, a consensus was reached with the assistance of a third author (YB), who acted as a tiebreaker. This process ensured a comprehensive and unbiased selection of studies for review.

Charting data

Data from the selected articles are summarised in a table describing the following elements: authors, year, country, aims, study design, sample size, setting, low-cost simulation strategies, cost-related considerations and fidelity level. For each included study, we noted the described fidelity level, understood as the degree to which the simulation replicates real-world conditions (mechanical, environmental or psychological). It is important to note that fidelity does not inherently determine the cost of the simulation.

Collating, summarising and reporting the results

The data were synthesised to provide a comprehensive overview of the use of low-cost simulations in healthcare training. The findings were organised as follows: study characteristics, competencies addressed, low-cost simulation strategies and cost-related considerations.

Results

The study selection process is presented in the PRISMA-ScR flowchart (figure 1). A total of 3939 articles were identified, of which 607 were duplicates and were removed, leaving 3332 records to be examined. After reviewing titles and abstracts, 107 papers were selected for full-text screening. Additionally, 31 relevant records were identified through a search of the reference list, five of which were read in full text. Ultimately, 39 studies met the eligibility criteria and were included in the scoping review.

Figure 1. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram.

Study characteristics

The characteristics of the included studies are shown in online supplemental table S2. Thirty-five studies (89.7%) were conducted on a single continent, whereas four studies (10.3%) were conducted across multiple continents. Specifically, the studies conducted on a single continent were as follows: 30.7% (n=12) in North America, 15.4% (n=6) in South America, 10.3% (n=4) in Europe, 12.8% (n=5) in Africa, 15.4% (n=6) in Asia and 5.1% (n=2) in Australia. Among the four studies conducted across several countries, three (7.7%) spanned Europe, Africa, Asia and North America and one (2.6%) focused solely on North American countries.

The study designs encompassed thirty-six primary research articles (92.3%) and three reviews (7.7%). Primary research articles included experimental studies (n=12, 30.7%), observational studies (n=16, 41.0%), mixed-method studies (n=5, 12.9%), technical reports (n=2, 5.1%) and validation studies (n=1, 2.6%). The reviews comprised two systematic reviews (5.1%) and one scoping review (2.6%).

Twelve studies (30.7%) included only nurses as the whole sample, while 69.3% (n=27) of the studies involved multiple professions besides nurses. All three reviews analysed articles involving health professionals, including nurses.

Low-cost simulation strategies

The included studies encompassed various low-cost simulation strategies; specifically, training conducted solely on task trainers (n=5, 12.8%), the exclusive use of mannequins (n=5, 12.8%), computer-based tools (n=7, 17.9 %), hybrid forms (n=19, 48.8%), and serious games (n=3, 7.7%).

Task trainer

In five studies (12.8%), simulation training was conducted exclusively using low-cost task trainers that replicated individual body parts. Three of these studies used models made from commercially available or widely available materials, including parts from ex vivo animal models.20,22 In two studies (5.1%), task trainers were obtained through direct 3D printing²³ or by creating moulds for mass production using silicone.²⁴

Mannequin simulators

In five studies (12.8 %), mannequins were exclusively used for simulation training. One study (2.6%) developed rubber models described by the authors as both low-cost and low-fidelity for cardiopulmonary resuscitation (CPR) training.²⁵ In two studies (5.1%), modifications to high-fidelity mannequins enabled training on complex procedures, such as extracorporeal membrane oxygenation (ECMO), using low-cost materials, such as polyvinyl chloride or plastic tubes,²⁶ and 3D-printed components.²⁷ Additionally, two studies (5.1%) employed simulation sessions with high-dose and low-dose training approaches. One study (2.6%) used a commercially available, low-cost mannequin with manoeuvre feedback software,²⁸ whereas another study (2.6%)²⁹ used low-fidelity mannequins for neonatal resuscitation training in resource-limited settings, emphasising ongoing knowledge updates for better retention.

Computer-based tools

Computer-based tools were employed in seven articles (17.9%). Specifically, three studies (7.7%) used static computer-based simulations: recorded clinical scenarios as videos, discussed by students during online meetings focusing on care procedures,³⁰ involved asynchronous case-solving on computers,³¹ and combined task trainers with remote simulations conducted at learners’ homes via online sessions with instructors.²⁴ In four studies (10.2%), virtual simulation programmes or platforms, including online options, offered high-fidelity interactive experiences.32,35 These platforms feature virtual patients who are capable of providing feedback post-treatment.

Hybrid forms

Nineteen studies (48.8%) showed diverse low-cost simulation strategies using hybrid approaches, combining different simulation methods. First, simulations conducted in clinical settings with varying-fidelity manikins were prevalent across five articles (12.8%). In these studies, non-computerised mannequins were used alongside facilitators who played the role of the patient or instructor or participants were trained on real clinical materials, such as anaesthesia apparatus or electronic lung simulators.36,40 Additionally, international Programa de Rescate Obste’trico y Neonatal: Tratamiento O’ptimo y Oportuno programmes for obstetric and neonatal emergencies were implemented in five studies (12.8%). These programmes employed group-based, in situ simulations with standardised patients and hybrid birthing task trainers made from hospital materials.41,45 Moulage techniques were employed in two studies (5.1%) and applied to standardised patients and low-fidelity manikins with real medical materials.^{46 47} Furthermore, simulation integration into broader educational interventions was observed in three studies (7.7%) that used pre-learning modules and practical sessions with low-cost models.48,50 Finally, simulations structured around role-playing and standardised patients were detailed in six articles (15.4%). These studies incorporated moulage for pressure injuries and used computer tools for scenario recording and playback.3039 46 51,53 These hybrid simulation strategies demonstrate effective educational enhancements while catering to cost constraints and offering various clinical learning modalities.

Serious games

In three studies (7.7%),54,56 cost-effectiveness was achieved through serious games. Two studies (5.1%)^{54 55} employed board games to simulate clinical scenarios or environments, enabling learners to apply reasoning skills to solving healthcare or management situations within care pathways. Only one study (2.6%)⁵⁶ focused on serious electronic games.

Competences

Thirty-one studies (79.5%) focused on specific areas: 11 (28.2%) on critical care and emergency, and 16 (41%) on neonatal, paediatric and gynaecological-obstetric areas. Additionally, eight studies (20.5%) covered transversal skills applicable across multiple settings. Table 1 summarises the competencies reported in the included studies.

Table 1. Competencies of the included studies.

Authors and year	Area		Skills
	Specific	Transversal	Non-technical	Technical
Ali et al20	Emergency/paediatric intensive care			Paediatric care (intubation)
Anuntaseree et al25		Clinical care/educational (training and simulation)		CPR
Barth et al24		Clinical care/educational (training and simulation)		Wound care and catheterisation
Sarabia-Cobo et al52	Emergency/acute care			Emergency care (real-world assessments and interventions)
Van Schaik et al38	Emergency/intensive care unit			Tracheostomy management
Chiaravalli et al39	Emergency/obstetrics perioperative care			Obstetrics care (perioperative anaesthetic)
Cordova et al29	Emergency/neonatal intensive care unit			Paediatric care (neonatal resuscitation)
Wisborg et al36	Emergency/paediatric intensive care		Paediatric CRM management
Endo et al26	Emergency/intensive care unit			ECMO management
Bø et al53	Emergency/paediatric intensive care			Paediatric care (neonatal resuscitation)
Walker et al44	Emergency/paediatric intensive care			Paediatric care
Tsoy et al55	Emergency/acute care			Emergency care (real-world assessments and interventions)
Umoren et al32	Pneumology/medical care		Management of COPD patients
Hauglum et al21	Emergency/critical care			Ultrasound-guided CVC insertion
Haynes et al28	Emergency/paediatric intensive care			Paediatric care (neonatal resuscitation)
Hogan et al23	Emergency/critical care			Cricothyrotomy
Mestre et al34	Emergency/paediatric intensive care			Paediatric care (shock management)
Graafland et al56	Emergency/trauma Care			Emergency nursing (ATLS)
Uzelli Yilmaz et al46	Emergency/paediatric intensive care			Paediatric care
Haerling et al33		Clinical care/educational (role-playing and scenario-based learning)	Patient interaction in a clinical setting (diagnostic reasoning and decision-making)
Pemberton et al50	Emergency/operating room		Non-technical skills in anaesthesia care
Pang et al27	Emergency/intensive care unit			Emergency care (ECMO and resuscitation)
Tiu et al49	Emergency/trauma care			Traumatic patient management
McDonald et al47	Emergency/paediatric intensive care			Paediatric care (tracheostomy)
Mossenson et al51		Palliative care/educational (communication workshops and simulations)	Social and communication skills for quality palliative/end-of-life care (active listening, empathy, decision-making)
Snelling et al22	Emergency/paediatric trauma care			Paediatric care (fracture detection)
Sandler et al48	Emergency/otolaryngology			Tracheostomy care
Ghoman et al54	Emergency/educational (training simulations and case studies)		Managing patient flow in the emergency department
Yeh et al31		Clinical care/educational (team-based learning and simulations)	Teamwork and communication skills in various clinical scenarios
Ghosh et al45		Clinical care/educational (training workshops and hands-on practice)	Pressure injury assessment
Van Der Wege et al30		Clinical care/educational (scenario-based learning and critical thinking exercises)	Critical thinking and problem-solving in clinical scenarios
Emani et al37	Emergency/paediatric intensive care			Paediatric care (neonatal resuscitation)
Walker et al43	Obstetrics emergency care/obstetrics and gynaecology			Obstetrics care (emergencies and resuscitation)
Walker et al41	Obstetrics emergency care/obstetrics and gynaecology			Obstetrics care (emergencies and resuscitation)
Chima et al40	Obstetrics emergency care/obstetrics and gynaecology			Obstetrics care (emergencies and resuscitation)
Walker et al42	Obstetrics emergency care/obstetrics and gynaecology			Obstetrics care (emergencies and resuscitation)
James et al35	Emergency/educational (teamwork training and simulations)		Effective teamwork and communication (enhancing collaboration, prioritisation, and communication, especially with traumatised patients)
Zendejas et al58		Emergency/educational (interprofessional education and training)	Interprofessional communication in critical situations (SBAR method)
Khan et al57	Various			Various techniques (managing allergic contrast reactions, performing ACLS, AED and cricothyrotomy, and executing various surgical procedures and intubation)

ACLS, Advanced cardiac life support skills; AED, Automated external defibrillator; ATLS, Advanced Trauma Life Support; COPD, Chonic Obstructive Polmunary disease; CPR, Cardiopulmonary Resuscitation; CRM, Crisis Resource Management; CVC, Central venous catheter; ECMO, Extracorporeal membrane oxygenation; SBAR, Situation, Background, Assessment, Recommendation.

Of the thirty-one studies focusing only on specific nursing competencies, two (5.1%) addressed the use of point-of-care ultrasound for intubation or fracture detection,20,22 while one (2.6%) focused on ultrasound-guided central venous catheter insertion.²¹ Four studies (10.3%) examined airway management practices and competencies, including tracheostomy and cricothyrotomy.^{23 39 48 49} Other studies have addressed the complex and multidisciplinary competencies that require high levels of expertise, such as ECMO management (n=2, 5.1%),^{26 27} trauma patient management (n=3, 7.7%)^{36 50 57} and anaesthesiological perioperative care (n=2, 5.1%).^{40 51} Additionally, several studies have focused on non-technical skills in emergency situations, such as communication, critical reasoning, problem solving, decision making and crisis resource management skills (n=3, 7.7%).^{37 54 55} Most studies addressed the management of obstetric and neonatal emergencies and resuscitation (n=10, 25.6%).28,3035 41 Two studies (5.1%) examined the various competencies in critical care settings.^{56 58} Only one study (2.6%) focused on paediatric immunisation care,⁴⁷ and one study (2.6%) focused on the management of patients with chronic obstructive pulmonary disease.³³

Among the eight articles on transversal competencies, two (5.1%) covered technical skills such as CPR,²⁵ wound care and catheterisation.²⁴ Six studies (15.4%) addressed non-technical skills, including pressure injury assessment,⁴⁶ clinical reasoning and communication30,3234 and palliative care.⁵²

Costs

Only 38% (n=15) of the included studies reported on cost-related factors. Among these studies, eleven (73.3%) reported costs related to materials, supplies and equipment;21,2426 27 33 37 48 51 58 nine studies (60%) reported costs associated with simulators;^{21 23 25 27 33 48 49 55 58} three studies (20%) mentioned costs for educational tools such as booklets;^{48 51 58} six studies (40%) reported costs related to simulation sessions^{21 27 33 36 51 58} and two studies (13.3%) addressed costs associated with professional or human resources.^{24 33} The majority of studies did not include detailed cost data.

Discussion

This scoping review aimed to map evidence on low-cost simulation methods in nursing education. A total of 39 studies were identified that examined various low-cost strategies, including task trainers, mannequins, computer-based tools, hybrid forms and serious games. These methods offer cost-effective alternatives to high-fidelity simulations, providing practical solutions for healthcare professional training.¹⁵

This review identifies several key low-cost simulation strategies for nursing education. Task trainers and mannequins constructed from inexpensive materials allow learners to practise essential clinical skills such as airway management in a hands-on environment. Computer-based tools, including virtual patient simulators and virtual reality platforms, offer flexible and scalable solutions that complement traditional methods. Hybrid simulations, which combine various tools, enhance training by integrating real-world materials with low-cost simulators, enabling realistic, interactive scenarios.^{59 60} Serious games, designed as board or computer-based simulations, engage learners through ‘gamification’, enhancing their problem-solving and clinical decision-making skills.⁶¹

Although these low-cost simulations offer financial advantages, several cost factors must still be considered. These include not only the initial expenses for materials and equipment, but also ongoing costs for maintenance, instructor fees, consumable materials and repeated sessions to train large cohorts. These financial aspects, although lower than high-fidelity simulators, are critical for institutions when assessing the feasibility of these approaches.^{62 63} The predominance of certain low-cost strategies, such as task trainers, mannequins and hybrid simulations, may reflect not only their affordability and ease of implementation but also the availability of resources in specific educational contexts. In many cases, these methods seem to be adopted based on feasibility rather than a deliberate alignment with curriculum-based competency priorities. While they offer significant advantages, particularly in resource-constrained environments, their ability to fully replace high-fidelity methods remains uncertain. Some critical psychomotor or situational skills may require more immersive training. A clearer understanding of the educational outcomes of low-cost approaches compared with high-fidelity simulations is still needed.

The identified simulation methods addressed a broad range of competencies in nursing education. Technical skills such as airway management and CPR are developed through task trainers and mannequins. Non-technical skills, including communication, teamwork and clinical reasoning, are targeted through more interactive simulations such as virtual patient scenarios and serious games. These methods provide a well-rounded approach for developing both technical and behavioural competencies.^{64 65}

The implementation of low-cost simulations in nursing education presents several challenges. Despite their lower upfront costs, logistical barriers such as the time required for curriculum integration remain significant. The lack of standardised metrics to evaluate their effectiveness also complicates the comparisons between different methods and their impact on learning outcomes.⁶⁶ Moreover, while initial costs may be lower, ongoing expenses, such as maintenance, instructor fees and disposable materials, are often overlooked.⁶³ Ensuring that these methods align with educational objectives and seamlessly integrate into curricula is crucial but requires careful planning.⁶⁷

Strengths and limitations

This scoping review offers a comprehensive overview of low-cost simulation methods in nursing and multidisciplinary training, capturing a broad spectrum of approaches and providing valuable insights for educators and practitioners seeking cost-effective solutions. Its strength lies in its extensive coverage of diverse study designs and methodologies, which facilitate the identification of research gaps and highlight practical examples from various international contexts. However, the review also faces limitations, including variability in study quality and inconsistent reporting of cost data, with only 38% of the studies detailing expense items. The heterogeneity in simulation methods and the absence of standardised evaluation metrics and consistent cost reporting further complicate direct comparisons and synthesis of results. Consequently, although the included studies describe their interventions as ‘low-cost’, the lack of objective cost data limits the ability to validate this categorisation across contexts. Additionally, 25% of studies identified through database searches could not be retrieved for full-text screening, which may have limited the comprehensiveness of the evidence map. In addition, the rapid evolution of simulation technologies means that some of the most recent advancements may not be fully represented in the review. Finally, the diversity of study designs makes it challenging to determine which method is most suitable for evaluating the effectiveness of low-cost simulation systems compared with other teaching methods or technological solutions.

Conclusion

Low-cost simulation strategies offer valuable solutions for enhancing nursing and multidisciplinary training by improving educational practices and managing financial constraints. Although challenges such as cost reporting, standardisation and curricular integration remain, the diverse available methods provide effective alternatives to high-fidelity simulators. This scoping review highlights the significant potential of low-cost simulations in healthcare and nursing education and emphasises the need for future research to rigorously evaluate their long-term effectiveness and optimise their implementation across various educational contexts.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.