Effect of the Jeffries Simulation Framework on the Core Competence of New Graduate Paediatric Surgery Nurses: A Quasi‐Experimental Study

ABSTRACT

Aims

Newly graduated paediatric surgery nurses must be able to identify and handle potential risks to ensure patient safety. It is necessary to reinforce their understanding of their roles and responsibilities to achieve this goal. However, the limitations of traditional classroom‐based teaching hinder the exploration of learners' potential. This study aimed to evaluate the effectiveness of the Jeffries simulation framework in improving the core competence of new graduate nurses in paediatric surgery.

Design

A quasi‐experimental study, descriptive design following STROBE checklist.

Methods

A quasi‐experimental methodology with a pretest/posttest design was used. The study involved 60 new graduate paediatric nurses who work in the paediatric surgery department of a level A tertiary hospital in Southwest China. Clinical scenario simulation cases, which were designed based on the Jeffries simulation framework, were used to improve clinical competence. Before and after the training, teachers assessed each nurse's core competency and clinical decision‐making ability by the Chinese Registered Nurse Core Competency Scale (CIRN) and the Clinical Decision‐Making in Nursing Scale (CDMNS). In addition, participants provided self‐reported reflective feedback during the debriefing sessions following each simulation scenario.

Results

Across all 60 newly graduated paediatric surgical nurses, significant improvements in clinical competence were observed following the simulation‐based training (p < 0.001). The total score of core competence increased significantly from 118.48 ± 8.84 pre‐training to 142.56 ± 6.11 post‐training, with a mean difference of 24.08 ± 9.51 points. Similarly, the total score of clinical decision‐making ability showed a marked improvement, rising from 83.92 ± 2.43 to 91.15 ± 3.24, representing a mean increase of 7.23 ± 4.17 points. Moreover, the dimensions of ‘clinical nursing’, ‘critical thinking/scientific’ and ‘clear goals and values’ also showed significant improvements.

Conclusion

Training new graduate paediatric nurses via the Jeffries simulation framework can enhance their clinical competence by helping them internalize knowledge and skills and improve their core competencies and clinical decision‐making abilities.

Patient or Public Contribution

The study analysed the core competency levels of newly graduated paediatric surgery nurses, providing a valuable reference for the management, training and evaluation of these nurses as well as establishing qualification criteria for paediatric specialist nurses. Identifying the factors that influence core competitiveness is crucial for developing standardized training programmes and enhancing the construction of nursing safety and paediatric nursing talent.

Trial Registration

Clinical Trial Registry registration number: ChiCTR2400082003

1. Introduction

Nurses' core competence refers to the integration of relevant knowledge, skills and judgement in a nurse's daily practice or job performance (Clark et al. 2016). It is a crucial indicator of competent practices for both paediatric registered nurses and advanced practice registered nurses (Fukada 2018). The American Association of Colleges of Nursing and the COPA (Competency Outcomes and Performance Assessment) model emphasize the importance of critical thinking, management assessment, intervention, teaching, communication, leadership, knowledge integration and assessment skills for new graduate nurses (American Association of Colleges of Nursing 2021; Lenburg et al. 2009). The term ‘new graduate nurses’ refers to employed nurses who have graduated within the past 3 years (Rudman and Gustavsson 2011). However, many nurses encounter a theory‐practice gap during their clinical work and remain unaware of it (Monaghan 2015). This may be due to the lack of paediatric clinical nursing core competence training during the undergraduate education stage for new graduate nurses.

Paediatric nursing is internationally included in the undergraduate nursing curriculum. However, in terms of curriculum design, the United States places greater emphasis on specialized education and practical skill development, while China focuses more on general education and theoretical instruction, with a smaller proportion dedicated to clinical practice (Ming and Wang 2018). Paediatric surgical nursing is an essential component of paediatric care, yet our previous investigation of the paediatric nursing curriculum in several schools revealed that only 10% of the chapters in paediatric nursing were dedicated to paediatric surgical care. As a result, new graduate nurses receive limited theoretical training in paediatric surgery during their education. However, there are numerous emergency cases in paediatric surgery where conditions change rapidly and patients require immediate surgery. Nurses need to have advanced clinical thinking abilities as well as observation and decision‐making skills. Additionally, compared to adults, paediatric patients have unique psychological and emotional needs, and patients' family members have greater expectations for nurses, which requires nurses to have more professional and technical skills (Thomas 2003; Wen et al. 2014). Consequently, new nurses in paediatric surgery often experience significant anxiety and lack confidence in their daily work. This may be the reason why new graduate paediatric nurses are very likely to commit an adverse event in their first year of practice (Almeida et al. 2018). According to one study, nurses with ≤ 3 years of service experience greater stress in patient management (Liao et al. 2020). A study conducted in China revealed that the core competencies of new graduate paediatric nurses were at an intermediate level, indicating that they did not possess the necessary qualifications for their clinical work (Ou et al. 2015). The lowest proficiency was observed in critical thinking and research aptitude. Despite their own high need for core competence, their current level of core competence is insufficient for clinical work. Chinese postgraduate continuous education in paediatric nursing mainly relies on teacher‐centred teaching, which focuses on imparting knowledge and experience but neglects the development of clinical practice skills (Guo et al. 2022). Therefore, finding effective strategies to enhance the professional competence of newly graduated paediatric surgery nurses has become an urgent issue that needs to be addressed.

Situational simulation is an instructional approach that replicates authentic clinical working environments to develop critical thinking and clinical decision‐making skills through role‐playing, interactive videos and standardized patient simulations (P. R. Jeffries 2005). The Jeffries simulation framework, developed by Jeffries, is based on experiential learning theory and is specifically designed for simulation‐based instruction. The Jeffries simulation framework consists of context, background, design, educational practices, simulation experience and outcomes. It has a strong foundation of continuity and empirical validation, offering an effective approach for students to prepare themselves for complex clinical scenarios, especially those involving rare but high‐risk events (Almeida et al. 2018). Franklin et al. (2014) and LaFond and Van Hulle Vincent (2013) further substantiated its scientific rigour and practical applicability, and it was widely adopted in the United Kingdom, the United States and other countries as a guiding tool for high‐fidelity simulation education. In the field of nursing education, a large number of studies have shown that simulation is highly valuable and beneficial for both nurses and students in fostering metacognitive thinking, enhancing learners' self‐confidence and promoting satisfaction with the learning process (P. R. Jeffries 2012; Lee et al. 2020; Yeun et al. 2014). Analysis of the hot spots and frontiers of nursing scenario simulation teaching revealed that simulation teaching was motivating, gradually improved student hands‐on skills, developed clinical thinking skills and increased learners' competitiveness for employment after graduation (Song et al. 2023).

This study described a simulated scenario of paediatric diseases that enabled new graduate paediatric surgery nurses to assess and manage critical patients to avoid risk. These findings should be used in the development of teaching methods that facilitate the early identification and management of critical patients and improve the clinical competency of new graduate paediatric surgery nurses. Our study aimed to evaluate the application of the Jeffries simulation framework in the core competence training of new graduate paediatric surgery nurses.

2. Methods

2.1. Study Design

A quasi‐experimental methodology with a pretest/posttest design was used in this study. This study compared the core competencies and clinical decision‐making abilities of novice paediatric surgery nurses before and after simulation‐based teaching, as assessed by the Competency Inventory for Registered Nurses and Clinical Decision Making in Nursing Scale.

2.2. Settings and Participants

This study was conducted in Chengdu from July 2023 to October 2023, and a convenience method was used to recruit participants from the Department of Paediatric Surgery at an academically affiliated tertiary 3A hospital. The inclusion criteria for participants were as follows: (1) registered nurses who had been recruited after 1 July 2020, (2) had no history of mental illnesses, (3) were involved in clinical nursing, (4) had no prior simulation experience and (5) consented to participate in the study. Nurses were excluded if they were intern nurses, were undergoing standardized training, or had left or gone on leave during the study period.

2.3. Instruments

All the participants completed questionnaires, including a self‐designed general information questionnaire, the Competency Inventory for Registered Nurses (CIRN) and the Clinical Decision Making in Nursing Scale (CDMNS). The CIRN and CDMNS scales were completed by the clinical preceptors who supervised the newly graduated nurses. Each preceptor independently rated the nurse's performance based on their direct observation of the nurse's clinical practice during the study period. The scales were administered twice: at baseline and at post‐training.

2.3.1. General Information Questionnaire

The self‐designed general information questionnaire included age, gender, marital status, education level and work experience.

2.3.2. Competency Inventory for Registered Nurses

The CIRN was developed by Liu et al. (2007) as an objective tool to assess the proficiencies of registered nurses in various clinical practice domains. The scale consists of 55 items and seven subscales, including critical thinking and scientific research, clinical care, leadership, interpersonal relationships, ethical and legal practice, professional development, training and consultation. Each item was graded on a 4‐point Likert scale: (4) very competent, (3) competent, (2) not competent and (1) not competent at all. A higher score indicated better core competence status. The total score is 220 points, with a score of > 165 indicating high competence, a score ranging between 110 and 165 indicating medium competence, and a score of < 110 indicating low competence. The Cronbach's alpha for the total scale was 0.908, while the coefficients for the seven subscales ranged from 0.718 to 0.903. The correlation coefficient is r = 0.44 (p < 0.05) (Liu et al. 2009). In our study sample, the Cronbach's α for the total CIRN scale was 0.85, confirming its good internal consistency in this population.

2.3.3. Clinical Decision‐Making in Nursing Scale

The CDMNS was developed by Jenkins (1985) as an objective tool to assess nurses' clinical decision‐making awareness. The scale consists of 40 items and four subscales. These subscales included (1) search for alternatives or options, (2) canvassing of objectives and values, (3) search for information and unbiased assimilation of new information and (4) evaluating or re‐evaluating consequences. Each item was graded on a 5‐point Likert scale: (5) always, (4) frequently, (3) occasionally, (2) seldom and (1) never. Clinical decision‐making ability was considered better with a higher score. The scoring of this scale is based on the total score, with a score of > 146.67 indicating high clinical decision‐making, a range between 93.34 and 146.67 indicating medium clinical decision‐making and a score of < 93.34 indicating low clinical decision‐making. The Chinese translation of the CDNMS was conducted by China scholar Guo (2011); with a scale‐level content validity index (S‐CVI) of 0.90, the internal consistency (Cronbach's α) was 0.85. In our study sample, the Cronbach's α for the CDMNS total scale was 0.89.

2.4. Intervention Count Layout and Plan

2.4.1. Development of the Invention and Content Layout

The training course was prepared by an expert team consisting of eight clinical nursing specialists, all of whom had over 15 years of experience in paediatric surgery or professional titles such as nurses‐in‐charge or higher. Before the simulation course, the teachers received standard training to understand the course materials and process. Once the course began, they were randomly assigned to different groups to provide instructions during the simulation exercises. Based on the reviews of the relevant literature and guidelines, the expert team discussed the training content and selected clinical scenarios, including paediatric intestinal diseases, paediatric orthopaedic diseases, paediatric hepatobiliary diseases and paediatric acute and critical diseases.

2.4.2. Intervention Plan

All participants first completed questionnaires about their core competence. They conducted scenario simulation courses once a week for 2 months, with the following details. Figure 1 outlines the overall training workflow.

FIGURE 1.

The intervention plan of this study.

Before the simulation training, the teachers introduced the arrangement of the training course, the support that nurses can request during the simulation process, and the patient's medical history. Participants were randomly assigned to several groups. The groups had a brief discussion, assigned responsibilities and prepared necessary items. Two days later, teachers briefly explained the theoretical background and patient information involved in this case. The team members played the roles of doctors, nurses, patients and family members and were simulated according to the preset scenario. Following the training, the nurses were allowed to review their simulation experience through teacher‐guided debriefing using the ‘reaction, understanding, summary and take‐home massage (RUST)’. Second, the teacher guided the discussion through a series of questions and pointed out the areas that required further improvements. Third, each nurse was asked to compile a list of the key takeaways they had acquired during their training that could be effectively applied in clinical practice. The duration of each class session ranged from 35 to 70 min, depending on the theme of the scenario.

After completing specialized theoretical courses, the nursing team underwent an operational training session. The teachers chose a nursing skill related to the simulated scenario case and informed each group 2 days before the training session. During the demonstration, the nurses provided a comprehensive overview of the nursing procedure process and its intricacies. After the simulation exercise, each nurse discussed their mistakes and doubts during the exercise. Then, the teacher addressed any questions that arose and explained the key issues involved in the operation. Following the teacher's guidance, the practice continued. Finally, the teachers summarized the operation and indicated the most significant operational problem, guiding the nurses to learn from their mistakes. The entire course lasted from 35 to 50 min.

2.5. Data Analysis

To ensure the accuracy of the data, Excel software was used to create a database, and double‐entry verification was performed. Statistical analyses were performed using IBM SPSS Statistics version 26.0 (IBM Corp., Armonk, NY, USA). A paired samples t‐test was used for the comparison of the data before and after training at p < 0.05. Normality of the difference scores (posttest minus pretest) was examined using the Shapiro–Wilk test. The results indicated that the data met the normality assumption (p > 0.05 for all variables). Therefore, paired‐samples t‐tests were used to compare before and after intervention scores at p < 0.05. To account for the potential inflation of Type I error due to multiple comparisons, we applied the Bonferroni correction. A total of 13 paired t‐tests were performed (7 CIRN subscales, 4 CDMNS subscales and 2 total score for each scale), therefore the significance level was adjusted to α = 0.05/13 = 0.0038 (p < 0.001). All p‐values reported in Tables 2 and 3 are original values, and differences with p < 0.0038 were considered statistically significant after Bonferroni adjustment.

TABLE 2.

Comparison of core competence scores before and after training.

Items	Before training	After training	Δ (Mean ± SD) a	t	Cohen's d	p
Clinical care	22.65 ± 3.66	29.02 ± 3.10	6.34 ± 5.20	−8.824	1.14	< 0.001
Critical thinking/scientific research	19.56 ± 3.62	21.33 ± 2.08	1.77 ± 4.49	−2.843	0.37	< 0.001
Interpersonal relationship	20.25 ± 2.77	21.42 ± 1.47	1.17 ± 3.13	−2.703	0.35	< 0.001
Professional development	14.42 ± 2.75	14.79 ± 1.26	0.37 ± 2.85	0.922	0.12	0.361
Training and consultation	13.35 ± 1.85	14.90 ± 1.64	1.56 ± 2.73	−4.111	0.53	< 0.001
Ethical and legal practice	19.15 ± 2.41	21.67 ± 2.19	2.52 ± 2.88	−6.293	0.81	< 0.001
Leadership	19.78 ± 2.20	22.08 ± 3.48	2.29 ± 4.29	−3.842	0.50	< 0.001
Total	118.48 ± 8.84	142.56 ± 6.11	24.08 ± 9.51	−18.254	2.36	< 0.001

Note: p‐values are original. A Bonferroni‐corrected significance level of α = 0.0038 (0.05/13) was applied to control for Type I error due to multiple comparisons. Differences with p < 0.0038 were considered statistically significant.

^a Δ = after training score minus before training score.

TABLE 3.

Comparison of clinical decision‐making scores before and after training.

Items	Before training	After training	Δ (Mean ± SD) a	t	Cohen's d	p
Finding information or new information	21.17 ± 1.57	23.15 ± 1.46	1.98 ± 2.21	−6.465	0.83	< 0.001
Clarifying goals and values	20.69 ± 1.46	23.23 ± 1.85	2.53 ± 2.28	−8.032	1.04	< 0.001
Finding alternative options	21.12 ± 1.48	22.44 ± 1.32	1.33 ± 1.81	−5.281	0.68	< 0.001
Evaluating or repeatedly Evaluating outcomes	20.94 ± 1.26	22.33 ± 1.50	1.38 ± 1.89	−5.281	0.68	< 0.001
Total	83.92 ± 2.43	91.15 ± 3.24	7.23 ± 4.17	−12.515	1.62	< 0.001

Note: p‐values are original. A Bonferroni‐corrected significance level of α = 0.0038 (0.05/13) was applied to control for Type I error due to multiple comparisons. Differences with p < 0.0038 were considered statistically significant.

^a Δ = after training score minus before training score.

3. Results

3.1. Characteristics of the Nurses

During the study period from July 2023 to October 2023, 60 newly graduated nurses in the paediatric surgery department were eligible and enrolled. Table 1 summarizes their demographic and clinical characteristics. All 60 provided informed consent and completed the study (100% participation rate). A total of 60 female participants with a mean age of 22.91 ± 2.05 years (range 21–31 years) were recruited. Among the education levels, six possessed associate degrees, 48 held an undergraduate degree in nursing, and six had obtained a graduate degree in nursing. The majority of them were unmarried women and held the professional designation of nurse.

TABLE 1.

Characteristics of the nurses (n = 60).

Variable		N (%)
Age (years)
21–25	32	53.34%
26–29	28	46.66%
Gender
Male	0	0
Female	60	100%
Marital status
Unmarried	46	76.67%
Married	14	23.33%
Divorce	0
Education level
Associate degree	6	10%
Undergraduate degree	48	80%
Graduate degree	6	10%
Medical professional title
Primary grade	41	68.33%
Senior grade	19	31.67%
Work experience (years)
1	14	23.33%
2	19	31.67%
3	27	45%

3.2. Core Competence

The core competence of nurses significantly improved after training (p < 0.001), with an average increase of 24.08 ± 9.51 points. The ‘critical thinking/scientific research’, ‘clinical care’ and ‘interpersonal relationship’ dimensions showed the most significant improvements. However, there was no significant improvement in the ‘professional development’ dimension before or after training (p > 0.001). Table 2 compares the different dimensions of core competence before and after training.

3.3. Clinical Decision‐Making

The clinical decision‐making ability of nurses was significantly improved after training (p < 0.001). The average score of clinical decision‐making ability increased by 7.23 ± 4.17 points. The dimension that showed the most significant improvement was ‘clarifying goals and values’. The detailed comparison of each dimension of clinical decision‐making ability before and after training is shown in Table 3.

4. Discussion

This study used a pretest/posttest design to assess the clinical competence of new graduate nurses in paediatric surgery on Jeffries' simulation framework. Before the intervention, new graduate nurses in paediatric surgery exhibited the lowest level of proficiency in critical thinking and research skills, as well as in the evaluation or reevaluation of outcomes. This finding suggested that newly graduated nurses might face challenges in effectively and comprehensively diagnosing and treating patients' conditions during their clinical work. In the present study, the mean CIRN total score of the responding new graduate paediatric nurses in China was 118.48 ± 8.84, which was marginally lower than the 137.01 ± 37.45, 159.24 ± 29.84 and 195.77 ± 37.61 reported in previous studies (Xie et al. 2021; Zhao et al. 2018; Wu et al. 2018). The fact that the previous studies were geared toward nurses who had worked for more than 5 years and nurses who cared for adults may be responsible for the differences among the CIRN scores. After completing the simulation curriculum, both the CIRN and the CDMNS reported significant enhancements in their core competence.

Under the conditions of this study—specifically, among newly graduated female nurses with ≤ 3 years of experience at a single tertiary hospital in Southwest China—the Jeffries simulation framework demonstrated positive effects in improving the targeted competency outcomes. However, these observed improvements should be interpreted with great caution. Due to the absence of a control group in this single‐group pretest–posttest design, it is not possible to attribute the observed changes solely to the intervention; the participating nurses may have concurrently gained clinical experience through routine ward practice over the approximately 8‐week period, which could have contributed to competency development independently of the simulation training. Moreover, the Hawthorne effect—wherein participants modify their behaviour in response to being observed or evaluated—may have influenced both the faculty members' assessments and the participants' performance during the post‐intervention evaluation. These confounding factors cannot be ruled out. Furthermore, the homogeneous nature of our sample and the single‐centre design severely limit the generalizability of our findings to other regions, hospital tiers or nursing populations with diverse characteristics. Therefore, future multicentre studies with controlled designs and more diverse samples are urgently needed to confirm both the internal and external validity of simulation‐based training before definitive conclusions can be drawn.

In the present study, there was a significant change in core competence during the simulation. This outcome was the same as that of Karageorge et al.'s (2020) study, in which simulated scenarios improved paediatric ICU nurses' core competence in the face of severe child health conditions. However, the training intervention conducted by Karageorge was implemented on a computer. In addition, ‘critical thinking/scientific research’ exhibited the most significant improvements. Farashahi and Tajeddin (2018) indicated that simulation training was more effective at promoting critical thinking. Simulation‐based education is an effective teaching method for improving the knowledge and clinical ability of new nurses learning cardiopulmonary emergency care (Kim and Jang 2011). Ren et al. (2022) showed that simulation training was a potentially viable and effective method for teaching new graduate nurses how to manage clinical incidents. Raab et al. (2024) used VR simulation to assess new nurses' paediatric respiratory distress skills and found that VR might offer a new method for enhancing training in paediatric‐specific assessment skills. Although these studies used situational simulation teaching, the scope of instruction was limited to a single disease. In practical settings, nurses encounter complex diseases and diverse emergencies; thus, a situational teaching simulation focused on a single disease is insufficient to meet the training needs of newly graduated nurses.

The Jeffries simulation framework we adopted is only a part of scenario simulation teaching, which focuses on simulating clinical scenarios and does not utilize simulated patients (SPs). By comparing the outcomes of our study with those of other studies that used standardized patients, we found that both approaches could enhance clinical core competence among newly graduated nurses. Participation in a standardized patient‐based simulation for anaphylactic shock management significantly enhanced clinical competency (Xu et al. 2018). Using high‐fidelity simulation of a bacterial meningitis case scenario among paediatric nursing students, Ayed et al. (2022) improved their clinical judgement. Based on high‐fidelity simulations of ECMO training courses for ICU nurses, Fouilloux et al. (2019), improved nurses' personal clinical competence at the team level. A study on nursing education for cardiovascular health behaviour revealed that the implementation of online courses based on case studies, participatory teaching and learning, role‐playing, and SP within the CDIO model exhibited enhanced efficacy in promoting healthy education and clinical decision‐making competency (Dong et al. 2023). However, standardized patients (SPs) primarily exhibit typical symptoms; in clinical practice, real patients display unpredictable and diverse characteristics that cannot fully represent the patient population (Gao et al. 2026). Moreover, SPs rarely offer comprehensive evaluation and feedback, which fails to meet the learning needs of newly graduated nurses in terms of communication skills and clinical decision‐making abilities. Conversely, role play based on authentic clinical cases can effectively simulate real‐life clinical environments, enhance communication skills and facilitate a more comprehensive mastery of clinical knowledge (Nair 2026; Ghonchehpour et al. 2025). The majority of studies utilizing standardized patients employ high‐fidelity simulation models, which are characterized by substantial cost, technological prerequisites and specialized classrooms, rendering them unsuitable for primary healthcare institutions (Luo et al. 2021; Uslu‐Sahan et al. 2025; Yu et al. 2026). Compared with other models, the Jeffries simulation framework is more convenient and cost‐efficient.

Currently, the simulation teaching of nurses' core competences has gradually become standardized and harmonized. However, there is a lack of a core competence simulation training curriculum for paediatric surgery nurses. In the future, the training of paediatric surgery nurses can be implemented via a progressive and layered approach. During an undergraduate internship, comprehensive paediatric surgery knowledge and practical training programmes should be established, with a focus on enhancing learners' understanding of paediatric general knowledge and operation procedures. In the initial stage of newly graduated nurses, the primary emphasis lies on augmenting their clinical competence, particularly by fortifying their ability to handle critical situations and fostering effective teamwork skills. Therefore, incorporating scenario‐based simulation courses that integrate technical training with clinical emergencies, team cooperation and communication can prove advantageous for newly graduated nurses. Senior nurses or paediatric surgery nurses with a graduate degree or above can enrol in scenario simulation courses designed for advanced paediatric practice nurses or clinical nursing specialists with specialized skills in paediatrics. Due to the flexibility of online classes, nurses can complete their internships from anywhere as long as they have internet access. This allows us to develop an online course specifically for paediatric surgery nurses, including those working in primary hospitals.

This study has several limitations. First, the sample size was not predetermined due to the absence of relevant literature for reference during our comprehensive literature search. Fortunately, all new graduate paediatric surgery nurses who were contracted to work at the hospital actively participated in this study. Second, the absence of randomized groups and a control group was noted in this study. However, to enhance the clinical competency of all new graduate paediatric nurses, a pretest–posttest study design was implemented. Third, the single‐centre and short‐term design of this study limits the generalizability of our findings to the wider population of newly graduated paediatric nurses in China. Future research should include larger, multi‐regional samples from diverse hospital settings and incorporate extended follow‐up to assess the long‐term sustainability of the intervention effects. Fourth, the debriefing feedback, which involved nurses recalling specific moments during the simulation, relied entirely on subjective self‐report. Although this method facilitates data collection, it is susceptible to response bias, including social desirability bias, due to the potential for inaccurate recall and variations in nurses' ability to accurately comprehend the questions and reflect on their own experiences. Fifth, this study lacked objective assessments of clinical performance in real‐world practice settings (e.g., bedside observation) and patient‐centred outcome indicators (e.g., safety, satisfaction), which limited the assessment of ecologically valid competence. Additionally, as all participants were recruited from the same clinical department, there was a potential risk of contamination, as participants may have informally shared training content.

5. Conclusions

Despite these limitations, this study has demonstrated that the implementation of the Jeffries simulation framework and flipped classroom teaching based on clinical scenarios may effectively enhance nurses' enthusiasm. Through deliberate practice, constructive feedback, collaborative discussions and other interactive activities, nurses can internalize knowledge and skills and improve their core competencies and clinical decision‐making abilities as new graduate paediatric surgery nurses. The disparities in teaching qualifications, instructional levels, nurse education levels, evaluation criteria and teaching equipment across different hospitals lead to variations in simulation cases and the efficacy of instruction. In the future, we should prioritize the implementation of multicentre randomized controlled trials to validate the efficacy of this teaching method in enhancing clinical competence among newly graduated paediatric surgery nurses.

Author Contributions

Wenjing Luo: data curation, investigation, validation, writing – original draft, visualization. Liwei Feng: conceptualization, funding acquisition, formal analysis, supervision, resources, project administration, writing – review and editing. Yuanyuan Liang: writing – review and editing, funding acquisition, supervision, resources, project administration, formal analysis. Runyu Yang: methodology, conceptualization, software, writing – original draft, visualization.

Funding

The authors have nothing to report.

Ethics Statement

The study protocol was approved by the Institutional Review Board of West China Hospital (approval no. 2024‐407) prior to data collection. All procedures were performed in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki Declaration and its later amendments.

Consent

Written informed consent was obtained from each participant after they had been fully informed of the study's purpose, procedures, potential risks and benefits, and their rights. Participants were informed that their decision to participate or decline would not affect their employment status, performance evaluations or any professional opportunities. They were also assured that all data collected, including questionnaire responses, would be kept strictly confidential and reported only in aggregate form. After data collection, all paper‐based questionnaires were stored in a locked filing cabinet, and all electronic data were stored on a secure, password‐protected institutional server. To ensure confidentiality, all data were anonymized and stored in a password‐protected computer accessible only to the research team. No individual identifiers were included in any data analysis or reporting.

Conflicts of Interest

The authors declare no conflicts of interest.

Luo, W. , Yang R., Feng L., and Liang Y.. 2026. “Effect of the Jeffries Simulation Framework on the Core Competence of New Graduate Paediatric Surgery Nurses: A Quasi‐Experimental Study.” Nursing Open 13, no. 9: e70779. 10.1002/nop2.70779.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.