Impact of a structured simulation program with progressive fidelity on stress response in nursing students: A quasi-experimental longitudinal study

Background: Clinical simulation can trigger anticipatory stress.Aim: To evaluate the effect of a progressive life support simulation program on anticipatory stress responses.Methods: Longitudinal quasi-experimental study.A 10-hour program was applied to students without clinical experience.Heart rate (HR), blood pressure (BP), salivary cortisol, self-efficacy, and perceived stress were measured as indicators of anticipatory stress responses.Results: Eighty students (83.8% female) participated.Training reduced anticipatory stress responses.In the most demanding scenario, HR fell from 98.8 to 80.1 beats per minute, systolic blood pressure (SBP) 131.1 117.0, diastolic blood pressure (DBP) from 78.1 65.5, and perceived stress (visual analogue scale, VAS) 6.48 1.58 ( p < .001).Cortisol decreased (0.41 0.21 g/dL, p = .002),self-efficacy increased (3.09 4.64, p < .001),and perceived stress levels slightly declined.Students with prior cardiopulmonary resuscitation (CPR) training showed lower initial anticipatory stress.Conclusions: Progressive simulation improves adaptation and coping as part of the anticipatory stress response.