The effect of high-fidelity simulation-based learning on knowledge and critical thinking skills among nursing students in Chiang Rai, Thailand

Purpose This study aimed to examine the effect of high-fidelity simulation (HFS) on knowledge and critical thinking skills among third-year nursing students caring for high-risk newborns. Design/methodology/approach A single-group repeated measurement experimental design was used to investigate the effect of HFS integration in a pediatric nursing practicum on students’ critical thinking skills, knowledge, and satisfaction. The 6-week intervention consisted of four modules: neonatal jaundice, respiratory distress syndrome, hypoglycemia, and hypothermia. Two sets of multiple-choice questions (MCQs) were completed pre- and post-intervention to assess students’ knowledge and critical thinking skills. Students’ satisfaction was assessed using semi-structured interviews. Findings A total of 72 third-year nursing students volunteered to participate and completed all measurements. There was no statistically significant increase in the critical thinking score from pretest (M = 10.64, SD = 2.95) to posttest (M = 11.60, SD = 2.53; p > 0.05), whereas the students’ knowledge increased from pretest (M = 35.52, SD = 5.54) to posttest (M = 42.10, SD = 5.53; p < 0.001). Furthermore, one of the main themes to emerge from the content analysis was “realism reinforcing clinical practice,” reflecting students’ satisfaction with HFS as an active learning method. Research limitations/implications This study has certain limitations that should be acknowledged. It was conducted in a single nursing school using a convenience sample, which may limit the generalizability of the findings. The measurement instrument for nursing care of high-risk newborns had a reliability coefficient of KR 0.64, which falls below the generally recommended threshold for research instruments; the marginal reliability may have attenuated the reliability of the findings. Moreover, the relatively short six-week intervention period, together with the absence of a control group, may have constrained the ability to fully capture long-term effects and critical thinking outcomes. Future research extending this line of inquiry should adopt more rigorous designs than the single-arm pretest-posttest approach used here: a two-arm design comparing HFS with standard clinical practicum or lower-fidelity simulation, ideally with random assignment at the group or cohort level, would allow the improvements observed here to be attributed more confidently to the HFS intervention itself rather than to maturation, repeated testing, or concurrent curricular exposure. Multi-site replication would also address the single-institution, convenience-sample limitation of the current study. The instrument would need to undergo further psychometric testing so that its reliability could reach an adequate standard, and appropriate control groups are warranted to strengthen the evidence base. Plausible confounders were not controlled for in this single-arm design. Concurrent coursework and clinical placements during the six-week intervention period may have independently contributed to gains in knowledge and critical thinking, apart from any effect of HFS itself. Finally, as noted above, the study was powered to detect only moderate-to-large effects (dz = 0.33); the non-significant overall critical thinking result should therefore be interpreted with this power limitation in mind rather than as evidence that HFS has no effect on critical thinking. Practical implications Our study findings may serve as an inspiration for nursing educators to embed HFS into their curricula, not only to motivate students but also to encourage active learning strategies and ultimately improve patient outcomes. Originality/value Simulation-based learning (SBL) offers a structured, context-driven approach that enhances critical thinking, problem-solving, and real-world application of knowledge. It also complies with regulations mandating nursing students to engage in simulation-based training before entering clinical practice, ensuring safety and competence. By supporting lifelong learning and addressing technological disruptions, SBL aligns with the pedagogical foundation of HFS, emphasizing improved learning outcomes, the integration of digital technology, and a commitment to social progress.