Longitudinal development of self-assessed nursing competence following high-fidelity simulation among undergraduate nursing students: a mixed-methods study protocol

High-fidelity simulation (HFS) is an established pedagogical approach in nursing education that enables students to engage with complex clinical situations in a safe and structured learning environment. Although previous research has demonstrated short-term improvements in knowledge, clinical skills, self-efficacy, and perceived competence following simulation-based education, evidence regarding the persistence and development of competence beyond the immediate post-intervention period remains limited. This study aims to examine longitudinal changes in self-assessed professional nursing competence following HFS and to explore how nursing students experience and interpret their competence development over time. A non-randomised explanatory sequential mixed-methods design will be used. In the quantitative phase, undergraduate nursing students will complete the Austrian German version of the Nurse Professional Competence Scale-Short Form (NPC-SF-AUT) at four measurement points: immediately before HFS, immediately after completion of the final debriefing on the same simulation day, six weeks after HFS, and 12 weeks after HFS. Quantitative analyses will primarily examine longitudinal changes in the predefined NPC-SF-AUT domain process-guided nursing care, with multi-professional cooperation and development considered a key secondary outcome. The remaining predefined competence domains and an overall competence score will be examined exploratorily. The subsequent qualitative phase will use narrative-episodic individual interviews to explore students’ experiences and to contextualise patterns identified in the quantitative findings. Qualitative data will be analysed using qualitative content analysis supported by iterative coding procedures. Quantitative and qualitative findings will be integrated using joint displays and the Pillar Integration Process to generate mixed-methods meta-inferences. The study will distinguish immediate from longer-term changes in self-assessed competence and explore the educational experiences students associate with these changes. Ethical approval was obtained from the Ethics Committee of the St. John of God Hospital Vienna. The study was prospectively registered with the Open Science Framework (OSF) Registries (osf.io/6ba3k) prior to participant recruitment.