The Role of Laboratory Simulation in The Development of Caring Behavior in Nursing Students: A Scoping Review

Authors

DOI:

https://doi.org/10.19166/nc.v13i2.9927

Keywords:

Caring Behaviour, Empathy, High-fidelity, Nursing Students, Simulation

Abstract

Caring behavior is a fundamental value in nursing practice and education. Simulation has emerged as an effective strategy to enhance not only clinical competence but also empathy, communication, and self-awareness in nursing students. This scoping review aims to explore the role of laboratory simulation in developing caring behaviors among nursing students and to identify the types of simulation used and related outcomes. Following the Joanna Briggs Institute (JBI) methodology, literature was searched in four databases (PubMed, EBSCO, ScienceDirect, and ProQuest) for studies published between 2015 and 2025. Inclusion criteria focused on nursing students, simulation-based learning, and caring or empathy outcomes. Twelve studies were included, predominantly quantitative in design (n = 10), along with one qualitative and one mixed-method study. Sample sizes ranged from 26 to 248 participants. Simulations used included high-fidelity (n = 4), virtual reality (n = 3), standardized patients (n = 3), and low-fidelity or role-play (n = 2). Most studies showed positive effects on empathy, communication skills, and caring behavior, especially with immersive or high-fidelity simulations. Overall, simulation-based learning, particularly high-fidelity and immersive methods, supports the development of caring behavior in nursing students. Its integration into nursing curricula is essential to prepare nurses for patient-centered, empathetic care.

Author Biographies

Heman Pailak, Faculty of Nursing, Universitas Pelita Harapan

Faculty of Nursing, Universitas Pelita Harapan

Yakobus Siswadi, Faculty of Nursing, Universitas Pelita Harapan

Faculty of Nursing, Universitas Pelita Harapan

References

Arrogante, O., Velarde-García, J.F., Blázquez-González, P., Nieves Moro-Tejedor, M., 2022. The effects of high-fidelity simulation training on empathy and attitudes toward older people among undergraduate nursing students: A quasi-experimental study. Nurse Education in Practice 64, 103441. https://doi.org/10.1016/j.nepr.2022.103441

Ayed, A., Malak, M.Z., Al-amer, R.M., Batran, A., Salameh, B., 2021. Fffect of high-fidelity simulation on perceptions of self-awareness, empathy, and patient-centered care among university pediatric nursing classes. Clinical Simulation in Nursing 56, 84–90. https://doi.org/10.1016/j.ecns.2021.04.005

Durham, K.R.A., 2008. Chapter 51. Enhancing patient safety in nursing education through patient simulation. in: hughes rg, editor. Patient safety and quality: An evidence-based handbook for nurses. rockville (md): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 51. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2628/

Cho, M.-K., & Kim, M.Y., 2024. Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis. BMC Nursing 23, 319. https://doi.org/10.1186/s12912-024-01944-7

Deprey, S.M., & Kobiske, K.R., 2023. Dementia simulation impact on empathy of nursing and physical therapy students: A quantitative study. Clinical Simulation in Nursing 81, 101412. https://doi.org/10.1016/j.ecns.2023.03.005

Edgar, A.K., Macfarlane, S., Kiddell, E.J., Armitage, J.A., Wood-Bradley, R.J., 2022. The perceived value and impact of virtual simulation-based education on students’ learning: a mixed methods study. BMC Medical Education 22, 823. https://doi.org/10.1186/s12909-022-03912-8

Fernández-Gutiérrez, M., Bas-Sarmiento, P., del Pino-Chinchilla, H., Poza-Méndez, M., Marín-Paz, A.J., 2022. Effectiveness of a multimodal intervention and the simulation flow to improve empathy and attitudes towards older adults in nursing students: A crossover randomised controlled trial. Nurse Education in Practice, 64, 103430. https://doi.org/10.1016/j.nepr.2022.103430

Fitzgerald, M. & Ward, J., 2019. Using standardized actors to promote family-centered care. Journal of Pediatric Nursing, 45, 20–25. https://doi.org/10.1016/j.pedn.2018.12.002

Haley, B., Heo, S., Wright, P., Barone, C., Rettigantid, M.R., Anders, M., 2017. Effects of Using an Advancing Care Excellence for Seniors Simulation Scenario on Nursing Student Empathy: A Randomized Controlled Trial. Clinical Simulation in Nursing 13, 511–519. https://doi.org/10.1016/j.ecns.2017.06.003

Harrison, R., Jones, B., Gardner, P., Lawton, R., 2021. Quality assessment with diverse studies (QuADS): an appraisal tool for methodological and reporting quality in systematic reviews of mixed- or multi-method studies. BMC Health Services Research 21, 144. https://doi.org/10.1186/s12913-021-06122-y

Hayden, J. K., Smiley, R.A., Alexander, M., Kardong-Edgren, S., Jeffries, P.R., 2014. The NCSBN national simulation study: A longitudinal, randomized, controlled study replacing clinical hours with simulation in prelicensure nursing education. Journal of Nursing Regulation 5, S3–S40. https://doi.org/10.1016/S2155-8256(15)30062-4

Holland, T., Walter, L., Langevin, K., Bourgoin, A., McKelvey, M., Kirk, C., Thomas, C., 2024. Nursing students’ experience of a poverty simulation and its impact on empathy and social justice awareness: A descriptive qualitative study. Creative Nursing 30, 65–73. https://doi.org/10.1177/10784535241229143

Holst, H., Ozolins, L.-L., Brunt, D., Hörberg, U., 2017. The learning space—interpersonal interactions between nursing students, patients, and supervisors at developing and learning care units. International Journal of Qualitative Studies on Health and Well-being 12, 1368337. https://doi.org/10.1080/17482631.2017.1368337

Hovland, C., Gergis, M., Milliken, B., DeBoth Foust, K., Niederriter, J., 2024. The value of learning virtual interprofessional collaboration during a pandemic and the future “new normal”: health professions students share their experiences. Journal of Interprofessional Care 38, 87–94. https://doi.org/10.1080/13561820.2023.2232401

Huang, K.T., & Ma, Z., Yao, L., 2025. Media-Induced and Psychological Factors That Foster Empathy Through Virtual Reality in Nursing Education: 2×2 Between-Subjects Experimental Study. JMIR Medical Education 11. https://doi.org/10.2196/59083

Inocian, E.P., Hill, M.B., Felicilda-Reynaldo, R.F.D., Kelly, S.H., Paragas, E.D., Turk, M.T., 2022. Factors in the clinical learning environment that influence caring behaviors of undergraduate nursing students: An integrative review. Nurse Education in Practice 63, 103391. https://doi.org/10.1016/j.nepr.2022.103391

Jacobs, S., Taylor, C., Dixon, K., Wilkes, L., 2019. The advantages and disadvantages of using High Fidelity Simulation as an environment to observe undergraduate nurses’ actions and their alignment with clinical judgement characteristics. Clinical Nursing Studies 8, 15. https://doi.org/10.5430/cns.v8n1p15

Jafarian-Amiri, S., Zabihi, A., Qalehsari, M., 2020. The challenges of supporting nursing students in clinical education. Journal of Education and Health Promotion 9, 216. https://doi.org/10.4103/jehp.jehp_13_20

Juniarta, Eka, N.G.A., Ferawati Sitanggang, Y., 2024. Empathy in nursing students: a scoping review. Journal of Holistic Nursing 42, S59–S86. https://doi.org/10.1177/08980101231163966

Kaur, A., 2022. All about simulation in nursing: The Indian scenario. Bulletin of Environment, Pharmacology and Life Sciences, 11(Special Issue 4), 190–197

Koukourikos, K., Tsaloglidou, A., Kourkouta, L., Papathanasiou, I., Iliadis, C., Fratzana, A., Panagiotou, A., 2021. Simulation in clinical nursing education. Acta Informatica Medica 29, 15. https://doi.org/10.5455/aim.2021.29.15-20

Liu, J.Y.W., Mak, P.Y., Chan, K., Cheung, D.S.K., Cheung, K., Fong, K.N.K., Kor, P.P.K., Lai, T.K.H., Maximo, T., 2024. The effects of immersive virtual reality–assisted experiential learning on enhancing empathy in undergraduate health care students toward older adults with cognitive impairment: Multiple-Methods Study. JMIR Medical Education 10, e48566. https://doi.org/10.2196/48566

Massoth, C., Röder, H., Ohlenburg, H., Hessler, M., Zarbock, A., Pöpping, D.M., Wenk, M., 2019. High-fidelity is not superior to low-fidelity simulation but leads to overconfidence in medical students. BMC Medical Education 19, 29. https://doi.org/10.1186/s12909-019-1464-7

Mercan, N., Mersin, S., 2025. Evaluating the therapeutic communication skills of nursing students in the clinical setting: The experiences of students, patients, and patients’ relatives. Heliyon 11, e41677. https://doi.org/10.1016/j.heliyon.2025.e41677

Park, Y., Lee, S.-J., Hur, Y., 2025. Facilitators, barriers, and future direction of high-fidelity simulation in nursing education: a qualitative descriptive study. BMC Nursing 24, 881. https://doi.org/10.1186/s12912-025-03541-8

Poorchangizi, B., Borhani, F., Abbaszadeh, A., Mirzaee, M., Farokhzadian, J., 2019. The importance of professional values from nursing students’ perspective. BMC Nurs 18, 26. https://doi.org/10.1186/s12912-019-0351-1

Qu, Z., Sun, J., Li, L., Zhao, L., Jiang, N., Fan, J., Zhang, J., Liang, B., 2024. The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: A quasi-experimental study. Nurse Education in Practice 80, 104119. https://doi.org/10.1016/j.nepr.2024.104119

Raghunathan, K., Houghty, G.S., Siswadi, Y., Eka, N.G.A., Bourke, S., Cardwell, R., Copnell, B., Duncan, R., Moss, C., 2025. The use of simulation to improve non-technical skills in undergraduate nurse education: A scoping review. Clinical Simulation in Nursing 99, 101686. https://doi.org/10.1016/j.ecns.2025.101686

Sideras, S., McKenzie, G., Noone, J., Dieckmann, N., Allen, T.L., 2015. Impact of a simulation on nursing students’ attitudes toward schizophrenia. Clinical Simulation in Nursing 11, 134–141. https://doi.org/10.1016/j.ecns.2014.11.005

Tseng, T.-J., Ray, M.A., Wu, C.-J., 2025. Examining nursing students’ learning through reflective analysis using ray’s transcultural caring dynamics in nursing and health care theory. BMC Medical Education 25, 559. https://doi.org/10.1186/s12909-025-07123-9

Witherspoon, M., Pankonien, C.A., Baldwin, J., Hunter, C., 2023. The impact of a role-play patient simulation on nursing students as measured by the comprehensive state empathy scale. Teaching and Learning in Nursing 18, e79–e83. https://doi.org/10.1016/j.teln.2023.04.016

Yazeedi, B., Azri, Z., Prabhakaran, H., John, S.E., Shakman, W L.M., Raghavan, D., Roach, E.J., Sabari, S., Arulappan, J., 2025. Efficacy of high-fidelity pediatric simulation on nursing students’ self-awareness and empathy in a Middle Eastern Country. Heliyon 11, e42524. https://doi.org/10.1016/j.heliyon.2025.e42524

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Published

2025-12-10

How to Cite

Pailak, H., & Siswadi, Y. (2025). The Role of Laboratory Simulation in The Development of Caring Behavior in Nursing Students: A Scoping Review: . Nursing Current: Jurnal Keperawatan, 13(2), 114–125. https://doi.org/10.19166/nc.v13i2.9927

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