Types of Simulation in Nursing Education

Rebecca Munday
Updated November 15, 2022
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Simulation first appeared in nursing in 1911 when Mrs. Chase, the first mannequin, was used to teach students how to turn, transfer, and dress patients. Simulation techniques have greatly advanced in the last 111 years, but the basic concept remains the same.

Simulation provides a realistic setting and safe environment for students to apply the knowledge they learned in class. Then, they can use what they learned in simulation and apply it to clinical practice.

Simulation might seem like it’s one more complicated thing to add to your already full plate as a nursing student. Consider the pros and cons of simulation, what to expect, and how to complete them successfully.

Types of Simulation in Nursing Education

Nursing students may be familiar with types of simulation in nursing education, such as standardized patients, role playing, and low-fidelity mannequins. Yet, nursing education uses so many more types of simulation.

The online learning environment for nurses brought on by the COVID-19 pandemic forced nursing programs to come up with new ways to teach students nursing skills.

  1. 1

    Unfolding Case Studies

    Unfolding case studies change over a period of time in a way that the student cannot predict. They help students practice their patient assessment skills. Unfolding case studies allow students to dive deep into their patients’ complex situations, and because some of them are available at no cost, they are cost effective.

    Unfolding case studies may also prepare students to apply clinical reasoning and critical thinking skills.

  2. 2

    High-fidelity Mannequins

    High-fidelity mannequins are computer-controlled full-body mannequins. They most closely replicate the responses, physiology, and anatomy of a patient. Because they are the most adaptable form of simulation, high-fidelity mannequins are typically the most favorable. However, they are also one of the most expensive.

  3. 3

    Low-fidelity Mannequins

    Low-fidelity mannequins include two-dimensional displays, static models, and partial-task simulators. They are the least real type of simulation. They can help students build knowledge because they allow students to go at their own pace. They can also help students learn a specific skill, such as cardiopulmonary resuscitation or intravenous insertion.

  4. 4

    Partial-task Simulators

    Partial-task simulators are a body part, such as an arm or a head, that allow nursing students to practice a skill many times without causing wear and tear or using more expensive equipment.

  5. 5

    Volunteers Who Act as Standardized Patients

    Standardized patients are volunteers who behave in a realistic way to simulate clinical interaction. Standardized patients can make practicing communication and assessment skills more successful. Some of these skills include taking a patient history, asking for informed consent, explaining a procedure, and giving bad news.

  6. 6


    Role-playing asks students to act out a situation. Because role-playing does not require any props or realistic surroundings, this method of simulation is relatively low cost. Despite its low-fidelity, role-playing can benefit students, especially for changing attitudes or team training.

  7. 7

    Virtual Reality

    Virtual reality uses computers and standardized patients to create a realistic simulation. This form of simulation is still new and gaining popularity in healthcare. Virtual reality can be used to teach patients about complex situations with many people involved because some technologies allow students to care for more than one patient at a time.

  8. 8


    E-learning includes all simulations on the computer. These can be a video computer program explaining how to use a device or a highly complicated virtual reality situation where students interact with patients and other healthcare providers.

  9. 9

    A Combination of Simulations

    A combination of simulations uses two or more of the previous types of simulations to create a more realistic simulation. It can also help students practice more than one skill at a time. For example, an instructor could secure a suture cushion to a standardized patient. In this simulation, the student can practice suturing a wound while getting informed consent and explaining the procedure.

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Examples of Simulation Scenarios for Different Classes

The American Nurses Association recommends that the most effective simulations require faculty to coordinate what classes are going to use simulation scenarios. This way, students only repeat key skills in multiple classes. Otherwise, they learn different skills and experience new simulations in each of their classes. Below are examples of common scenarios.

bookmarkMaternal Health

Students can perform newborn assessments using a newborn simulator or an appropriately sized doll. Students learn how to care for a laboring pregnant individual, especially in high-risk situations such as the pregnant patient hemorrhaging.

bookmarkLeadership Courses

Students benefit from role-playing scenarios of ethical dilemmas or nurse-to-nurse bullying to learn useful strategies on how to deal with it.


Students can practice infant assessment in a clinical setting. Standardized patients can act as parents or guardians with cultural differences to help students practice with scenarios, such as with a parent or guardian who does not want their child vaccinated.

bookmarkMental Health Nursing

Standardized patients help reduce students’ anxiety and stress and build their communication skills by listening to the patients and answering their questions correctly.

bookmarkMedical-Surgical I or II

Students practice recognizing the signs of stroke in an older patient who was admitted to the hospital for another condition like surgery.

bookmarkMultiple Classes

Students may practice their skills in patient handoffs, handwashing, and medication safety in multiple classes because those skills need repeating.

Preparing for Simulation

Faculty and students must prepare for the simulation, so students can get the most out of the simulation experience. Faculty prepare when they set up the simulation in a way that best helps students meet the objectives of the simulation. Students prepare in the prebriefing stage when they gather information, ask questions, and make a plan of action for the simulation.


Faculty design simulation scenarios that help students best meet the objectives of the simulation and learn the skills they need to be successful. Simulation faculty need to be trained in simulation and debriefing techniques, according to the National Council of State Boards of Nursing Simulation Guidelines and the International Nursing Association of Clinical and Simulation Learning (INACSL) Standards for Designing Simulation.

Other key standards from the INACSL:

  • Create a case scenario that provides context for the simulation
  • Begin with a prebriefing and end with a debriefing or feedback session
  • Provide preparation materials and resources that help students meet the objectives and outcomes of the simulation
  • Use an approach based on the participant’s level of knowledge, skills, and experience as well as the outcomes of the simulation
  • Structure the simulation to have a starting point that shows the initial circumstances of the patient, structured activities for participant engagement, and an endpoint (that is usually when learning outcomes are achieved)


Students prepare for the simulation in the prebriefing stage. The type of simulation will help determine how students prepare. Some of the ways students can prepare for the simulation include:

  • Reviewing key nursing skills like surgical techniques or intravenous insertion
  • Preparing a plan of care for the patient and questions for the patient or parent/guardian
  • Listening to the prebriefing
  • Discussing their approach to the simulation with their classmates
  • Researching the patient’s condition

What to Expect in Nursing Simulation

Well-planned, effective simulation consists of three phases: prebriefing, simulation, and debriefing. Faculty must plan for and students must participate in all three phases for the simulation to be successful.

check-circlePrebriefing: The prebriefing phase of simulation tells students what to expect. It sets up the case scenario and the expected outcomes and objectives. The instructor should set ground rules and remind students that it’s okay to make mistakes. They will discuss the mistakes in the debriefing.

check-circleSimulation: The simulation phase should have a clear starting point that sets up the context for the simulation. The activities are designed to help students learn skills and practice what they would do in a clinical situation. They should be centered around the participants and their level of knowledge, skills, and experience. The endpoint is usually when the learning objectives are met.

check-circleDebriefing/Evaluation: Debriefing immediately follows the simulation. During the debriefing, students receive feedback from their instructor. They discuss mistakes and ways to improve their skills next time. Students reflect on their own performance and incorporate what they learned into their previous knowledge.

Pros and Cons of Simulation in Nursing Education

Simulations provide students with a safe environment to practice skills as much as needed without harming patients. However, they can be costly, they cannot replicate the clinical situation, and they can cause students to learn incorrect information if designed poorly.


  • thumb-upDoes not harm patients
  • thumb-upReal-time feedback
  • thumb-upSafe environment
  • thumb-upLessens the need for clinical sites
  • thumb-upCan be repeated until the student masters the skill


  • thumb-downCan be costly
  • thumb-downCannot replicate all the elements of a clinical situation
  • thumb-downRequires nursing faculty trained in simulation
  • thumb-downCan cause students to learn incorrect information if poor quality


Page last reviewed September 12, 2022

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