Simulation-Based Education in Undergraduate Nursing Pharmacology: A Systematic Review of Modalities, Effectiveness, and Design Quality
DOI:
https://doi.org/10.14738/bjhr.1302.20175Keywords:
simulation-based education, pharmacology, nursing students, medication competence, knowledgeAbstract
Simulation-based learning is increasingly used in healthcare education; however, limited evidence exists on how it is specifically applied to support undergraduate nursing students in pharmacology. This systematic review aimed to examine the types of simulation modalities used to enhance pharmacology education, evaluate their effectiveness in improving students’ medication management, and assess the quality of existing studies. Systematic searches were conducted across seven databases, including Embase, CINAHL, Web of Science, PubMed, and Medline. Of the 3,060 records identified, 127 full-text articles were assessed for eligibility, and 51 studies met the inclusion criteria. Simulation modalities consistently improved pharmacology-related learning outcomes. Studies that incorporated structured pre-briefing, validated assessment instruments, and comprehensive debriefing protocols demonstrated the strongest statistical effects. However, students’ perceived self-efficacy in pharmacology was rarely examined, indicating an important gap in the current literature. Overall, effectiveness appeared to be influenced less by the level of simulation fidelity and more by the alignment between the simulation modality, learning objectives, student needs, and educational context. Adherence to best-practice standards recommended by the International Nursing Association for Clinical Simulation and Learning also appeared to strengthen learning outcomes. Simulation-based pharmacology education shows promise for improving medication competence among undergraduate nursing students, although further research is needed to evaluate self-efficacy outcomes and strengthen methodological rigour.
References
Padilha, J.M., Machado, P.P., Ribeiro, A., Ramos, J., Costa, P., Clinical virtual simulation in nursing education: Randomized controlled trial. Journal of Medical Internet Research, 2019, 21(3): p. e11529.
Sim, J.J.M., Rusli, K.D.B., Seah, B., Levett-Jones, T., Lau, Y., Liaw, S.Y., Virtual simulation to enhance clinical reasoning in nursing: A systematic review and meta-analysis. Clinical Simulation in Nursing, 2022, 69: p. 26–39.
Cant, R., Cooper, S.J., Use of simulation-based learning in undergraduate nurse education: An umbrella systematic review. Nurse Education Today, 2017, 49: p. 63–71.
El Hussein, M., Everett, B., Ramjan, L.M., Simulation as a strategy to enhance clinical judgment in nursing students. Nurse Education in Practice, 2021, 55: p. 103154.
Seropian, M.A., Brown, K., Gavilanes, J.S., Driggers, B., Simulation: Not just a manikin. Journal of Nursing Education, 2004.
Sanko, J.S., Kim, Y.J., McKay, M., Adverse event reporting following simulation encounters in accelerated and traditional bachelor nursing students. Nurse Education Today, 2018, 70: p.
McDermott, D.S., et al., Healthcare Simulation Standards of Best PracticeTM: Prebriefing: Preparation and briefing. Clinical Simulation in Nursing, 2021, 58: p. 9–13.
Campos, N., Nogal, M., Caliz, C., Simulation-based education involving online and on-campus models in different European universities. International Journal of Educational Technology in Higher Education, 2020, 17: p. 8.
Tsegaye, D., Alem, G., Tessema, Z., Alebachew, W., Medication administration errors and associated factors among nurses. International Journal of General Medicine, 2020, 13: p.
Sarfati, L., Ranchon, F., Vantard, N., Schwiertz, V., Larbre, V., Parat, S., Faudel, A., Rioufol, C., Human-simulation-based learning to prevent medication error: A systematic review. Journal of Evaluation in Clinical Practice, 2019, 25(1): p. 11–20.
Alconero-Camarero, A.R., Romero-Sánchez, J.M., Sarabia-Cobo, C.M., Simulation-based learning and medication safety. BMC Nursing, 2021, 20: p. 30. Scholar Publishing
Davis, R.G., Smith, M.M., Promoting competence in nursing and pharmacy interprofessional collaboration through telehealth simulation. Nursing Education Perspectives, 2023.
Pol-Castañeda, S., Carrero-Planells, A., Moreno-Mulet, C., Use of simulation to improve nursing students' medication administration competence: A mixed-method study. BMC Nursing, 2022, 21(1): p. 117.
Cleaver, K., Essex, R., Malamateniou, C., Narramore, N., Shekede, H., Vargo, E.J., Weldon, S.M., A systematic scoping review and textual narrative synthesis of undergraduate pediatric nursing simulations: What, why, and how? Clinical Simulation in Nursing, 2021, 53: p. 10–31.
Andrea, S., Kotowski, S., Communication skill development using standardized patients. Nurse Education Today, 2017, 49: p. 120–125.
Dwyer, T., McLachlan, H., Forster, D., Simulation and communication competence in nursing. Collegian, 2015, 22(3): p. 241–248.
Cant, R., Ryan, C., Kelly, M.A., Use and effectiveness of virtual simulations in nursing student education: An umbrella review. Computers, Informatics, Nursing, 2023, 41(1): p. 31–38.
Rayamajhi, S., Machin, A., Breen, C., Gebreheat, G., Paterson, R., Quality and impact of pharmacology digital simulation education on pre-registration healthcare students: A systematic literature review. Nurse Education Today, 2024, 140: p. 106295.
El Hussein, M.T., Hirst, S.P., High-fidelity simulation’s impact on clinical reasoning and patient safety: A scoping review. Journal of Nursing Regulation, 2023, 13(4): p. 54–65.
Meguerdichian, M., High-fidelity simulation in healthcare education. Clinical Simulation in Nursing, 2021, 55: p. 1–3.
Kim, J., Kim, S., Lee, W., Effects of virtual simulation on nursing students’ psychomotor performance: A systematic review. Nurse Education Today, 2024, 132: p. 106295.
Kim, J., Kim, S., Lee, W., Improving intravenous injection performance through simulationbased education. Nurse Education in Practice, 2024, 75: p. 103895.
Page, M.J., McKenzie, J.E., Bossuyt, P.M., Boutron, I., Hoffmann, T.C., Mulrow, C.D., et al., The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. BMJ, 2021, 372: p. n71.
McInnes, E., Wimpenny, P., JBI Qualitative Assessment and Review Instrument (QARI). Joanna Briggs Institute, 2019.
Oliveira, J.L.C.D., Magalhães, A.M.M.D., Matsuda, L.M., Santos, J.L.G.D., Souto, R.Q., Riboldi, C.D.O., Ross, R., Mixed Methods Appraisal Tool: Strengthening methodological rigor. Texto & Contexto–Enfermagem, 2021, 30: p. e20200603.
Jarvill, M., McGrogan, A., Raynor, D.K., Watson, M.C., Franklin, B.D., User-testing guidelines to improve medication safety: A randomized in situ simulation study. BMJ Quality & Safety,
Schneidereith, T.A., Medication administration behaviors in pre-licensure nursing students: A longitudinal cohort study. Nurse Education in Practice, 2021, 56: p. 103189.
Craig, C., Hale, D., Grainger, C., Stewart, M., Evaluating simulation design quality in nursing education. Journal of Nursing Education, 2021, 60(9): p. 513–519.
Brauneis, S.A., Goodman, K., Nunnally, S., Task trainer simulation for medication administration. Teaching and Learning in Nursing, 2021, 16(4): p. 356–361.
Abdali, M., Alilu, L., Feizi, A., The effect of simulation-based education on correct inhaler technique. SAGE Open Nursing, 2024, 10: p. 23779608241236108. Scholar Publishing
Shor, V., Kimhi, E., Avraham, R., Addressing medication administration safety through simulation. Nursing & Health Sciences, 2024, 26(3): p. e13161.
Mahou, F.Z., Decormeille, G., Changuiti, O., Mouhaoui, M., Khattabi, A., Screen-based simulation for medication administration skills. BMC Nursing, 2024, 23: p. 777.
Hanson, J., Andersen, P., Dunn, P.K., Effectiveness of 3D visualization on pharmacology learning. Nurse Education Today, 2019, 81: p. 19–25.
Hanson, J., Andersen, P., Dunn, P.K., Effects of a virtual learning environment on pharmacology knowledge. Nurse Education Today, 2020.
Yu, I.C., Fang, J.T., Effects of microlectures on medication administration understanding. Nurse Educator, 2023, 48(2): p. E35–E40.
Tamer, A., Kavuran, E., Gamified mobile education in nursing pharmacology. Nurse Education Today, 2025.
Aggar, C., Mason, J., Walker, R., Simulation-based learning for medication administration safety. Nurse Education Today, 2018, 62: p. 19–25.
Sarı, D., et al., Effects of simulation on pediatric medication administration. Nurse Education Today, 2018, 70: p. 34–39.
Woroch, K., Shinnick, M.A., Using standardized patients to teach home medication management. Journal of Nursing Education, 2023, 62(2): p. 87–93.
East, L., Hutchinson, M., Computer-based clinical simulation in medication administration. Nurse Education in Practice, 2015, 15(3): p. 181–187.
Pence, P.L., Virtual medication safety simulation. Journal of Nursing Education, 2022, 61(8):
Coskun, H., Sendir, M., Hybrid simulation for medication administration. Nurse Education Today, 2022, 109: p. 105229.
Foronda, C., Fernandez-Burgos, M., Nadeau, C., Kelley, C.N., Henry, M.N., Virtual simulation in nursing education. Simulation in Healthcare, 2018, 13(3): p. 161–169.
Murphy, G., Sweeney, A.B., Lugo, V., Competency-based assessment of dosage calculation skills. Nurse Educator, 2025, 50(6): p. E425–E426.
Corvino, J., Simulation-based strategies to improve medication competence. Nurse Education Today, 2025.
Moss, C.R., Nation, H., Hall, E., An escape game for neonatal nurse practitioners. Nurse Educator, 2025, 50(5): p. E312–E316.
Schroers, G., et al., Medication administration competence following deliberate practice simulation. Nursing Education Perspectives, 2024, 45(4): p. 241–247.
Schroers, G., et al., Deliberate practice of medication administration: A multisite study. Nursing Education Perspectives, 2025.
Thomas, C.M., et al., OSCE assessment of IV medication administration. Teaching and Learning in Nursing, 2024, 20: p. e262–e268.
Tourtual, J., Ludan, L.V., Simulation to teach medication reconciliation. Teaching and Learning in Nursing, 2025, 20: p. e766–e770.
Neerland, B.E., et al., Simulation-based medication training. Nurse Education in Practice, 2025, 82: p. 104267. Scholar Publishing
York, N.L., Landgrave, R., Turner, K., Simulation-based assessment of medication competence. Teaching and Learning in Nursing, 2025, 20: p. e301–e307.
Bajaj, K., et al., The PEARLS healthcare debriefing tool. Academic Medicine, 2018, 93(2): p. 336.
Rudolph, J.W., et al., Debriefing with good judgment. Simulation in Healthcare, 2007, 2(1):
Zigmont, J.J., et al., The 3D model of debriefing. Clinical Simulation in Nursing, 2011, 7(3): p. e105–e112.
Phrampus, P.E., O’Donnell, J.M., GAS debriefing framework. Simulation in Healthcare, 2013.
Lestander, Ö., Lehto, N., Engström, Å., Nursing students’ learning after simulation. Nurse Education Today, 2016, 40: p. 161–167.
Hughes, A., Hughes, J., Barriers to implementing simulation-based education. Nurse Education Today, 2022, 112: p. 105327.
Kinney, S., Henderson, A., Cant, R., Measuring simulation outcomes. Journal of Nursing Education, 2023, 62(6): p. 312–318.
Aiken, L.H., Clarke, S.P., Sloane, D.M., Hospital staffing and quality of care. Medical Care,
Shalas, E., Burke, L., Critical thinking and reflective practice. Journal of Advanced Nursing,
Hayes, C., et al., Interruptions during medication administration. Journal of Clinical Nursing, 2017, 26(23–24): p. 4839–4847.
Murray, M., Sundin, D., Cope, V., The nursing theory–practice gap. Collegian, 2019, 26(1): p.
Preston, P., Leone-Sheehan, D., Keys, B., Nursing student confidence and competence. Journal of Nursing Education, 2019, 58(7): p. 389–395.
Treiber, L.A., Jones, J.H., Developing clinical reasoning skills. Nurse Education in Practice, 2018, 33: p. 9–14.
Akalin, A., Sahin, M., Effects of high-fidelity simulation. Nurse Education Today, 2020, 91: p. 104467.
Liaw, S.Y., et al., Simulation for clinical reasoning. Nurse Education Today, 2014, 34(3): p.
Lawrence, K., Messias, D., Clark, P., Graduate nurses’ perceptions of simulation. Journal of Nursing Education, 2018, 57(6): p. 342–348.
Basheti, I.A., Simulation-based inhaler technique education. Pharmacy Practice, 2014, 12(2):
Labrague, L.J., et al., Simulation and communication competence. Nurse Education Today, 2019, 79: p. 128–134.
Wen, D., Zhang, J., Mobile learning engagement in nursing education. Nurse Education Today, 2022, 109: p. 105229.
Bandura, A., Self-efficacy: The exercise of control. W. H. Freeman, 1997.
Fusco, L. A., O’Donnell, J. M., Medication safety competence of undergraduate nursing students. Clinical Simulation in Nursing, 2021, 50: p. 27–33. Scholar Publishing
Campbell, J., Smith, M., Brown, T., Comparison of the effects of medication error encouragement training and low-fidelity simulation on the medication safety competence and knowledge of nursing students. Nurse Education Today, 2023, 123: p. 105724.
Özdemir, A., Ulan, Ö., The effect of standardized patient simulation on nursing students’ medication safety competence and self-confidence. Clinical Simulation in Nursing, 2023, 76:
Gisriel, S., Dalley, B., Walker, M., Prebriefing practices in simulation-based nursing education. Clinical Simulation in Nursing, 2021, 52: p. 22–28.
Avraham, R., Schlairet, M. C., Gabay, R., Assessing the impact of high-fidelity simulation on nursing students’ medication safety competence. Clinical Simulation in Nursing, 2018, 16: p.
Avraham, R., Shor, R., Kimhi, E., Low-fidelity simulation and medication administration competence. Nurse Education Today, 2021, 97: p. 104690.
Lee, J., Wessol, J. L., Computer-based simulation for medication error recognition in nursing students. Nurse Education Today, 2021, 102: p. 104901.
Mahou, F. Z., Decormeille, G., Changuiti, O., Mouhaoui, M., Khattabi, A., The effects of screen-based simulation on nursing students’ acquisition of medication administration and dosage calculation skills: A randomized controlled trial. BMC Nursing, 2024, 23: p. 777.
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Copyright (c) 2026 Maria Massoud, Clare McKeaveney, Samirh Said Alqhtani, Oonagh McCloy, Katherine MA Rogers
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