Technology-Enriched High-Fidelity Simulation in Nursing Education: Learning Effectiveness and Mediating Model

Background: Despite extensive research documenting high-fidelity simulation benefits, limited evidence exists regarding the effectiveness of simulation explicitly enriched with clinical technologies or the mechanisms through which simulation components influence learning outcomes. Aims: To evaluate nursing students’ learning effectiveness across multiple dimensions following high-fidelity simulation enriched with clinical technologies (HFSECT) and to test whether course arrangement, equipment resources, and clinical ability mediate the relationship between debriefing quality and problem-solving. Methods: Eighty-one third-year undergraduate nursing students participated in a quasi-experimental one-group pretest–posttest study involving HFSECT with dual-component debriefing. The Simulation Learning Effectiveness Inventory assessed seven dimensions: course arrangement, equipment resources, debriefing, clinical ability, confidence, problem-solving, and collaboration. Learning satisfaction was assessed separately. A parallel mediation analysis was conducted using the PROCESS macro with 5,000 bootstrap samples. Results: Significant improvements occurred in six dimensions: course arrangement, equipment resources, debriefing, problem-solving, clinical ability, and confidence, with substantial satisfaction gains. Collaboration showed no significant change. Mediation analysis showed a significant indirect association through clinical ability, whereas the indirect associations through course arrangement and equipment resources were not significant. The direct association between debriefing and problem-solving remained significant. Conclusions: HFSECT was associated with improvements in nursing students’ perceived learning effectiveness and satisfaction. Clinical ability mediated the association between debriefing and problem-solving, suggesting that debriefing may support problem-solving partly through clinical ability.