Effects of NICU Scenario-Based Simulation on Nursing Students' Perceived Stress, Satisfaction, Self-Confidence, and Learning: A Mixed-Methods Study

Neonatal intensive care units (NICUs) are complex clinical environments requiring advanced technical skills, rapid decision-making, teamwork, and effective communication. Nursing students often face significant challenges in these settings, including stress related to patient acuity, fear of making errors, and difficulties in communicating with emotionally vulnerable parents.

This study will be conducted at Atılım University Faculty of Health Sciences, Nursing Skills Laboratory in Ankara, Turkey. Third-year nursing students who have not yet completed the Child Health and Diseases (NURS302) course will be eligible to participate. The entire third-year cohort (n=18) will be invited to participate; no sampling will be applied.

The study employs a parallel mixed-methods design. The quantitative component uses a single-group pre-post quasi-experimental design. The qualitative component involves semi-structured focus group interviews to explore students' simulation experiences in depth.

The NICU simulation scenario includes three interconnected components: initiating therapeutic communication with a postpartum mother whose preterm infant is admitted to the NICU, performing emergency neonatal intervention during an acute event, and supporting the initiation of mother-infant contact and breastfeeding. The scenario was developed in accordance with the Healthcare Simulation Standards of Best Practice™.

Data collection will occur in three phases. In Phase 1, participants will complete the Student Descriptive Information Form and the Perceived Stress Scale for Nursing Students (pre-test). In Phase 2, the simulation and PEARLS-based debriefing will be conducted, followed by post-test administration of the Perceived Stress Scale, Simulation-Based Learning Evaluation Scale, and Student Satisfaction and Self-Confidence in Learning Scale. In Phase 3, semi-structured focus group interviews will be conducted and audio-recorded with participant consent.

Quantitative data will be analyzed using SPSS 29.0. Qualitative data will be analyzed using MAXQDA through thematic coding. Findings from both components will be integrated during the interpretation phase.

Inclusion criteria

• Third-year undergraduate nursing students at Atılım University Faculty of Health Sciences
• Voluntarily willing to participate and providing written informed consent
• Have not yet completed the Child Health and Diseases (NURS302) course

Exclusion criteria

• Withdrawal from the study at any stage
• Incomplete completion of data collection forms