ORIGINAL RESEARCH article
Front. Med.
Sec. Healthcare Professions Education
Effect of Direct vs Indirect Supervision on Psychological Outcomes of Nursing Students During Clinical Simulations: A Quasi-Experimental Study
Provisionally accepted
Azizah Alhaggas Albaqami1,2*
Homood Alharbi1- 1King Saud University, Riyadh, Saudi Arabia
- 2Qassim University, Buraydah, Saudi Arabia
Select one of your emails
You have multiple emails registered with Frontiers:
Notify me on publication
Please enter your email address:
If you already have an account, please login
You don't have a Frontiers account ? You can register here
Background: Clinical simulation bridges the gap between theory and practice in nursing education. However, the optimal design specifically, direct observation or faculty presence, remains unsettled. This study compares the short-term effects of faculty presence during clinical-simulation re-demonstrations on student anxiety, self-confidence, and satisfaction, with the goal of informing more effective, student-centered simulation strategies. Methods: A pretest–posttest quasi-experimental design was implemented between January and April 2024 at a university in Saudi Arabia. A convenience sample of 138 senior Bachelor of Nursing students was divided into a control group (faculty member present in the simulation lab) and an intervention group (faculty members observing and evaluating students through a one-way mirror from the control room). Group allocation followed pre-existing class arrangements, and randomization was not performed. Data were collected using validated instruments: the State-Trait Anxiety Inventory (STAI, Forms Y-1/Y-2), the Student Satisfaction and Self-Confidence in Learning Scale (SCLS), and a demographic questionnaire. Results: Posttest results indicated that the intervention group demonstrated significantly lower state anxiety (M = 60.9) compared with the control group (M = 78.09; effect size r ≈ −0.22). The intervention group also reported higher self-confidence (M = 73.57) than the control group (M = 65.43; effect size r ≈ −0.07). Conversely, satisfaction scores were higher in the control group (M = 72.25) than in the intervention group (M = 66.75; effect size r ≈ −0.10). Among participants in the intervention group, female students exhibited significantly higher anxiety and lower satisfaction and self-confidence than male students (p < 0.05). Conclusion: The intervention enhanced students' self-confidence and revealed gender-related differences in simulation learning. These findings underscore the need for tailored simulation strategies that address specific learning needs. Differentiated feedback and structured debriefings may strengthen confidence and reduce anxiety. Future research should explore faculty presence versus absence using larger samples and mixed-method designs to identify conditions optimizing learning and student affect. Clinical trial number: not applicable.
Keywords: Simulation training, Education, Nursing, Faculty, Anxiety, self-efficacy
Received: 24 Aug 2025; Accepted: 27 Oct 2025.
Copyright: © 2025 Alhaggas Albaqami and Alharbi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Azizah Alhaggas Albaqami, 443203576@student.ksu.edu.sa
Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.