Effects of a Blended Simulation for High-risk Neonatal Nursing on Nursing Students’ Learning Outcomes by Learning Strategy

Objectives: This study examined the effects of blended simulation education, combining web-based virtual and high-fidelity hands-on modalities, on nursing students’ learning outcomes. It focused on differences by debriefing type and learning strategies when caring for high-risk neonates with convulsive disorders. Methods: Participants included 197 fourth-year nursing students enrolled at a college in Daegu, South Korea. A non-equivalent control group post test-only design was employed. Data were collected from October 1 to December 30, 2024, using structured questionnaires that assessed learning strategies, core skill performance, clinical judgment, satisfaction, and self-confidence. Descriptive statistics, independent-samples t-tests, Pearson’s correlation coefficients, and the Fisher Z-test were used for data analysis. Results: Following the implementation of blended simulation-based education, no significant differences emerged between groups in overall core skill performance, subjective clinical judgment, satisfaction, or self-confidence. However, the peer-debriefing group demonstrated significantly higher team objective clinical judgment scores compared with the faculty-debriefing group, except in the noticing and reflecting domains. The peer-debriefing group also showed higher individual objective scores in the responding domain. Across both groups, learning strategies were not significantly correlated with core skill performance or clinical judgment but were positively correlated with satisfaction and self-confidence. Conclusions: Blended simulation education incorporating peer reflective debriefing produced comparable learning outcomes to faculty-led debriefing, with additional benefits for objective clinical judgment. These findings support the feasibility of peer debriefing in blended simulation programs and highlight the need for future research to explore strategies that enhance nursing students’ learning approaches in evolving simulation-based education environments.