Changes in emotional intelligence, self-confidence, and clinical decision-making following postpartum hemorrhage simulation-based education among nursing students: a single-group pretest–posttest study

Background Postpartum hemorrhage (PPH) is a life-threatening obstetric emergency that requires rapid recognition and coordinated management. Nursing students may have limited opportunities to encounter such high-risk events during routine clinical training, making simulation a useful strategy for standardized practice. This study examined pretest-to-posttest changes in emotional intelligence, self-confidence, and clinical decision-making following participation in PPH simulation-based education. Methods A pre-experimental single-group pretest–posttest study was conducted using a convenience sample of 63 fourth-year nursing students from a single institution, Al Rawdah University College, Nablus, Palestine. Participants completed electronic questionnaires immediately before and after a structured three-day PPH simulation-based educational program. Outcomes were measured using the Schutte Self-Report Emotional Intelligence Test, the National League for Nursing Self-Confidence in Learning Scale, and the Nursing Clinical Decision-Making Scale. Analyses included descriptive statistics, paired-samples t tests, Pearson correlations, bivariate comparisons, multiple linear regression, and an exploratory bootstrap indirect-effect analysis. Results Significant pretest-to-posttest increases were observed in all three outcomes. Total self reported emotional intelligence increased from 109.01 ± 15.31 to 118.39 ± 14.62 (t = 4.02, p < .001, d = 0.51), self-reported self-confidence from 34.66 ± 6.31 to 37.15 ± 2.85 (t = 4.95, p < .001, d = 0.62), and total clinical decision-making from 122.09 ± 17.84 to 131.21 ± 17.06 (t = 4.56, p < .001, d = 0.57). Posttest emotional intelligence correlated with self-confidence ( r = .38, p < .01) and clinical decision-making ( r = .45, p < .001), while self-confidence correlated with clinical decision-making ( r = .43, p < .001). In adjusted regression, baseline clinical decision-making, posttest emotional intelligence, and self-confidence were independently associated with posttest clinical decision-making, explaining 64% of the variance. Exploratory bootstrap analysis showed a significant indirect association through self-confidence. Conclusions Participation in PPH simulation-based education was associated with short-term increases in self-reported emotional intelligence, self-confidence, and perceived clinical decision-making. Because the study used a single-group pretest–posttest design, these changes cannot be attributed causally to the intervention. Controlled, multi-site studies with objective performance measures and longer follow-up are needed to determine the durability and clinical relevance of these findings.