The impact of clinical simulation on bridging the theory–practice gap in nursing education: a systematic review

Bridging the gap between theoretical instruction and practical competence remains a central challenge in nursing education. Nursing students often struggle to transfer classroom-acquired knowledge into real-world clinical environments, resulting in decreased confidence, impaired decision-making, and compromised patient care. Clinical simulation has emerged as a promising pedagogical tool to address this longstanding theory-practice gap by recreating realistic scenarios in a controlled setting. This systematic review synthesized studies published from 2010 to 2025 concerning the use of clinical simulation in nursing education. Five databases were searched using defined keywords to identify relevant studies. Eligible studies focused on simulation-based interventions aimed at enhancing nursing students' clinical competence, decision-making, confidence, and knowledge transfer. Data extraction was independently performed by reviewers, and methodological quality was assessed using the Cochrane RoB 2, CASP, and Newcastle-Ottawa Scale (NOS) checklists. A thematic synthesis approach was employed to analyze both qualitative and quantitative findings. Of the fifteen included studies, twelve reported significant improvements in nursing students' clinical decision-making, judgment, or self-confidence, involving over 1,100 participants. High-fidelity simulation and structured scenario-based interventions were particularly effective in enhancing core competencies such as cardiopulmonary resuscitation (CPR), infection control, and diagnostic reasoning. Thematic synthesis categorized findings into six domains: clinical decision-making, clinical judgment, learner self-confidence, empathy development, experiential learning, and learner satisfaction. Reported challenges included limited technological access, inconsistent debriefing, and insufficient faculty training. No adverse outcomes were noted, although potential publication bias and short follow-up durations were identified as limitations. Simulation-based education can serve as an effective and scalable strategy to reduce the theory-practice gap in nursing education. Its success depends on sustained implementation, institutional support, and pedagogical integration. Future research should emphasize long-term effectiveness and explore context-specific barriers.