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Rigorous simulation design grounded in best practice reduces learner anxiety
  1. Jennifer Dale-Tam
  1. Nursing Education, The Ottawa Hospital, Ottawa, Ontario, Canada
  1. Correspondence to Ms Jennifer Dale-Tam, Nursing Education, The Ottawa Hospital, Ottawa, Ontario, Canada; jdale-tam{at}

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Commentary on: Oliveira Silva G, Oliveira FSE, Coelho ASG, Fonseca LMM, Vieira FVM, Campbell SH, Aredes NDA. Influence of simulation design on stress, anxiety and self-confidence of nursing students: Systematic review with meta-analysis. J Clin Nurs. 2023 Sep;32(17-18):5668-5692. doi: 10.1111/jocn.16681. Epub 2023 Mar 9.

Implications for practice and research

  • Simulation-based learning (SBL) design should be grounded in best practices, such as the Healthcare Simulation Standards of Best Practice™, to optimise the learner’s experience and self-confidence.

  • Further research is needed to assess if another component of simulation design, a rigorous educational needs assessment, contributes to decreased anxiety in learners while increasing their self-confidence.


SBL experiences are known to increase stress and anxiety in healthcare learners, including nursing students. High stress levels can impair decision-making, working memory, retrieval of information from memory and tasks requiring divided attention1 of learners in SBL. Facilitators of …

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  • Competing interests None declared.

  • Provenance and peer review Commissioned; internally peer reviewed.