MEDIUM-FIDELITY SIMULATION: BRIDGING THE THEORY-PRACTICE GAP IN NURSING CLINICAL SKILL IN NURSING EDUCATION

Abstract

Background: A significant challenge in nursing education in Pakistan is the persistent gap between theoretical instruction and clinical practice, particularly in acquiring practical skills such as intramuscular (IM) injection. Factors such as overcrowded clinical settings, limited time, and faculty shortages hinder students’ readiness for real-world nursing care. Medium-fidelity simulation (MFS) has emerged as a pedagogically sound and cost-effective strategy to enhance skill development, build procedural confidence, and promote patient safety (Al-Ghareeb et al., 2019). This study aimed to evaluate the effectiveness of MFS in improving clinical competence, confidence, and learning attitudes among undergraduate nursing students in a resource-constrained academic environment in Pakistan. Methods: A quasi-experimental pretest-posttest study took place at Rawalpindi College of Nursing. A purposive sample of 86 Bachelor of Science in Nursing (BSN) students engaged in a structured MFS training session that emphasized procedural accuracy, patient communication, and safety. Students’ performance in the IM injection procedure was evaluated using a validated clinical checklist that was administered both prior to and after the intervention. Data analysis was performed using McNemar’s test in SPSS version 23.0, with significance indicated at p < 0.05. Results: Post-intervention findings showed statistically significant improvement (p < 0.001) in 28 of 29 performance indicators. Notable gains included patient introduction (38.4% to 98.8%, χ² = 50.019), syringe selection (1.2% to 100.0%, χ² = 83.012), and needle withdrawal (1.2% to 100.0%, χ² = 83.012). Improvements were consistent across attitudes, equipment handling, and procedural execution.

Conclusion: MFS proved a highly effective, practical, and scalable educational strategy. It significantly enhanced clinical competence, procedural confidence, and professionalism among nursing students, ultimately contributing to safer patient outcomes and better educational quality in resource-limited settings