Simulator and Standardized Patient Training for Cardiopulmonary Examination Skills in Nursing Students

From Skill to Confidence: The Multifaceted Role of Simulation in Nursing Students' Learning of Cardiac and Pulmonary Assessment

Cardiopulmonary physical examination is a fundamental nursing skill that is essential for the early recognition of patient problems and safe clinical decision-making. Nursing students often experience difficulties in developing competence and confidence in performing cardiac and pulmonary assessment skills during their early clinical education.

This quasi-experimental study aims to compare the effects of simulation-based training and standardized patient-based training on first-year nursing students' cardiopulmonary physical examination outcomes. The study will evaluate knowledge, clinical skill performance, learning satisfaction, self-confidence, and anxiety levels before and after the educational interventions.

Participants will be first-year nursing students enrolled in a health assessment course. Students will be assigned to either a simulation-based training group or a standardized patient-based training group. Data will be collected using knowledge tests, skill assessment checklists, satisfaction and self-confidence scales, and anxiety measures. The findings are expected to contribute to evidence-based nursing education by identifying effective teaching strategies for improving cardiopulmonary assessment competence among nursing students.

Cardiopulmonary physical examination is one of the core clinical competencies expected of nursing students. Accurate assessment of cardiac and pulmonary functions is essential for identifying patient deterioration, supporting clinical decision-making, and ensuring patient safety. However, undergraduate nursing students frequently report difficulties in performing comprehensive physical examinations and often lack confidence in applying these skills in clinical settings.

Simulation-based education and standardized patient-based education are widely used experiential learning strategies in nursing education. Simulation provides a safe and controlled environment in which students can repeatedly practice assessment skills and receive feedback without risking patient safety. Standardized patient encounters, on the other hand, offer opportunities for realistic interpersonal communication and clinical interaction. Although both educational approaches are commonly used, evidence regarding their comparative effectiveness for teaching cardiopulmonary assessment skills remains limited.

The purpose of this quasi-experimental study is to compare the effects of simulation-based training and standardized patient-based training on cardiopulmonary physical examination outcomes among first-year nursing students. The study will examine differences in knowledge acquisition, clinical skill performance, learning satisfaction, self-confidence, and anxiety levels associated with the two educational methods.

Participants will be recruited from first-year undergraduate nursing students enrolled in a health assessment course. Eligible students who provide informed consent will be assigned to either a simulation-based training group or a standardized patient-based training group. Both groups will receive the same educational content related to cardiac and pulmonary physical examination, including inspection, palpation, percussion, auscultation, vital sign assessment, and clinical communication skills. The primary difference between groups will be the instructional method used during practical training.

Data collection will be conducted at multiple time points using validated measurement instruments. Knowledge regarding cardiopulmonary assessment will be evaluated through a structured knowledge test. Clinical performance will be assessed using standardized skill checklists developed for cardiac and pulmonary examination procedures. Student satisfaction and self-confidence will be measured using established nursing education scales, while anxiety levels will be evaluated using a standardized anxiety instrument.

The study aims to generate evidence regarding effective teaching strategies for developing cardiopulmonary assessment competence in undergraduate nursing education. The findings may contribute to curriculum development and support the selection of educational methods that enhance students' clinical skills, confidence, and preparedness for patient care.

Inclusion Criteria:

• First-year nursing students enrolled in the Nursing Department of the Faculty of Health Sciences during the 2025-2026 academic year.
• Enrolled in the Health Assessment I and II courses for the first time.
• Willing to participate and able to provide written informed consent.
• Agree to attend all educational sessions, including theoretical instruction and practical training.
• Agree to participate in all data collection procedures, including pre-test, post-test, and follow-up assessments.

Exclusion Criteria:

• Previous formal training in cardiopulmonary physical examination (e.g., summer school, certification course, or equivalent training).
• Transfer students admitted through horizontal or vertical transfer programs.
• Receiving ongoing psychological or psychiatric treatment for a diagnosed mental health condition, particularly anxiety-related disorders.
• Withdrawal of informed consent at any stage of the study.
• Absence from theoretical, simulation-based, or standardized patient training sessions.
• Incomplete or incorrectly completed study questionnaires or assessment forms.