Exploring simulation as a teaching pedagogy for male undergraduate nursing students: A Qualitative Study in the United Arab Emirates

Introduction

Increased knowledge, improved satisfaction with skill performance, and improved critical thinking and self-confidence in the students’ skill set were the goals of the educational outcomes. Nursing education includes both theoretical and practical instruction to educate students in nursing. Developing knowledge and clinical skills depends on the time allotted to teaching and clinical practice and the content of both. Simulation is how we attempt to attain outcomes that closely resemble clinical practice (Khan et al., 2022). It is a nursing instructional strategy that simulates patient care experiences by re-enacting scenarios or real-life circumstances. It offers nursing students and working nurses a secure and regulated setting to develop their clinical expertise. Simulation can help students gain knowledge, hone their clinical reasoning abilities, and become capable of caring for patients and their families in a complicated healthcare setting (Aebersold, 2018). Over time, its technology has advanced significantly, allowing for replicating complex patient scenarios and conditions through high-fidelity manikins and simulated environments (Herrera-Aliaga & Estrada, 2022).

In nursing education, simulation allows students to practice in a safe setting. Simulations are valuable because they give students real-world experience and allow them to reflect on their learning while playing various roles (Haddeland et al., 2021). Simulations teach students to share responsibility, encourage one another, give constructive criticism, communicate clearly, and be honest about negative experiences (Jeffries, 2022). In higher education, simulation-based learning substantially contributes to student-centered, collaborative, active, and interprofessional learning (Glavin, 2009).

Various sources emphasized the value of simulation as a training method that offers a secure, authentic setting to improve learning and develop nursing abilities, along with how these skills can affect critical thinking, judgment, problem-solving, and self-confidence. Additionally, the experiences of male nursing students exposed to lab training using high-fidelity simulation has been reported earlier by the same authors. Furthermore, simulation has proven to be an effective tool for instruction in nursing as an interactive teaching method (Khan et al. 2022). A study had the same result (Smith, Jordan, & Li, 2022). According to other research, clinical internships and simulation exercises are closely related examples of how practical teaching and learning form the foundation of nursing education (Dias et al., 2023; Ahmed et al., 2025). The capacity to identify symptoms, conduct evaluations, and take necessary action was displayed for others to observe and evaluate (Peachey, 2021). Simulation made clinical judgment on subscales, including observing, interpreting, responding, and reflecting (Ayed et al., 2022). However, prior research has concentrated on how students respond to negative emotions when learning through simulation (Ko & Choi, 2020). However, when it comes to encouraging learning, positive emotions work better than negative ones (Keskitalo & Ruokamo, 2021). The students experienced positive and negative emotions during the simulation (Salo et al., 2025). Teachers should therefore be mindful of the stressors in the simulation scenario, such as sensitivity in interpersonal interactions, unfamiliarity with new learning methods, the weight of being observed, and dread of evaluation (Ko & Choi, 2020).

More male nursing students are enrolling in educational institutions in the United Arab Emirates (Subu et al., 2022). However, the number of real-world training opportunities available for these students is not keeping up with the increasing demand. Simulation as a teaching pedagogy is essential to integrate nursing students into the field and provide them with the necessary skills (Rattani et al., 2020). The maternal health course has presented several difficulties as male students register in nursing programs. In addition, because of cultural restrictions that prevent them from entering the maternity hospital, nursing faculty find it challenging to locate suitable practice opportunities in obstetrics for male baccalaureate nursing students due to the conservative Arab culture. Students were given simulated experiences to gain the skills required for the course, such as maternal health, to overcome these cultural barriers to clinical learning and guarantee that they met the maternal course competencies.

Methods

Data analysis

This study adopted a thematic analysis and adhered to the six data analysis phases described by Braun and Clarke (2006)( Figure 1). The thematic analysis objective is to identify data patterns pertinent to the study’s purpose. Phase one (phase familiarization) involved verbatim transcriptions of every interview. This study conducted all the FGDs and interviews in English.

Figure 1. Phases of thematic analysis (Braun & Clarke, 2006).

At this stage, notes were taken as a beginning point. We created initial codes in step two by performing line-by-line coding, marking, and assigning codes to essential information from the raw data. In the third phase, known as ‘searching for themes,’ all codes are input into a different spreadsheet, where all authors assess and discuss them to find and classify similar codes into themes. In step four, we review the themes to determine their validity in terms of internal homogeneity. We have regular meetings throughout this stage to discuss the data and make any necessary revisions. To ensure the themes relate to the data and make the themes and their connections more straightforward, we reviewed all the data again in phase five (defining and naming themes). Our findings are presented in a document generated in the last phase (phase six, creating the report). Braun and Clarke (2006) state that the writing moved from data summaries to analytical tales.

Ethical consideration

The University of Sharjah’s Research Ethics Committee (REC) REC-23-02-27-02-S approved this research project.

Participants received a thorough explanation of the research prior to the interview. Every student participating in the study was aware of its purpose and methodology. Prior to each interview, we gave each participant signed informed consent. They received guarantees regarding the study’s secrecy and anonymity. Students who participated in the study were informed that it was entirely voluntary and that they might leave at any moment. Furthermore, their grades were unaffected by their involvement in this study. To ensure that every participant felt at ease and secure, we chose interview settings for this study that could offer seclusion and silence. Furthermore, none of the participants in this study were paid directly for their time.

Study rigor

A participant’s private information disclosed to a researcher is considered confidential. There are restrictions on when and how it can be shared with a third party. Without their explicit consent, study participants were guaranteed that their data would remain anonymous. Keeping a person’s name apart from their involvement in a study is known as anonymity, and no names were used in this study. Each participant was assigned A random alpha-numeric code so that no one could associate a transcription with a specific participant (P1 for Participant 1). A password-protected private computer was used to download the digitally recorded interviews. Researchers should always be the only ones handling the interview material, including the recordings and transcriptions. All private information and documents were secured in the University of Sharjah’s chief researcher’s office. Data were stored for five years after the study ended, and then the material was destroyed (tapes were demagnetized and transcriptions were shredded).

Results

In this study, forty-three male students, aged between 19 and 23, participated. All verbatim transcripts from the interviews were thoroughly read and extensively discussed with all authors. Two focus group interviews were conducted in a virtual meeting for the study. Six students participated in the first FGD in the fourth year, while the second FGD included five participants from the third year. The interviews’ audio recordings were fully transcribed, and transcripts of the interviews were checked against written summaries of the contributions made by each interviewer. After reviewing the transcripts, we identified four major themes: 1) Students’ perceptions of simulation, 2) Preparation for realistic situations, 3) Feeling of anxiety and stress, and 4) Theory and practice abilities gaps.

Discussion

In this study, we found that male participants generally had a positive perception of the objectives and information provided during the simulation. These results suggest that the simulation design provided a supportive learning environment, with participants feeling that their needs were recognized and that support was available on time. The male student participants felt the support provided was effective in helping them learn and problem-solve during the simulation. Using simulation as a teaching tool can help by giving students realistic chances to participate in learning activities that call for making their own clinical decisions and seeing the outcomes of their answers in a secure setting (Newton & Krebs, 2020; Saifan et al., 2021). Faculty can detect knowledge and education gaps through simulation, and students can remark on what happened during the simulation experience (Ali & Musallam, 2018; Gantt et al., 2018).

Simulation has increased nursing students’ confidence, which was not previously known in the literature (Malya et al., 2025). According to earlier studies, simulation helped nursing students become more competent and confident by providing them with safe practice (Khan et al., 2022; Dias et al., 2024a). Given that pre-service education frequently lacks opportunities for practical experience, these findings are novel and pertinent, indicating that simulation can boost students’ confidence in providing first neonatal care (Khan et al., 2022; Al Gharibi and Arulappan, 2020; Bailey & Emory, 2022). It is crucial to impart information and competence to students during their education (Kruk et al., 2018). To prepare students to become competent professionals who can improve the quality of neonatal care in settings with a high neonatal mortality rate, it is essential to use simulation to increase their procedural confidence (Khan et al., 2022; Tjoflåt, Koyo, & Bø, 2021; Dias et al., 2024b). Furthermore, during simulation practice, students’ physiological stress and anxiety levels rise, which may impact their performance in real-world scenarios and simulations (O’Regan, Ekelund, & Watterson, 2022).

Simulation is important since it prepares for realistic situations. Simulation allows nursing faculty to replicate the clinical environment, immersing students in a nonthreatening, guided learning experience. Our findings indicated that most male students indicated that simulation is a way to prepare for realistic situations in clinical settings. Salo et al. (2025) believe that better instruction and greater student satisfaction in simulation-based learning can result from acknowledging and treating students’ emotions. To achieve the optimal learning results, nursing students must improve their practical competence and be ready to work in relationships with people who have not had exposure to the maternal health setting. The study participants indicated that the simulation experience was supportive and provided feedback. Also, the simulation was well-designed to provide participants with the necessary support and feedback to learn and apply new skills effectively in real situations in clinical settings. According to research, simulation can help students gain clinical reasoning abilities and knowledge while preparing them to provide patient and family care in a complicated healthcare setting (Aebersold, 2018). Following best practice recommendations is necessary for simulation to effectively replace or supplement traditional clinical experiences (Newton & Krebs, 2020). Nursing students saw simulation as a helpful way to prepare for and enhance clinical practice (Furuheim & Lindenskov, 2025).

Research on the emotional experiences of nursing students during simulation has shown that they go through a range of coexisting and fluctuating feelings, such as pleasurable and unpleasant (Salo et al., 2025; Madsgaard et al., 2022). However, most research has been on how nursing students respond to negative emotions when learning through simulation (Ko & Choi, 2020). Our results showed that several students experienced stress and anxiety during simulation exercises. Emotions also impact how information is encoded, retrieved, and used to solve problems (LeBlanc & Posner, 2022). According to Caloca-Amber et al. (2024), emotional control, tension, worry, and self-assurance can impact learning outcomes, knowledge, and abilities. Unpleasant feelings like tension and worry interfere with students’ ability to study (Salo et al., 2025; Amimaruddin & Ruditaldris, 2022). Proper preparation, including outlining the learning objectives, can increase psychological safety and lessen students’ fear, improving their educational experiences (Somerville et al., 2023). According to Roh and Jang (2017), students frequently feel stressed during simulations, vulnerable, and at high risk of making mistakes or coming off as insufficient. Effective learning requires addressing this problem, and simulation is essential. The students felt the stress of being watched and assessed by facilitators and observers. According to studies, students experience stress and anxiety when participating in a simulation (Tosterud et al., 2020). Since emotions greatly influence learning, it is critical to examine nursing students’ feelings during simulation (Madsgaard et al., 2022). Students can be better prepared for problems in the workplace, and a supportive learning environment can be created by acknowledging and treating their emotions. Training professionals with emotional intelligence can help them become well-prepared (Ahn et al., 2023). According to He et al. (2024), students’ subjective emotions are crucial in perceiving and engaging with their learning environment. The students’ past experiences and knowledge should be the foundation for this. Through carefully thought-out briefings, the facilitator can lower stress levels by acquainting students with the simulation room, the simulator’s capabilities, and the facilitator’s expected role throughout the simulation. A thorough briefing can avoid misunderstandings during the simulation (Rattani, 2020). Simulation-based learning can be stressful and challenging, impacting learning (LeBlanc & Posner, 2022). It elicits strong student emotions (Behrens et al., 2021). With various professional groups and patients, students take on various responsibilities and engage in collaborative learning (MacLean et al., 2019). In this situation, group skills and emotional control are crucial. Simulations elicit both positive feelings (like surprise and attention) and negative emotions (like dread and anxiety) in nursing students, according to other studies (Madsgaard et al., 2022). In a simulated environment, students who experience less anxiety might perform better clinically (Al-Ghareeb, McKenna, & Cooper, 2019). Positive simulation progress experiences heighten positive emotions like confidence, serenity, and a sense of competence, which are thought to affect learning positively. On the other hand, students who felt like they had failed at simulations experienced negative emotions such as stress, worry, fear, despair, and uneasiness. This made them doubt their ability to perform in the future and was thought to have a detrimental effect on their learning (Behrens et al., 2021). Positive emotions are generally better at fostering learning than negative ones (Keskitalo & Ruokamo, 2021). Simulations have emerged as a helpful tool for practicing the application of academic information in real-world skill-use scenarios.

The ability of nursing students to integrate classroom knowledge and apply it to clinical practice must be strengthened by nursing instructors. Thus, the theory-practice gap in education may be closed by repeatedly using simulation games and virtual simulation to approximate theory-based teaching practices (Dias et al., 2023). In nursing education, the theory-practice gap is a significant issue. Nurse educators frequently find it challenging to incorporate theoretical knowledge into their lessons. Educators or mentors may either not know which theoretical knowledge student educators have learned, or their priorities for teaching are inconsistent with the knowledge learned in university. Commonly employed in the simulation phase, pedagogical techniques like debates, reflections, critical thinking, and reasoning are underutilized in many low-income higher health education institutions (Bø et al., 2022; Tjoflåt, Koyo & Bø, 2021).

The gap between theory and practice, a lack of resources, and a lack of experience with the medical environment are some of the many challenges nursing students have in the clinical context (Panda et al., 2021). Li et al. (2022) assert that simulation-based education is a practical pedagogical approach for nursing students. A secure and regulated framework provides students an intense clinical setting for skill development and experiential learning (Tamilselvan et al., 2023). This educational method fosters the development of several competences, including knowledge, skills, interprofessional collaboration, critical thinking, empathy, and a passion for learning (Rattani, 2020, Tamilselvan et al., 2023). Furthermore, students can implement the concepts acquired in intricate and demanding scenarios (Chernikova et al., 2020). A recent meta-analysis revealed that simulation enhances nursing students’ knowledge acquisition more effectively than computer-based simulation. In nursing education, the combination of simulation and computer-based simulation is the most prevalent blended learning methodology (student stressors).

Combining theoretical knowledge with practical skills is crucial for patient care, and simulation discussions promote students’ reflection, critical thinking, and reasoning (Bailey & Emory, 2022).

The study results showed that participants believed simulation is about preparing for real life and realistic situations. The simulation sessions helped students handle emergency obstetric situations and prepared them for upcoming events (Khan et al., 2023). The study also identified several new issues that will be considered, such as the gap between theoretical knowledge and practical abilities and the need for more practice time in simulation labs. Simulation-based learning methods are becoming increasingly popular in nursing education to mimic real-life conditions (Somerville et al., 2023). They can offer an alternative to realistic and real-life situations in clinical encounters (Leighton et al., 2021). Simulation helps students adapt to professional occupations and prepares them for real-life situations (Mishra, Hemlata & Trivedi, 2023). Students in this study reported that simulation aided their skill development and knowledge transfer during neonatal resuscitation. These findings consistently show that simulation enhances practicing proficiency, skills, and confidence (Alalhareth & Howarth, 2020; Mishra, Hemlata, & Trivedi, 2023). The study’s findings support the idea that simulation is an effective teaching strategy that can help students put theory into practice (Wong & Kowitlawakul, 2020). In addition, during neonatal emergencies, such as breathing difficulties after birth, effective communication was enabled through calls, shouts for help, interactions, and role allocation—skills essential for successful interprofessional teamwork (Khan et al., 2023). These scenarios’ actions are consistent with earlier research showing that simulation enhances students’ teamwork and communication skills (Hustad et al., 2019).

Conclusion and recommendation

The study findings indicate that male nursing students received the overall simulation experience well. However, it can be ameliorated by promoting active learning and integrating simulation-based learning with clinical practice. The study highlights the importance of skilled and encouraging simulation instructors who can provide participants with valuable guidance and feedback and the need for more individualized teaching. These results provide important new information about how simulation-based learning could improve nursing education and further studies in this field. Furthermore, the findings shed light on the problems that male nursing students have been dealing with for years and highlight efforts to make changes as soon as feasible. Based on the study results, it may be helpful to revise the simulation to provide more opportunities for independent problem-solving skills and to incorporate more real-life factors and variables into the scenario. Developing more individualized approaches to building self-confidence may be helpful, such as providing personalized feedback and guidance based on each student’s strengths and weaknesses. Incorporating more opportunities for reflection and self-assessment may also help build self-confidence.