Unlocking the power of reflection: how simulation debriefing shapes clinical decision-making and competence in nursing students

Abstract

Simulation debriefing is widely recognized as a critical component of simulation-based education, yet its specific contribution to clinical decision-making and competence development among undergraduate nursing students remains insufficiently explored. To examine the impact of simulation debriefing on clinical decision-making and nursing competence among nursing students and to determine whether clinical decision-making mediates this relationship. A multi-center, cross-sectional study was conducted among 650 third- and fourth-year undergraduate nursing students from two XX universities. Participants completed validated instruments assessing debriefing experiences, clinical decision-making, and nursing competence. Data were analysed using Pearson correlation, multiple regression analyses, and mediation analysis using the PROCESS macro. Students demonstrated moderately high levels of debriefing experience, clinical decision-making, and competence. Simulation debriefing showed strong positive associations with both clinical decision-making and competence. Regression analyses identified debriefing quality and clinical rotation frequency as strong predictors. Mediation analysis revealed a significant partial mediation effect, indicating that debriefing improves competence partly by strengthening clinical decision-making processes. Simulation debriefing plays a pivotal role in enhancing students' cognitive integration of simulation experiences, supporting the development of informed clinical judgment and competence. Strengthening debriefing practices is therefore essential for advancing simulation-based nursing education and supporting readiness for clinical practice.