Simulation-based patient safety training, performance outcomes, and cultural influences among nursing students: A mixed-methods study

Background: Simulation-based education effectively develops patient safety competencies in nursing students; however, cultural and religious backgrounds may influence learning outcomes, warranting further investigation. Design: A mixed-methods study. Methods: Of 71 invited second-year nursing students, 45 (63%) completed presimulation surveys, 23 participated in two simulation scenarios, and 42 (59%) completed postsimulation surveys. Students performed IV cannulation and medication administration scenarios, with deliberate errors introduced in the second scenario. The modified Health Professional Education in Patient Safety Survey (H-PEPSS) assessed confidence across nine domains. Results: Postsimulation confidence increased slightly across domains except the domain “effective communication”. Only 44% of students took corrective action when errors were detected. Cultural differences emerged: postsimulation, religious students rated clinical safety (4.5 vs. 4.9, p < .01) and effective communication (4.4 vs. 4.7, p < .05) significantly lower than nonreligious students. Qualitative findings revealed students valued safe error-making environments and experienced varied emotional responses. Conclusion: Nursing education programs should integrate patient safety training into simulation curricula, with particular attention to cultural sensitivity and diverse learning needs.