Perceived Impact of High-Fidelity Simulation-Based Learning on Engagement and Motivation Among Undergraduate Nursing Students in Qatar

Abstract

Background

Simulation-based learning (SBL) bridges theoretical knowledge and clinical practice in nursing education. Although global studies support its benefits, evidence from Middle Eastern contexts is limited. This study explored how SBL influences nursing students’ engagement and motivation in Qatar.

Methods

A quantitative, cross-sectional survey was conducted with 312 undergraduate nursing students at a nursing education institution in Qatar. Stratified random sampling ensured representation across academic years. Participants had completed at least one structured high-fidelity, in-person group simulation that included prebriefing, enactment, and debriefing. Validated instruments measured perceptions of the SBL environment, engagement, and intrinsic and extrinsic motivation. Descriptive statistics, Pearson correlations, and multiple regression analyses were used to examine relationships and predictors.

Results

SBL demonstrated strong positive correlations with perceived engagement (r = .878, p < .001) and perceived motivation (r = .752, p < .001). Regression analysis revealed that perceived engagement was the strongest predictor of perceived SBL outcomes (β = 0.52, p < .001), followed by intrinsic motivation (β = 0.34, p < .01). Reliability analysis confirmed high internal consistency across all scales (Cronbach’s α > 0.95).

Conclusion

Perceived engagement emerged as the primary factor linking SBL to learning outcomes. The findings emphasize the need for simulation environments that promote active behavioral, cognitive, and emotional participation. Future research should examine instructional methods and repeated exposure to determine how ongoing simulation experiences sustain engagement and motivation among diverse nursing students.

Keywords

simulation-based learning nursing education engagement motivation Qatar

Introduction

Simulation-Based Learning (SBL) has become a cornerstone of contemporary nursing education, offering immersive environments where students can develop clinical reasoning, communication, and decision-making skills without risk to patients (Jeffries, 2020). Evidence shows that SBL enhances knowledge retention, clinical competence, and learner satisfaction, making it a powerful pedagogical strategy in preparing practice-ready nurses (Al-Hassan & Al-Omari, 2023; Cant & Cooper, 2017; Crowe et al., 2018).

In Qatar, where nursing education continues to expand in alignment with the workforce development goals outlined in the Qatar National Vision (QNV) 2030, SBL serves as a critical pedagogical bridge between theoretical instruction and clinical practice (Al-Hassan & Al-Omari, 2023; Wiseman et al., 2014). Institutions, such as the University of Calgary in Qatar, Qatar University, and the University of Doha for Science and Technology, have increasingly embedded simulation within undergraduate and postgraduate curricula. These efforts strengthen clinical competence and support professional readiness among nursing students (Loizou et al., 2024; Ziegler et al., 2025). Despite these advancements, limited empirical research has explored SBL’s impact on psychological and behavioral outcomes, specifically, student engagement and motivation, within Qatar’s distinct multicultural and multilingual educational context.

Engagement and motivation are recognized as central to academic persistence, skill mastery, and professional readiness (Doyle, 2023; Ryan & Deci, 2017). Engagement in SBL encompasses behavioral, emotional, and cognitive investment in learning activities (Wang & Ji, 2021) while motivation, particularly intrinsic motivation, drives persistence, self-regulation, and deep learning (Funao et al., 2025; Ryan & Deci, 2017). Together, these constructs influence how learners interact with simulation environments, reflect during debriefing, and translate experiences into clinical competence (Al-Hassan & Al-Omari, 2023; Alzahrani et al., 2024). According to Self-Determination Theory (SDT), environments that support autonomy, competence, and relatedness are most likely to foster intrinsic motivation and engagement (Ryan & Deci, 2017). In nursing education, such environments translate into active, student-centered learning experiences that prepare graduates for the complexity of clinical practice (Saeedi & Parvizy, 2019). Simulation-based approaches improve learning outcomes and increase student confidence in applying clinical judgment during practice (Cant & Cooper, 2017; Crowe et al., 2018).

SBL aligns well with these educational theories, particularly SDT, by immersing students in realistic scenarios that promote active participation, teamwork, and reflection (Cant & Cooper, 2017; Crowe et al., 2018). When implemented in accordance with the Healthcare Simulation Standards of Best Practice®, including structured prebriefing, skilled facilitation, and reflective debriefing, simulation enhances engagement, builds motivation, and provides opportunities for safe, repeated practice (INACSL Standards Committee et al., 2021, 2025). Faculty support, scenario authenticity, and resource adequacy have also been shown to strengthen these effects (Bayoumy & Alsayed, 2021).

In this study, perceived learning outcomes refer to students’ self-reported judgments about what they learned through simulation experiences. These perceptions capture cognitive, affective, and behavioral dimensions of learning, such as confidence, critical thinking, and readiness for clinical practice (Cant & Cooper, 2017; Levin et al., 2023). Measuring perceived outcomes offers valuable insight into how students internalize the effects of engagement and motivation when objective performance assessments are not available (Kim et al., 2022). Within SDT, perceived outcomes reflect a sense of competence and mastery, representing the internalization of motivation into meaningful learning experiences (Ryan & Deci, 2017; Torbergsen et al., 2023).

International studies demonstrate that SBL can significantly increase student engagement and intrinsic motivation by making learning relevant, interactive, and student-centered (Al-Osaimi & Fawaz, 2022; Tokan & Imakulata, 2019). However, Qatar’s nursing cohorts present unique challenges. Students come from diverse cultural and linguistic backgrounds, with varying levels of academic preparation. Cultural norms emphasizing deference to authority may discourage active questioning or participation in high-pressure scenarios (Chen et al., 2018; Nadolny & Halabi, 2016). Without culturally responsive design and skilled facilitation, these dynamics risk limiting the benefits of SBL.

Despite Qatar’s growing investment in simulation infrastructure, there is limited empirical evidence on how SBL affects student engagement and motivation in this context. Most regional research has focused on clinical skill acquisition and competence, leaving the psychological and behavioral dimensions of engagement underexplored (Al-Hassan et al., 2025; Sullivan et al., 2021). Recent reviews have emphasized that while SBL is gaining traction across Gulf Cooperation Council (GCC) institutions, its influence on learner motivation and sustained engagement remains insufficiently documented (Al-Hassan et al., 2025). Addressing this gap is vital to ensuring that simulation not only builds competence but also nurtures the motivation and engagement necessary for long-term professional growth and retention.

The aim of this study was to examine the relationship between SBL, student engagement, and motivation among undergraduate nursing students in Qatar, and to identify the strongest predictors of perceived learning outcomes. Recent studies in the Gulf region have emphasized that students’ perceptions of learning outcomes provide critical insight into the educational impact of simulation experiences, reflecting cognitive, affective, and skill-based dimensions of learning (Alharbi et al., 2024; Raman et al., 2024; Samir, 2025). These findings affirm the importance of examining perceived outcomes as indicators of simulation effectiveness within culturally diverse nursing education contexts.

Methods

Design

A quantitative, cross-sectional design was employed to examine relationships between SBL and students’ perceptions of engagement and motivation among undergraduate nursing students in Qatar (Creswell & Creswell, 2018). This design provided a snapshot of these constructs within a culturally diverse student population.

Setting

The study was conducted at a nursing education institution in Qatar that integrates simulation as a core pedagogical component of its undergraduate nursing curriculum.

Participants

A stratified random sampling strategy was used to ensure proportional representation of students from all four academic years of the undergraduate nursing program (Year 1 through Year 4). This approach captured the perspectives of learners at different stages of their education, ranging from foundational coursework to advanced clinical preparation, thereby enhancing the generalizability of findings. A total of 312 undergraduate nursing students were included in the sample, producing a response rate of 86 percent.

Eligibility criteria included current enrollment in the nursing program, completion of at least one structured SBL activity, and provision of informed consent. Students who were on academic leave or who had no prior simulation experience were excluded.

Ethical Considerations

Ethical approval was obtained from the Institutional Review Board of the participating institution (Ref. QNURS/2024/021). Participants received study information electronically and provided informed consent prior to completing the survey. No direct identifiers were collected. Responses were assigned numeric codes at the point of data export. IP addresses and metadata were disabled during survey collection. Data were stored in aggregated form on encrypted servers with access limited to the research team to ensure confidentiality. All data were anonymized and stored on encrypted servers to ensure confidentiality.

Simulation Context

All simulations were conducted in person using medium to high fidelity manikins in small groups of four to six students, with designated observers, structured prebriefing, scenario enactment, and debriefing. In this study, medium- and high-fidelity refer to the degree of realism achieved through manikins, environment, and facilitation, consistent with the Healthcare Simulation Dictionary definition of fidelity. (Batley-Heath, 2025; Kim et al., 2025).This survey assessed learners’ perceptions of the simulation curriculum rather than a single simulation event. In this program, students engage in multiple simulation scenarios that are progressively integrated across the academic years, beginning in the first year and continuing through the fourth year. These scenarios vary in complexity and are aligned with specific course outcomes at each level. As a result, participants’ responses reflect cumulative exposure to multiple simulation experiences across their academic trajectory. Small-group participation and trained faculty facilitation were emphasized to enhance engagement and reflective learning.

Instrument

Data were collected using the Comprehensive Healthcare Education Simulation Tool (CHEST), a recently validated instrument designed to capture multiple dimensions of SBL experiences (Al-Hassan et al., 2025). Unlike single domain scales used in previous research, CHEST integrates perceptions of realism, resource adequacy, and faculty support with measures of learner engagement, motivation, and the cultural relevance of simulation scenarios (Al-Hassan et al., 2025). Engagement was assessed through behavioral, cognitive, and emotional participation, and motivation was measured in terms of intrinsic and extrinsic drivers, consistent with SDT (Ryan & Deci, 2017). All items measured students’ perceptions of their experiences with SBL, engagement, and motivation using a five-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), and responses were summed within each domain to generate composite scores for analysis. Subscale scores are calculated by summing item responses within each domain, with higher scores indicating more positive perceptions. The SBL Environment subscale includes 20 items with scores ranging from 20 to 100. The Engagement subscale includes 10 items with scores ranging from 10 to 50. The Motivation subscale includes 10 items with scores ranging from 10 to 50. The total CHEST score, calculated by summing all 40 items, ranges from 40 to 200.

CHEST has demonstrated strong psychometric properties, with reported Cronbach’s alpha values above 0.95 across domains (Al-Hassan et al., 2025). In this study, pilot testing confirmed high internal consistency (α ≥ 0.85). Permission to use the CHEST instrument was obtained from the original developers. In addition, basic demographic information (age, gender, academic year, first language, and prior SBL exposure) was collected to contextualize responses and ensure representation across the student population.

Although the instrument did not include a specific item quantifying the number of simulation sessions completed, demographic data captured whether participants had previous simulation exposure prior to entering the program. This allowed differentiation between students who experienced multiple simulation activities throughout the curriculum and those with limited or single exposures. Given that simulation is embedded across the academic years, most respondents had participated in several scenarios, particularly students in Years 3 and 4.

Data Collection

Surveys were administered between March and May 2024 via an encrypted online platform. Participation was voluntary, and no incentives were provided. Reminder notifications were sent twice to maximize response rates.

Data Analysis

Data were analyzed using IBM SPSS Statistics version 28. Descriptive statistics summarized demographic variables and construct means. Reliability was assessed using Cronbach’s alpha (Tavakol & Dennick, 2011). Pearson correlations examined associations among SBL, engagement, and motivation, and multiple regression analysis tested the predictive influence of engagement and motivation on perceived learning outcomes. Statistical significance was set at p < .05 (Field, 2024).

Results

The results reflect students’ self reported perceptions of SBL, engagement, motivation, and their associated learning outcomes.

Sample Characteristics

A total of 312 undergraduate nursing students completed the survey (response rate = 86%). The majority were female (263; 84.3%). Most participants were between 18 and 24 years of age (211; 67.6%). Students were enrolled across all academic years: first year (50; 16.0%), second year (120; 38.5%), third year (111; 35.6%), and fourth year (31; 9.9%). More than half of respondents (162; 52.0%) reported previous SBL experience prior to entering the program. Regarding primary language, 128 students (41.0%) identified Arabic, 90 (29.0%) identified English, and 94 (30.0%) reported other languages such as Hindi, Urdu, Tagalog, and Malayalam. As illustrated in Figure 1, these demographic characteristics demonstrate a heterogeneous and representative sample of nursing students across academic years, gender, and linguistic backgrounds.

Figure 1.

Demographic profile of nursing student participants (N = 312).

Reliability of Instruments

Internal consistency reliability was assessed using Cronbach’s alpha. All survey scales demonstrated excellent reliability (Tavakol & Dennick, 2011). The SBL Environment scale showed a coefficient of 0.967, the Engagement scale 0.955, and the Motivation scale 0.953. When all 40 items were combined into a single measure, the overall Cronbach’s alpha was 0.981. All three scales exhibited excellent reliability coefficients, providing strong confidence in the internal stability of the CHEST instrument and supporting the validity of conclusions drawn from the study.

Descriptive Findings of SBL

Survey responses indicated consistently positive perceptions of SBL across domains. As shown in Table 1, students reported favorable ratings for the simulation environment, faculty support, cultural relevance, engagement, and motivation.

Table 1.

Distribution of Responses Across Major Constructs of Simulation-Based Learning (N = 312).

Domain	Strongly Disagree (%)	Disagree (%)	Neutral (%)	Agree (%)	Strongly Agree (%)
Simulation environment & resources	1.0	3.0	10.0	56.0	30.0
Faculty support & instruction	0.5	1.5	7.0	58.0	33.0
Cultural & contextual relevance	1.5	4.0	14.0	56.0	24.5
Impact on skills & confidence	0.8	2.0	6.5	54.5	36.2
Engagement	0.5	1.0	6.0	55.0	37.5
Motivation	0.7	1.8	7.5	53.0	37.0

Note. Percentages represent the proportion of participants selecting each response option on a five-point Likert scale (1 = Strongly Disagree to 5 = Strongly Agree). Minor rounding may cause totals to deviate slightly from 100 percent.

Relationships Among Perceived Engagement, Motivation, and SBL Environment

Pearson correlation coefficients were calculated to assess relationships among perceived engagement, motivation, and the SBL environment. Perceived SBL showed strong positive correlations with engagement (r = .878, p < .001) and motivation (r = .752, p < .001). Engagement and motivation were also positively correlated (r = .778, p < .001). Table 2 summarizes these statistically significant associations.

Table 2.

Pearson Correlation Coefficients Among SBL, Engagement, and Motivation.

Variable	SBL	Engagement	Motivation
SBL	1
Engagement	.878**	1
Motivation	.752**	.778**	1

Note. N = 312. **p < .001.

Predictors of Perceived Learning Outcomes

Multiple regression analysis examined how perceived engagement and perceived motivation predicted perceived learning outcomes in SBL. The model was statistically significant, F(2, 201) = 361.35, p < .001, indicating strong predictive validity. Together, perceived engagement and motivation explained 78% of the variance (R = .885, R² = .782, Adjusted R² = .780) in students’ perceptions of SBL outcomes. Engagement emerged as the strongest predictor (β = .740, B = .757, SE = .054, t = 14.14, p < .001), highlighting that students who perceived themselves as more engaged also perceived greater learning gains. Motivation contributed significantly (β = .177, B = .183, SE = .054, t = 3.38, p = .001), suggesting that while motivation reinforced engagement, it had a smaller independent effect (See Table 3).

Table 3.

Multiple Regression Predicting Perceived Learning Outcomes From Engagement and Motivation.

Predictor	B	SE	Beta	t	Sig.
(Constant)	0.224	0.160	–	1.402	0.162
Engagement	0.757	0.054	0.740	14.139	<.001
Motivation	0.183	0.054	0.177	3.376	.001

Model summary: R = .885, R² = .782, Adj. R² = .780, Std. Error = .298.

Discussion

This study provides initial empirical evidence that nursing students perceived SBL as an educational approach that supports engagement and motivation within Qatar’s diverse context. SBL was strongly associated with students perceived engagement (r = .878, p < .001), aligning with international findings that link well structured simulation environments with active, reflective, and emotionally meaningful learning experiences (Batley-Heath, 2025; Kaplan et al., 2025; Shin et al., 2023). Although the program used a mix of medium and high-fidelity simulations, the perceived authenticity of these experiences aligns with global literature showing that realistic and well facilitated scenarios, regardless of technology level, support emotional connection, motivation, and reflective participation (Chan et al., 2025; Wong et al., 2025). When simulations are facilitated in culturally responsive and psychologically safe settings, students perceive higher engagement and deeper reflection, both important for professional growth and clinical competence (Batley-Heath, 2025; Díaz-Navarro et al., 2024).

From the perspective of SDT (Ryan & Deci, 2017), the findings suggest that students perceived SBL as an environment that supports autonomy, competence, and relatedness, psychological needs that foster intrinsic motivation. Regression analysis revealed perceived engagement as the strongest predictor of perceived learning outcomes (β = 0.74), surpassing perceived motivation (β = 0.18). This pattern indicates that while motivation supports persistence, engagement, expressed through experiences such as problem solving, collaboration, and reflection, was most closely associated with students’ perceptions of meaningful learning. These elements were reflected in students’ overall engagement scores but were not separate subscales within the CHEST tool. In this sense, engagement appears to be the central mechanism through which students perceive the educational value of SBL. Only a limited number of items indirectly addressed experiences such as collaboration, interactive design, or structured debriefing. Consequently, the results should be interpreted as reflecting students’ overall perceptions of engagement and motivation rather than the impact of specific instructional techniques. Future research should include subscales or mixed methods designs to examine how distinct pedagogical elements contribute to perceived engagement and learning outcomes.

Perceived engagement was the strongest predictor of perceived learning outcomes, indicating that students who described themselves as more behaviorally, cognitively, and emotionally involved in simulation also reported greater perceived gains in learning and professional readiness (Saeedi & Parvizy, 2019). It is important to note that engagement and motivation were assessed based on cumulative perceptions rather than the frequency of simulation exposure. Although the survey distinguished between students with and without prior simulation experience, it did not quantify the number of sessions attended. Given that simulation activities are progressively integrated across the curriculum, senior students likely had greater exposure than junior students. This variability may have influenced perceptions of engagement and motivation. Future research should include frequency of simulation participation as a variable to determine whether repeated exposure further strengthens these perceptions. These results highlight that perceived engagement was the dominant factor shaping how students evaluated their simulation experiences. It is important to note that the CHEST tool measured engagement as a composite construct encompassing behavioral, cognitive, and emotional dimensions rather than discrete teaching strategies (Al-Hassan et al., 2025).

The findings are consistent with the Healthcare Simulation Standards of Best Practice® particularly the standards for Prebriefing, Facilitation, and Debriefing, which emphasize scenario authenticity, supportive guidance, and structured reflection (INACSL Standards Committee et al., 2021, 2025). Students perceived these elements as central to engagement and motivation in SBL. Faculty support emerged as a particularly strong factor in shaping perceived engagement, indicating that students valued instructors who created psychologically safe environments, provided constructive feedback, and guided reflection. These perceptions reinforce that the quality of simulation is influenced not only by technological fidelity but also by facilitation that aligns with learners’ developmental needs and cultural contexts.

Simulation fidelity and scenario complexity are frequently considered indicators of high-quality learning, yet students’ perceptions of authenticity may rely more on how well simulations align with their learning level and context (Alinier, 2011; Lioce et al., 2020). According to the Healthcare Simulation Dictionary (Lioce et al., 2020), fidelity is defined as the degree of realism achieved through equipment, environment, and participant engagement. Research suggests that excessive complexity can overwhelm learners, while overly simplified scenarios may reduce perceived engagement (Alinier, 2011). Psychological safety, defined as a climate in which learners feel free to take interpersonal risks without fear of negative consequences, has been shown to be a significant factor in simulation-based education (Lateef, 2020; Madsgaard & Svellingen, 2025). In the current study, students perceived supportive facilitation, clear expectations, and structured debriefing as conditions that enabled psychological safety and heightened engagement. These findings suggest that the quality of simulation is shaped not only by fidelity in general, which the CHEST tool does not measure directly, but also by how students experience authenticity, feedback, and inclusion within the learning environment (Al-Hassan et al., 2025).

The observed association between perceived faculty support and perceived engagement underscores the central role of educators in shaping students’ learning experiences. Within Qatar’s multilingual and multicultural classrooms, faculty serve not only as facilitators but also as cultural mediators and reflective guides. To meet these demands, faculty development should include training in intercultural communication, digital empathy, and trauma-informed pedagogy (Harder et al., 2021). Such competencies help educators create inclusive environments where students perceive equitable participation and psychological safety, key factors in sustaining engagement during SBL.

At the study site, SBL is fully integrated across the second to fourth years of the undergraduate nursing curriculum. Students participate in structured, scenario-based simulations using medium-to high-fidelity manikins within a dedicated simulation center equipped with control rooms and observation spaces. Each two-hour session follows a standardized structure of prebriefing, active scenario enactment, and guided debriefing. Simulations are conducted in small groups of four to six students to ensure balanced participation and peer observation. Faculty facilitators, many of whom hold Certified Healthcare Simulation Educator (CHSE) credentials from the Society for Simulation in Healthcare and Canadian Certified Simulation Nurse Educator (CCRNE) certification, are trained in accordance with the Healthcare Simulation Standards of Best Practice® (INACSL et al., 2021, 2025). They emphasize psychological safety, reflective dialogue, and cultural sensitivity. Each session begins with clear learning objectives and defined team roles to promote accountability and active engagement. Facilitators use open-ended questioning, immediate feedback, and guided reflection to reinforce autonomy and competence, two key components of SDT (Ryan & Deci, 2017). Post-simulation debriefings focus on self-assessment and peer dialogue rather than evaluation. Scenario complexity increases progressively across the curriculum, supporting learners’ developmental growth and confidence through repeated exposure. Assessment is formative, based on structured observation and feedback, reinforcing learning rather than grading. Collectively, these design elements appear to foster students’ perceived engagement and motivation through realism, collaboration, and guided reflection rather than performance pressure.

Faculty who facilitates simulation at the study site complete structured onboarding and continuing development focused on simulation pedagogy, psychological safety, and learner engagement. New instructors undergo an orientation program that includes observation of live sessions, participation in debriefing workshops, and mentorship from experienced simulation educators. All facilitators are encouraged to complete INACSL-sponsored professional development modules and simulation education certifications, including the CHSE (Society for Simulation in Healthcare (SSH), 2025) or the CCRNE (The Canadian Nurse Educators Institute (CNEI), 2025). Ongoing faculty workshops emphasize scenario design, intercultural communication, and trauma-informed teaching to align with Qatar’s multicultural learning environment. This systematic preparation ensures that facilitators maintain consistency in prebriefing, scenario delivery, and debriefing, creating a safe, engaging, and reflective learning environment for all students.

The multicultural and multilingual composition of Qatar’s nursing cohorts enriches peer learning but also presents challenges. Cultural norms that discourage questioning authority may limit participation (Chen et al., 2018), highlighting the importance of intentionally cultivating inclusivity and psychological safety within simulation settings. Evidence from the Middle East supports this context. For example, Saudi nursing students reported perceived increases in empathy and attitudinal shifts following culturally aligned simulation experiences (Shin et al., 2023), while Gulf-region nurses described heightened anxiety and the need for contextual adaptation in simulation-based education (Sullivan et al., 2021). At the institutional level, organizational commitment was perceived as critical for successful implementation of simulation, including adequate infrastructure, technical support, and faculty development (Benchadlia et al., 2023). A recent Gulf-country survey reported that nursing students’ mean attitude toward high-fidelity simulation was 68.26 and was unaffected by academic year or gender (Raman et al., 2024). Aligning simulation priorities with QNV 2030 may support simulation as both an educational and strategic initiative for building workforce readiness.

This study contributes to the limited regional literature by providing initial quantitative evidence of nursing students’ perceived psychological and behavioral benefits of SBL within Middle Eastern nursing education. While international studies have documented advantages of simulation, these findings extend that body of work by exploring how students in Qatar’s unique sociocultural and institutional context perceive engagement and motivation in relation to SBL. The results suggest that engagement functions as a central mechanism shaping students’ perceptions of learning effectiveness. These outcomes align with international recommendations to integrate simulation not only as a pedagogical strategy in undergraduate curricula but also as a foundation for ongoing professional development in nursing practice (Al-Hassan & Al-Omari, 2023).

Looking ahead, the results indicate that SBL may serve broader educational purposes beyond clinical skills training. Simulation-based experiences support interprofessional collaboration, ethical decision making, disaster preparedness, and culturally responsive patient care, as documented in recent simulation research (Diaz-Navarro et al., 2024; Kim et al., 2025; Sullivan et al., 2021). Through these applications, simulation may help prepare nursing graduates who are viewed as clinically competent and socially responsive, ready to contribute effectively within Qatar’s evolving healthcare system.

Implications for Practice

The findings of this study underscore the critical role of SBL as more than a supplemental activity; it should be considered a central pedagogical approach in nursing education. By fostering engagement and motivation, SBL helps students perceive greater confidence and opportunities to practice critical thinking and collaboration in preparation for competent nursing practice. Importantly, the strong influence of engagement on perceived learning outcomes highlights that effective simulation must prioritize interactive, student-centered design supported by skilled faculty facilitation.

Culturally responsive approaches are particularly vital in Qatar’s linguistically and culturally diverse classrooms. Faculty must serve not only as technical facilitators but also as cultural interpreters and emotional guides, ensuring psychological safety and equitable participation for all learners. Institutional commitment to simulation infrastructure, reliable technical support, and sustained faculty development programs is equally important to maximize the long-term benefits of SBL.

Beyond undergraduate education, the role of simulation extends into continuous professional development. As highlighted by Al-Hassan and Al-Omari (2023), simulation serves as a powerful tool for lifelong learning, supporting ongoing skill refinement, reflective practice, and excellence in nursing care. Integrating simulation across the continuum of nursing education, from foundational training to professional development, aligns with both international best practices and Qatar’s healthcare workforce priorities.

Taken together, these implications call for a holistic strategy that situates simulation at the core of nursing education and practice. Doing so will not only enhance immediate learning outcomes but also cultivate a culture of lifelong learning that empowers nurses to meet the evolving challenges of modern healthcare.

Limitations and Future Research

This study has several limitations. As data were collected from a single nursing institution in Qatar, the findings may not be generalizable to other contexts. Reliance on self-report measures also raises the possibility of response bias, and the cross-sectional design prevents causal inference. In addition, cultural and linguistic diversity within the sample may have influenced how students interpreted survey items, while faculty perspectives, central to effective facilitation, were not directly examined.

Participants represented different academic years, resulting in unequal exposure to simulation. Senior students experienced multiple high-fidelity simulations across the curriculum, whereas junior students engaged in fewer activities. This variability may have influenced perceptions of engagement, realism, and faculty support and should be considered when interpreting the findings. Because the study did not quantify the exact number of simulation sessions completed by each participant, it is not possible to determine how exposure frequency shaped engagement and motivation. These results add to existing evidence by demonstrating that structured simulation experiences, supported by skilled facilitation and psychological safety, are perceived as meaningful learning opportunities within Qatar’s multicultural nursing education context.

Future research should adopt longitudinal and mixed-methods designs to capture sustained effects of SBL, integrate observational and performance-based measures to enhance validity, and explore faculty experiences in greater depth. Comparative studies across diverse cultural and institutional settings would further clarify how SBL fosters engagement and motivation in global nursing education.

Conclusion

This study provides quantitative evidence that nursing students perceived SBL as an approach that enhances engagement and motivation within Qatar’s multicultural educational context. Perceived engagement emerged as the strongest predictor of perceived learning outcomes, underscoring its central role in shaping meaningful learning experiences. Perceived motivation reinforced this relationship but contributed less strongly.

Students’ perceptions suggest that engagement arises from active participation, collaboration, reflection, and problem-solving within realistic and psychologically safe simulation environments. Although institutional and faculty factors were not directly measured, participants’ responses imply that structured facilitation, inclusive teaching, and scenario authenticity are essential conditions for sustaining positive perceptions of engagement.

Integrating SBL throughout the curriculum and aligning it with established simulation standards can strengthen students’ perceived readiness for professional practice, including their perceptions of critical thinking, communication, and adaptability within Qatar’s evolving healthcare system.

Footnotes

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author received no financial support for the research, authorship, and/or publication of this article.

Informed Consent

Informed consent was obtained from all participants prior to data collection. Participants were informed of the study purpose, procedures, voluntary nature of participation, and their right to withdraw at any time without penalty. Consent was provided electronically before accessing the survey.

ORCID iD

Mohammed Adnan Al-Hassan

Author Biography

Mohammed Adnan Al-Hassan is an Assistant Professor in the Faculty of Nursing at the University of Regina. He has more than 20 years of experience in healthcare education, simulation-based learning, and curriculum innovation. His research and teaching interests focus on simulation education, interprofessional education, emergency nursing, and qualitative and quantitative methods. He holds a Doctorate in Management and Leadership and multiple simulation education certificates, and he contributes to international nursing education scholarship and professional communities.

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