Gail Johnson

Date of Award

January 2017

Document Type


Degree Name

Doctor of Philosophy (PhD)



First Advisor

Glenda Lindseth


Introduction: The literature is limited and conflicting regarding the effect of simulation fidelity on nurse performance during simulation. Limited publications were found that addressed all aspects of simulation in health care: mannequin, environment, equipment, scenario, and psychological.

Purpose: The purpose of this study was to examine the relationship between fidelity and nurse experience on performance in simulation. The NLN/Jeffries Simulation Framework provided the theoretical foundation for this study

Design and Sample: For this descriptive study, 35 registered nurses were randomly assigned to participate in a high fidelity or low fidelity simulation scenario. A 12-minute scenario was administered and identical for both groups. Fidelity level differences included mannequin type, equipment/environment, and psychological factors.

Methods: Nurse performance was measured by the Clinical Simulation Evaluation Tool (CSET). CSET scores were analyzed using independent t-tests for differences and two-way ANOVA to detect main effects and interaction between fidelity and experience. Pearson’s Correlation was used to determine correlation between demographic variables as well as between SDS score and fidelity level; T-tests were conducted to determine difference in SDS means between fidelity levels.

Results: There was no statistically significant difference in performance based on nurse experience alone (t = -1.50, p = .143). There was a statistically significant difference in performance based on fidelity level (t=5.02, p = .001) and a significant interaction effect between fidelity and experience (F(1,31) = 10.231, p = 0.003). SDS score correlated with fidelity level.

Implications: Results of this study have implications for undergraduate, graduate and continuing nursing education. Simulation is used frequently in nursing education and can be resource intensive. This study may provide information that will allow educators to choose the best level of fidelity for participants. Results will also contribute to the body of knowledge regarding the NLN/Jeffries Simulation Framework.