General self-efficacy, self-confidence, and satisfaction in simulation-based nursing education: a structural equation modeling and mediation analysis

Abstract

Simulation-based learning has become a fundamental component of nursing education, providing students with opportunities to develop clinical competence, critical thinking, and professional confidence in a safe learning environment. While learning satisfaction and self-confidence are recognized as key outcomes of simulation-based education, the extent to which general self-efficacy is associated with these outcomes remains insufficiently understood. This study examined the associations among general self-efficacy, self-confidence, and satisfaction with simulation-based learning among undergraduate nursing students. A cross-sectional study was conducted among undergraduate nursing students at King Saud University, Saudi Arabia. All enrolled nursing students were eligible to participate. A total of 209 complete responses were included in the final analysis. Satisfaction and self-confidence were measured using the Student Satisfaction and Self-Confidence in Learning Scale. General self-efficacy was assessed using the General Self-Efficacy Scale. Multiple linear regression identified factors associated with self-confidence and satisfaction, while structural equation modeling examined the hypothesized associations among latent constructs. Bootstrap mediation analysis was conducted to evaluate the indirect association between general self-efficacy and satisfaction through self-confidence. Our findings showed that general self-efficacy was positively associated with self-confidence ( β  = 0.715, p  < 0.001), and both general self-efficacy ( β  = 0.249, p  = 0.002) and self-confidence ( β  = 0.650, p  < 0.001) were positively associated with satisfaction. Students reporting a greater number of simulation sessions also demonstrated higher self-confidence ( β  = 0.352, p  = 0.002), whereas academic year was inversely associated with self-confidence ( β  = −0.233, p  = 0.037). Multiple linear regression produced findings consistent with the structural equation model. Mediation analysis showed a significant indirect association between general self-efficacy and satisfaction through simulation-related self-confidence (standardized indirect association = 0.465, p  < 0.001), alongside a significant direct association ( β  = 0.249, p  = 0.002). General self-efficacy and self-confidence were positively associated with nursing students’ satisfaction with simulation-based learning, with self-confidence demonstrating the strongest association and partially mediating the relationship between self-efficacy and satisfaction. Our findings highlight the importance of fostering students’ confidence and self-efficacy within simulation-based education. Because of the cross-sectional design, the observed relationships should be interpreted as associations rather than causal effects.