Effectiveness of simulation-based neonatal resuscitation training in improving nursing students’ knowledge and cognitive clinical decision-making: A quasi-experimental controlled study in Morocco

Abstract

Simulation-based learning has emerged as an effective educational strategy for neonatal resuscitation training; however, evidence from low- and middle-income countries remains limited. This prospective quasi-experimental controlled study evaluated the effectiveness of simulation-based neonatal resuscitation workshops, combined with conventional teaching, in improving theoretical knowledge and cognitive clinical decision-making among undergraduate nursing students. Thirty-three fifth-semester emergency and intensive care nursing students from a Moroccan higher institute of nursing participated in the study. Seventeen students received simulation-based workshops following conventional theoretical and practical instruction, whereas sixteen received conventional instruction alone. Learning outcomes were assessed using a study-specific written questionnaire administered before and after the intervention. Based on the responses collected in the present study, the questionnaire demonstrated good internal consistency (KR-20 = 0.735). Because questionnaires were completed anonymously, individual pre-test and post-test responses could not be matched; therefore, between-group comparisons were performed using Welch’s independent-samples t-test, and effect sizes were estimated using Hedges’ g. Baseline scores were comparable between groups (8.71 ± 2.05 vs. 8.66 ± 1.57; p = 0.938). Following the intervention, the simulation group achieved significantly higher post-test scores than the comparison group (15.09 ± 1.73 vs. 12.13 ± 1.36; mean difference = 2.96 points; 95% CI: 1.86–4.07; p < 0.001; Hedges’ g = 1.85), with greater absolute (+6.38 vs. +3.47 points) and normalized (0.565 vs. 0.306) learning gains. These findings indicate that simulation-based neonatal resuscitation workshops, when combined with conventional teaching, improve immediate theoretical knowledge and cognitive clinical decision-making more effectively than conventional teaching alone. Because practical performance was not objectively assessed, these findings should not be interpreted as evidence of improved clinical competence. Further randomized studies incorporating objective practical assessments and long-term follow-up are warranted.