Alrashidi et al. BMC Medical Education (2023) 23:815 https://doi.org/10.1186/s12909-023-04793-1 RESEARCH Effects of simulation in improving the self- confidence of student nurses in clinical practice: a systematic review Nojoud Alrashidi 1* , Eddieson Pasay an 2 , Maha Sanat Alrashedi 1 , Aidah Sanad Alqarni 2 , Ferdinand Gonzales 2 , Enas Mohammed Bassuni 2 , Petelyne Pangket 1 , Lorraine Estadilla 2 , Lizy Sonia Benjamin 2 and Kawther Elthayeb Ahmed 2 Abstract Background Considering the positive influence of simulation from previous literature may encourage educa- tors to regard it as a valuable teaching strategy in nursing schools. This literature review aims to investigate whether the use of simulation improves undergraduate nurses’ self-confidence during clinical practice. Methodology This study employed a literature-based design. Five academic databases, including CINAHL, EBSCO, ProQuest, PubMed and Medline, were utilised to extract relevant studies using appropriate keywords and Boolean operators. Studies published in the last 15 years (2005–2020) were included in the search. Studies were retrieved using the Exclusion and Inclusion criteria. The Critical Appraisal Skills Programme (CASP) was used to critically appraise the studies. Results A total of 15 primary research studies were extracted for review. Four major themes emerged from the review: Improved self-confidence to carry out clinical tasks, Increased ability to work in teams, Improved self- confidence to perform community work and Improved self-confidence in communicating with patients and team members. Conclusion Clinical simulation is a useful tool in increasing the self-confidence of nursing students to perform clinical tasks, make clinical judgements, communicate with patients and team members and improve their team- work. To improve the quality of care received by patients, it is recommended that clinical simulations be integrated into the nursing curriculum in Saudi Arabia. Increasing the confidence of students has been shown to be associated with greater confidence in performing clinical tasks. Keywords Simulation, Self-confidence, Student nurses, Clinical practice Introduction Nurse educators view repetitive simulation as a benefi- cial teaching strategy for supporting students’ learning objectives [1]. It provides an experiential environment that eases the feeling of pressure while on placement [2]. As an innovative method of teaching using simulation- based clinical education, nursing students are provided the opportunity to hone their clinical and decision- making abilities through a variety of real-life situational Open Access © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecom- mons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. BMC Medical Education *Correspondence: Nojoud Alrashidi Nojood202223@gmail.com 1 College of Nursing, University of Hail, Hail City, Saudi Arabia 2 College of Nursing, King Khalid University, Abha, Saudi Arabia