Simulator and Standardized Patient Training for Cardiopulmonary Examination Skills in Nursing Students (CPPE-Train)

From Skill to Confidence: The Multifaceted Role of Simulation in Nursing Students' Learning of Cardiac and Pulmonary Assessment

Cardiopulmonary physical examination is a fundamental nursing skill that is essential for the early recognition of patient problems and safe clinical decision-making. Nursing students often experience difficulties in developing competence and confidence in performing cardiac and pulmonary assessment skills during their early clinical education.

This quasi-experimental study aims to compare the effects of simulation-based training and standardized patient-based training on first-year nursing students' cardiopulmonary physical examination outcomes. The study will evaluate knowledge, clinical skill performance, learning satisfaction, self-confidence, and anxiety levels before and after the educational interventions.

Participants will be first-year nursing students enrolled in a health assessment course. Students will be assigned to either a simulation-based training group or a standardized patient-based training group. Data will be collected using knowledge tests, skill assessment checklists, satisfaction and self-confidence scales, and anxiety measures. The findings are expected to contribute to evidence-based nursing education by identifying effective teaching strategies for improving cardiopulmonary assessment competence among nursing students.

Study Overview

• Status: Not yet recruiting
• Conditions: Nursing Education
• Intervention / Treatment: Behavioral: Simulation-Based Training; Behavioral: Standardized Patient-Based Training

Detailed Description

Cardiopulmonary physical examination is one of the core clinical competencies expected of nursing students. Accurate assessment of cardiac and pulmonary functions is essential for identifying patient deterioration, supporting clinical decision-making, and ensuring patient safety. However, undergraduate nursing students frequently report difficulties in performing comprehensive physical examinations and often lack confidence in applying these skills in clinical settings.

Simulation-based education and standardized patient-based education are widely used experiential learning strategies in nursing education. Simulation provides a safe and controlled environment in which students can repeatedly practice assessment skills and receive feedback without risking patient safety. Standardized patient encounters, on the other hand, offer opportunities for realistic interpersonal communication and clinical interaction. Although both educational approaches are commonly used, evidence regarding their comparative effectiveness for teaching cardiopulmonary assessment skills remains limited.

The purpose of this quasi-experimental study is to compare the effects of simulation-based training and standardized patient-based training on cardiopulmonary physical examination outcomes among first-year nursing students. The study will examine differences in knowledge acquisition, clinical skill performance, learning satisfaction, self-confidence, and anxiety levels associated with the two educational methods.

Participants will be recruited from first-year undergraduate nursing students enrolled in a health assessment course. Eligible students who provide informed consent will be assigned to either a simulation-based training group or a standardized patient-based training group. Both groups will receive the same educational content related to cardiac and pulmonary physical examination, including inspection, palpation, percussion, auscultation, vital sign assessment, and clinical communication skills. The primary difference between groups will be the instructional method used during practical training.

Data collection will be conducted at multiple time points using validated measurement instruments. Knowledge regarding cardiopulmonary assessment will be evaluated through a structured knowledge test. Clinical performance will be assessed using standardized skill checklists developed for cardiac and pulmonary examination procedures. Student satisfaction and self-confidence will be measured using established nursing education scales, while anxiety levels will be evaluated using a standardized anxiety instrument.

The study aims to generate evidence regarding effective teaching strategies for developing cardiopulmonary assessment competence in undergraduate nursing education. The findings may contribute to curriculum development and support the selection of educational methods that enhance students' clinical skills, confidence, and preparedness for patient care.

• Study Type: Interventional
• Enrollment (Estimated): 90
• Phase: Not Applicable

Contacts and Locations

• Study Contact: Name: Nevin Uslu, PhD; Phone Number: 3567 +902482133500; Email: nuslu@mehmetakif.edu.tr

Study Locations

• Turkey (Türkiye)
  • Burdur, Turkey (Türkiye), 15030
    • Burdur Mehmet Akif Ersoy University Faculty of Health Sciences, Department of Nursing
    • Contact: nEVİN Uslu, PhD; Phone Number: 3567 +90 248 213 3500; Email: nuslu@mehmetakif.edu.tr
    • Principal Investigator: Nevin Uslu, PhD
    • Contact: Ayşe Uçak, PhD; Phone Number: +902482133500; Email: ayseucak@mehmetakif.edu.tr

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• First-year nursing students enrolled in the Nursing Department of the Faculty of Health Sciences during the 2025-2026 academic year.
• Enrolled in the Health Assessment I and II courses for the first time.
• Willing to participate and able to provide written informed consent.
• Agree to attend all educational sessions, including theoretical instruction and practical training.
• Agree to participate in all data collection procedures, including pre-test, post-test, and follow-up assessments.

Exclusion Criteria:

• Previous formal training in cardiopulmonary physical examination (e.g., summer school, certification course, or equivalent training).
• Transfer students admitted through horizontal or vertical transfer programs.
• Receiving ongoing psychological or psychiatric treatment for a diagnosed mental health condition, particularly anxiety-related disorders.
• Withdrawal of informed consent at any stage of the study.
• Absence from theoretical, simulation-based, or standardized patient training sessions.
• Incomplete or incorrectly completed study questionnaires or assessment forms.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: None (Open Label)

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Simulation-Based Training Group; Participants assigned to this group will receive cardiopulmonary physical examination training using a nursing simulation manikin in a simulated clinical environment. Training will include cardiac and pulmonary assessment skills, vital sign evaluation, and clinical communication practices.	Behavioral: Simulation-Based Training; Simulation-based training designed to improve nursing students' cardiopulmonary physical examination knowledge, skills, satisfaction, self-confidence, and clinical preparedness through structured practice using a nursing simulation manikin.
Active Comparator: Standardized Patient Training Group; Participants assigned to this group will receive cardiopulmonary physical examination training using standardized patients. Training will include cardiac and pulmonary assessment skills, vital sign evaluation, and clinical communication practices in a realistic patient interaction setting.	Behavioral: Standardized Patient-Based Training; Standardized patient-based training designed to improve nursing students' cardiopulmonary physical examination knowledge, skills, satisfaction, self-confidence, and clinical preparedness through structured interactions with trained standardized patients.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiopulmonary Physical Examination Skill Performance	Clinical skill performance scores obtained using a 27-item cardiopulmonary physical examination skills checklist. The checklist assesses students' performance in communication, vital signs assessment, inspection, palpation, cardiac auscultation, and pulmonary auscultation. Each item is scored on a 3-point scale (0 = not performed, 1 = performed incorrectly or incompletely, 2 = performed correctly and completely). Total scores range from 0 to 54, with higher scores indicating greater competence in cardiopulmonary physical examination skills.	Immediately after completion of the training intervention

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Cardiopulmonary Physical Examination Knowledge	Knowledge scores obtained from a 25-item multiple-choice test assessing theoretical knowledge related to cardiopulmonary physical examination. Scores range from 0 to 100, with higher scores indicating greater knowledge.	Baseline, immediately after training, and 1 month after training
Student Satisfaction With Learning	Learning satisfaction scores measured using the Student Satisfaction and Self-Confidence in Learning Scale developed by the National League for Nursing (NLN). Higher scores indicate greater satisfaction with the learning experience.	Immediately after training
Self-Confidence in Learning	Self-confidence scores measured using the Self-Confidence subscale of the Student Satisfaction and Self-Confidence in Learning Scale. Higher scores indicate greater confidence in performing cardiopulmonary assessment skills.	Immediately after training
State Anxiety Level	State anxiety scores measured using the State-Trait Anxiety Inventory (STAI). Higher scores indicate greater anxiety	Baseline, immediately after training, and 1 month after training

Collaborators and Investigators

• Sponsor: Burdur Mehmet Akif Ersoy University
• Investigators: Principal Investigator: Nevin Uslu, PhD, Burdur Mehmet Akif Ersoy University

Study record dates

Study Major Dates

• Study Start (Estimated): May 24, 2026
• Primary Completion (Estimated): June 1, 2026
• Study Completion (Estimated): July 1, 2026

Study Registration Dates

• First Submitted: June 2, 2026
• First Submitted That Met QC Criteria: June 2, 2026
• First Posted (Actual): June 5, 2026

Study Record Updates

• Last Update Posted (Actual): June 5, 2026
• Last Update Submitted That Met QC Criteria: June 2, 2026
• Last Verified: June 1, 2026

More Information

Terms related to this study

• Keywords: Nursing Education, Simulation-Based Training, Standardized Patient,Cardiopulmonary Assessment
• Other Study ID Numbers: MAKU-NURS-CPPE-2025-001; 1144-MP-25 (Other Grant/Funding Number: Burdur Mehmet Akif Ersoy University Scientific Research Projects Coordination Unit)

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No