Effectiveness of high-fidelity simulation interventions in enhancing interpersonal skills in nurse-patient relationships among undergraduate nursing students: A systematic review

Aim: To identify and summarise evidence on the effectiveness of high-fidelity simulation in developing interpersonal skills in undergraduate nursing students, including verbal and non-verbal communication, empathy and active listening. Background: High-fidelity simulation is widely adopted in nursing education to support interpersonal skills required for effective nurse–patient relationships, but it remains unclear which simulation design features most effectively foster interpersonal skill development. Design: Systematic review and narrative synthesis following the Joanna Briggs Institute (JBI) methodology for reviews of effectiveness and reported according to the PRISMA checklist. Methods: The search was conducted across five databases, including RCTs and quasi-experimental studies involving nursing students. Methodological quality was appraised using the JBI checklists and data were extracted and narratively synthesised according to review objectives. Results: Nineteen studies met inclusion criteria, involving standardised patients (n = 10), immersive virtual reality (n = 6) and manikin-based simulation (n = 3). Communication and active listening were most frequently assessed (68.4%). Improvements across all interpersonal skills were reported with standardised patients and immersive virtual reality, while manikin-based studies showed improvements only in verbal communication. However, most studies used single-session exposure, none reported scenario validation and only six incorporated a pedagogical framework. Outcome measurement was heterogeneous and often lacked evidence of psychometric robustness. Conclusions: High-fidelity simulation, particularly standardised patients and immersive virtual reality, shows potential for enhancing interpersonal skill development in undergraduate nursing education. Future research should invest in developing high-quality, standardised simulation interventions grounded in validated scenarios, reliable measurement tools and coherent pedagogical frameworks to ensure alignment between learning objectives and outcomes.