The effect of high-fidelity simulation with live actors on nursing students’ communication self-efficacy: a pre-post intervention study

Effective communication is essential for safe and patient-centered care, particularly in intensive care units (ICUs), where interactions with critically ill patients and their families are emotionally demanding. Nursing students often lack confidence in such high-stakes communication, and culturally tailored educational strategies are limited in Saudi Arabia. This study evaluated the effectiveness of High-Fidelity Simulation (HFS) with live actors on nursing students’ communication self-efficacy in ICU settings. A one-group pre–post repeated-measures study was conducted with 50 fourth-year nursing students at a public university in Saudi Arabia, with assessments at four time points. Participants completed two HFS sessions with live actors portraying patients’ families, followed by ICU clinical placements. Self-efficacy was measured using the 10-point SE-12 scale at four time points: T0 (pre-simulation), T1 (post 1st HFS-LA), T2 (post 2nd HFS-LA), and T3 (post-ICU placement). Repeated-measures ANOVA with Greenhouse–Geisser correction analyzed changes over time. Mean self-efficacy scores increased from T0 = 7.33 (SD 1.81) to T1 = 7.91 (SD 1.76), T2 = 8.39 (SD 1.57), and T3 = 8.02 (SD 1.58). Repeated-measures ANOVA indicated a significant time effect (F = 9.25, p < .001, partial η² = 0.16). Clinical significance analysis showed small but meaningful improvement (Δ = 0.69; effect size d = 0.41). High-fidelity simulation with live actors improves nursing students’ perceived communication competence in ICU settings. Beyond statistical significance, this improvement has clinical and educational significance as well, since being more confident about communicating may help students to be better equipped to deal with critically ill patients and their family members in actual clinical settings. Repeated, culturally relevant simulation experiences foster confidence in engaging with patients and families, aligning with Saudi cultural norms of family involvement in care. These findings support the integration of multiple actor-based HFS scenarios into undergraduate curricula to enhance communication skills in critical care. Not applicable.