Data summarization was performed by qualitative synthesis with descriptive analysis and quantitative synthesis by meta-analytic methods and meta-regression. Critical appraisal of the studies was managed by means of the risk of bias tools RoB 2 and ROBINS-I, and quality of evidence by means of the GRADE tool. Study selection and data extraction steps were performed independently by two reviewers. Experimental and quasi-experimental studies that compared the effects of simulation on stress, anxiety, and self-confidence of nursing students were included. This study was conducted by the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. Additional searches occurred in PQDT Open (ProQuest), BDTD, Google Scholar and journals with a specific scope in clinical simulation. The databases used included: CENTRAL, CINAHL, Embase®, ERIC, LILACS, MEDLINE, PsycINFO®, SCOPUS and Web of Science. Systematic review with meta-analysis and meta-regression. To evaluate the effect of simulation-based experiences on stress, anxiety, self-confidence and learning of undergraduate nursing students compared to conventional teaching strategies or no intervention. Thus, better evidence is needed of the impact of simulation on these competences, essential for health professional education. Simulation is a promising strategy in health education, with evidence of importance for learning, but the available systematic reviews are still inconclusive about the effect of the strategy on stress, anxiety, and self-confidence of nursing students, which impact the adherence to and sustainment of this strategy.

Nursing students must be educated with the most realistic technologies available to improve patients' safety. Students trained with high-fidelity simulation achieved higher scores in acquired and retained BLS knowledge and higher self-efficacy perception, indicating the value of simulation in improving knowledge and self-efficacy in nursing students. Neither knowledge acquisition nor knowledge retention showed any significant differences between the groups however, self-efficacy showed significant differences. The experimental group (n = 52) received traditional teaching of BLS (3-hour PowerPoint presentation and demonstration on static manikin in groups of 6 to 7 students) and high-fidelity BLS simulation, while the control group (n = 58) received only traditional teaching of BLS (3-hour PowerPoint presentation and demonstration on static manikin in groups of 6 to 7 students). The purpose of this quasi-experimental research study was to examine the effect of high-fidelity basic life support (BLS) simulation on knowledge acquisition, knowledge retention, and self-efficacy of Jordanian nursing students.

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