The effects of mental health simulations on nursing students’ knowledge and performance: A systematic review and meta-analysis

AIM: This systematic review and meta-analysis examined the effects of mental health simulations on undergraduate nursing students' knowledge and performance. BACKGROUND: Mental health nursing education requires safe, effective and engaging approaches to develop students' knowledge and clinical performance. Simulation-based education, including virtual reality and other mental health simulations, is increasingly used, yet its effectiveness remains unclear. DESIGN: Systematic review and meta-analysis. METHODS: Eight electronic databases were searched including CINAHL, Scopus, Ovid Medline, PubMed, Web of Science, Cochrane, ProQuest and Academic Search Complete. Eligible studies included nursing students, used mental health simulations as an intervention, reported knowledge or performance (such as skill, competency) outcomes and were published in English. Random-effects meta-analyses were conducted to estimate effect sizes. Heterogeneity was assessed using funnel plots, Q statistics and I². Moderator analyses explored sources of heterogeneity. RESULTS: Six studies involving 473 nursing students met inclusion criteria. Of these, 248 students participated in mental health simulations and 225 served as controls. Interventions significantly improved knowledge (Hedges' g = 0.483, 95 % CI 0.003-0.962, p = 0.048, I² = 79 %) and performance (g = 1.186, 95 % CI 0.161-2.210, p = 0.023, I² = 95 %) compared with controls. Subgroup analyses indicated that a priori power analysis, disguised allocation and duration post-intervention moderated effect sizes. No additional quality factors influenced outcomes. CONCLUSIONS: Mental health simulations appear effective for enhancing nursing students' knowledge and performance, supporting their integration into curricula. However, substantial heterogeneity and methodological variation highlight the need for further rigorous research and standardised outcome measures.