A qualitative study of nurse educators’ experiences with simulation-based learning in critical care nursing education in Norway

Abstract

Abstract Background Simulation-based learning is recognized as an effective pedagogical approach in nursing education. Prior research has focused on student outcomes and facilitation strategies in undergraduate and continuing education, but less attention has been given to nurse educators’ experiences with simulation-based learning in master’s-level critical care nursing programs. Facilitators must balance clinical authenticity with pedagogical support, adapt to diverse learning needs, create psychologically safe environments and promote reflective learning. There is limited knowledge about how nurse educators experience and enact their facilitation role, particularly in Norway. The aim of this study is to explore the experiences of nurse educators with primary responsibility for simulation-based learning in master’s-level critical care nursing education. Methods This is an exploratory study with a qualitative approach using reflexive thematic analysis. This study was conducted in Norway, where critical care nursing education is offered at the master’s level. Contextual information about educational institutions was collected with a questionnaire before the interview. Nine educators from eight educational institutions were interviewed in eight sessions. Participants were selected based on their specific responsibility for simulation within critical care nursing education. The interview guide was based on the didactic relational model by Bjørndal and Lieberg. Results Three main themes were identified: complex competence, careful facilitation, and system barriers. Complex competence concerned the mentally demanding nature of SBL and the need for broad facilitation skills, including experience-based, pedagogical, professional and technical competence, as well as continuity and peer support to build confidence. Careful facilitation described preparation, creation of safe and progressive learning environments, and tailoring scenarios and roles to students’ experiences. System barriers captured misalignment between strategic ambitions and available time, resources and technical support, making personal engagement and support by leaders crucial for sustaining high-quality simulation. Conclusion The nurse educators in our study described simulation-based learning as both valuable and demanding. Their accounts suggest that effective simulation relies on the interplay between educator expertise, learner-centered facilitation, and organizational conditions. For facilitators and educational leaders, these perceptions highlight that the implementation of simulation-based learning depends not only on individual competence but also on sufficient time, continuity, and organisational support.