Transformative experiential learning in psychomotor skill development: a model informed by international nursing students' learning experiences.

Aim: This study aimed to examine how international undergraduate nursing students experience psychomotor skill learning within culturally diverse simulation-based education and to elucidate the cognitive, emotional, and developmental processes shaping this learning. Drawing on Mezirow's Transformative Learning Theory and Kolb's Experiential Learning Model, the study explored how early laboratory-based training contributes to professional competence relevant to safe and effective healthcare practice. Methods: An interpretive qualitative design was employed. Semi-structured interviews were conducted with 20 international undergraduate nursing students enrolled in a Turkish-medium nursing program. Data were analyzed using a hybrid thematic approach that integrated inductive thematic analysis with theory-informed deductive mapping to capture both lived experiences and underlying learning mechanisms. Results: Four main themes and 14 subthemes were identified, reflecting a progressive learning process. Integrating these findings led to the development of the Transformative Experiential Learning Model, which conceptualizes a developmental trajectory from initial disorientation to conceptual understanding and professional confidence. Early learning was characterized by linguistic barriers, cultural differences, unfamiliar technological platforms, performance anxiety, and challenges with medical terminology. Visual scaffolding, structured instructional guidance, immediate feedback, and peer support facilitated learners' reinterpretation of challenges through repeated practice, observation, and reflection. Conclusion: The findings indicate that transformative learning related to professional identity formation and clinical reasoning can begin within simulation-based education prior to clinical placement, positioning the simulation laboratory as a critical early site for healthcare workforce preparation. Culturally responsive instruction, multimodal educational supports, and psychologically safe learning environments are essential for fostering international nursing students' psychomotor skill development. Strengthening these elements may enhance readiness for clinical practice, reduce transition-related performance anxiety, and support safer and more effective healthcare delivery. It should be noted that these findings reflect early transformative processes and the development of an emerging professional identity within a preclinical context, rather than a full epistemic transformation in the Mezirow sense.