Evaluating student satisfaction and self-confidence across a scaffolded simulation curriculum in undergraduate nursing education.

Introduction: Simulation in undergraduate nursing education is often evaluated as a single teaching event rather than as a coherent curriculum across multiple clinical contexts. Less is known about how students experience simulation when it is delivered as a scaffolded sequence across settings. To evaluate student satisfaction and self-confidence in learning across a scaffolded simulation curriculum delivered in four clinical settings within undergraduate nursing education. Methods: This prospective longitudinal repeated-measures study was conducted in a third-year undergraduate nursing simulation course at a university of applied sciences. The curriculum comprised four sequential blocks and combined prelearning, team-based standardized patient simulation, and PEARLS-guided debriefing. Of 135 students who completed the course in the standard format, 106 completed the Student Satisfaction and Self-Confidence in Learning Scale at least once, yielding 396 survey responses. Results: Satisfaction and self-confidence were high overall, though scores were characterized by prominent ceiling effects and negative skew (residuals skewness = -2.56). While ratings increased significantly across the sequential blocks ( Conclusion: Students perceived the curriculum as coherent and supportive across diverse care settings. However, as curriculum blocks were delivered in a fixed order, sequence and setting effects remain confounded. Observed block differences should therefore be interpreted as reflecting cumulative familiarity rather than being uniquely attributable to the clinical settings or the scaffolded design itself. Study registration: This study was preregistered within a larger longitudinal project and later registered as a stand-alone study in the Open Science Framework (OSF) (https://doi.org/10.17605/OSF.IO/CXJ3M).