Background The most significant component in nursing education is clinical experience. An educational learning environment encompasses a considerable number of conditions that affect students clinical learning results (Dunn 1995).

Background The most significant component in nursing education is clinical experience. An educational learning environment encompasses a considerable number of conditions that affect students clinical learning results (Dunn 1995).

According to Johnson Lewis (2010) in their case study it was shown that methods used in clinical teaching represent one of the crucial matters which are related to education and affect the performance of students in a number of clinical environments. Preparation of nursing students to enter into clinical practice as with other health care students such as medical students has for a long time been based on clinical clerkship programmes in which students is allowed to learn and practice various clinical skills under the supervision of a qualified health practitioner in their respective clinical fields (Neary 1997; Nehls Rather and Guyette 1997; Jalili Mirzazadeh and Azarpira 2008; Kim and Myung 2014).
Real encounters with patients in a hospital setting are a critical component for preparing medical students to apply their preclinical knowledge and skills in real clinical practice. This allows students to develop clinical thinking communication skills and a professional attitude (Kim and Myung 2014). However data from extensive surveys suggest that nursing and medical students do not feel adequately prepared for clinical practice after their respective clinical clerkship programmes (Kim and Myung 2014; Jalili et al. 2008; Linder and Pulsipher 2008). Most of the students who complete their studies successfully have plenty of knowledge but lack a hands-on experience Scheetz (1989 cited in Hakimzadeh Ghodrati Karamdost et al. 2013). It is crucial for students to be exposed to both theoretical and hands-on learning processes to enable them to become professional practitioners of health.
Prince Boshuizen Van Der Vleuten et al. (2005) surveyed fourth-year medical students on the transition from preclinical to clinical practice during clinical clerkship programmes and a majority of students felt they were moderately prepared with regard to applying their preclinical knowledge and skills especially when they had a drastic increase in clinical workload that reduced their study hours.
To enhance the learning experience and self-efficacy of medical students who are in transition from preclinical to clinical practice clinical teaching method that is being continuously applied for teaching medical students at the undergraduate level is called simulation-based medical education (SBME) as a prerequisite or an adjunct to the traditional clinical clerkship programme (Chakravarthy ter Harr Bhat et al. 2011; Sperling Clark and Kang 2013).
Sperling et al. (2013) assessed the impact of SBME on students clinical knowledge and skills acquisition comfort and perceived clinical competence with regards to attending to patients with altered mental status (AMS). It was found that students who attended simulation learning sessions exhibited higher post-test scores than those who did not and they were clinically relaxed in their overall clinical approach to treating AMS patients. These findings strongly indicate that the learning and clinical practice experience of medical students in a clinical clerkship programme can be enhanced by preclinical simulation learning sessions.
An effective learning experience for nursing students might contribute to both learning and achievement. The author a teacher assistant in nursing education recognized that students feel nervous when dealing with real patients and do not have the confidence to provide care in clinical settings. Although nursing education systems attempt to close the gap between theory and practice (Gallagher 2004) in Saudi Arabia the gap has increased. For several reasons the place where the author works does not have a university hospital so patients refuse to receive care from students. Also there is a lack of hospitals and due to their small size they cannot accept a large number of students. Moreover nursing-skills laboratories are not fully equipped and there is a faculty and preceptors shortage as well. Development of students cognitive affect and psychomotor skills has been influenced by the learning environment (Hart and Rotem 1993).
In Saudi Arabia student nurses rely entirely on the clinical clerkship programme and tutors to receive information as opposed to high-fidelity patient simulation. Consequently nursing students have high anxiety levels when they start their clinical clerkship programme and they do not feel impassioned to develop and increase their ability to self-learn. Nursing programmes must address these challenges by using alternative methods of clinical education such as simulation as learning strategy.
High-fidelity patient simulation (HFPS) is one of the successful approaches to SBME with the potential to enhance cognitive associative and self-sufficient nontechnical skills as well as clinical reasoning in medical students on transition from preclinical to clinical practice (Takayesu Farrell Evans et al. 2006). HFPS entails the use of a full-body simulated patient with computerized organ components called manikins (or mannequins) that simulate real-life scenarios in clinical settings and provide feedback. Although the technological advances that come from using HFPS and the potential benefit in practical education it can be available only in limited areas because of the high cost of maintaining the equipment and such sophisticated equipment could require expert operation.

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