The Effect of Scenario-Based Simulation Training for Nutritional Counseling During Pregnancy on Nursing Students' Anxiety Levels, Self-Efficacy Perceptions, and Clinical Skill Performance

Clinical Skill Performance

Clinical skill performance will be evaluated using the Pregnancy Nutrition Counseling Skills Checklist, an 18-item instrument developed by the researchers based on the relevant literature. The checklist assesses students' competency in providing pregnancy nutrition counseling, including therapeutic communication, history taking, assessment of maternal nutritional status, identification of gestational diabetes mellitus (GDM) risk factors, development of individualized nutrition counseling plans, application of motivational interviewing techniques, patient education, and follow-up planning. Each item is rated as "Performed," "Partially Performed," or "Not Performed." Students are expected to demonstrate these competencies while managing a standardized pregnancy nutrition counseling scenario. Total clinical skill performance scores obtained after the intervention will be compared between the intervention and control groups, with higher scores indicating better clinical performance.

Change in State Anxiety Level

Anxiety will be assessed using the State Anxiety Inventory (SAI) and the Beck Anxiety Inventory (BAI). The 20-item SAI measures current state anxiety (score range: 20-80), with higher scores indicating greater anxiety. The 21-item BAI assesses the severity of anxiety symptoms experienced during the previous week (score range: 0-63), classified as minimal (0-7), mild (8-15), moderate (16-25), or severe (26-63). Both instruments will be administered immediately before and after the intervention. Pretest scores will establish baseline anxiety levels, while posttest scores will evaluate changes following the intervention. Reductions in SAI and BAI scores will indicate improved anxiety outcomes. Score changes will be compared between the intervention and control groups to evaluate the effectiveness of the scenario-based simulation training.

Change in Perceived Self-Efficacy

Perceived self-efficacy will be assessed using the Nursing Learning Self-Efficacy Scale. The scale consists of 21 items across five domains: conceptual understanding, higher-order cognitive skills, practical work, everyday application, and nursing communication. Each item is rated on a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Total scores range from 21 to 105, with lower scores indicating lower perceived self-efficacy and higher scores indicating greater perceived self-efficacy in nursing learning. The Turkish version demonstrated excellent content validity (language CVI = 0.95; content CVI = 0.92) and high internal consistency (Cronbach's α = 0.95). In the present study, the Cronbach's α coefficient was 0.993. Participants will complete the scale before and after the intervention. Changes in mean scores will be compared between the intervention and control groups.