ith advancements in digital technologies and challenges in securing clinical placements, virtual simulation (v-sim) is becoming a cost-effective and easily accessible pedagogical strategy in health care education. 1 The Healthcare Simulation Dictionary defines v-sim as "[a] simulation involving real people operating simulated systems. Virtual simulations may include surgical simulators that are used for on-screen procedural training and are usually integrated with haptic device(s)" 2(p54) as well as simple screen-based clinical simulations that only require the use of a computer with Internet access. As v-sim accessibility and demand increase, health care educators should incorporate evidence-based simulation-based education (SBE) strategies, such as structured prebriefing and debriefing, to promote positive v-sim experience outcomes. 3 Virtual simulation can be an effective strategy to improve student learning outcomes. 1 Self-confidence is identified as an essential participant outcome in SBE in the National League for Nursing Jeffries Simulation Theory. 4 In a recent systematic review article examining the impact of v-sim in student learning outcomes, an increase of self-confidence resulting from v-sim was reported. 1 The terms self-confidence and self-efficacy are often used interchangeably in the simulation literature. However, a clear definition, as well as the distinction between these 2 terms, is lacking. 5 According to Bandura, 6,7 self-efficacy is an individual's sense of confidence in the ability to perform a specific behavior to produce an outcome. Self-efficacy is domain and task specific and should not be confused with general confidence, which is a global attribute that lacks specificity to an area of functioning. 6,7 The term selfconfidence refers to a nondescriptive personal belief that is not specific to a particular function domain or behavior. 6 Self-efficacy evolves and changes throughout one's life as
In light of the technological, social, and political changes taking place in the world today, it is important that nurses are not just culturally competent but globally informed and engaged. The goal of this paper is to help nurses help their patients and themselves to benefit from globalization. The use of guided simulation, virtual reality, and augmented reality learning experiences is considered for each of five areas of global nursing; global aesthetics, global intelligence, global ethics, global politics, and global health. This approach invites nurses and student nurses to discern new patterns, take charge of their learning, and build multiple iterations to facilitate the processing of new and different information and "realities."
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