Abstract
Background: Simulation-based learning has become a standard method in nursing education for the development of clinical skills. However, increasing scenario complexity and higher cognitive load may elevate stress levels among nurses, potentially reducing the accuracy of their performance in simulations. Despite these concerns, empirical evidence on the interaction among scenario complexity, cognitive load, anxiety, and simulation accuracy remains limited. This study aimed to examine the impacts of scenario complexity and cognitive load on simulation accuracy and to assess the mediating role of anxiety in these relationships.Methodology: A quantitative cross-sectional research design was employed. The study included 360 nurses who completed structured questionnaires measuring scenario complexity, cognitive load, anxiety, and simulation accuracy. Data were analyzed using SPSS version 26, incorporating descriptive statistics, correlation analysis, regression analysis, and mediation analysis through the PROCESS Macro (Model 4). Results: The findings revealed that both scenario complexity and cognitive load had a significant negative impact on simulation accuracy, while cognitive load showed a positive association with anxiety. Furthermore, anxiety was found to partially mediate the effects of scenario complexity and cognitive load on simulation accuracy, indicating that heightened anxiety contributes to reduced performance precision during simulations. Conclusion: The study concludes that increased scenario complexity and excessive cognitive load can diminish simulation accuracy, partly through elevated anxiety levels. Gradual implementation of complex simulation scenarios is recommended to prevent excessive cognitive burden. Additionally, pre-briefing strategies and psychologically safe learning environments are suggested to reduce anxiety and enhance the overall quality and effectiveness of simulation-based training