Purpose: This study aimed to construct and test a hypothetical model to explain predictive factors affecting nursing students' satisfaction and self-confidence in simulation-based education based on the National League for Nursing Jeffries Simulation Theory. Methods: A cross-sectional study was conducted on 305 fourth-year nursing students with experience in simulation-based education enrolled at universities in Gangwon-do, Gyeongsangbuk-do, and Gyeonggi-do. Data were analyzed using SPSS 25.0 and AMOS 25.0. Results: The hypothetical model showed good fit with the empirical data: χ2/df 2.17, RMSEA=.01, RMR=.01, GFI=.95, AGFI=.91, NFI=.94, TLI=.95, CFI=.97, and PNFI=.68. Simulation design characteristics, teaching efficiency, and flow were found to affect satisfaction and self-confidence directly. A bootstrap test indicated that teaching efficiency and flow mediated the relationship between simulation design characteristics and satisfaction and self-confidence. Conclusion: Simulation educators should apply best practice that enhance teaching efficiency and flow through well-organized simulation designs, nursing students can attain satisfaction and self-confidence through simulation-based education.

Purpose: The National League for Nursing/Jeffries Simulation Theory (NLN/JST) is a middle-range theory widely used in nursing simulation education. Although the NLN/JST was revised in 2015, there is still no formal critique of the theory. The purpose of this study is to present a critique of the NLN/JST. Method: This study comprehensively analyzes and evaluates the theory using Fawcett and DeSanto-Madeya’s (2013) framework. Results: The theory demonstrates positive social and theoretical significance, testability, and empirical and pragmatic adequacy. Nevertheless, semantic clarity and internal consistency need to be made clearer. Conclusion: The NLN/JST is a suitable framework for nursing simulation education. The theory considers not only participants but also patients and systems as outcomes of simulation education, and is able to incorporate situation-specific backgrounds. That said, it is still necessary to develop a systematic nursing curriculum for clinical reasoning competence of both nursing students and nurses, given the wide range of clinical situations they may encounter.