Social cognitive theory, metacognition, and simulation learning in nursing education.

Simulation learning encompasses simple, introductory scenarios requiring response to patients' needs during basic hygienic care and during situations demanding complex decision making. Simulation integrates principles of social cognitive theory (SCT) into an interactive approach to learning that encompasses the core principles of intentionality, forethought, self-reactiveness, and self-reflectiveness. Effective simulation requires an environment conducive to learning and introduces activities that foster symbolic coding operations and mastery of new skills; debriefing builds self-efficacy and supports self-regulation of behavior. Tailoring the level of difficulty to students' mastery level supports successful outcomes and motivation to set higher standards. Mindful selection of simulation complexity and structure matches course learning objectives and supports progressive development of metacognition. Theory-based facilitation of simulated learning optimizes efficacy of this learning method to foster maturation of cognitive processes of SCT, metacognition, and self-directedness. Examples of metacognition that are supported through mindful, theory-based implementation of simulation learning are provided.