With an increasing number of patients receiving nursing care in outpatient settings, it is the responsibility of nursing education programs to provide students with adequate training to enable them to develop the skills necessary to provide safe, effective care in diverse environments, including the home. Providing care to patients in their own homes requires nursing students to enter an environment that is unfamiliar; this may cause students to experience high levels of anxiety. Anxiety may also negatively affect students' confidence levels. Anxiety and confidence have a direct impact on students' clinical performances. The use of simulation in nursing education has increased over the past decade, but the majority of the literature focuses on simulation in acute care or institutional settings. Incorporating high-fidelity simulations that focus on the home setting will allow students to become familiar with the unique challenges they will face when providing care in this environment. The purpose of the study was to determine whether exposure to a high-fidelity home health care simulation scenario decreases anxiety levels, increases confidence levels, and improves the overall clinical performances of senior-level students enrolled in a baccalaureate nursing program at a state university in western Pennsylvania. A mixed-method design was utilized for this study. The quantitative findings revealed that no statistically significant differences in anxiety, confidence, or clinical performances existed between students who participated in a high-fidelity home health nursing simulation and students who did not participate in the simulation. In contrast, analysis of the qualitative data indicated that the participants who did not participate in the home health nursing simulation felt more anxious/nervous, less confident, and that their clinical performances had suffered compared to the participants who had participated in the simulation. Information from this study will serve to stimulate further research on the use of simulation in nursing education which focuses on diverse practice settings. [The dissertation citations contained here are published with the permission of ProQuest LLC. Further reproduction is prohibited without permission. Copies of dissertations may be obtained by Telephone (800) 1-800-521-0600. Web page: http://www.proquest.com.bibliotheek.ehb.be/en-US/products/dissertations/individuals.shtml.]