The relationship between self-efficacy (self-confidence) and anxiety levels, and the use of Human Patient Simulations (HPS) as a teaching-learning strategy, has not been sufficiently studied in the area of clinical nursing education. Despite the evidence in the literature indicating that HPS increases self-efficacy/self-confidence and decreases anxiety levels in clinical skills performance, a great number of third-year undergraduate nursing students have difficulty transitioning from the nursing learning laboratory setting to the real-life hospital setting in all nursing specialties. The purpose of this study is to evaluate the self-efficacy/self-confidence and anxiety levels in clinical skills performance of undergraduate nursing students, pre use and post use of Human Patients Simulations (HPS), as a teaching and learning strategy in maternity nursing. The evaluation was conducted in a nursing learning laboratory. The study used a quantitative, pre-experimental, one group study design with a pretest and posttest experiment in data collection. A convenience sample of 32 third-year undergraduate nursing students ( n = 32) participated in the study. The study was a cross-sectional study with data collected at one point pre summative and post summative evaluations for the simulated clinical skills performance and decision-making. The findings concluded that HPS reduced anxiety and increased self-efficacy/self-confidence in clinical skills performance and decision-making of the participants. In addition, the study found that the participants had difficulties in tasks performance with the following action verbs associated with the cognitive domain of Bloom's taxonomy. The verbs were "Identify", "Apply", and "Analyze". The findings might assist nurse educators in focusing on the clinical objectives when developing, teaching, assessing, and evaluating clinical nursing courses in order to resolve the problem of poor clinical skills' performance and decision-making related to high anxiety and low self-efficacy/self-confidence levels of their students. [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.]