Use of virtual reality in nursing education: a scoping review

Abstract

Objective  To map in literature the application of virtual reality (VR) in teaching undergraduate nursing students.

Methods  This is a scoping review prepared according to the JBI framework, guided by the PRISMA-ScR checklist. The articles were selected in January 2024 from 12 data sources. The results were analyzed descriptively and summarized in charts.

Results  Twenty-three articles were selected for the research synthesis. The included research was conducted between 2020 and 2024, with a notable concentration of publications in 2023. Concerning the geographical origin, most of the studies originated in Asia. Furthermore, it was noted that 69.6% of studies adopted VR glasses with the intervention groups. It was noted that most of students who participated in the interventions generally experienced a positive feeling towards VR.

Conclusion  It was possible to map the use of VR in the context of the teaching-learning process in undergraduate nursing courses. The technology has proven to be an innovative tool that complements traditional methodologies in nursing education, promoting greater interactivity. Its positive impact is reflected in the improvement of skills, although challenges such as cost and technological adaptation still need to be overcome. Thus, the planned integration of VR can contribute to more dynamic and effective training.

Keywords:
Virtual reality; Nursing education; Teaching

Resumo

Objetivo  Mapear na literatura a aplicação da realidade virtual (RV) no ensino de estudantes de graduação em enfermagem.

Métodos  Trata-se de revisão de escopo elaborada de acordo com o referencial do JBI, guiada por meio do checklist PRISMA-ScR. A seleção dos artigos foi realizada em janeiro de 2024 em 12 fontes de dados. Os resultados foram analisados de forma descritiva e sintetizados em quadros.

Resultados  Foram selecionados 23 artigos para a síntese da pesquisa. As pesquisas incluídas foram conduzidas no período de 2020 a 2024, sendo notável a concentração de publicações em 2023. No que tange à origem geográfica, a maioria dos estudos se originou no continente asiático. Ademais, notou-se que 69,6% dos trabalhos adotaram os óculos de RV com os grupos de intervenção. Notou-se que a maioria dos alunos que participaram das intervenções experimentou, em geral, um sentimento positivo em relação à RV.

Conclusão  Foi possível mapear o uso da RV no contexto do processo de ensino-aprendizagem nos cursos de graduação em enfermagem. A tecnologia demonstrou ser uma ferramenta inovadora e complementar às metodologias tradicionais no ensino de enfermagem, promovendo maior interatividade. Seu impacto positivo reflete-se no aprimoramento de habilidades, embora desafios como custo e adaptação tecnológica ainda precisem ser superados. Assim, a integração planejada da RV pode contribuir para uma formação mais dinâmica e eficaz.

Descritores:
Realidade virtual; Educação em enfermagem; Ensino

Resumen

Objetivo  Mapear en la literatura la aplicación de la realidad virtual (RV) en la enseñanza de estudiantes de la carrera de enfermería.

Métodos  Se trata de una revisión de alcance elaborada de acuerdo con el marco referencial del JBI, guiada mediante el checklist PRISMA-ScR. La selección de los artículos se realizó en enero de 2024 en 12 fuentes de datos. Los resultados fueron analizados de forma descriptiva y sintetizados en cuadros.

Resultados  Se seleccionaron 23 artículos para la síntesis del estudio. Los trabajos incluidos fueron realizados entre 2020 y 2024, donde se observó la concentración de publicaciones en el año 2023. En lo que atañe al origen geográfico, la mayoría de los estudios se originó en el continente asiático. Además, se observó que en el 69,6 % de los trabajos se utilizaron los anteojos de RV con los grupos de intervención. También se percibió que la mayoría de los alumnos que participó en las intervenciones experimentó un sentimiento positivo en general con relación a la RV.

Conclusión  Fue posible mapear el uso de la RV en el contexto del proceso de enseñanza-aprendizaje en las carreras de grado de enfermería. La tecnología demostró ser una herramienta innovadora y complementaria de los métodos tradicionales en la enseñanza de enfermería, lo que promueve una mayor interactividad. Su impacto positivo se refleja en la mejora de las habilidades, aunque aún existen desafíos, como el costo y la adaptación tecnológica, que deben ser enfrentados. De esta forma, la integración planificada de la RV puede contribuir a una formación más dinámica y eficaz.

Descriptores:
Realidad virtual; Educación en enfermería; Enseñanza

Introduction

Virtual reality (VR) has revolutionized the way we interact with knowledge and experience learning. This emerging technology enables the creation of highly immersive three-dimensional environments in which users not only observe but can actively interact, significantly expanding the possibilities for teaching and training.( ¹ )By integrating advanced computing systems with sensory devices, VR provides a high level of immersion and presence, simulating realistic scenarios that favor the development of technical and cognitive skills.( ¹ )

In the healthcare field, for instance, the use of VR has demonstrated great potential by allowing students and professionals to train procedures in a controlled environment, reducing risks and improving clinical decision-making.( ² )Thus, it is observed that VR has been consolidating itself as an innovative tool for education and professional training, and its potential to transform traditional paradigms and open new perspectives for teaching based on interactive experiences is believed.

This advancement is largely due to its ability to offer different levels of immersion, adapting to the specific needs of the educational context. Thus, technologies such as high-immersion VR glasses, for instance, allow for more realistic interaction, as they integrate movement tracking and spatial mapping, thus providing students or professionals/users with an enhanced sense of presence in the virtual environment.( ² )In contrast, simulations accessed via computer screens or mobile devices, although still effective and widely used in classrooms, present a lower degree of immersion. These technological variations directly influence student or professional/user experience, making it essential to choose the most appropriate resource for each application in teaching and/or clinical practice.( ² )

The adoption of VR was significantly boosted by the advent of the Fourth Industrial Revolution, a transformational milestone characterized by the convergence of technologies in the physical, digital and biological spheres.( ³ )This new era is characterized by the interconnection of systems and integration of innovative technologies, transforming various sectors of society and driving advances in the field of virtual experience. Industry 4.0 has driven several changes in the education sector, and one of the transformations observed is integration of VR as part of the teaching-learning process in various institutions, including universities.( ⁴ )

In the context of undergraduate nursing courses, the importance of teaching methods that incorporate new technologies, such as VR, is evident in working with students on real-life situations in the profession. The use of VR in teaching is presented as a strategy that can provide practical and immersive learning aligned with the principles of andragogy, since it favors active and meaningful learning and allows students to actively participate in knowledge construction.( ³ )From this perspective, it contributes to the improvement of technical skills, promoting the development of behavioral and attitudinal skills that are fundamental for professional practice.( ³ )

In this regard, integration of VR into nursing education is considered to comprehensively prepare students for the challenges of a healthcare environment, enabling the simulation of complex scenarios and decision-making in a safe and controlled context, as well as leading students to develop clinical reasoning, attitudes and skills essential to professional practice, preparing them for the challenges of a clinical environment. In this sense, in addition to improving technical and cognitive skills, VR also meets the growing demand for more dynamic and interactive teaching strategies, aligning with students’ expectations regarding learning.

In order to better illustrate this need highlighted by students, a study by Chan, Chang and Huang( ¹ )highlighted the implementation of VR in teaching chemotherapy administration, in which students seek a diversity of approaches to fill the gaps in the traditional teaching-learning methodology. As a result, the recommendation of adopting a combination of different teaching methods is widely recommended as an effective strategy to achieve more significant and comprehensive results in the educational process.( ¹ )

Given the above, VR analysis as an educational tool plays a crucial role in the search for efficient andragogical approaches adapted to the contemporary demands of nursing practice.( ³ )In this context, the research is justified by the growing demand for innovation in teaching-learning methodologies, allowing the exploration of VR as a technological resource that aims to improve the quality of nursing training. Therefore, the aim is to map in literature the application of VR in the teaching of undergraduate nursing students.

Methods

This is a scoping review prepared in accordance with the JBI framework and guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist.( ⁵ )

To avoid conducting duplicate reviews, protocols and scoping reviews with the same objective as this research were tracked in May 2023, and a search was carried out on the Open Science Framework, International Prospective Register of Systematic Reviews, The Cochrane Library and Database of Abstracts of Reviews of Effects registration platforms. Subsequently, this study was entered into the Open Science Framework platform for scientific work registration, under registration osf.io/yz7tj.

In order to formulate the question that guides the scope review, the mnemonic strategy PCC (Population, Concept and Context) was used, with undergraduate nursing students indicated as Population, VR as Concept, and teaching as Context.( ⁶ )In view of this, the following research question was defined: How is VR being applied in the teaching of undergraduate nursing students? To answer this question, three specific questions were developed: (1) What strategies have been used to integrate VR into nursing education?; (2) How does the adoption of VR impact the experience and academic performance of nursing students?; and (3) What topics are being addressed with VR in nursing education?

Initially, the following descriptors were defined according to the Health Science Descriptors (DeCS) and Medical Subject Headings (MeSH): Universities; Virtual Reality; Nursing Education; Nursing. After this definition, the Boolean operators AND and OR were used to cross-reference the descriptors and develop the search syntax in information sources.

The search and identification of articles for the research scope were carried out in January 2024. The databases and portals searched were Cochrane Library, Scientific Electronic Library Online (SciELO), Web of Science, Scopus, Science Direct, Virtual Health Library (VHL) and PubMed Central. The search in gray literature included the Coordination for the Improvement of Higher Education Personnel Thesis and Dissertation Catalog, Biblioteca Digital Brasileira de Teses e Dissertações (BDTD), Repositório Científico de Acesso Aberto de Portugal (RCAAP), Europe E-Theses Portal (DART) and Theses Canada.

The search strategies were adjusted according to the particularities of each database and portal researched, as shown in Chart 1 . Despite this, the combinations between descriptors were preserved. For greater comprehensiveness in the search, time and language restriction filters were not used.

Chart 1
Search syntax according to source of information

Sources of information	Syntax
Cochrane Library	((“nursing”) OR (“education, nursing*”)) AND (“universities”) AND (“virtual reality*”)
PubMed Central	(((“nursing”[all fields]) OR (“education, nursing*”[MeSH Terms])) AND (universities[all fields]) AND (“virtual reality*”[all fields]))
SciELO	(TS=(nursing) OR TS=(education, nursing*)) AND TS=(universities) AND TS=(virtual reality*)
Web of Science	((nursing) OR (education, nursing*)) AND (universities) AND (virtual reality*)
Scopus	((“nursing”) OR (“education, nursing*”)) AND (“universities”) AND (“virtual reality*”)
Science Direct	(“nursing” OR “education, nursing”) AND “universities” AND “virtual reality”
Coordination for the Improvement of Higher Education Personnel Thesis and Dissertation Catalog	(“enfermagem” OR “educação em enfermagem”) AND “universidades” AND “realidade virtual”
VHL	((“nursing”) OR (“education, nursing*”)) AND (“universities”) AND (“virtual reality*”)
BDTD	(“enfermagem” OR “educação em enfermagem”) AND “universidades” AND “realidade virtual”
RCAAP	(“enfermagem” OR “educação em enfermagem”) AND “universidades” AND “realidade virtual”
DART	(nursing OR education, nursing) AND universities AND virtual reality
Theses Canada	(nursing OR education, nursing) AND universities AND virtual reality

Complete studies available online that addressed the use of VR in higher education in nursing were included. Articles that did not answer the research question or deviated from the study objective as well as abstracts, reviews, letters to the editor, and research protocols were excluded. Duplicate studies were considered only once. Study assessment and preliminary selection were conducted systematically by two independent collaborators, simultaneously during the data collection period. This stage involved screening studies based on specific criteria, including title and abstract analysis. In situations of disagreement among evaluators, a third reviewer was consulted to resolve any divergences. Only after this initial phase of preliminary analysis were the studies subjected to a complete reading for final selection. A total of 3,320 studies were identified in the searches of data sources; however, after applying the open access filter, 1,263 remained. The collected articles were imported into the EndNote Web reference management software. The programs identified duplicates, of which the duplicate was excluded from the analysis, resulting in 1,112 studies for the selection process, including those from VHL, Cochrane Library, PubMed, SciELO, Science Direct, Scopus, Web of Science and Theses Canada. The other sources did not yield results. After checking the titles and abstracts, a total of 62 studies were selected for further analysis by reading their full texts. Subsequently, a detailed selection resulted in the selection of 23 articles to guide the scope of this research. Figure 1 presents a flowchart that illustrates the paper eligibility process, in accordance with PRISMA-ScR guidelines.

Figure 1
Flowchart of literature search and inclusion of articles according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews

It is worth noting that it was not necessary to submit this study to the Research Ethics Committee, as the data included in it are secondary and publicly accessible.

Results

This study included 23 studies published between 2020 and 2024, with a concentration of publications in 2023 representing 39.1% of the selected sample. Regarding the geographical origin, most studies originated in Asia, covering approximately 69.6% of the findings. This geographical distribution included countries such as China (n=1), Hong Kong (n=1), Singapore (n=1), Taiwan (n=2), and South Korea (n=11), reflecting a diversity of contexts and approaches in the application of VR in nursing education. The most predominant study design design in the sample was the experimental one, corresponding to 91.3% of selected articles. The preference for this type of design can be attributed to its ability to provide robust evidence on the effectiveness and effects of VR-related interventions in the educational context in nursing. Chart 2 provides a description of the authors, year, country and study design, in addition to offering a mapping of the various subjects addressed using VR, together with the main results derived from the studies selected for this review.

Chart 2
Characterization and mapping of selected studies

Authorship (year), Country	Objective	Method	Main results
Hardie et al. (2020),(7)Ireland.*	Investigate the subjective experience of using an immersive VR storytelling experience as active pedagogy.(7)	Study design: Observational mixed methods study. Procedure: 94 students were invited to watch the VR storytelling experience, “Wonderful You” (BHD Immersive), which tells the story of the first nine months of a baby’s life inside a woman’s womb.(7)	Participants reported good engagement and motivation in learning from the video. Most found the immersive experience enriching. However, they mentioned negative aspects, such as the discomfort of the glasses and the feeling of dizziness and nausea.(7)
Smith, S.; Farra, S. L.; Hodgson, E. (2021),(8)United States.*	Examine differences in learning outcomes for the skill of decontamination of multiple casualty incidents based on the type of simulation.(8)	Study design: Quasi-experimental study. Procedure: 121 students were recruited for the research. After a didactic presentation, students were randomly assigned to two treatment groups (VR simulation or manikin-based simulation training) to learn the decontamination skill.(8)	The study found no statistically significant differences between the VR and mannequins simulation groups, which does not allow us to conclude that one simulation method is superior to the other. Both groups expressed equal confidence in their sense of self-efficacy and in the skills they had acquired.(8)
Lo et al. (2022),(9)Taiwan *	Test whether students in long-term care departments who underwent IVR training would have significantly higher levels of knowledge about nasogastric tube feeding skills, greater learning motivation, lower cognitive load and greater satisfaction than the control group.(9)	Study design: Randomized clinical trial. Procedure: 107 students were recruited and distributed into the intervention group (n=54) and the control group (n=53). The intervention group learned the nasogastric tube feeding procedure through IVR, while the control group watched a 15-minute 2D video.(9)	After the intervention, both the intervention group and the control group had a significant increase in the level of knowledge, with no statistical difference between them. The VR group showed greater motivation and satisfaction in learning, but also faced greater cognitive load compared to the control group.(9)
Yang, S. Y.; Oh, Y. H. (2022),(10)South Korea.*	Examine the effects of a neonatal resuscitation gamification program using immersive VR based on Keller’s ARCS model.(10)	Study design: Quasi-experimental study. Procedure: 83 nursing students participated. The VR group (n=29) underwent a neonatal resuscitation gamification program using VR based on Keller’s ARCS model; the simulation group (n=28) received high-fidelity neonatal resuscitation simulations and online lectures from the neonatal resuscitation program; and the control group (n=26) received only online lectures from the neonatal resuscitation program.(10)	After the intervention, all groups (VR, realistic simulation, and control) had increased scores on knowledge and clinical reasoning development. Problem-solving ability increased only in the VR and simulation groups. Self-confidence improved in all groups, with a significant increase in the VR group. Anxiety decreased in all groups.(10)
Choi, K. S. (2022),(11)China.*	Assess virtual dressing simulators developed for learning basic skills.(11)	Study design: Crossover clinical trial. Procedure: A desktop simulator and an immersive simulator were assessed by 30 nursing students. Participants highlighted the usefulness, interest, ease and comfort of both types of simulators (desktop and VR glasses) for learning.(11)	VR was well received, and both systems had satisfactory usability. The desktop is easier to implement, while the VR headsets are more realistic and engaging.(11)
Liaw et al. (2023),(12)Singapore.	Describe the development of an AI-enabled VR simulation and assess nursing students’ competencies and experiences in communicating with an AI physician.(12)	Study design: Mixed methods experimental study. Procedure: Nursing students from a university were recruited to complete the two-hour VRS with AI. Pre-tests and post-tests were administered to assess participants’ communication knowledge and self-efficacy.(12)	The use of VR improved competence and self-efficacy in interprofessional communication. More than 90% of participants found the AI physician interesting and motivating, but suggested that his expressions should be more human. They concluded that VR simulation with AI should complement, rather than replace, in-person simulation, being a pre-learning resource.(12)
Jeong et al. (2021),(13)South Korea.*	Establish and assess the effectiveness of a VR simulation program using the COVID-19 scenario for nursing students.(13)	Study design: Quasi-experimental study. Procedure: 65 students were divided into a control group and an intervention group (VR). Knowledge about infectious diseases of the respiratory system, self-efficacy, clinical reasoning ability and satisfaction with learning were assessed.(13)	The VR group showed a higher level of knowledge about the diseases, compared to the control group, which received only lectures, although both improved. There was no statistically significant difference in self-efficacy and clinical reasoning ability on the topic.(13)
Liu et al. (2021),(14)United States.*	Examine the effects of incorporating a VR activity on hospital-acquired infections in the classroom and in an online environment.(14)	Study design: Quasi-experimental study. Procedure: 25 students participated in person in the classroom and 25 participated in an online environment using a communication platform. Through a VR activity, students took a tour that demonstrated the identification of infectious sites in a hospital environment.(14)	At the end of the intervention, students in the VR applied in the classroom and VR applied remotely groups correctly identified the number of infectious sites. However, there was a significant difference in perceived ease of the task, with higher scores for students who received classroom instruction compared to those who received online instruction.(14)
Jung et al. (2022),(15)South Korea.*	Develop an HMD-based VR program and understand the effects of the program on nursing students’ knowledge, learning attitude, practice satisfaction, and learning motivation.(15)	Study design: Quasi-experimental study. Procedure: A nursing scenario of Chemoport insertion surgery was developed using HMD-based VR. The experimental group, consisting of 30 students, underwent pre-debriefing, followed by VR using HMD and debriefing. The control group, consisting of 30 students, underwent pre-debriefing, followed by learning through handouts about the surgical procedure for 30 minutes and debriefing.(15)	The VR group showed significant improvements in knowledge, proactivity, and satisfaction compared to the control group after the intervention. Both groups increased motivation to learn, but there was no significant difference between them in this aspect.(15)
Lee et al. (2022),(16)South Korea.*	Develop a program on mechanical ventilation using VR and assess the effect on knowledge, self-efficacy, clinical reasoning ability, learning immersion and learning satisfaction among nursing students.(16)	Study design: Quasi-experimental study. Procedure: 60 students were divided between a control group and an experimental group to participate in the study on nursing care in mechanical ventilation.(16)	After the simulation carried out by the experimental group, there were significant improvements in self-efficacy, clinical reasoning, immersion and satisfaction, favoring the use of VR.(16)
Plotzky et al. (2023),(17)Germany.	Investigate the effects of using different teaching methodologies on endotracheal suctioning.(17)	Study design: Mixed methods experimental study. Procedure: The outcomes investigated were knowledge and skills acquisition, student satisfaction, and technology acceptance. A total of 131 undergraduate nursing students were randomized into three groups based on the interventions they received (video tutorial, low-tech VR, and high-tech VR).(17)	All groups improved in theoretical knowledge. The video tutorial group acquired more practical skills, while the low-tech VR group reported greater cognitive satisfaction.(17)
Oh et al. (2023),(18)South Korea.*	Develop a VR application for smartphones that improves patient safety competency among nursing students, focusing on knowledge, attitudes, and confidence in safety management.(18)	Study design: Mixed methods experimental study. Procedure: Participants were randomly assigned to either the experimental group (n=22), which received a teaching program on patient safety management in the app, or the control group (n=22), which received a teaching booklet. Participants completed a pre-test and two post-test questionnaires to assess the impact of the program.(18)	As a result, significant improvements in students’ knowledge, conduct and confidence regarding patient safety were highlighted in the VR group, compared to the other group.(18)
Lee, J. S; Son, H. K. (2023),(19)South Korea.	Identify the effectiveness of PBL associated with VR simulation in improving neurological examination.(19)	Study design: Mixed methods experimental study. Procedure: 76 participants were recruited. Students in the control group underwent conventional lectures and demonstration of neurological assessment, while students in the experimental group underwent PBL+VR on the Glasgow Coma Scale assessment in a virtual patient.(19)	The study confirmed that the self-efficacy and performance of students undergoing VR associated with the PBL method were improved compared to the control group. Thus, it proposed that the implementation of VR with the PBL method is beneficial to improve nursing students’ performance.(19)
Pazo et al. (2023),(20)Spain.*	Assess the usefulness of VR as a tool for teaching nursing assessment in critically ill patients.(20)	Study design: Cross-sectional study. Procedure: A specific environment was designed for VR immersion using a VR headset. Data were collected through three questionnaires: perception of self-efficacy regarding the acquisition of skills in the care process; immersiveness; usefulness and satisfaction with the tool.(20)	The students assessed that the methodology met its purpose, being useful for learning about nursing assessment of critically ill patients and increasing their attention and motivation in these aspects.(20)
Acosta et al. (2023),(21)Spain.	Assess the effectiveness of video and VR teaching methodology in training nursing students to acquire knowledge about creating safe and inclusive environments for trans people.(21)	Study design: Quasi-experimental study. Procedure: 60 students participated in the study. The virtual scenarios addressed theory and elements to promote empathy and respect, differentiating inclusive and exclusionary environments regarding nursing care in the face of sexual and gender diversity.(21)	These resources improved skills learning in a safe environment, increasing students’ confidence in the skills they had acquired. Students also showed high levels of satisfaction with the methodology.(21)
Lee et al. (2023),(22)Hong Kong. *	Develop VR simulation videos for blood transfusion practice and assess their effectiveness by measuring knowledge, confidence, and satisfaction.(22)	Study design: Randomized clinical trial. Procedure: VR simulation videos were developed on the physiology of blood formation, side effects of blood transfusion and nursing practice in blood transfusions. Students were randomly allocated to intervention groups (n=75), who received traditional classes and VR videos, and control groups (n=76), who received only the traditional class.(22)	The effectiveness of VR simulation was confirmed by the improvements observed in participants’ knowledge, self-confidence, and satisfaction with the topic of blood transfusion.(22)
Andreasen et al. (2023),(23)Norway.	Investigate whether the practice of preoperative patient handover using the ISBAR approach using VR presents a non-inferior learning outcome compared to the practice of the traditional paper-based method for classifying patient information.(23)	Study design: Randomized clinical trial. Procedure: After a 20-minute introductory session, participants (n=175) were randomized to practice the ISBAR approach for 45 minutes in an interactive VR application (intervention) or traditional paper-based simulation.(23)	The results showed that learning was equally significant for the group that used VR and the one that participated in the realistic simulation. However, students preferred VR simulation, considering it more engaging than the traditional simulation approach.(23)
Kim et al. (2024),(24)South Korea.	Investigate the impact of a VR-based practical mental health nursing simulation on nursing students’ competence in caring for individuals with mental disorders.(24)	Study design: Quasi-experimental study. Procedure: 50 students participated in the research. The VR simulation included nursing competencies in mental health, covering cases of delirium, hallucination, mania, geriatric depression, adolescent depression with suicidal ideation and obsessive-compulsive disorder. Pre-simulation questionnaires and post-simulation questionnaires were administered to assess the impact.(24)	The parameters assessed in the study, including knowledge, communication, problem-solving, critical thinking, clinical confidence, and approach to mental health, showed significant improvements after the VR intervention.(24)
Lee et al. (2024),(25)South Korea.*	Develop an educational program on ECMO for nursing students and assess its effects on education.(25)	Study design: Mixed methods experimental study. Procedure: 66 students participated, 33 in each of the experimental and control groups. The program consisted of pre-training, orientation, VR simulation on nursing performance in handling ECMO based on the case of a critically ill patient diagnosed with acute respiratory distress syndrome, and debriefing.(25)	Comparative analyses between the control and VR groups addressed several aspects, such as knowledge, confidence, clinical reasoning, immersion, and satisfaction with learning. Only the levels of immersion and satisfaction showed significant differences, favoring VR.(25)
Chang et al. (2024),(26)Taiwan.*	Develop a VR intravenous injection simulator program and analyze its effect on knowledge, acceptability and motivation to learn among nursing students.(26)	Study design: Mixed methods experimental study. Procedure: 128 students participated in IV injection practice in VR. The study included a single-group pre- and post-test approach and qualitative analysis of written text reflection records.(26)	The program, introduced as a supplementary tool to enhance IV injection education, was well received and considered interesting by students. However, there were criticisms about the realism of simulation, indicating areas for improvement.(26)
Kang et al. (2020),(27)South Korea.	Examine the learning effects of the combined and isolated use of VR simulation and realistic simulation on nursing care for asthmatic children.(27)	Study design: Quasi-experimental study. Procedure: 192 participants contributed to the research, who were divided into three comparison groups for a pre- and post-test approach.(27)	The group that received the combination of simulations showed better results in knowledge, confidence in practice and performance compared to the groups that received the simulations separately.(27)
Lee, E.; Baek, G.; Hwang, Y. (2023),(28)South Korea.*	Develop a VR-based nursing education program aimed at improving nursing students’ risk classification competency.(28)	Study design: Quasi-experimental study. Procedure: 34 students were divided into two groups and subjected to a pre- and post-test approach on risk classification skills.(28)	The results showed substantial improvements in participants’ competence in assessing a patient’s risk classification, confidence in their performance, and ability to make clinical decisions after applying clinical scenarios in VR.(28)
Lee, Y.; Kim, S. K.; Eom, M-R. (2020),(29)South Korea.*	Assess the usefulness of VR simulation for teaching mental health nursing through videos watched via VR glasses.(29)	Study design: Mixed methods experimental study. Procedure: 60 nursing students were subjected to watch VR videos of five different scenarios, reflecting clinical symptoms of patients with schizophrenia, and performed treatment-related tasks through VR glasses.(29)	Participants had predominantly positive experiences with the VR simulation, describing it as realistic and interesting. Some mentioned discomfort when wearing the VR headset. All agreed that the VR simulation program would benefit their future clinical practice.(29)

• VR – virtual reality; ECMO - extracorporeal membrane oxygenation; IVR – immersive virtual reality; AI - artificial intelligence; HMD - head-mounted display; ISBAR - Identity, Situation, History, Assessment and Recommendation; ARCS - Attention, Relevance, Confidence and Satisfaction; *Studies that applied virtual reality using virtual reality glasses.

Based on the information presented in Chart 2 , it is possible to highlight the variety of topics covered in the interventions, such as anatomy and physiology, respiratory diseases, assessment of critically ill patients, neurological assessment, mental health, nasogastric tube placement, dressings, neonatal resuscitation, endotracheal aspiration and mechanical ventilation, insertion of fully implanted catheters and intravenous puncture, blood transfusion, extracorporeal membrane oxygenation, effective communication, and nursing care for the LGBTQIA+ population. In addition, there are studies in which VR was applied through the use of high-immersion VR headsets. These data reveal that 69.6% of them chose to use the high-immersion feature in intervention groups. This choice indicates a significant preference for technologies that provide a more engaging and immersive experience for study participants.

Discussion

The 23 selected studies considered that the use of VR in teaching environments can be advantageous as a complement to conventional pedagogical approaches already adopted in undergraduate nursing courses. This finding is also supported by a systematic review that investigated the effectiveness of VR practice as a means of improving undergraduate nursing students’ knowledge. The results of this analysis indicated that practice combined with the use of this technology was significantly more successful compared to traditional simulation methods. This idea highlights the potential of VR as a valuable tool to enrich the academic training of nursing students.( ³⁰ )

Given the results presented, there is a predominance of works from Asia, especially from South Korea. This finding can be explained, in part, by the significant investment in education, science and technology observed in several Asian countries in recent decades.( ³¹ )For this reason, different countries can implement different policies and programs to support the progress of innovation in multiple sectors of society, with a particular focus on the educational sphere.

Among the studies assessed, two ways of applying VR were identified: (A) using high-immersion VR glasses; and (B) using only computer or cell phone screens. VR is divided into immersive and non-immersive categories.( ² )Some studies based their intervention on non-immersive application, using a computer or cell phone.( ¹² , ¹⁷ , ¹⁹ , ²¹ , ²³ , ²⁴ , ²⁷ )The remaining articles (n=16) used VR glasses and resulted in greater immersion in their use and more active student participation.

The topics covered in the study interventions varied greatly, from the review of theoretical knowledge and the development of practical skills to the effective interdisciplinary communication assessment. Several topics were covered in the research, and this fact demonstrates the numerous possibilities for implementing VR in nursing education.

Considering the negative aspects of immersive VR, in some studies, the target audience reported discomfort with VR glasses and feelings of dizziness and nausea during the immersive experience.( ⁷ , ¹¹ , ¹⁷ )These results can be attributed to the requirement of additional devices in the immersive approach, such as the VR headsets themselves and other sensory devices, which promote a more intense physical interaction. Some sensitive individuals may experience nausea and/or dizziness when using immersive devices due to the discrepancy between body signals and visual stimuli. The body at rest contrasts with virtual movement; the balance informed by the vestibular system does not match VR; and ocular convergence conflicts with the immersive display, triggering discomfort or uneasiness as a natural reflex.( ³² )

Regarding the limitations identified by students in relation to the use of VR, the issue of lack of familiarity with the new technology and its interface stands out.( ⁹ , ¹⁰ , ¹⁹ )This aspect created a difficulty in adapting to VR, since students faced challenges when dealing with an unknown virtual environment and a user interface that was not very intuitive. Other studies also highlight technical failures due to dependence on equipment and the possibility of difficulties in use due to lack of knowledge of the means used.( ³³ )Therefore, this can negatively impact the interest and continuity of training.

Furthermore, the lack of tactile sensation and limited realism in simulation scenarios are also aspects to be considered.( ¹¹ , ¹⁵ , ¹⁷ , ²⁶ , ³³ )These studies indicated that VR simulators are not advantageous in the development of maneuvers and tactile sensations, since the equipment only provided interaction through mouse clicks or other controls, finding that these simulators would be more useful for cognitive or procedural learning in clinical teaching than in the development of practical manual skills.

Given the problems mentioned above, it is also possible to highlight financial obstacles to implementing the VR strategy in the context of education, since VR may have higher initial costs to acquire equipment and develop teaching software, particularly for the health area.( ³⁴ )For a thorough analysis of the costs of this strategy, further studies are needed to assess the cost-benefit ratio of implementing VR.

Despite some negative points mentioned, there is a consensus that VR contributes to the teaching-learning process, providing high levels of attention, interest and motivation among students, as highlighted in most studies. Some authors have highlighted the opportunity to understand ideas that are conceptually complex through visualization in VR.( ⁷ , ²² , ²⁸ )Furthermore, they emphasized free access to simulation, regardless of time and place, as long as the equipment is available.( ⁸ , ¹⁶ , ²⁷ )In this area, some studies have pointed to the possibility of experiencing rare and high-risk clinical cases and situations without there actually being a real imminent risk.( ⁹ , ²⁹ )

Implementing VR encourages motivation and academic performance by encouraging students to make active decisions in their learning and to explore the virtual environment independently, which enhances the development of skills. Real-time interaction and immersion reduce distractions, placing students as protagonists of the educational process.( ³⁵ )However, the effectiveness of this approach may depend on factors such as accessibility to technology and the adaptation of each student, limiting its universal application.

In the context of healthcare, VR also presents notable improvements in technical skills and consolidation of theoretical knowledge.( ³⁵ )This way, students gain greater confidence to perform technical procedures in real clinical settings. Despite this, it is essential to balance the use of this technology with traditional methods and practical experiences in the real environment, ensuring training that prepares students for the complexity and unpredictability of clinical care.

During the study, some limitations were pointed out: (A) publication bias, since the inclusion of only published studies can lead to a bias, with positive studies being more likely to be published than studies with negative results; and (B) the diversity of interventions and results in the included studies made it difficult to synthesize the results and identify clear patterns or trends.

Conclusion

The research provided an analysis of the use of VR in the context of the teaching-learning process in undergraduate nursing courses. The results suggest that VR can be an innovative resource that complements traditional methodologies, expanding the pedagogical possibilities in nursing education. This approach can enhance the development of essential skills for professional practice, promoting more interactive and contextualized learning. Based on the results presented, two main strategies for integrating technology stood out: the use of immersive systems, with VR glasses, and non-immersive platforms, accessed via computers or mobile devices. While immersive tools offer greater engagement and realism in simulation, non-immersive tools present advantages in terms of accessibility and reduced cost. The adoption of VR has demonstrated a positive impact on nursing students’ experience and academic performance. The technology promotes greater motivation and engagement, allowing students to explore simulated clinical environments without the risks inherent to real practice. However, challenges such as lack of familiarity with the technology, high implementation costs, and potential side effects such as dizziness and discomfort still represent limitations to be considered. The topics addressed in the VR interventions offered a wide range of learning opportunities, including training in specific technical skills, such as medication administration and invasive procedures, and the development of interpersonal skills, such as interdisciplinary communication. In addition, the technology was used to simulate complex clinical scenarios, allowing students to safely experience high-risk cases. However, it was not possible to identify a pattern in the results presented. By recognizing the role of VR as a complementary resource, this research reinforces the importance of a comprehensive approach in improving health education. However, for its implementation, structured planning that considers the benefits and limitations of technology is essential, ensuring a balance between digital methods and practical face-to-face experiences. Therefore, it is essential to continue exploring the theme of VR in the context of nursing education, aiming to improve its potential in professional training.

Data availability

: The authors did not make the data from this article available in repositories prior to submission.

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Edited by

• Associate Editor:
  Alexandre Pazetto Balsanelli ( https://orcid.org/0000-0003-3757-1061 ) Escola Paulista de Enfermagem, Universidade Federal de São Paulo, SP, São Paulo, Brasil

Publication Dates

• Publication in this collection
  09 Jan 2026
• Date of issue
  2025

History

• Received
  13 June 2024
• Accepted
  5 May 2025