Impact of virtual reality simulation on pre-registration nursing students’ preparation for clinical practice
Creators: name: Bana, Fatima
Publisher: name: OSF Registries
Year: 2024
Subjects: subject: Medicine and Health Sciences
subject: Other Nursing
subject: Nursing
subject: FOS: Health sciences
subject: virtual reality simulation

description: Scoping Review Protocol: Impact of virtual reality simulation on pre-registration nursing students’ preparation for clinical practice

Introduction: 
VR as a form of simulation is an innovative and emerging technology that is scalable and capable of offering large numbers of students with a fully immersive simulation experience. Immersive VR engages the user’s senses (vision, hearing, and motion) in a 3D virtual world. It requires a head mounted display e.g. VR headsets/googles that may be enhanced by haptic devices, visual tracking, motion sensors or speech (Cant et al., 2019; Moro et al., 2017). Less immersive VR learning (virtual simulation) offers repetition and accessibility of content through screen-based simulation (Phillips, Harper, &amp; DeVon, 2023).

The evidence for the effectiveness of VR in health professions education is mounting. A systematic review and meta-analysis of VR in nursing education found that VR offers superior potential in advancing nursing students’ theoretical knowledge, practice proficiencies and overall satisfaction (Liu et al., 2023). Other literature reviews emphasise the effectiveness of VR at improving cognitive outcomes such as theoretical knowledge (Chen et al., 2020; Shorey &amp; Ng, 2021; Woon et al., 2021). Kiegaldie and Shaw (2023) found that VR fostered critical thinking and provided an efficient and sustainable platform for learning about complex clinical situations. 

Little is known about how well undergraduate nurses are prepared for clinical practice or placements when offered simulation in a virtual environment. The objective of this research is to evaluate the effectiveness of virtual reality-based simulation on pre-registration students’ preparation for clinical practice. An examination of the literature revealed that many studies examined perceptions of learning and learner satisfaction rather than the achievement of learning outcome. As academics we need to examine the effectiveness and retention of learning resulting from virtual reality simulation. If it is shown to be effective, we also need to assess whether virtual reality simulation could be a suitable alternative for a select amount of clinical practicum in the future. Additionally, virtual reality-based simulation may offer a solution to managing the difficulties of simulation physical space thus enabling education providers the ability to expand the number of clinical scenarios available for student education. 















Key definitions: 

Virtual reality – The use of computer technology to create an interactive three-dimensional world in which the objects have a sense of spatial presence: virtual environment and virtual world are synonyms for virtual reality (Healthcare Simulation Dictionary, 2020)

Augmented reality - A technology that overlays digital computer-generated
information on objects or places in the real world for the purpose
of enhancing the user experience (Healthcare Simulation Dictionary, 2020)

Virtual simulation – According to the Healthcare Simulation Dictionary (2020) and a study conducted by Cant et al. (2023) virtual simulation offers real people (learners) the opportunity to engage with interactive technology to immerse themselves in a virtual world—a world that does not exist in real time—using a computer screen, haptic devices and audio-visual aides so they may develop their psychomotor and psychosocial skills and learn to apply theoretical knowledge.

Mixed reality - A simulator that combines virtual and physical components (Healthcare Simulation Dictionary, 2020)

Virtual environment - A simulated environment rendered by a computer, mobile device, or virtual reality / augmented reality / mixed reality device (Healthcare Simulation Dictionary, 2020)

Virtual world - Like Virtual Environment, though implies multiple characters, learners, or participants and potentially, a larger scale than a virtual environment. A virtual world or massively multiplayer online world (MMOW) in a computer-based simulated environment (Healthcare Simulation Dictionary, 2020)

Virtual patient - A representation of an actual patient. Virtual patients can take
many forms such as software-based physiological simulators,
simulated patients, physical manikins, and simulators (Healthcare Simulation Dictionary, 2020)

Aim: 

The aim of this scoping review is to synthesize the best available evidence regarding the use and effectiveness of virtual reality simulation for pre-registration nursing students’ preparation for clinical practice.

Question:

How is virtual reality simulation being used to prepare pre-registration nursing students for clinical practice?



Search Criteria:

Population Concept Context
Nursing student Virtual reality Pre-registration Nursing
 Augmented reality Pre-licensure Nursing
 Virtual simulation Undergraduate Nursing 
 VR 
 Mixed reality 
 Virtual environment 
 Virtual world 
** When screening look for ‘preparation for clinical practice” 

Inclusion &amp; Exclusion Criteria:

Inclusion Criteria Exclusion Criteria
All studies published between 2013 to 2024 Any study outside the year range
Peer-reviewed Non- peer reviewed
Must be primary studies (quantitative, qualitative and/or mixed methods) 
English language Non-English
Full-text available Full text not available 
Under-graduate / pre-licensure nursing education
Include if mixed studies with undergraduate plus postgraduate student cohorts Post graduate studies 
Nursing only Any other health profession
Among virtual simulation technologies, there are several technologies: virtual simulation (VS), virtual reality (VR), mixed reality (MR), augmented reality (AR) and 3D simulation, virtual worlds (VWs) delivered via any digital device (headset, phone, iPad, laptop, tablet, computer). In person simulation e.g. mannikin based, simulated participants, part-task skills education
Must make reference to VR etc used to prepare students for clinical placement/practice No explicit reference to preparation for clinical placement/practice 

Search Strategy:

From year 2013 to current
• CINAHL
• ProQuest
• ERIC
• Ovid-Medline (Pub Med and Medline is 98% same)


Screening and extraction protocol:

Covidence
• 2 people screen title and abstracts
• 3rd person to manage any disagreements
• 2 people screen full text
• 3rd person to manage any disagreements 
• 1 person to extract data using piloted form below (need to finalise)
• Second reviewer to check for correctness and completeness of extracted data 

Data Extraction and Charting Results:

Title Format
Covidence # Numerical 
Title Text 
Authors Text
Journal Text
Year Text
Country(s) of origin Code 1=AU, 2=USA, 3=UK, 4=Canada, 5=Europe, 6=Asia etc
Study Aim Text
Study Method for Primary Research 1=Quantitative, 2=Qualitative, 3=Mixed methods, 4=RCT, 5=Quasi experimental, 6=Case study etc
Population/Year level/progress Code 1= First year, 2= Second year, 3= Third year +
Population size Numerical 
Course Text 
Cultural Context Text
Description of the type of VR modality e.g. VR, AR, MR, Virtual Sim and how it is used Text 
Clinical practice focus Text 
Length of intervention Numerical (days, hours, weeks, semester)
Instances of intervention Numerical 
Type of outcome measure used Code
Communication platform technologies Text
Educational technologies Text
General findings Text
Educational impact
Clinical placement/practice impact
Attrition Text
Limitations Text
References:

Cant, R., Cooper, S., Roland, S., &amp; Bogossian, F. (2019). What’s in a Name? Clarifying the 
Nomenclature of Virtual Simulation. Clinical Simulation in Nursing, 27, 26-30. https://doi-org.ez.library.latrobe.edu.au/10.1016/j.ecns.2018.11.003

Chen, F. Q, Leng, Y. F., Jian, F. G., Dan, W. W., Cheng, L., Bin, C., Zhi, L. S. (2020). 
Effectiveness of virtual reality in nursing education: metanalysis. Journal of Medical Internet Research, 22(9). https://www.jmir.org/2020/9/e18290/

Kiegaldie, D., &amp; Shaw, L. (2023). Virtual reality simulation for nursing education: 
effectiveness and feasibility. BMC Nursing, 22, 1-13. https://doi.org/10.1186/s12912-023-01639-5

Liu, K., Zhang, W., Li, W., Wang, T., &amp; Zheng, Y. (2023). Effectiveness of virtual reality in 
nursing education: a systematic review and meta-analysis. BMC Medical Education, 23, 1-10. https://doi.org/10.1186/s12909-023-04662-x 

Moro, C., Stromberga, Z., Raikos, A., &amp; Stirling, A. (2017). The effectiveness of virtual 
and augmented reality in health sciences and medical anatomy. Anatomical Sciences Education, 10(6), 549-559. https://anatomypubs-onlinelibrary-wiley-com.ez.library.latrobe.edu.au/doi/full/10.1002/ase.1696

Phillips. J.M., Harper. M.G., &amp; DeVon. H.A. (2023). Virtual Reality and Screen-Based 
Simulation Learner Outcomes Using Kirkpatrick's Evaluation Levels: An Integrative Review. Clinical Simulation in Nursing, 79, 46-60. https://www-sciencedirect-com.ez.library.latrobe.edu.au/science/article/pii/S1876139923000154?via%3Dihub

Shorey, S., &amp; Ng, E.D. (2021). The use of virtual reality simulation among nursing 
students and registered nurses: A systematic review. Nursing Education Today, 98, 1-12. https://search.lib.latrobe.edu.au/permalink/f/rl56ei/TN_cdi_openaire_primary_doi_dedup_d94ceed6b04bb335028ca3cb7584bb98

Woon, A.P.N., Mok, W.Q., Chieng, Y.J.S., Zhang, H.M., Ramos, P., Mustadi, H.B., &amp; Lau, 
Y. (2021). Effectiveness of virtual reality training in improving knowledge among nursing students: A systematic review, meta-analysis and meta-regression. Nursing Education Today, 98, 1-9. https://doi-org.ez.library.latrobe.edu.au/10.1016/j.nedt.2020.104655