# NursingXR: Advancing Nursing Education Through Virtual Reality-Based Training
## 1 Introduction  
As healthcare technology evolves, nurses must continually adapt to increasingly complex medical devices, treatment protocols, and patient care techniques. This growing demand for technical proficiency places significant pressure on nursing education to ensure students acquire both theoretical knowledge and hands-on clinical skills [1]. However, nursing students often struggle with the abstract and intricate concepts of foundational courses such as physiology, pharmacology, and pathophysiology. These difficulties are exacerbated by academic deficits, including limited scientific literacy and insufficient exposure to high-level medical content. Moreover, stress plays a crucial role during training,particularly in initial hands-on practice. These challenges are especially significant in high-stakes clinical settings, where performance anxiety further limits opportunities for gaining experience [2]. Furthermore, clinical placements are often limited, making it difficult for students to gain sufficient real-world experience. Many institutions struggle to provide adequate hands-on training due to faculty shortages, resource constraints, and competition for clinical sites [3]. Additionally, physical simulations, such as the use of mannequins, while helpful, do not always fully replicate the complexity of patient care [4]. These constraints have driven the need for alternative learning methods that can provide students with the flexibility to practice clinical tasks in a realistic and controlled environment. Virtual reality (VR) training platforms offer a solution by enabling students to repeatedly practice procedures in an immersive, interactive setting without the constraints of physical labs or patient availability [5]. The integration of emerging technologies into education is transforming how students learn and acquire practical skills. Virtual reality (VR) and immersive learning environments have gained considerable attention in the past decade for their potential to revolutionize training across various fields, particularly in healthcare [6; 7]. Nursing education, which traditionally relies on physical simulations, textbooks, and supervised clinical practice, is increasingly looking to such immersive training tools to enhance the learning experience [8]. By immersing students in realistic, interactive environments, VR allows them to practice critical skills in a risk-free setting, offering an approach to bridging the gap between theoretical knowledge and hands-on clinical practice. Recent studies [5; 8; 9; 10] have shown that VR can significantly enhance skill acquisition, decision-making, and confidence in medical and nursing students. For instance, research by [PERSON] et al. [5] demonstrated that VR-based simulations enhance knowledge, task performance, and safety of clinical practice. Despite its promise, the adoption of VR in nursing education is still met with skepticism. Some researchers and academics question whether VR can fully replace traditional hands-on training, particularly for tasks that require tactile feedback, such as wound care, peripheral pulse, or intravenous (IV) insertion [11; 12]. Furthermore, concerns about the cost of VR implementation, the learning curve for students unfamiliar with the technology [13; 14], and issues such as motion sickness highlight the need for continued research [7; 15]. This divergence in perspectives underscores the necessity to further investigate the efficacy of VR as a supplementary, not replacement, tool for nursing education, particularly in skill retention and clinical performance. NursingXR, an immersive learning environment for nursing fundamentals, was designed to address many of the challenges faced in nursing education. By simulating real-world clinical environments and procedures, this platform enables nursing students to practice fundamental tasks, such as patient assessments, wound care, and IV insertion, within an immersive, interactive setting.