Effects of Immersive Technology-Based Education forUndergraduate Nursing Students:Systematic Review andMeta-Analysis Using the Grading of Recommendations,Assessment, Development, and Evaluation (GRADE) Approach

Background: The adoption of immersive technology in simulation-based nursing education has grown significantly, offeringa solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diversereports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology innursing education to inform future educational programs. Objective: This systematic review aimed to identify the contents of immersive technology-based education for undergraduatenursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods. Methods: A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latestsearch was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursingstudents; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomizedstudies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Qualityassessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool forNonrandomized Studies. The main outcomes of the included studies were classified according to the New World KirkpatrickModel (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software,and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations,Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevantliterature. Results: A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studiesadopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home healthcare; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on theNWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation,confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in theselected studies. Results of the subgroup analysis showed that immersive technology-based nursing education is more effectivethan traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%)vel 4. Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70,95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%). Conclusions: These findings support the effectiveness of immersive technology-based education for undergraduate nursingstudents, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluatethe effects of immersive technology-based nursing education on NWKM level 4.