Effectiveness of immersive virtual reality in nursing education for nursing students and nursing staffs: A systematic review and meta-analysis

Aim: This study evaluates the effectiveness of immersive virtual reality (VR) in nursing education, with a focus on its impact on knowledge acquisition, skill development, and problem-solving abilities among nursing students and nursing staff. In addition, it examines the effects of different levels of VR immersion across various learner populations, as well as potential side effects. Background: Traditional nursing education often lacks realistic clinical settings, leading to "reality shock" during clinical practice. VR provides a safe environment for learners to simulate clinical scenarios and practice without fear of errors. However, the effects of varying levels of VR immersion remain unclear. Design: Systematic review and meta-analysis. Review Methods: A systematic search of the Cochrane Library, Embase, PubMed, CINAHL, and Airiti Library was conducted for Chinese and English studies published up to October 22, 2024, following PRISMA guidelines. Risk of bias was assessed using RoB 2.0 and ROBINS-I tools, while evidence quality was evaluated with GRADE. Metaanalyses used standardized mean differences (SMD) and a significance threshold of p < .05. Results: Twenty-four studies involving 1812 participants showed that VR significantly improved knowledge (small effect, SMD = 0.34, 95 % CI: 0.06-0.62, p = .02), skills (medium effect, SMD = 0.72, 95 % CI: 0.35-1.10, p = .0002), and problem-solving abilities (large effect, SMD = 1.46, 95 % CI: 0.65-2.28, p = .0004). Fully immersive VR was particularly effective in enhancing nursing students' knowledge (SMD = 0.41, 95 % CI: 0.11-0.70, p = .007), while semi-immersive VR was more effective for nursing staff (SMD = 1.34, 95 % CI: 0.85-1.84, p < .001). Six of the 24 studies examined side effects, with four reporting adverse reactions. The most common side effect was motion sickness, manifesting as nausea, vomiting, and cold sweats. Conclusions: Immersive VR is an effective tool for improving knowledge, skills, and problem-solving abilities in nursing education, with fully immersive VR benefiting students and semi-immersive VR benefiting staff. Despite its advantages, potential side effects like motion sickness should be considered. VR presents a promising, realistic, and repeatable approach to nursing education.