The impact of virtual reality applied in nurse education on students' clinical thinking: A systematic review.

OBJECTIVE

To summarise and compare the applications and effectiveness of virtual reality in cultivating clinical thinking among nursing students and to further analyse the active ingredients of virtual reality applications.

DESIGN

Systematic review.

REVIEW METHODS

A systematic and comprehensive search of PubMed, Web of Science, Cochrane, Scopus, Embase, and CINAHL was conducted from the inception until 5th of February 2024. The standardised JBI critical appraisal tools for randomised controlled trials (RCTs) and quasiexperimental studies were used to assess the quality of the selected studies.

RESULTS

After screening, 17 articles were ultimately included, including 5 RCTs and 12 quasiexperimental studies. The findings reveal that different applications of virtual reality have varying impacts on nursing students' clinical thinking. The analysis of active ingredients reveals a number of key factors that enhance learning in virtual reality applications. A hybrid approach benefits development across critical thinking, clinical judgement, and clinical decision-making. Nonimmersive virtual reality appears to be active and effective for critical thinking, whereas immersive virtual reality proves to be effective for problem solving. Shorter simulation running times enhance clinical judgement. Shorter prebriefing sessions, fewer simulation scenarios, and structured debriefing centred on the algorithm of the scenario contribute positively to clinical reasoning. Individual operation of the virtual reality system, immediate scenario-embedded feedback, and instructor-led debriefing support clinical decision-making.

CONCLUSIONS

Nurse educators should consider integrating virtual reality technology with other teaching methods to increase the effectiveness of the development of clinical thinking among students. The prebriefing time and debriefing structure should be tailored to specific contexts and objectives. To maintain students' attention during the simulations, allowing students to operate the system independently and shortening the simulation cycles are advisable while limiting the number of scenarios to reduce the cognitive load. For effective reflection, combining scenario-embedded feedback within the virtual reality system with teacher-led debriefing is essential. Additionally, a sensible design of the level of immersion is necessary due to differences in accessibility, the complexity of the learning environment, and the costs between nonimmersive and immersive virtual reality.