Abstract
Purpose
This review was aimed to evaluate the effectiveness of virtual reality simulation as a teaching / learning strategy on the acquisition of clinical skills and performance, self-confidence, satisfaction and anxiety level in nursing education.
Methodology
The Preferred Reporting Items for Systematic Reviews guidelines, using the PICO model that is based on an evidence-based practice process was matched. A total of twenty-three studies included six themes: performance skills (n = 13), self-confidence (n = 8), satisfaction (n = 10), anxiety level (n = 3), self-efficacy (n = 4), and knowledge (n = 15). Experimental randomised control trials and quasi-experimental studies from 2009 to 2019, conducted in English, were included. Nursing students (n = 1797; BSN, ADN, MSc, LPN) participated.
Results and conclusion
This review was indicated that virtual reality simulation provides learning strategy to acquire clinical skills, improve knowledge acquisition, increase self-confidence, self-efficacy, and satisfaction level, and decrease anxiety levels among nursing students.

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Foronda CL, Hudson KW, Budhathoki C (2017) Use of virtual simulation to impact nursing students’ cognitive and affective knowledge of evidence-based practice. Worldviews on Evidence-Based Nursing 14(2):168–170. https://doi.org/10.1111/wvn.12207
Yilmaz DU, Tuncalı SH, Yilmaz Y (2020) Nursing education in the era of virtual reality. In: Virtual and augmented reality in education, art, and museums. IGI Global, pp 47–70.
Ferguson TD, Howell TL, Parsons LC (2014) The birth experience: learning through clinical simulation. International Journal of Childbirth Education 29(3).
Dubovi I, Levy ST, Dagan E (2017) Now I know how! The learning process of medication administration among nursing students with non-immersive desktop virtual reality simulation. Comput Educ 113:16–27
Cant RP, Cooper SJ (2014) Simulation in the Internet age: the place of Web-based simulation in nursing education. An integrative review Nurse Education Today 34(12):1435–1442. https://doi.org/10.1016/j.nedt.2014.08.001
Hege I, Kononowicz AA, Adler M (2017) A clinical reasoning tool for virtual patients: design-based research study. JMIR medical education 3(2):e21.
Jeffries P (2013) Simulation in nursing education: from conceptualization to evaluation. 2nd ed. edn., New York: National League for Nursing.
Cant RP, Cooper SJ (2017) Use of simulation-based learning in undergraduate nurse education: an umbrella systematic review. Nurse Educ Today 49:63–71
NLN (2013) National League for Nursing & Society for Simulation in Healthcare. White paper to advance interprofessional education and practice through simulation.
Isik B, Jallad ST (2019) Future of nursing education: changing values, educational paradigm and learner-educator profiles and roles. New Trends and Issues Proceedings on Humanities and Social Sciences 6(1):165–174
Lioce L, Lopreiato J, Downing D et al (2020) Healthcare simulation dictionary. Agency for Healthcare Research and Quality: Rockville, MD, USA,
Işık B, Kaya H (2014) The effect of simulation software on learning of psychomotor skills and anxiety level in nursing education. Procedia Soc Behav Sci 116:3864–3868
Farra S, Miller E, Timm N, Schafer J (2013) Improved training for disasters using 3-D virtual reality simulation. West J Nurs Res 35(5):655–671
Boland A, Cherry G, Dickson R (2017) Doing a systematic review: a student’s guide. Sage
Higgins J (2011) Cochrane handbook for systematic reviews of interventions. Version 5.1. 0 [updated March 2011]. The Cochrane Collaboration. www cochrane-handbook org
Rossler KL, Sankaranarayanan G, Duvall A (2019) Acquisition of fire safety knowledge and skills with virtual reality simulation. Nurse Educ 44(2):88–92. https://doi.org/10.1097/NNE.0000000000000551
Farra SL, Smith S, Gillespie GL et al (2015) Decontamination training: With and without virtual reality simulation. Adv Emerg Nurs J 37(2):125–133. https://doi.org/10.1097/TME.0000000000000059
LeFlore JL, Anderson M, Zielke MA et al (2012) Can a virtual patient trainer teach student nurses how to save lives—teaching nursing students about pediatric respiratory diseases. Simulation in Healthcare 7(1):10–17
Smith SJ, Farra S, Ulrich DL et al (2016) Learning and retention using virtual reality in a decontamination simulation. Nurs Educ Perspect 37(4):210–214. https://doi.org/10.1097/01.NEP.0000000000000035
Ausburn LJ, Ausburn FB, Kroutter P (2010) An exploration of desktop virtual reality and visual processing skills in a technical training environment. J Educ Technol 6(4):43–54
Bryant R, Miller CL, Henderson D (2015) Virtual clinical simulations in an online advanced health appraisal course. Clin Simul Nurs 11(10):437–444. https://doi.org/10.1016/j.ecns.2015.08.002
Padilha JM, Machado PP, Ribeiro A et al (2019) Clinical virtual simulation in nursing education: randomized controlled trial. J Med Internet Res 21(3):e11529. https://doi.org/10.2196/11529
Smith SJ, Farra SL, Ulrich DL et al (2018) Effectiveness of two varying levels of virtual reality simulation. Nursing education perspectives 39(6):E10-E15. https://doi.org/10.1097/01.NEP.0000000000000369
Verkuyl M, Atack L, McCulloch T et al (2018) Comparison of debriefing methods after a virtual simulation: an experiment. Clin Simul Nurs 19:1–7
Verkuyl M, Hughes M, Tsui J et al (2017) Virtual gaming simulation in nursing education: A focus group study. J Nurs Educ 56(5):274–280. https://doi.org/10.3928/01484834-20170421-04
Vidal VL, Ohaeri BM, John P, Helen D (2013) Virtual reality and the traditional method for phlebotomy training among college of nursing students in Kuwait: implications for nursing education and practice. J Infus Nurs 36(5):349–355. https://doi.org/10.1097/NAN.0b013e318243172f
Ismailoglu EG, Zaybak A (2018) Comparison of the effectiveness of a virtual simulator with a plastic arm model in teaching intravenous catheter insertion skills. CIN: Computers, Informatics, Nursing 36(2):98–105
Reinhardt AC, Mullins IL, De Blieck C, Schultz P (2012) IV insertion simulation: confidence, skill, and performance. Clin Simul Nurs 8(5):e157–e167
Bayram SB, Caliskan N (2019) Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: A randomized controlled trial. Nurse Educ Today 79:25–31. https://doi.org/10.1016/j.nedt.2019.05.010
Jung E-Y, Park DK, Lee YH et al (2012) Evaluation of practical exercises using an intravenous simulator incorporating virtual reality and haptics device technologies. Nurse Educ Today 32(4):458–463
Luctkar-Flude M, Pulling C, Larocque M (2012) Ending infusion confusion: evaluating a virtual intravenous pump educational module. Clin Simul Nurs 8(2):e39–e48
Smith PC, Hamilton BK (2015) The effects of virtual reality simulation as a teaching strategy for skills preparation in nursing students. Clin Simul Nurs 11(1):52–58
Wright RR, Tinnon EA, Newton RH (2018) Evaluation of vSim for nursing in an adult health nursing course: a multisite pilot study. CIN: Computers, Informatics, Nursing 36(2):84–89
Cobbett S, Snelgrove-Clarke E (2016) Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: a randomized controlled trial. Nurse Educ Today 45:179–184. https://doi.org/10.1016/j.nedt.2016.08.004
Kardong-Edgren S, Breitkreuz K, Werb M et al (2019) Evaluating the usability of a second-generation virtual reality game for refreshing sterile urinary catheterization skills. Nurse Educ 44(3):137–141
William A, Vidal VL, John P (2016) Traditional instruction versus virtual reality simulation: a comparative study of phlebotomy training among nursing students in Kuwait. J Educ Pract 7(9):18–25. https://doi.org/10.1097/NAN.0b013e318243172f
Bandura A (1986) Fearful expectations and avoidant actions as coeffects of perceived self-inefficacy.
Farra S, Miller ET (2013) Integrative review: virtual disaster training. J Nurs Educ Pract 3(3):93. https://doi.org/10.5430/jnep.v3n3p93
Kolb DA (2014) Experiential learning: experience as the source of learning and development. FT press,
Squire K (2006) From content to context: videogames as designed experience. Educ Res 35(8):19–29. https://doi.org/10.3102/0013189X035008019
Poore JA, Cullen DL, Schaar GL (2014) Simulation-based interprofessional education guided by Kolb’s experiential learning theory. Clin Simul Nurs 10(5):e241–e247
Succar T, Zebington G, Billson F et al (2013) The impact of the Virtual Ophthalmology Clinic on medical students’ learning: a randomised controlled trial. Eye 27(10):1151–1157
Foronda CL, Fernandez-Burgos M, Nadeau C et al (2020) Virtual simulation in nursing education: a systematic review spanning 1996 to 2018. Simulation in Healthcare 15(1):46–54
Curtin LB, Finn LA, Czosnowski QA et al (2011) Computer-based simulation training to improve learning outcomes in mannequin-based simulation exercises. Am J Pharm Educ 75(6)
Chen FQ, Leng YF, Ge JF et al (2020) Effectiveness of virtual reality in nursing education: meta-analysis. J Med Internet Res 22(9):e18290
Nielsen B, Harder N (2013) Causes of student anxiety during simulation: what the literature says. Clin Simul Nurs 9(11):e507–e512
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Jallad, S.T., Işık, B. The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review. Ir J Med Sci 191, 1407–1426 (2022). https://doi.org/10.1007/s11845-021-02695-z
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DOI: https://doi.org/10.1007/s11845-021-02695-z