Health care delivery continues to evolve, with digital technologies creating new opportunities to enhance continuing professional development and lifelong clinical competency (Zhao et al., 2024). Extended reality (XR), an umbrella term encompassing virtual reality (VR), augmented reality (AR), and mixed reality (MR), creates immersive learning environments that bridge theory and clinical practice (Choi et al., 2022; López-Ojeda & Hurley, 2021). Within nursing continuing education and professional development, traditional teaching approaches, such as classroom instruction and skills labs, remain common (Aydın et al., 2023). Although these methods are effective, limited access to specialized training and mentorship often restricts nurses' development of clinical judgment and evidence-based practice skills that are essential for professional growth (Kaldheim et al., 2023). The use of XR technologies can help address these barriers by offering structured, consistent, and risk-free environments for repeated practice and skill development (Car et al., 2019). They also simulate complex clinical scenarios, support interprofessional training, and provide immediate feedback, all without compromising patient safety (Choi & Kim, 2024). Despite the growing presence of XR in health care, a clear understanding of its specific contributions to continuing education in nursing and professional development remains limited (Coughlin et al., 2024). To address this gap, this scoping review examines current literature on XR technologies in continuing education in nursing.
Method
Design
This scoping review was guided by the methodological framework proposed by Levac et al. (2010), further informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews checklist (Tricco et al., 2018). The review addressed the specific research question: What is the extent of the literature on the use of XR technologies for the professional development of nurses? A systematic search strategy was implemented with three electronic databases, including MEDLINE, Scopus, and CINAHL. The search was limited to literature published between January 2022 and March 2025. The start year of 2022 was chosen to capture postpandemic applications of XR technology in nursing professional development. As noted by Kiegaldie and Shaw (2023), the postpandemic period marked increased recognition of virtual educational modalities. The following search syntax was applied to each database: (nurs*) AND (virtual realit* OR augmented realit* OR mixed realit* OR extended realit*) AND (professional development OR continuing education OR train*) NOT (student*). This search syntax was designed to target literature on the use of XR technologies for professional development of nursing staff and exclude studies focused on nursing students. Study characteristics (author, year, country, design, sample size, technology, duration, setting, and nurse experience) were charted into a standardized data extraction form.
Study Selection
According to the Joanna Briggs Institute Manual for Evidence Synthesis and its population, concept, and context framework (Aromataris et al., 2024), the inclusion criteria encompassed nursing staff from all health care areas, without restrictions on age or experience. As defined by Adil et al. (2024), to fully cover the concept of XR, research studies on AR, VR, or MR were included. Studies addressing continuing education or training were applicable to the context of professional development. Primary research studies of any design, regardless of country of origin, were included. Exclusion criteria omitted studies including nursing students, as the review targeted practicing nursing staff; advanced practice nurses, to maintain population consistency; and studies involving mixed health care professionals, to focus exclusively on nursing populations. Nonresearch publications, including systematic reviews, meta-analyses, textbook chapters, opinion papers, editorials, and gray literature, were not considered.
The screening process was conducted in two phases with Covidence systematic review software (Veritas Health Innovation), after removal of duplicate studies by the software and the research team. In the first phase, two researchers independently assessed titles and abstracts against the inclusion and exclusion criteria, meeting afterward to resolve uncertainties and refine the criteria (Levac et al., 2010). In the second phase, eligible articles underwent a full-text review by two researchers, with a third researcher resolving conflicts. To ensure transparency, selection decisions and justifications for exclusions were documented within Covidence. Figure 1 shows the selection process with a PRISMA flow diagram (Tricco et al., 2018).
Enlarge this image.Figure 1. - Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. Covidence = Covidence systematic review software (Veritas Health Innovation); XR = extended reality.
Data Extraction and Analysis
The team developed a data charting form to systematically extract key variables on XR technologies in nursing professional development, as recommended by Levac et al. (2010). Extraction categories included article metadata (i.e., author[s], year, country, design, purpose); XR specifications (i.e., type, hardware platforms, software, fidelity levels); implementation details (i.e., integration strategies, duration, barriers, facilitators); educational context (i.e., pedagogical methods, learning modalities, nursing competencies, specialties); and reported study findings. An open extraction approach was adopted to acknowledge the diverse ways outcomes were conceptualized across different study designs, allowing for emergent findings that otherwise might have been overlooked (Levac et al., 2010).
With an iterative approach as recommended by Levac et al. (2010), the research team piloted data extraction, with each researcher independently extracting data from five sample articles. Findings were compared to resolve discrepancies and refine extraction categories. Once validated, the extraction form was applied to the remaining articles, ensuring each was reviewed by at least two researchers, aligning with the recommendation of Levac et al. (2010) for enhancing methodological rigor in the data charting process. Disagreements were resolved through discussion, with a third researcher consulted if needed. Emerging patterns were identified from the extracted data (Braun & Clarke, 2006). Drawing on the method of Braun and Clarke (2006), researchers familiarized themselves with the data, allowing themes to emerge naturally and capture both expected and unexpected outcomes for XR in nursing professional development. Initial coding was conducted independently to ensure sensitivity to emerging patterns, followed by collaborative refinement to group patterns into broader thematic categories based on interpretive description (Thorne et al., 2004). The descriptive analysis summarized key study characteristics, including the number of studies, publication years, research designs, XR modalities (i.e., VR, AR, MR), target populations, and implementation settings.
Results
The search strategy yielded 983 studies across three databases: 600 from MEDLINE, 272 from Scopus, and 111 from CINAHL. After 166 duplicates were removed (four identified manually and 162 through Covidence), 817 studies remained for title and abstract screening. Initial screening excluded 696 irrelevant studies, leaving 121 for full-text review. A further 96 studies were excluded after full-text assessment, resulting in 25 studies included for data extraction and analysis (Figure 1).
Study Characteristics
Publications from 2022 to 2025 were included, with most studies published in 2024 (n = 13). Studies originated from 10 countries, most commonly Taiwan and South Korea (n = 6 each). Most studies used quantitative methods (n = 20), with the remainder using mixed methods (n = 5). Research designs included quasi-experimental (n = 10) and randomized controlled trial (n = 8) designs. The remaining studies (n = 7) used mixed methods, pre-experimental, feasibility, or descriptive approaches.
Sample sizes varied considerably, ranging from seven nurses (Nguyen et al., 2024) to 1,868 nurses (Zhang et al., 2022). Most studies used VR (n = 21), with the remainder using AR (n = 3) and MR (n = 1). Head-mounted displays were the most common equipment (n = 20). Intervention duration ranged from 15 to 240 minutes, with most interventions lasting 1 hour or less. Most studies (n = 18) delivered XR training in a single session, whereas a smaller subset (n = 7) used multiple-session approaches or extended learning windows (e.g., daily app use over 1 month or multiweek access periods) (Table A, available in the online version of this article). Expanded data charting forms (including findings, implementation details, reported challenges, and recommendations) are shown in Table B, available in the online version of this article.
Table A.
Characteristics of Included Studies
| Chang & Hwang | 2023 | Taiwan | quasi-experimental | 76 | VR | Single session | teaching hospital | average 8.6–8.8 years |
| Chang et al. | 2022 | Taiwan | quasi-experimental | 67 | VR | 40 min | emergency department | emergency nurses |
| Choi & Kim | 2024 | South Korea | quasi-experimental | 61 | MR | Single session | hospitals | mixed |
| Coughlin et al. | 2024 | USA | program evaluation | 59 | VR | 3-phase program | hospitals | mostly new nurses |
| Ezenwa et al. | 2022 | Kenya & Nigeria | randomized controlled trial | 179 | VR | ≥20 min modules | teaching hospital | varied |
| Heo et al. | 2022 | South Korea | randomized controlled trial (pilot) | 30 | AR | 15 min | hospital | novice |
| Ichihara et al. | 2025 | Japan | quasi-experimental | 13 | VR | one time session | operating room | experienced |
| Jung & Moon | 2024 | South Korea | mixed methods | 35 | VR | 45 min | hospital | novice (<2 years) |
| Kim & Kim | 2024 | South Korea | quasi-experimental | 18 | AR | 120 min | tertiary hospital | novice (<12 months) |
| Lemée et al. | 2024 | Canada | pre-experimental (mixed methods) | 11 | VR | 45 min | rural hospital | novice (<24 months) |
| Li et al. | 2024 | Taiwan | quasi-experimental | 34 | VR | 45 min | teaching hospital | experienced (∼8 years) |
| Nguyen et al. | 2024 | Canada | feasibility study | 7 | VR | 25 min | operating room | mixed |
| Phillips et al. | 2024 | USA | randomized controlled trial | 84 | VR | 30 days | acute care unit | varied (∼12 years) |
| Rappolt & Hadenfeldt | 2024 | USA | pre-experimental pilot study | 15 | VR | 30–60 min | hospital | new nurses |
| Ryu & Yu | 2023 | South Korea | quasi-experimental | 40 | VR | 50–55 min | neonatal intensive care unit | varied |
| Shih et al. | 2023 | Taiwan | mixed methods | 43 | VR | 70 mins | teaching hospital | average 12 months |
| Stafford et al. | 2024 | Australia | randomized controlled trial | 22 | VR | Half-day workshop | university lab | ≥5 years experience |
| Stuart et al. | 2025 | USA | program evaluation (VR) | 68 | VR | 3 15-minute sessions | hospitals | median 9.2 years |
| Sun et al. | 2024 | Taiwan | randomized controlled trial | 102 | AR | 1 hr | hospitals | varied |
| Wang et al. | 2022 | Taiwan | randomized controlled trial | 83 | VR | 1 time training | hospitals | varied |
| Yoo et al. | 2024 | South Korea | mixed methods | 28 | AR | 2-month program | intensive care unit | median 3 years |
| Zabaleta et al. | 2024 | Spain | randomized controlled trial | 56 | VR | 33 min | operating room | Novice-no prior experience |
| Zhang et al. | 2025 | China | randomized controlled trial | 90 | VR (NIVR) | 4 hr | hospital isolation wards | ≥1 yr experience |
| Zhang et al. | 2022 | China | mixed methods pilot study | 1868 | VR | Self-paced online | hospital isolation ward | ≤3–≥10 years |
| Zhao & Li | 2022 | China | quasi-experimental | 60 | VR | 6-month program | hospital operating room | specialty nurses (25–35 years) |
Note. AR = augmented reality; MR = mixed reality; NIVR = non-immersive virtual reality; VR = virtual reality.
Table B.
Data Extraction Table
| Chang & Hwang | 2023 | An Experiential Learning-Based Virtual Reality Approach to Fostering Problem-Resolving Competence in Professional Training | Taiwan | Interactive Learning Environment | Quasi-experimental study | VR (spherical video-based virtual reality) | Hospital nursing staff with an average 8.6-8.8 years of experience | Experimental group (experiential learning-based VR approach) significantly outperformed control group on learning achievement | Motion sickness reported by some participants using VR | Further investigate how to promote spherical video-based VR in workplace environments, especially for first-time users and apply to other occupations/industries and different training courses |
| UPTALE system with Google Cardboard | ||||||||||
| Mobile VR headset | Gender differences in motion sickness susceptibility were discussed; women may be more prone | |||||||||
| Interactive with system feedback | Technical issues with different phone models | Explore influence on trainees with different learning achievements and cognitive styles | ||||||||
| 76 nursing staff (39 experimental group, 37 control group) | Chemotherapy drug leakage accident protection | Experiential learning-based approach with four stages (concrete experience, reflective observation, abstract conceptualization, active experimentation) | ||||||||
| At a regional teaching hospital | Individual learning with instructor guidance | Significantly better learning attitudes, learning satisfaction, and problem-solving skills | Compatibility problems with outdated applications | Develop solutions to overcome motion sickness in VR applications | ||||||
| Suitable for individual experiences | Improve product design and program development to address technical issues | |||||||||
| Learning achievement test, learning attitudes questionnaire, learning satisfaction questionnaire, and problem-solving skill test | experiential learning-based VR approach enhanced the nursing staff's clinical practice ability in a safe learning environment | |||||||||
| 50-minute sessions | ||||||||||
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| Chang et al. | 2022 | Effectiveness of the Virtual Reality Chemical Disaster Training Program in Emergency Nurses: A Quasi Experimental Study | Taiwan | Nurse Education Today | Quasi-experimental study with two-group repeated measures dsign | 360° VR | Emergency nurses | Experimental group showed significantly higher self-assessment chemical disaster preparedness | Limited tactile experience and skill manipulation in VR | VR could be used for disaster preparedness training for nurses without prior disaster response experiences |
| VIRTI platform | Individual VR experience with first-person perspective roles | |||||||||
| Interactive with adaptive multiple-choice knowledge tests | VR may not be more effective than other educational methods for skill development | Tabletop drills more suitable for nurses with prior experiences | ||||||||
| 67 emergency nurses (32 in experimental | Self-paced individual learning | |||||||||
| group, 35 in control group) | Chemical disaster response training using H.A.Z.M.A.T. model | Self-assessment of chemical disaster preparedness and self-efficacy measures | scores one week after intervention | High cost and need for technical expertise to develop VR content | Education in chemical disaster training should implement suitable teaching strategies with consideration of nurses' experiences | |||||
| Emergency nurses from two hospitals in emergency departments | No significant differences were found three weeks after intervention | 360° VR is appropriate for training in rare events like chemical disasters that are difficult to replicate | ||||||||
| Measurements at three time points (before, one week after, and three weeks after intervention) | 40-minute VR simulation plus 20-minute lecture | Both VR and tabletop drills improved preparedness and self-efficacy in chemical disasters | ||||||||
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| Choi & Kim | 2024 | Effects of Team-Based Mixed Reality Simulation Program in Emergency Situations | South Korea | PLoS ONE | Nonequivalent control group pretest-posttest design; quasi-experimental | MR | Nurses with varying experience levels (less than 6 months excluded) | Significant increases in critical thinking | Insufficient precedent research to establish reliability and effectiveness | Expand simulation education using MR as an effective educational strategy |
| Team-based simulation with 4 participants per team | Significant increases in learning transfer motivation | Technical constraints in applying MR-based simulation | Develop diverse simulation programs utilizing MR | |||||||
| HoloLens Headset with shared content visible to all team members | ||||||||||
| 61 nurses (30 experimental group, 31 control group) | CPR emergency situations | |||||||||
| Three hospitals, various hospital departments- internal medicine, surgical wards, Intensive Care Unit (ICU), Emergency Room (ER) | Simultaneous team-based training Critical thinking, learning transfer motivation, communication clarity, communication confidence, learning immersion | Significant increases in communication confidence | Need for further research to assess long-term effects | Conduct continuous technical and nontechnical verification studies | ||||||
| Limited ability to fully implement all aspects of MR simulation | Design simulation education models that enhance practical skills in real-world settings | |||||||||
| 220 minutes total (including pre-briefing, simulation, and debriefing) | Significant increases in learning immersion | Further research needed to assess long-term effects and practical applicability | ||||||||
| No significant difference in communication clarity | ||||||||||
| Coughlin et al. | 2024 | Welcome to the Metaverse: Virtual Reality in Nursing Professional Development | USA | Journal for Nurses in Professional Development | Program evaluation with self-reported survey | VR | Primarily new nurses (87.2% with ≤1 year experience) | 52.4% agreed/strongly agreed VR improved confidence | Only immediate outcomes reported | Partner with IT departments to overcome cybersecurity challenges |
| 59 staff nurses at four hospital campuses at academic health system | Oculus-headset and hand controllers | Instructor-led with pre-training tutorial videos | Wi-Fi connection issues, firewall limitations, multiplayer capability blocked by security measures | Consider adding age demographics to future evaluations to measure VR impact across generational differences | ||||||
| Interactive with simulated objects and people; avatar representation of users | Individual participants with observers who watched VR projected onto large screen | 44.4% agreed/strongly agreed VR reduced performance anxiety | High costs for equipment and maintenance noted | Address issues of cybersickness | ||||||
| Clinical skills (medication administration, blood product administration, end-of-life care) | Self-reported surveys on knowledge, skills, confidence, and satisfaction | 67.7% agreed/strongly agreed VR enhanced clinical knowledge retention | 40% of participants reported cybersickness (nausea, disorientation, uncomfortable visual sensations) | Need for studies on VR implementation across the dynamic nursing workforce | ||||||
| Hardware needs frequent battery changes, software requires regular updates | Further investigation of generational differences and preferred learning styles | |||||||||
| 3 phased approach-preparation implementation and debriefing | 66.7% agreed/strongly agreed VR was effective for learning clinical skills | Limited research on VR in clinical settings beyond academic environments | ||||||||
| Create instructional materials for orientation to VR equipment | ||||||||||
| Establish workgroups with key stakeholders for feedback and troubleshooting | ||||||||||
| 69.8% agreed/strongly agreed the VR learning environment was enjoyable | ||||||||||
| Statistical significance not reported | ||||||||||
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| Ezenwa et al. | 2022 | Using Mobile Virtual Reality Simulation to Prepare for In-Person Helping Babies Breathe Training: Secondary Analysis of a Randomized | Kenya and Nigeria | JMIR Medical Education | Secondary analysis of a randomized controlled trial (the electronic Helping Babies Breathe/mobile | Mobile VR | Varied experience levels (46% with <10 years, 54% with >10 years) | Overall performance on knowledge checks, bag-valve mask skills, and | Using participants' own smartphones (91% owned smartphones) | Mobile VR is a viable approach to precourse preparation in neonatal resuscitation training |
| eHBB VR app with mHBS/DHIS2 (mobile Helping Babies Survive | Participants not educated on | Low-cost VR implementation noted | ||||||||
| Controlled Trial (the eHBB/mHBS Trial) | Helping Babies Survive Trial) | powered by District Health Information System 2) | neonatal resuscitation within the last year | OSCE A checklist was similar between the VR and control groups | Need to explore potential for cost savings and shorter in-person training times | |||||
| Increase pre-training VR exposure time to optimize learning | ||||||||||
| 179 nurses and nurse-midwives working in labor, delivery, and newborn care units (VR group: n=91; control group: n=88) | Low-cost VR headset with participants' smartphones interactive 3D simulation scenarios | Self-directed with minimum 20 minutes for familiarization | ||||||||
| Individual VR simulation modules plus digital Helping Babies Breathe Provider's Guide | VR group performed better in the critical step of head positioning and airway clearing (86% vs. 65%) | |||||||||
| 20 secondary and tertiary healthcare facilities in Nigeria and Kenya | Clinical skills (neonatal resuscitation skills) | Knowledge test, bag and mask ventilation (BMV) skills check | ||||||||
| Control group performed better in identifying helpers and washing hands | ||||||||||
| Low pass rates in both groups (only 3.4% of participants passed) | ||||||||||
| VR improved specific skills, but overall performance was not significantly different between groups | ||||||||||
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| Heo et al. | 2022 | An Augmented Reality-Based Guide for Mechanical Ventilator Setup: | South Korea | JMIR Serious Games | Prospective randomized controlled pilot study | AR | Novice (nurses with no prior ventilator setup experience) | People using AR for mechanical ventilator | Battery charging time | AR-based instructions are feasible for ventilator setup training for novices |
| Microsoft HoloLens 2 | Device overheating without breaks | |||||||||
| Prospective Randomized Pilot Trial | 30 participants-Randomized into 2 groups, manual and augmented reality (AR) | with Microsoft Dynamics 365 Guide and Remote Assist | Self-learning with 15 minutes of practice time with the HoloLens 2 | setup needed help much less often than those using manuals (48% vs 93%) | Network instability issues observed in some cases | AR training offers benefits for both instructors and trainees | ||||
| One participant excluded due to trouble with wearing/using the HMD | ||||||||||
| HMD | Individual learning with remote assistance available when needed | |||||||||
| Remote assistance through AR is more efficient than phone-based help | ||||||||||
| Nurses with no prior experience of mechanical ventilation (MV) or AR | Interactive with hologram instructions, step-by-step guidance, and remote assistance capabilities | Need for specific guidelines regarding technology issues | ||||||||
| Performance score (35 steps, 1 point per successful step) | The AR group required fewer instances of assistance (13 vs 33), felt more confident setting up ventilators, found AR more suitable for ventilator setup, and were more likely to recommend AR for ventilator training | Analysis of specific error types and step characteristics needed | ||||||||
| Samsung Medical Center-hospital | Approximately 20-25 minutes for procedure completion | Extend AR-based training to other step-by-step advanced procedures | ||||||||
| Mechanical ventilator setup with 35 procedural steps from plugging in the socket to setting the initial ventilation mode | No significant difference in performance and time to complete ventilator setup | Design training platforms with suitable technology integration based on step characteristics | ||||||||
| Main advantages of AR for ventilator training were reduced need for assistance and better | Plan for larger-scale studies addressing technical limitations |
| user experience | ||||||||||
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| Ichihara et al. | 2025 | Leveraging Virtual Reality for Advanced Scrub Nurse Education: A Non-Randomized Comparative Study of Training Effectiveness | Japan | Clinical Simulation in Nursing | Single-center non-randomized comparative study; quasi-experimental | VR | Experienced nurses (novice nurses were excluded) | Scrub nurses trained with VR rated their experience better than traditionally trained nurses in several ways; felt the training was more realistic, could observe details better, and better understood instrument setup, the surgical environment, and the sequence of surgical steps | Required dedicated space with reliable internet connection | Integrating VR into nursing education can enhance training outcomes |
| Meta Quest 2 VR headset | Self-paced learning with the VR system in a dedicated training room | Some participants reported difficulties with fine hand movements in VR | Combining VR with traditional methods may provide the most comprehensive learning experience | |||||||
| HMD | Individual learning with the ability to request remote assistance if needed | Potential for motion sickness or eye strain | Need for larger sample sizes | |||||||
| Need for multicenter studies | ||||||||||
| 13 participants (7 in VR group, 6 in manual group) | Users could engage with surgical instruments and procedures in an immersive environment | Self-assessment questionnaire and peer assessment questionnaire by orthopedic surgeon | VR unable to fully reproduce the tactile experience of actual instrument handling | Need for long-term studies to assess skill retention | ||||||
| Need for evaluation of combined approaches (VR + manual) | ||||||||||
| Scrub nurses who were involved in instrument preparation for orthopedic trauma surgeries | Measurement of surgery time, anesthesia time, and instrument errors | Address technical limitations of VR | ||||||||
| Explore applications for novice nurses and various surgical specialties | ||||||||||
| OR/surgical center at a tertiary emergency medical facility | Clinical skills training for scrub nurses involved in orthopedic trauma surgery instrument preparation | Qualitative analysis using Steps for Coding and Theorization (SCAT) methodology | However, when surgeons evaluated both groups: no differences in performance were noticed, and surgery times were the same for both groups | Develop more validated assessment tools | ||||||
| Evaluate comparative effectiveness against other training modalities | ||||||||||
| The VR environment helped nurses learn through | ||||||||||
| immersion and better visualization of surgeries, but this didn't translate to measurable differences in actual performance | ||||||||||
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| Jung & Moon | 2024 | Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study | South Korea | JMIR Serious Games | Mixed methods pilot quasi-experimental study | VR | Novice nurses (less than 2 years of experience) | Both VR-trained and traditionally trained nurses improved their pressure ulcer knowledge | Nurses said the scenarios felt real VR helped with learning: it was safe and enjoyable to use | VR simulation is effective for improving knowledge of PU management |
| Unity 3D platform with HTC Vive Pro headset and hand controllers | Structured program including pre briefing (15 minutes), VR simulation (10 minutes), and debriefing (20 minutes) | |||||||||
| 35 novice nurses (18 in experimental group, 17 in control group) | HMD | Some issues with the VR equipment itself like complex preparation process for running the VR program | PU-VRSim can be used as an educational method for clinical nurses | |||||||
| Control group received video-based lecture | Participants could engage with virtual patients, conduct assessments, perform dressings, and provide education | Individual learning with the opportunity for remote assistance | The VR group showed good clinical judgment skills | VR provides a safe learning environment without risk of contamination | ||||||
| Hospital setting (various departments) | Issues with focus clarity and controller recognition | Need for larger-scale studies with more diverse participants | ||||||||
| Weight of the HMD causing discomfort | Need for randomized controlled trials | |||||||||
| Knowledge test (Pieper-Zulkowski pressure ulcer knowledge test), Critical thinking disposition assessment, Self-efficacy assessment (Korean version of General Self-Efficacy Scale), Clinical judgment (Lasater Clinical Judgment Rubric), Qualitative interviews | Neither group improved in self-confidence or critical thinking | Vision difficulties for participants who wore glasses | Limitations in generalizing results due to small sample size | |||||||
| Clinical skills for pressure ulcer (PU) management, including risk assessment, wound evaluation, dressing application, and patient education | No real difference between groups in knowledge improvement | Text sometimes appeared blurry | Develop more user-friendly VR equipment that is comfortable and easy to use | |||||||
| Mentioned high cost of VR implementation as a limitation | Create more affordable VR solutions (e.g., smartphone apps) | |||||||||
| Develop field-tailored VR simulations for various health professions | ||||||||||
| Incorporate new technologies like artificial intelligence | ||||||||||
| Conduct long-term follow-up studies to assess skill retention | ||||||||||
| Kim & Kim | 2024 | Effects of a Simulation-Based Care After-Death Mentoring Program for New Nurses: Augmented Reality End-of-Life Experience | South Korea | Journal of Palliative Medicine | Quasi-experimental pre- to post-test design | AR | Novice nurses (<12 months experience) | Nurses felt much more comfortable handling end-of-life care after AR training | The study identified that death anxiety was not significantly reduced by the intervention | Development of web-based hands-on training programs to aid nurses in performing postmortem care in various settings |
| 18 nurses-new nurses with less than 12 months of experience | Web-based AR application developed using Unity 3D engine and Vuforia software development kit | Structured mentoring program with expert guidance | Their compassion skills improved significantly | The authors noted that cognitive behavioral therapy (CBT) might be more effective for reducing death anxiety | Implementation of CBT-based death anxiety management programs for new nurses | |||||
| Tertiary general hospital (intensive care units and general wards) | Download application to Android smartphone or tablet | Combined individual learning with mentorship | Integration of AR technology in simulation-based mentoring for end-of-life care | |||||||
| Interactive-learners could guide their learning through step-by-step instructions | Pre-post survey on comfort in bereavement/end-of-life care, Death anxiety measurement, Compassion competency assessment, Program satisfaction evaluation | Their anxiety about death stayed about the same | Need for randomized controlled trials with a control group | |||||||
| Participants were very satisfied with the AR training overall (4.5/5 rating) | Need to investigate long-term impact of the intervention | |||||||||
| Need to analyze how previous experience with end-of-life care may influence results | ||||||||||
| Clinical skills (end-of-life care), including Communication skills (interaction with bereaved families), Patient monitoring in end-of-life situations, Simulation of patient's dying process (changes in vital signs, facial color, breathing patterns) | 120 minutes total (20 min pre-learning, 20 min pre-briefing, 40 min mentoring program I, 20 min mentoring program II, 20 min debriefing) | They especially valued mentor support (4.7/5) and communication practice (4.7/5) | Further research needed on the relevance of AR content to learning outcomes | |||||||
| Combining AR technology with mentoring as an effective educational strategy | ||||||||||
| Considering age demographics in technology-based interventions (younger individuals typically feel more comfortable with digital technologies) | ||||||||||
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| Lemée et al. | 2024 | Exploring the Acceptability and Feasibility of an Immersive Virtual Reality Intervention for Newly Graduated Nurses Working in a Rural Area | Canada | Clinical Simulation in Nursing | Descriptive pre-experimental study with post-intervention measures (mixed methods) | Immersive VR | Novice nurses with less than 24 months of experience | New nurses rated the VR training as “extremely effective” | Need for dedicated physical space for IVR training | Progressive gradation of case complexity for different experience levels |
| Ubisim® platform with Oculus Quest 2™ headset | 45-minute individual IVR session (5 min briefing, 10 min | They gained better | Need for flexible scheduling and remuneration for participation | Adequate familiarization time to mitigate cybersickness | ||||||
| 11 newly graduated nurses less than 24 months experience (NGNs) | Individual Immersive Virtual Reality (IVR) sessions with headset and haptic controllers | equipment familiarization, 8 min IVR intervention, 12 min debriefing) | clinical judgment, assessment skills, ability to prioritize, and self-confidence | Cognitive overload was reported by some participants | Dedicated location and incentives (flexible scheduling, remuneration) | |||||
| Rural hospital setting in Quebec, geographically isolated from university teaching hospitals | Users could navigate the environment, assess a virtual patient, and communicate using pre-recorded responses | Individual training with a facilitator present | Very few side effects were reported (only minor eye strain) | Cybersickness (primarily visual discomfort) was mentioned but was not a significant barrier | Complementary use of standardized patients for communication skills | |||||
| Need for higher-level evidence studies to determine effectiveness | ||||||||||
| Treatment Acceptability and Preference (TAP) Questionnaire, Simulator Sickness Questionnaire (SSQ), Semi-structured interviews | Limited ability to practice technical skills (inability to touch the virtual patient) | Use of IVR as a complement to, not replacement for, other educational modalities | ||||||||
| Clinical skills (patient assessment, clinical monitoring), Clinical judgment (responding to respiratory depression), communication skills (interacting with virtual patient and physician), patient education | VR made high-quality simulation training possible in remote locations | Communication practice was less effective than with standardized patients | Potential application in all healthcare settings, not just rural areas | |||||||
| Need for familiarization with the technology | ||||||||||
| New nurses felt better prepared, which they believed improved patient safety | ||||||||||
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| Li et al. | 2024 | Impacts of a Spherical Video-Based Virtual Reality-Integrated Problem-Based Learning Mode on Working Staff's Counseling Competences in Professional Training | Taiwan | Interactive Learning Environments | Quasi-experimental with pre-post-test design | Spherical Video-based Virtual Reality 58(SVVR) | Experimental group 8.6 years of experience | Higher palliative care knowledge scores (both right after training and in later follow-ups) | Some participants preferred non-immersive mode (smartphone/tablet) which may have affected sense of presence | Design VR learning environments with larger samples to explore impacts on different knowledge levels |
| 34 nurses (17 in experimental group, 17 in control group) | A web-based VR application developed using Uptale platform integrated with Unity 3D engine and Vuforia SDK | Control group 8.4 years of experience | Need for dedicated space for VR training | Extend SVVR-PBL to other courses and clinical scenarios | ||||||
| Clinical staff nursing teachers/nurse preceptors from a teaching hospital | Problem-based learning (PBL) approach integrated with SVVR | Risk of emotional discomfort when dealing with end-of-life topics in immersive environment | Investigate whether learners feel tension during SVVR-PBL tasks | |||||||
| Individual VR experience | More positive attitudes toward palliative | Explore differences between immersive and non-immersive delivery methods | ||||||||
| Teaching hospital in northern Taiwan | Both headset and non-immersive options (smartphone/tablet) | followed by small group discussions | care and better problem-solving abilities | Limited period of exposure to SVVR may have been insufficient | Examine impact of self-regulated learning, collaboration, or group self-efficacy | |||||
| Palliative Care Cognition Test, Questionnaires on palliative care attitude, critical thinking, problem-solving, Learning motivation assessment | Found VR training more useful and valuable | Communication skills in virtual environment were less realistic than with standardized patients | Limited sample size from one hospital | |||||||
| Users could navigate the environment, interact with virtual instructors, select options during scenarios, access supplementary materials | Semi-structured interviews conducted 12 days post learning | No difference in critical thinking awareness, interest and enjoyment levels or overall learning motivation | Need for non-technical support and adequate briefing time | Results may not be applicable to different working environments | ||||||
| Need to understand emotional responses in SVVR-PBL systems | ||||||||||
| Expand VR implementation to grief counseling training for novice nurses | ||||||||||
| Communication skills for grief counseling, Palliative care education, End-of-life care scenarios, Problem identification and solving in clinical situations | 45-minute SVVR-PBL session within a larger palliative care course | Additional benefits noted: better long-term memory retention | Develop VR experiences that balance technical limitations with authentic learning goals | |||||||
| Interviews showed VR training provided more engaging learning experience, more realistic practice scenarios and better development of communication skills | Integrate real-time feedback and supplementary materials to enhance learning |
| Nguyen et al. | 2024 | Using Virtual Reality for Perioperative Nursing Education in Complex Neurosurgical Surgeries: A Feasibility and Acceptance Study | Canada | Cureus | Feasibility and acceptance study (pre-post intervention design) | Oculus Rift VR | Mixed (novice to experienced OR nurses) | Increased self-reported confidence in 5 of 6 evaluated skills | Absence of haptic qualities (touch-based feedback or physical sensations) in the VR simulation | VR simulation is an acceptable model to train OR nurses for craniotomy procedures |
| HMD | ||||||||||
| 7 OR nurses | Interactive-users could pick up and manipulate virtual surgical instruments | Individual-Self-paced with virtual assistant orientation | Limitations in replicating the full length of actual procedures | VR is particularly valuable for skills training in procedures that occur inconsistently in real-time practice | ||||||
| OR nurses with varying experience levels | Self-reported confidence measured through a 7-item questionnaire pre- and post-VR training | No statistical significance testing performed due to small sample size (n=7) | Small sample size limited statistical analysis | VR can be used for both new and experienced nurses | ||||||
| OR pediatric neurosurgery (craniotomy procedures) | Clinical skills (scrub nurse role in craniotomy procedures), Decision-making (selecting appropriate instruments for different stages of surgery), Anticipating surgical team needs during the procedure, Recognizing intraoperative bleeding | VR can improve nurses' self-confidence in specific perioperative neurosurgical skills | Non-immersive VR mode (smartphone/tablet) may have affected sense of presence | Need for haptic elements in future VR simulations for procedural learning | ||||||
| 25-minute VR simulation (compressed from real procedures lasting 90 minutes to 6 hours) | Need for studies with larger sample sizes to test statistical significance | |||||||||
| Need for comparative studies of VR versus traditional learning methods | ||||||||||
| Particular areas show notable improvement (recognizing bleeds, assisting in craniotomies The technology appears feasible for this type of training | Conduct larger prospective studies to confirm the positive signal from this feasibility study | |||||||||
| Study duration: 25-minute VR simulation (condensed from procedures that can last 90 minutes to 6 hours) | Test knowledge acquisition with VR versus traditional learning models | |||||||||
| Consider incorporating haptic elements for more complex procedures | ||||||||||
| VR training allows repeated practice in safe environment without patient risk |
| High satisfaction scores reported by participants | ||||||||||
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| Phillips et al. | 2024 | Effect of Virtual Reality Simulation Versus Traditional Education on Rates of Clostridium Difficile Infection and Experimental Cluster Randomized Control Trial and Return on Investment Analysis | USA | Journal of Continuing Education in Nursing | RCT | VR simulation: computer screen, keyboard, mouse, voice & text recognition, first person-based avatar | Full time nurses (medical surgical); experience varied from 12.31 ± 9.10 years | Both VR and traditional education modalities positively impacted C diff rates, positive return on investment (ROI) | Small sample size | Use organizational metrics and patient outcomes to evaluate ROI |
| 84 medical surgical | ||||||||||
| RNs | ||||||||||
| Adult acute care | ||||||||||
| 30 days | ||||||||||
| Self-paced | Educational intervention/grouping by units may have created inequities-some RNs wanted to try VRS, other individuals had user difficulties in using VR | |||||||||
| Active | 30 days for participants to complete | VR not realistic compared to headsets | Applying VR in practice and evaluating its efficacy to inform decision making development of a root cause analysis approach with nosocomial infections and further exploration of VR education methods for HCP team | |||||||
| Effect of education on C difficile rates and return on investment | Pre and post test scores, tools related to knowledge and behaviour, monthly outcome data on C diff infections | VRS shows greater potential for ROI and positive patient outcomes | Limited configuration of workstations re: computer hardware and software | |||||||
| Limited VR software options | ||||||||||
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| Rappolt & Hadenfeldt | 2024 | Using Virtual Reality to Increase Nurses' Knowledge of Adolescence Suicide Precautions | USA | Journal of Continuing Education in Nursing | Pilot study | VR | Newly employed nurses (learning activity as part of their orientation) | Virtual learning can be an effective method | Convenience sampling | Further research to study short and long-term impacts on nursing knowledge |
| Pre and posttest questionnaire | Virtual escape room on a computer | Small sample size | ||||||||
| 15 newly employed nurses at a pediatric medical center | Active | 30-60 minutes to complete | One participant failed to complete the pretest | |||||||
| Increase knowledge of suicide precautions for adolescents admitted | Pre and posttest instrument | Virtual escape room was an effective method to teach participants policies and procedures | ||||||||
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| Ryu & Yu | 2023 | Virtual Reality Simulation for Advanced Infection Control Education and Neonatal Intensive Care Units: Focusing on the Prevention of Central Line-Associated | South Korea | Healthcare (Basel, Switzerland) | Non-equivalent control group pretest-post-test design; quasi-experimental | VR | Varying experience levels of nurses | Experiment group showed significantly greater improvements in infection control knowledge | Convenience sampling | The program has implications for the educational needs of nurses working in NICUs and enhances their knowledge and performance of infection control |
| Identify the Neonatal Intensive Care Unit (NICU) | Vive Pro Full-Kit HMD and sensor, with LEAP Motion Controller hand-tracking device | Experimental group underwent pre-survey, experimental treatment & | Homogeneity in education level between the experimental and control groups could not be established because the NICU nurses from the experiment and control groups were from two | |||||||
| Bloodstream Infections and Ventilator-Associated Infections | program's effects on infection control knowledge, confidence, presence, empathy, & program satisfaction | 3 infection control scenarios were selected for VR simulation: catheter-related bloodstream infection (CRBSI), infection-prone intralipid infusion, and ventilator-associated infection, which are healthcare quality indicators for infection control | postsurvey from 1–20 February 2022. | and performance confidence compared to the pretest | different General hospitals | |||||
| 40 NICU nurses from two different hospitals | Three stages of pre-briefing (20 minutes), VR simulation (10-15 minutes per scenario), and debrief (20 minutes) | All nurses except managers were enrolled in the study | ||||||||
| Control group underwent pre-survey and post-survey from 7–30 July 2022 | ||||||||||
| 3 scenarios: high risk medication with lipid solution, dressing and management for peripheral inserted central line, and aspiration prevention and skincare management during ventilator use for premature infants | Participants' characteristics: age, sex, education level, marital status, clinical career, NICU work experience, position, prior experience with NICU infection control education, and prior experience with VR-related education | |||||||||
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| Shih et al. | 2023 | Effects of Digital Learning and Virtual Reality in Port-A Catheter Training Course for Oncology Nurses: A Mixed Method Study | Taiwan | Healthcare (Basel, Switzerland) | Mixed-methods research design | VR & a digital learning-based Port-A-catheter educational course for oncology nurses | Nurses that had up to 2 years experience at a regional teaching hospital | Results showed significant improvements in Port-A catheter knowledge and skill levels and high learning attitude and satisfaction scores | Convenience sampling limiting generalizability | VR-based educational course effectively enhanced nurses' knowledge, skills, learning attitude, and satisfaction, recommending the inclusion of diverse clinical scenarios for practical learning |
| Quasi-experimental design with a single group but no control group for comparison | ||||||||||
| Convenience sample of 43 oncology nurses from a regional teaching hospital in Taiwan | Nursing experience <2 years | |||||||||
| 3 time points: pre-test, 1st post-test & 2nd post-test | Computer system, VR headsets and remote controllers | Average nursing experience was 12.19 ± 9.6 months | Intervention was delayed | |||||||
| Quasi-experimental single-group | VR Intervention of a Real-Situated Teaching | Around 58 minutes to finish the digital course, with an average participant training time of 9-12 minutes | Five qualitative themes: | VR lacking tactile experience which could affect a learner's sense of reality | ||||||
| repeated measures design to teach | System on Implanted Port-A Catheter Care Development of the Virtual Reality Teaching System | Data was analyzed using descriptive statistics and repeated ANOVA tests | highlighting the realistic VR scenarios, VR practice's usefulness, willingness to learn with VR, VR system limitations, & potential for future courses | |||||||
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| Stafford et al. | 2024 | Evaluating a Virtual Reality Dementia Training Experience Using Psychophysiological Methods: A Randomised Controlled Study | Australia | Australasian Journal on Ageing | RCT | VR (virtual reality) with digital studio Viewport Simulation | Compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training | Virtual reality evoked objectively significant greater positive and negative emotional responses than video | Small sample size & participants were recruited from a geographically isolated area, so results may not represent those of nursing staff in other areas of Australia and the world | VR offers a more immersive experience compared to conventional training for highly skilled dementia care practitioners |
| Developed in Unity for the Oculus Rift | ||||||||||
| 22 RNs, minimum of 5 years nursing experience within a nursing home | VR system | However, for many learners, VR may not necessarily surpass traditional training methods in terms of enhancing knowledge and attitudes | ||||||||
| VR application | Study only evaluated the effect of training upon the participant's knowledge and attitudes, not their care provision or other important factors like empathy | Future research in this field should concentrate on leveraging VR's enhanced emotional engagement to better prepare Australia's nursing workforce for the growing population of individuals living with dementia | ||||||||
| Completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centeredness | Meaningful Spaces, utilized in a half-day face-to-face workshop to help participants experience altered perceptions common in individuals with dementia, enhancing their understanding of the impact of environment and medications on managing BPSD (Behavioural & Psychological symptoms in Dementia) | Randomized to either interactive VR experience or video footage captured from within the app | Self-ratings of engagement and emotional state were similar | No qualitative assessment was conducted, so a participant's perception may not be fully captured | ||||||
| There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved | Study did not evaluate the training's long-term impact on practice | |||||||||
| Stuart et al. | 2025 | Visualizing the WHO “My Five Moments for Hand Hygiene,” Framework: A Virtual Reality Training Program for Improving Hand Hygiene Adherence Among Nurses | USA | American Journal of Infection Control | VR training program that uses the WHO's “My Five Moments for Hand Hygiene” framework to provide feedback about the pathogen transmission and hand hygiene in 4 clinical scenarios | VR based | Using theory of planned behavior, determinants (intention, attitudes, subjective norms, and perceived behavioral control (self-efficacy) of hand hygiene adherence pre, midway and post training | Self-efficacy scores and overall hand hygiene adherence in VR increased linearly by 11% and 68% | Lack of assessment on effect on actual clinical practice | VR is an effective educational tool for enhancing hand hygiene practices of nurses |
| A hands-on tutorial in an untethered VR headset (Quest Pro, Meta) | VR training program was designed to improve trainee's ability to recognize the 5 moments as opposed to improving their hand hygiene technique | Future research should assess the transfer of training to clinical settings and its impact on global adherence | ||||||||
| 68 RNs (median of 9.2 years experience with ICU/medical surgical units, ER, working for a staff nurse agency and float pool) from 4 hospitals in USA | For each level, trainees completed 3 VR sessions: an initial assessment session, a training session, and a reassessment session | Gaps in the hand hygiene technique still exist and should be targeted in future VR based hand hygiene training interventions | Future research could explore other types of extended reality modalities that do not require recreating physical environments, equipment supplies, and workflows in a virtual world | |||||||
| Each session was 15 minutes & began with a simulated patient handover, followed by a clinical scenario of 2 patient care tasks (e.g., inserting a peripheral IV and auscultating lung sounds), & lastly, a post-scenario summative view of pathogen transmission | This was only designed for nurses working in acute care settings, it is possible other HCPs would benefit | |||||||||
| Multi item scales were used to measure intentions, attitudes, subjective norms and self-efficacy in the context of hand-hygiene | ||||||||||
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| Sun et al. | 2024 | Nurses' Knowledge and Skills After Use of an Augmented | Taiwan | Journal of Medical | RCT | AR | AR group=crash cart learning system developed with AR | AR group outperformed the control | The teaching course based on the developed crash cart learning system | AR-based learning can significantly improve ACLS skill & knowledge especially |
| Reality App for Advanced Cardiac Life Support Training: Randomized Controlled Trial | Internet Research | Advanced Cardiovascular Life Support (ACLS)cart training course was developed using AR technologies in its first stage | First Stage: AR technology used to transform a physical crash cart into a virtual teaching tool comprising 5 parts: 1. Emergency medications, 2. Infusions, 3. Intubation equipment, 4. Tracheostomy tubes, 5. Ambu bags and suction devices | technology, control group=traditional learning lecture-based instruction | group regarding overall ACLS outcomes and crash cart learning outcomes | focused on the operations and function of the crash cart without offering opportunities for nurses to engage in critical emergent scenarios | with novice nurses compared to traditional methods; the high usability & motivational benefits of AR suggest it has broader implementation use for nursing education | |||
| Duration of sessions were around an hour | ||||||||||
| Single-blinded research method was adopted | Both groups were evaluated post course | Improvement rate was the largest for new staff regardless of their overall learning effect and the crash cart effect | Lack of integration with actual ACLS scenarios can limit the overall learning experience in the first aid training | Future systems could add critical emergent scenarios to enhance the connection between the system and practical emergency response training | ||||||
| Convenience sampling | Performance was assessed through learning outcomes related to overall ACLS & crash cart use | |||||||||
| All nurses had a bachelor's degree; 20 years of age or older, they could read and speak Mandarin, worked in ICU, ER or general medicine & participated in resus processes | Second Stage: developed crash cart learning system was applied to ACLS drills in a regular ACLS training program and an AR group scanned the dedicated AR marker equipment and other tools whereas the control group received instruction through lectures | Instructional Materials Motivation Survey (IMMS), System Usability Scale (SUS) and Cognitive Load Theory Questionnaire (CLQ) were used to assess secondary outcomes in AR group | Subgroup analysis containing nurses with <2 years experience in the AR group=more significant improvements were noted in overall learning & crash cart outcomes compared to their counterparts in the control group | |||||||
| 102 total nurses; 43 nurses=AR group; 59 nurses=control group | Questionnaire in study was rated by 3 experts who had 10+ years of experience in their field | Subgroup analyses were performed for nurses with less than 2 years of experience | Nurses >2 years+ experience, showed no significant differences between the AR and the control |
| group in post training learning outcomes for the crash cart | ||||||||||
| AR group showed high scores for motivation as well as a low score for cognitive load | ||||||||||
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| Wang et al. | 2022 | 3D Virtual Reality Smartphone Training for Chemotherapy Drug Administration by Non-oncology Nurses: A Randomized Controlled Trial | Taiwan | Frontiers in medicine | RCT: two-arm single-blind design, parallel RCT | VR | Nurses were randomized using a cluster approach (computer randomization) by nursing station; 2 groups: VR or control | No difference was found between VR and control groups in the KACA; the CAA score of the VR group was significantly higher than that of the control group | Small sample size, therefore statistical power lacks | VR is easy to use and does not require a lot of training to fit the teaching materials |
| N=83 nurses (employed for minimum 3 months; needed to know how to operate chemotherapy techniques, aged at least 20 years old) | Control group: Educational materials for the VR group are filmed and produced using EduVenture VR | |||||||||
| 360 VR camera | Data collectors and outcome adjudicators were blinded | Current restriction of mobile models' central processing unit and store size reduces users' intentions to download the App | This study shows the use of VR improves the learning efficacy of chemotherapy drug administration at least partially in non-oncology nurses | |||||||
| 10 questions were designed for KACA (Knowledge and Attitude of Chemotherapy Administration) based on previous literature; score of each question was measured using the Likert scale; 1=totally disagree, 5= totally agreed; higher score means positivity toward the knowledge & attitude of chemotherapy | This information can be used by downloading the App to the public smartphones of the nursing station | Data analyst receives the data and analyzes it after experiment | No compliance reporting was done | |||||||
| Learning objectives were to operate the chemotherapy administration process and chemical waste disposal procedures correctly and safely | The OSCE score of the VR group was significantly higher than the control group | Technical differences between different departments when operating chemotherapy drug admin (gynecological patients versus pediatrics); Therefore, different sets of VRs are required | ||||||||
| Each nursing station is equipped with VR glasses for viewing VR through a smartphone | Training had 5 parts: checking orders, 2. Prepare the premedication for chemo, 3. Check chemo drugs, 4. Perform chemo admin, 4. Chemo waste | OSCE failure rates were 9.5% in the VR group and 19.5% in the control group | Study did not involve debriefing | |||||||
| Participants could take the VR session at the nursing station or take it home. The App could have included simple | ||||||||||
| drug administration | interactions, including multiple-choice, true-false and recording question | sorting and 5. Disposal for both VR intervention and control groups | ||||||||
| Survey using the Checklist of Action Accomplishment (CAA), after intervention, another questionnaire designed by the authors and the OSCE, were conducted 1 month after the intervention | VR group: smartphone paired with VR glasses and audio device | Pre & Post Test | ||||||||
| Pre: 2 or 3 days before the initiation of the trial | ||||||||||
| Post: 1 month after trial | ||||||||||
| They were instructed to learn chemotherapy administration skills from the software or App for 1 month at least once a day | ||||||||||
| When the VR software was run for the first time, the experimental group operated with the assistance of the investigator to confirm that it was running normally | ||||||||||
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| Yoo et al. | 2024 | Adoption of Augmented Reality in Educational Programs for Nurses in Intensive Care Units of Tertiary Academic Hospitals: Mixed Methods Study | South Korea | JMIR serious games | Mixed methods study | AR | 3 years for nurses' median work experience | Trainees found AR useful for hands-on learning, appreciating its realism and the ability for repetitive practice | Challenges were expressed such as difficulty in adapting to the new technology | AR exhibits potential as a supplementary tool in nurse education |
| Experimental design methodology was based on Kern Six-Step approach: 1. Problem identification, 2. Needs assessment, 3. Setting goals & objectives, 4. | Microsoft Dynamics 365 Guides and HoloLens 2 | Semi-structured interviews were conducted with nurses from nursing education department via voice recordings | Restricted number of participants; larger sample size could be recruited to identify factors influencing user acceptability and to enhance usability | Study provides insight on development, launch and operation of an AR-based medical educational program which can be considered as an alternative to compensate for insufficient resources for conventional critical care nursing education | ||||||
| Choosing education | 5 HoloLens 2 devices | AR was chosen to enable nurses to interact with virtual | AR is effective in promoting | |||||||
| strategies, 5. Implementation, 6. Participant | medical devices within a realistic clinical setting | self-directed learning and hands-on practice, with participants displaying active engagement and enhanced skill acquisition | ||||||||
| Evaluation | AR-based educational program was set within the hospital's simulation laboratory | |||||||||
| Aim: develop, introduce, evaluate an AR-based educational program designed for nurses, focusing on its potential to facilitate hands-on practice and self-directed learning | Training goals of the platform were established by expert trainers and researchers, focusing on the utilization of a ventilator and extracorporeal membrane oxygenation system | |||||||||
| ICU nurses (n=28) were enrolled to evaluate | ICU nurses were enrolled to evaluate AR education | |||||||||
| AR education | ||||||||||
| 10 participants for each session, 5 nurses at a time | ||||||||||
| 2 experienced supervisors for each session | ||||||||||
| Usability and Acceptability of the AR training using the System Usability Scale (SUS) & Technology Acceptance Model (TAM) for the outcomes survey | Usability and acceptability of the AR training was assessed using the System Usability Scale and Technology Acceptable Model with ICU nurses who agreed to test the new platform | |||||||||
| ICU nurses who agreed to test the new platform | ||||||||||
| 2-month period | ||||||||||
| Interviews gathered feedback from training | ||||||||||
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| Zabaleta et al. | 2024 | Clinical Trial on Nurse Training Through Virtual | Spain | Cirugia Española | Open parallel group randomized clinical trial | VR | Median time spent in the simulator was 33 minutes | Participants achieved an average | Lack of objectivity regarding how the learning acquired in the | VR is a useful tool in nurse training, especially for |
| Reality Simulation of an Operating Room (OR): Assessing Satisfaction and Outcomes | 1 group=basic formation followed by an assessment module | Meta Quest 2 HMD using Unity Real-Time Development Platform | Control Group: completed basic training (OR table setup) followed exclusively by the OR simulator in the evaluation mode | mode score of 480 points | virtual reality environment, the ability to apply these skills and knowledge in real surgical settings has not been assessed | specialized roles like OR nurses in thoracic surgery | ||||
| HMD & Simulator | ||||||||||
| Experimental group=same basic formation, followed by thoracic surgery training & an assessment module | Operating Table setup: users in an OR before the patient's arrival – the scenario aims to introduce participants to surgical instrument names meant for use during surgery and familiarize them with tool-handling concepts while also assessing proper HMD positioning | Experimental group: same basic training (OR table setup) followed by the OR simulator in both formation and evaluation modes | Experimental group achieved an overall higher score than the control group | To consider that a transition from a controlled virtual environment to a real OR may involve additional challenges (stress, communication with team, adaptation to client/patient conditions) | It enhances their performance with complex procedures and promotes adaptability and versatility | |||||
| 56 nurses (51 female, 5 males, no left-handed participants with an average age of 41 years old), OR nurses without prior thoracic surgery experience | Outcome variables= Number of tasks completed (0-46), individual task scores (20 for correct performance, 0 for incorrect) | Women in the second quartile of age among participants (35 to 41 years) achieved significantly better results than the rest | This study only focused on 1 type of surgery (thoracic) | |||||||
| Exercises performed in the last 10 minutes obtained better results than those performed in the first 10 minutes | Results are only generalizable to that specific surgery, not to all types | |||||||||
| Computer based randomization | Adverse effects included blurred vision as the most frequent reported | Sample of participants were limited to OR nurses with no prior experience in this type of surgery which may not reflect the diversity in the field (of OR nurses) | ||||||||
| Overall satisfaction rating with experience was 8.5/10 |
| Zhang et al. | 2025 | Evaluating Whether Nonimmersion Virtual Reality Simulation Training Improves Nursing Competency in Isolation Wards: RCT | China | Journal of Medical Internet Research | Randomized Controlled Trial; parallel, open | Non-immersive VR (NIVR) simulation training program for isolation wards to validate its feasibility and training effectiveness in aiding nurses in adapting to isolation ward settings | Both groups had training on isolation ward (related to Pandemic) layout and nursing procedures | No significant differences in theoretical test or performance assessment scores between both groups | Small sample size limits generalizability of results, indicating a need for future research with larger samples | There is potential for NIVR simulation training for nurses working in isolation wards |
| 90 nurses from 3 hospitals in China | Methods and training materials are still in the early stages and need further development to effectively address a variety of nursing situations | NIVR does not significantly surpass traditional methods for developing foundational/theoretical knowledge, it does reduce task completion time for specific activities | ||||||||
| RNs ages 18 to 40 years with >= 1 year of clinical experience, no previous work experience in isolation wards, good physical health, willingness to fully participate in the training | Control Group: 4-hour conventional training session (with use of PowerPoint) consisting of 2 hours face-to-face lectures & 2 hours of ward visits | Intervention group completed 6 tasks faster than the control group with an average reduction of 3 minutes in time | Lack of blinding for assessors introduces potential bias in performance evaluations, this lacks reliability | NIVR can be considered a valuable tool in medical evaluation as has been shown to be safe and provide repetitive practice and realistic scenario simulation | ||||||
| Randomly assigned to either a control group or intervention group | NIVR=virtual environment via standard personal computer or mobile devices, no specialized headsets | Intervention Group: 4-hour NIVR simulation training session | ||||||||
| 45 individuals per group | Participants could use a keyboard, mouse or touch screen to engage | Both groups completed approximately 4 hours of emergency drills and assessments | ||||||||
| Unreal Engine 5 (Epic Games) was used as the platform (powerful graphic rendering ability) | ||||||||||
| Computer Simulated Laboratory | 2D map navigation and interactive 3D dynamic scenes of the isolation ward | |||||||||
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| Zhang et al. | 2022 | A Pilot Study to Investigate the Role of Virtual Reality in the Preservice Training of Nursing | China | CIN: Computers, Informatics, Nursing | Pilot study; mixed methods design | VR isolation ward was developed by the nursing department at the Hospital | Varying clinical experience levels (≤3 to ≥10 years) | The majority of participants were female, with nearly half having | Financial investment is required for VR training as well as technical assistance which can limit its application | Analysis of findings concluded that using quantitative and qualitative data (mixed methods) it showed that VR training is convenient and useful and provides inherent |
| N=1868 participants | VR training designed based on | |||||||||
| Staff in Isolation Wards | Online survey and semi-structured qualitative interviews (10-30 minutes in length) and digitally recorded and transcribed verbatim (wide range of opinions regarding feasibility and experience of utilizing VR training in an isolation ward among nurses) | Technologies were professional grade & free to use | the spare isolation ward with quick response code an arranged in person training on the learning platform identical to the VR training | over 10 years of clinical experience. Notably, 92.5% had no prior experience working in isolation wards | Only one clinical environment was used (due to convenience sampling) which may affect the generalizability of the findings | benefit (occupational protection) | ||||
| VR training: VR and audio narration synchronized with location freely under the guidance of the simplified user manual | Most nurses emphasized the value of pre-deployment training:
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Evaluation was more so subjective | VR is acceptable for in-person training and is a feasible instrument for isolation ward training and can be considered an alternative to familiarize oneself with the isolation ward under an emergency | |||||||
| Self-administered questionnaires (were to understand the nurses' opinion) | Panoramic camera (360-degree immersions) and 3D visualizations | Encouraged to browse freely through the images; Onsite 2 weeks after this | It was not clearly illustrated whether participants completing VR training would achieve the same or even better objective results than those completing in person training | |||||||
| Nonprobability, convenience, purposive sampling method within a general (critical care) hospital in China | Isolation ward was displayed on the hospital's learning platform of the smartphone app WeChat (a popular social media application) – it is an emerging rich media technology that can load pictures, sounds and videos | In-person training: 78 rounds, from August to September 2020, a specialist nurse who worked in the isolation ward during the pandemic & provided the audio narration in the VR training acted as the guide, showed participants around the ward | ||||||||
| RNs (male and female) aged 18 to 55 (undergrad and postgraduate), they could read and write Chinese, willing to participate | Online surveys were conducted after training for the VR experience | Regarding VR training:
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| VR isolation ward presented on the online platform of the hospital with a quick response code form |
| Allotted time: 10 days, any participant could freely scan the quick code via their smartphone or other computing device and swipe the screen to learn about the isolation ward; they could use touch screen to move forward/backward/left and right through the ward (on the screen); audio narration was synced with the location of 3 zones and 2 routes throughout the ward | person training for ward regulations | |||||||||
| Interview themes identified:
VR as an alternative training method Limitations of VR training Implications for integrating VR into nursing education | ||||||||||
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| Zhao & Li | 2022 | Comparison of Standard Training to Virtual Reality Training in Nuclear Radiation Emergency Medical Rescue Education | China | Disaster Medicine and Public Health Preparedness | Quasi-experimental study with control and experimental groups (non-randomized) | VR | OR nurses (specialty nurses), ages 25-35; experience levels omitted | Higher theoretical exam scores in VR group | Only immediate outcomes measured, no long-term follow-up | Broaden the scope of VR training to include more aspects of nuclear radiation response |
| 3ds Max, Photoshop, Unity3D, and Visual Studio platforms | ||||||||||
| 60 nurses total (30 in control group, 30 in experimental group) | Headset-based with two controllers (left handle for movement, right handle for operation) | Blended learning (theoretical knowledge plus VR training) | Higher skills operation scores in VR group | Limited scope of current VR system (doesn't include all aspects of nuclear radiation response) | Expand participant population to include multi-disciplinary team members | |||||
| OR nurses (specialty nurses), all female | ||||||||||
| Individual VR interactions within team-based scenarios | Higher total scores in VR group | Potential instructor-instilled bias due to non-randomized design | Use a randomized design with larger sample sizes in future studies | |||||||
| Hospital-based training for nuclear radiation emergency response | Interactive-users interact with the system in virtual scenes using controllers | Theoretical examination (50 points) | Improved learning enthusiasm in VR group | Small sample size | Need to include wound management, pollution personnel management, and critical case first aid in VR training | |||||
| Potential for non-uniform data collection | ||||||||||
| Skills operation examination (50 points) | Higher satisfaction scores | Need for studies involving full emergency response teams (doctors, nurses, radiologic technologists, etc.) | ||||||||
| Clinical skills (personal protective equipment use, | Learning enthusiasm questionnaire (IMMS) | All findings were statistically significant | Long-term retention and real-world application data are needed | |||||||
| exposure dosimeter use) | Self-designed learning effect questionnaire | |||||||||
| Decision-making (triage of simulated exposure victims) | Training satisfaction questionnaire | |||||||||
| Technical skills (decontamination procedures) | 6 months for the experimental group |
Note. ACLS = Advanced Cardiovascular Life Support; ANOVA = analysis of variance; AR = augmented reality; CAA = Checklist of Action Accomplishment; CPR = cardiopulmonary resuscitation; DHIS2 = District Health Information Software 2; eHBB = electronic Helping Babies Breathe; ER = emergency room; HCP = health care provider; HMD = head-mounted display; ICU = intensive care unit; IVR = immersive virtual reality; LEAP = Leap Motion Controller; MR = mixed reality; mHBS = mobile Helping Babies Survive; OR = operating room; OSCE = Objective Structured Clinical Examination; RCT = randomized controlled trial; RN = registered nurse; VR = virtual reality; WHO = World Health Organization; XR = extended reality.
Most interventions (n = 18) occurred in hospital-based settings, with seven spanning multiple sites, whereas remaining studies took place in medical centers (n = 3), health care facilities (n = 1), nursing homes (n = 1), or unspecified settings (n = 2). The majority of studies targeted specific specialties, most commonly intensive care, emergency, and operating room settings, with other specialty areas including labor and delivery, pediatrics, neonatal intensive care, and oncology. Six studies focused exclusively on novice nurses (one study defining this as ≤ 1 year experience, another as < 1 year, and three as < 2 years), whereas 15 studies included nurses with varying experience levels. Five studies imposed minimum requirements: excluding nurses with less than 6 months of experience (n = 1); excluding novice nurses (n = 1); and requiring a minimum of 3 months of experience (n = 1), a minimum of 1 year of experience (n = 1), and a minimum of 5 years of experience (n = 1). Three studies did not address experience levels.
Thematic Findings
Thematic analysis of the literature identified five main themes on the use of XR technologies in nursing professional development: (1) learning outcomes and educational effectiveness, (2) technical and implementation challenges, (3) realism and fidelity considerations, (4) specialized clinical applications, and (5) user experience and engagement.
Learning Outcomes and Educational Effectiveness. Studies showed that XR technologies consistently outperformed traditional teaching methods, with VR groups showing significantly better learning achievement, satisfaction, problem-solving skills, confidence in communication, and critical thinking, particularly among novice nurses (Chang & Hwang, 2023). Wang et al. (2022) found that VR-trained non-oncology nurses had lower failure rates on the chemotherapy Objective Structured Clinical Examination (9.5%) than control subjects (19.5%). Coughlin et al. (2024), Lemée et al. (2024), and Nguyen et al. (2024) reported increased confidence and skill acquisition after VR training. Sun et al. (2024) showed AR significantly improved crash cart learning and knowledge of Advanced Cardiovascular Life Support among novice nurses, although experienced nurses showed similar improvements in knowledge of Advanced Cardiovascular Life Support, regardless of the educational method, highlighting the greater suitability of AR for early learners. Studies also explored specialized learning gains: Ezenwa et al. (2022) found mobile VR improved performance of key neonatal resuscitation steps such as head positioning compared with the control group (86% vs. 65%, respectively). Rappolt and Hadenfeldt (2024) found that a virtual escape room effectively increased nurses' knowledge of suicide precautions.
Technical and Implementation Challenges. Implementation challenges were widely reported, including physical discomfort (motion sickness, visual strain, headset weight), with 40% experiencing cybersickness (Coughlin et al., 2024). Gender differences in susceptibility to motion sickness were discussed by Chang and Hwang (2023), who cited earlier research indicating that women may be more affected. Infrastructure and hardware concerns, including the need for dedicated physical space and stable internet connectivity, were outlined by Lemée et al. (2024). Cost was a recurrent theme, with Chang et al. (2022) identifying high expenses for equipment, development, and maintenance as major barriers to VR implementation. Nguyen et al. (2024) highlighted feasibility concerns, noting that although self-confidence improved, no statistical testing was conducted because of the small sample size. Similarly, Wang et al. (2022) cited technical limitations with mobile devices as barriers to VR uptake, and Heo et al. (2022) reported overheating and connectivity issues during AR training.
Realism and Fidelity Considerations. Across multiple studies, the absence of tactile or haptic feedback was identified as a key limitation. Chang et al. (2022), Ichihara et al. (2025), Jung and Moon (2024), Nguyen et al. (2024), and Shih et al. (2023) emphasized that XR simulations, although immersive, did not replicate the physical sensations needed for skill development. Nonetheless, perceived realism was generally high. For example, Jung and Moon (2024) found that pressure ulcer scenarios seemed authentic, and Ichihara et al. (2025) noted that VR-trained scrub nurses reported more realistic training, despite the finding of no measured improvement in actual surgical performance. Li et al. (2024) noted the engaging and emotionally resonant training scenarios offered by VR, whereas Stafford et al. (2024) confirmed that VR evoked stronger emotional responses than video-based dementia training. However, communication training remained limited. In addition, VR was less effective than the use of standardized patients in developing interpersonal communication skills, despite other educational benefits (Li et al., 2024).
Specialized Clinical Applications. Studies found that XR was especially beneficial for training in rare, high-stakes clinical scenarios. Chang et al. (2022) showed that 360° VR improved chemical disaster preparedness among emergency nurses. Nguyen et al. (2024) found VR effective for perioperative education in complex neurosurgical procedures, specifically training operating room nurses to assist as scrub nurses in craniotomies, procedures rarely encountered in routine practice. Infection control training showed mixed but promising results. Phillips et al. (2024) found both VR simulation and traditional education significantly reduced rates of Clostridium difficile infection, with VR offering potential long-term return on investment despite higher initial costs, although this method was not definitively superior in reducing infections. Ryu and Yu (2023) reported that VR simulation significantly improved nurses' confidence in infection control, but knowledge gains were similar to those associated with traditional education. End-of-life and palliative care training also benefited from XR. Kim and Kim (2024) reported increased comfort in bereavement care and greater compassion competency after AR-based simulation for new nurses, and Li et al. (2024) observed better palliative care knowledge retention and more positive attitudes after spherical video-based VR combined with problem-based learning.
User Experience and Engagement. Most participants reported high satisfaction and engagement with XR technologies, with nearly 70% of nurses finding the VR learning environment enjoyable (Coughlin et al., 2024). Jung and Moon (2024) found that nurses described VR as realistic and helpful for learning, with themes including safety benefits and enjoyment. Zhao and Li (2022) similarly noted that VR-trained nurses reported significantly higher learning enthusiasm and satisfaction compared with those receiving standard training. Demographic factors influenced engagement: Zabaleta et al. (2024) found age-related differences in performance, with women in the second quartile of age achieving significantly better results. Zhang et al. (2022) reported that 99.8% of nurses considered advance ward training important, and 83.3% believed VR helped reduce their anxiety. In a later study, Zhang et al. (2025) found VR reduced task completion time by approximately 3 minutes, although it did not improve test scores, highlighting gains in efficiency even without performance enhancement. In addition, AR was especially linked to improved self-directed learning. Both Heo et al. (2022) and Yoo et al. (2024) found that AR increased independent skill acquisition, with fewer participants in the AR group requesting assistance compared with the manual group.
Discussion
This review shows emerging evidence supporting the effectiveness of XR in enhancing clinical competency among staff nurses. The use of XR technologies offers immersive, high-fidelity simulations that enable repeated practice of procedures without posing risks to real patients (Stuart et al., 2025). This repeated exposure in safe, controlled environments strengthens procedural memory, confidence, decision-making speed, and patient safety outcomes (Li et al., 2024; Nguyen et al., 2024). Learners trained with XR often outperform those trained through traditional methods, particularly in practical examinations and knowledge retention (Chang & Hwang, 2023; Ezenwa et al., 2022). Studies also highlight the ability of XR to improve cognitive engagement and support learning through interactive, visual, and dynamic experiences (Sun et al., 2024). Features such as real-time feedback and scenario variability help develop essential clinical competencies such as situational awareness and multistep reasoning. These findings align with earlier research showing that XR-based training enhances procedural competence, knowledge retention, and decision-making (Chang & Hwang, 2023; Nguyen et al., 2024; Shih et al., 2023). Both VR and MR simulate complex clinical scenarios, allowing learners to make and learn from mistakes safely (Ichihara et al., 2025). In addition, XR supports interprofessional collaboration and is valuable for orienting new nurses to layouts, policies, and procedures (Zhang et al., 2022).
In addition to these findings, however, critical perspectives emerged. Some scholars caution that overreliance on simulation versus traditional methods may interfere with the development of empathy, communication, and nuanced clinical judgment (Koukourikos et al., 2021). Barriers to implementation, such as high costs and limited infrastructure, may also exacerbate educational inequities, particularly at underfunded institutions. The alignment between XR performance metrics (e.g., time on task, simulation accuracy) and real-world competency remains unclear, as these may not reflect actual clinical judgment or skills observed in practice (Khalil et al., 2023). Moreover, many XR platforms do not include social or collaborative components, potentially limiting their effectiveness for team-based learning (Khalil et al., 2023). As XR technology evolves, it shows strong potential for enhancing nursing professional development. Key advances, such as haptics for realistic tactile feedback, cloud/mobile XR for accessibility, and eye-tracking or biometric data for personalized learning, are making XR increasingly important (Coughlin et al., 2024). These technological advances directly address key needs identified in this review, including accessibility, personalized learning, and evidence-based implementation in nursing professional development. Artificial intelligence–powered, adaptive virtual patient scenarios may further improve clinical judgment (Kaldheim et al., 2023). However, physical discomfort, which can include cybersickness, eye strain, and disorientation, remains a challenge, potentially affecting learning unless mitigated by hardware improvements and usage protocols (Coughlin et al., 2024; Jung & Moon, 2024; Lemée et al., 2024). Ultimately, XR-based training should be integrated into quality improvement frameworks through stakeholder engagement, alignment with patient safety metrics, and collaboration with developers and regulators to ensure standardization and meaningful outcomes (Phillips et al., 2024).
Limitations
Several limitations should be considered when interpreting these findings. Included studies varied in methodological quality, and our thematic analysis reflects the authors' subjective interpretation. Limiting the time frame to 2022 to 2025 may have omitted earlier relevant work. Excluding nursing students, nurse practitioners, and educators narrowed the focus to practicing nurses, reducing applicability across nursing roles. Finally, the predominance of quantitative studies in the literature limited insights into nurses' subjective experiences and challenges with XR technology.
Conclusion
The use of XR technologies can enhance hands-on training, improve clinical decision-making, and elevate patient care by providing immersive, risk-free learning environments (López-Ojeda & Hurley, 2021). By bridging theory and practice, XR supports evidence-based advancements in nursing continuing education and professional development, ultimately fostering competence, confidence, and improved patient outcomes (Kaldheim et al., 2023). However, challenges such as cybersickness, hardware limitations, high costs, and limited tactile feedback remain significant barriers (Coughlin et al., 2024). These findings offer valuable guidance for continuing education providers, professional development teams, and practice leaders seeking to modernize learning approaches and enhance workforce competency. Future innovations should focus on overcoming these challenges through advances in haptics, artificial intelligence that personalizes learning based on individual performance, and inclusive design that accommodates diverse learner needs and physical abilities (Kim & Kim, 2024). Addressing these barriers will be essential to optimizing the integration of XR within continuing education for practicing nurses.
From Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada.
Disclosure: The authors have disclosed no potential conflicts of interest, financial or otherwise.
Address correspondence to Jennifer E. Mayer, RN, MN-LPNP, Arthur Labatt Family School of Nursing, Western University, Room 3306, FIMS & Nursing Building, London, ON, Canada, N6A 5B9; email: jennifer. [email protected].
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