Effectiveness of game-based VR simulation on nursing students' mastery of level D PPE: A quasi-experimental design

To evaluate the effectiveness of a game-based virtual reality (VR) simulation in improving undergraduate nursing students' competence in donning and doffing Level D personal protective equipment (PPE).

Proficiency in PPE use is essential for effective infection control in clinical settings. However, reduced clinical placement opportunities often limit hands-on training for nursing students. Game-based VR simulations offer a safe, standardized and repeatable modality for developing procedural competence and clinical reasoning in complex infection control scenarios.

This study employed a quasi-experimental pretest-posttest design with a non-equivalent control group.

A total of 50 final-year nursing students participated (25 per group) and were non-randomly assigned to either a game-based VR simulation or a video-based instruction condition using a time-lag design. The intervention was implemented over eight days during the clinical practicum. Outcome variables included PPE knowledge, critical thinking disposition, class immersion and problem-solving ability. Data were analyzed using independent t-tests and Mann-Whitney U tests.

The game-based VR simulation group showed significantly greater improvements in PPE knowledge (U = 227.00, p = 0.004) and problem-solving ability (t = 3.19, p = 0.003) compared with the video instruction group. However, differences in critical thinking disposition and class immersion were not statistically significant.

Incorporating game-based VR into nursing curricula significantly improved nursing students' procedural knowledge and problem-solving ability. This approach holds promise for enhancing learner preparedness and competence in infection control in high-risk clinical contexts, providing a scalable and accessible educational tool for contemporary nursing education.