Effects of Multiplayer Virtual Patient Simulation on Nursing Students: A Binational Quasi-Experimental Study

AbstractCultural collaboration can support a more holistic approach to nursing care in managing complex conditions, such as pressure ulcers. This study aimed to evaluate the effects of multiplayer, interactive, and noninteractive virtual patient simulations on knowledge, effectiveness, satisfaction, and self-confidence regarding pressure ulcer management among Portuguese and Turkish nursing students. The quasi-experimental, pre-posttest design study was conducted between March and July 2025; data were obtained from 52 nursing students (Experimental Group: 26; Control Group: 26) in Turkey and Portugal using the "Personal Profile Form," "Pressure Ulcer Prevention Knowledge Assessment Instrument," "Simulation Effectiveness Tool-Modified," "Student Satisfaction and Self-Confidence in Learning Scale," and "Structured Debriefing Questionnaire." Between-group comparisons of "Pressure Ulcer Prevention Knowledge Assessment Instrument" posttest scores revealed significant differences in the "Preventive Measures to Reduce the Duration of Pressure/Shear" subscale and total scores. Within the experimental group, pre-post comparisons revealed significant moderate improvements in the same subscale and total scores. "Simulation Effectiveness Tool-Modified" pre-post comparisons in the experimental group showed significant improvements in "Learning," "Confidence," "Debriefing" subscales, and total scores. "Student Satisfaction and Self-Confidence in Learning" scores improved significantly only in the experimental group. Qualitative data analysis identified themes, including Clinical Competence and Skill Acquisition, Reflective Practice, Communication and Collaborative Practice, Simulation Fidelity and Challenges, Confidence and Clinical Readiness, and Affective Response to Simulation. This study demonstrates that multiplayer, interactive virtual patient simulation is associated with improvements in nursing students' knowledge, perceived simulation effectiveness, and satisfaction in pressure injury management.