Mapping the complexity of psychomotor skills in core nursing procedures: A content analysis for simulation-based...

With increasing demand for immersive training in nursing education, identifying psychomotor skills suited for virtual reality is essential. Clarifying how physical actions interact with cognitive processes is critical for advancing simulation-based education.

To establish a structured and theoretically grounded framework for understanding psychomotor competence in core nursing procedures, this study was conducted to clarify how physical forces, motion characteristics, and embedded cognitive behaviors interact, thereby informing the design and evaluation of effective virtual reality-based educational strategies.

We used a qualitative content analysis, with quantitative data integrated to support analytic rigor and transparency. Qualitative content analysis was employed to explore and interpret patterns of psychomotor skill behaviors embedded within the simulation, with quantitative frequency counts used to descriptively summarize the distribution and relative prominence of identified codes. Six core nursing procedures commonly performed in South Korea were analyzed. Motion units were systematically extracted from documentary sources, skill elements were identified and categorized from video data based on their motion characteristics, and these characteristics were subsequently linked to associated cognitive behaviors. The analytic process comprised three sequential steps: (1) extraction of motion units from documents, (2) identification and categorization of corresponding skill elements in video recordings according to motion characteristics, and (3) thematic linking of motion characteristics to cognitive behaviors.

Thirteen psychomotor skills were identified and categorized with action verbs. Document analysis showed Pressing (42.35%), Pulling (28.24%), and Inserting (8.24%) as most common, while video analysis highlighted Pressing (21.84%), Pulling (19.42%), and Lifting (16.50%). Among 206 motion units, 85.43% engaged beyond simple cognitive behavior, particularly Safety Knowledge (39.69%), Associative Work (20.94%), and Nursing Judgment (14.38%). Frequent motion-cognition pairings included Simple Motion-Safety Knowledge (14.08%), Simple Motion-Simple Cognition (10.68%), and Directional-Associative Work-Safety Knowledge (10.19%).

We established a structured classification of psychomotor skills essential to nursing practice. We demonstrated that psychomotor actions were consistently accompanied by cognitive processes, such as noticing, interpretation, and clinical judgment. Virtual reality-based simulation programs should consider, therefore, integrating cognitive and decision-making elements with technical performance. These insights may provide a foundation for immersive training design and psychomotor skill assessment in nursing education.