Nursing Simulation 3.0: Contemporary issues in transitioning to extended reality

Simulation has long been used in nursing education to support the development of clinical skills and decision-making. Early approaches relied on static anatomical models such as the Mrs. Chase mannequin, while later systems including Resusci®-Anne and SimMan® introduced computerized physiological responses and scenario-based training. Although these technologies have significantly advanced simulation-based education, traditional approaches may have limitations in representing complex patient interactions, emotional responses, and dynamic clinical environments.

As healthcare systems become increasingly complex and technologically driven, nursing education faces the challenge of supporting the continued development of simulation technologies in response to changes in clinical practice. Continued reliance on traditional simulation tools may not always reflect the multidimensional and rapidly changing nature of contemporary healthcare environments.

This paper examines the historical development of nursing simulation through three phases: Simulation 1.0 (static task trainers), Simulation 2.0 (computerized manikins), and Simulation 3.0 (AI-enabled extended reality platforms). Emerging immersive technologies, including virtual reality, augmented reality, and mixed reality, offer new possibilities for simulation-based education by enabling interactive, scalable, and adaptive learning environments. These approaches may provide opportunities to support learning across cognitive, psychomotor, and affective domains while expanding possibilities for flexible and distributed simulation experiences. At the same time, challenges related to cost, infrastructure, interoperability, data security, and faculty training remain important considerations.

The ongoing development of immersive simulation technologies may expand the range of tools available to support nursing education and workforce preparation. Continued evaluation and thoughtful implementation will be important to guide the responsible and effective integration of emerging simulation technologies within nursing education systems.