The complementary effects of virtual reality and traditional simulation in nursing education: A qualitative study

Simulation-based education plays a pivotal role in bridging the gap between nursing theory and clinical practice. Although traditional scenario-based simulation is effective in enhancing clinical skills, it is often limited by its lack of situational fidelity. Conversely, virtual reality (VR) simulation provides highly immersive learning environments but is challenged by its inability to support genuine interpersonal interactions. There is a paucity of empirical evidence regarding the integration of the complementary strengths of these two modalities and the understanding of nursing students' authentic learning experiences within an integrated model.

Guided by Kolb's experiential learning theory, this study aimed to explore undergraduate nursing students' learning experiences within a dual-track simulation teaching model integrating VR simulation, traditional scenario-based simulation, and guided feedback. The objectives were to identify the perceived strengths and limitations of each modality and to generate evidence-based insights for optimizing simulation teaching design.

Guided by Kolb's experiential learning theory, this study explored undergraduate nursing students' learning experiences within a dual-track simulation teaching model integrating VR simulation, traditional scenario-based simulation, and guided feedback. Specifically, the study aimed to identify students' perceived strengths and limitations of each modality and to generate evidence-based insights for optimizing simulation teaching design.

Four primary themes were identified: (1) The dual dimensions of role immersion, encompassing environmental and interpersonal immersion. VR facilitated environmental immersion through its audiovisual effects, although technical issues occasionally detracted from the experience. In contrast, scenario simulation promoted relational immersion via authentic interpersonal interactions, thereby enhancing role identity, albeit limited by the acting abilities of peers. (2) The complementary construction of nursing competence, characterized by cognitive framing and dynamic adaptation. VR was particularly effective in developing systemic cognitive frameworks and rehearsing high-risk scenarios, while scenario simulation was indispensable for nurturing clinical operational skills, dynamic decision-making, and humanistic care. (3) The dual pathways of emotional experience, involving low-anxiety learning and empathy-driven reflection. VR offered a low-anxiety environment but provided mechanical emotional feedback, whereas scenario simulation elicited genuine emotional resonance and moderate anxiety, which in turn facilitated profound reflection. (4) Integrated Teaching Pathway: From Cognitive Rehearsal to Practice Internalization. Students appreciated an integrated teaching pathway that advanced from VR rehearsal to scenario simulation practice accompanied by guided feedback, thereby establishing a comprehensive experiential learning cycle.

The dual-track simulation teaching model, which leverages the synergistic effects of virtual reality and scenario-based simulation, provides nursing students with a holistic learning experience encompassing both cognitive development and practical application. It is recommended that nursing educators strategically incorporate these pedagogical methods, utilizing the cognitive rehearsal benefits of virtual reality while maintaining the distinct advantages of scenario-based simulation for skill acquisition and the cultivation of humanistic qualities. This integrative approach has the potential to produce nursing professionals who exhibit both clinical proficiency and humanistic awareness.