Effect of virtual reality assimilated the BOPPPS model on evidence-based healthcare curriculum: A mixed-methods study

Evidence-based healthcare (EBHC) has emerged as a global standard in clinical practice, offering a structured approach to improving patient outcomes. For nurses, EBHC serves as a critical framework for identifying and applying the best available evidence when addressing clinical challenges. This study aimed to examine the effectiveness of integrating virtual reality (VR) into the BOPPPS (Bridge-in, Objective, Pre-test, Participatory Learning, Post-test and Summary) teaching model to enhance the design and delivery of EBHC courses.

Participants were first-year graduate nursing students (N = 30) from a university in central Taiwan. A mixed-method, one-group pretest-posttest experimental design was used. The course incorporated six modules aligned with the BOPPPS framework, guiding students through structured learning stages. A VR simulation platform was integrated to enhance interaction and practical application.

The results of the study identified that EBHC competence, critical thinking disposition, course satisfaction and the VR applicability and acceptance were improved significantly (p < 0.001) among the students after course completion. The Chinese Fresno Test scores improved significantly from pretest (M = 19.33) to posttest (M = 79.33). Qualitative analysis of students' experience in teamwork and interactive learning with VR simulation indicated that not only there were improvement in their learning motivation and interest, but also there were assistance to the development of logical reasoning, the expansion of thinking and creativity, the enhancement of clinical decision capability in practice, and the improvement of EBHC performance further.

VR integration effectively enhanced learning outcomes and higher-order thinking. However, successful implementation required support for platform use, clear evaluation criteria, and careful instructional material selection. Despite these challenges, the study confirmed the value of combining VR with the BOPPPS model in EBHC education. Future research should refine program design to further advance nursing education and practice.