{"title":"Beyond Novelty to Transfer: Global Bibliometric Trends in Immersive (VR/AR/XR) Nursing Training and Clinical Skill Translation (2000–2025)","authors":"Rasha Sayed Ahmed PhD , Mostafa Shaban PhD","doi":"10.1016/j.ecns.2025.101892","DOIUrl":"10.1016/j.ecns.2025.101892","url":null,"abstract":"<div><h3>Background</h3><div>Immersive technologies such as virtual, augmented, and extended reality (VR/AR/XR), increasingly combined with haptics, are rapidly transforming nursing education. While individual studies and systematic reviews highlight benefits for knowledge and skills, less is known about the broader research landscape, particularly in relation to skill transfer and clinical application.</div></div><div><h3>Objectives</h3><div>The objectives were to: (1) analyze global publication trends in immersive nursing education from 2000 to 2025; (2) identify leading journals, authors, and institutions contributing to the field; and (3) map thematic emphases through keyword and co-citation analysis, with a focus on clinical transfer and retention outcomes.</div></div><div><h3>Design</h3><div>A descriptive bibliometric study of immersive technologies in nursing education.</div></div><div><h3>Methods</h3><div>Data were retrieved from Web of Science, Scopus, and PubMed/MEDLINE. Publications were included if they reported on VR/AR/XR or haptics applied to nursing education. Duplicates were removed, and bibliometric analyses were conducted using Excel and VOSviewer.</div></div><div><h3>Results</h3><div>A total of 1,622 publications were analyzed. Annual output rose sharply after 2017, peaking in 2024. The most productive journals were <em>Clinical Simulation in Nursing</em> and <em>Nurse Education Today</em>. The United States, South Korea, Taiwan, and China dominated contributions. Keyword clustering revealed a strong emphasis on skills training and engagement but limited focus on transfer and patient outcomes.</div></div><div><h3>Conclusion</h3><div>Immersive nursing education research is expanding globally, but evaluation of transfer and retention remains underdeveloped. Future studies should prioritize standardized outcome frameworks and longitudinal designs to establish clinical impact.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101892"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145941252","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Monica Millard PhD, RN , Du Feng PhD , Rebecca Benfield CNM, PhD, FACNM, FAAN , Clariana Ramos de Oliveira PhD., MSc, RN , Joseph Morgan PhD
{"title":"A comparative analysis of the impact of virtual patients versus high-fidelity manikin-based blended simulation on nursing students’ self-evaluation of clinical judgment skills","authors":"Monica Millard PhD, RN , Du Feng PhD , Rebecca Benfield CNM, PhD, FACNM, FAAN , Clariana Ramos de Oliveira PhD., MSc, RN , Joseph Morgan PhD","doi":"10.1016/j.ecns.2025.101896","DOIUrl":"10.1016/j.ecns.2025.101896","url":null,"abstract":"<div><h3>Background</h3><div>Virtual patient simulation (VPS) has been used as an alternative to in-person clinical placement and high-fidelity manikin simulation (HFMS). However, further research is needed to evaluate its effectiveness as an educational tool for developing clinical judgment in prelicensure nursing students. Limited evidence exists from mixed-design studies comparing the effects of HFMS and VPS alone versus VPS as a primer for HFMS in a blended modality.</div></div><div><h3>Methods</h3><div>A quasi-experimental study with a repeated-measures mixed design examined the effectiveness of VPS in acquiring clinical judgment among third-year bachelor of nursing prelicensure students, compared with HFMS and VPS as a primer for HFMS, using the Lasater Clinical Judgment Rubric.<!--> </div></div><div><h3>Results</h3><div>The mixed ANCOVA revealed no significant interaction effect of Time by study group for the clinical judgment total scale score between T1 and T2 (<em>p</em> = .33) or T1 and T3 (<em>p</em> = .12). Similarly, the mixed MANCOVA showed no significant differences in clinical judgment subscale scores between T1 and T2 (<em>p</em> = .54) or T1 and T3 (<em>p</em> = .65).</div></div><div><h3>Conclusion</h3><div>HFMS, VPS, and blended simulation approaches were similarly effective in fostering students’ clinical judgment.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101896"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038283","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Eleanor Rawson DNP, CRNA, CHSE, FAANA, Brittney McDowell DNP, CRNA, Kevin Nagapen DNP, CRNA, Morgan LaPorte DNP, CRNA
{"title":"Certified Registered Nurse Anesthetists’ use of the Stanford Emergency Manual during high-fidelity simulation of emergency scenarios","authors":"Eleanor Rawson DNP, CRNA, CHSE, FAANA, Brittney McDowell DNP, CRNA, Kevin Nagapen DNP, CRNA, Morgan LaPorte DNP, CRNA","doi":"10.1016/j.ecns.2025.101894","DOIUrl":"10.1016/j.ecns.2025.101894","url":null,"abstract":"<div><h3>Background</h3><div>This project explored high-fidelity simulation, utilizing an evidence-based practice emergency manual, for the purpose of improving Certified Registered Nurse Anesthetists’ (CRNAs) usage and belief of evidence-based practice.</div></div><div><h3>Methods</h3><div>Use of a cognitive aid helps providers deliver better evidence-based care during low-frequency, high-mortality perioperative events. CRNAs rotated through three different scenarios with the Stanford Emergency Manual available for reference.</div></div><div><h3>Results</h3><div>There was an increase in Evidence-Based Practice Belief Scale (EBP-BS) scores from presimulation to postsimulation (Z = 2.023, <em>p</em> = .043) and an increase from presimulation to three months postsimulation (Z = 2.023, <em>p = .</em>043). There was not a statistically significant change in EBP-IS scores pre- and three months postsimulation (Z = 0.944, <em>p = .</em>345).</div></div><div><h3>Conclusion</h3><div>An increase in EBP-BS scores reflected practitioners’ perceived ability to use EBP in their daily clinical practice, and most participants intended to include the cognitive aid in their anesthesia practice, providing an opportunity for future utilization.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101894"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Jiyoung Kim RN, ANP, PhD, Yeji Kim RN, Hyunji Park RN, Jiyeong Won RN, Jiwon Yun RN, Yuran Lee RN
{"title":"Safety-centered simulation education using the 360-degree video room of errors: A mixed-methods study","authors":"Jiyoung Kim RN, ANP, PhD, Yeji Kim RN, Hyunji Park RN, Jiyeong Won RN, Jiwon Yun RN, Yuran Lee RN","doi":"10.1016/j.ecns.2025.101899","DOIUrl":"10.1016/j.ecns.2025.101899","url":null,"abstract":"<div><h3>Background</h3><div>Recognizing situations that threaten patient safety and predicting potential risks are essential in nursing practice. This study aimed to evaluate the error detection rates and effects of safety-centered simulation education using a 360-degree video Room of Errors (ROE) on attitudes toward patient safety, confidence in performance, immersion, and learning satisfaction. Educational experiences were also explored qualitatively.</div></div><div><h3>Methods</h3><div>A concurrent mixed-methods design was employed. A total of 34 third- and fourth-year nursing students participated in Korea. A 360-degree video ROE simulation of perioperative patient safety management was developed and implemented. Attitudes toward patient safety, performance confidence, immersion, and learning satisfaction were measured and analyzed using SPSS/WIN 29.0. Experience was examined using qualitative content analysis.</div></div><div><h3>Results</h3><div>Students detected errors more frequently in the physical environment and patient identification but less often in medication administration. Scores for attitudes toward patient safety and performance confidence significantly improved postintervention (<em>p</em> < .001). Qualitative findings highlighted positive themes such as “emotional responses to the learning experience”, “structural and pedagogical benefits”, and “transformative outcomes of learning”, alongside a theme of “perceived weaknesses and suggestions”.</div></div><div><h3>Conclusions</h3><div>Safety-centered simulation education using 360-degree video can improve nursing students’ attitudes toward patient safety and confidence in performance, thus supporting the transfer of learning to clinical practice.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101899"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146078785","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Addressing language barriers in maternity emergency care in the UK: A mixed methods quality improvement simulation study","authors":"Sorcha Magee , David B. Olawade","doi":"10.1016/j.ecns.2025.101900","DOIUrl":"10.1016/j.ecns.2025.101900","url":null,"abstract":"<div><h3>Background</h3><div>Language barriers in maternity care compromise patient safety and quality, with poorer maternal outcomes observed when communication between obstetric staff and women with limited English proficiency is hindered, especially during emergencies.</div></div><div><h3>Objective</h3><div>To explore obstetric and maternity staff understanding of language barriers when caring for women during obstetric emergencies.</div></div><div><h3>Methods</h3><div>A six-week mixed-methods quality improvement study in a UK National Health Service (NHS) Trust maternity unit. Forty maternity and obstetric clinicians were recruited. Participants engaged in postpartum hemorrhage simulations using a simulation mannikin programmed to speak a foreign language. Data collection involved presimulation Likert-scale questionnaires (five items) and postsimulation debriefs. Quantitative data were analyzed descriptively; qualitative data underwent thematic analysis.</div></div><div><h3>Findings</h3><div>Presimulation data revealed limited staff confidence: 52% were dissatisfied with interpretation services, 60% were very dissatisfied with communication support, and 57% were neutral about understanding communication in obstetric emergencies. Thematic analysis identified three key themes: (a) unavailability of interpreting services during emergencies, (b) undervaluing the importance of communication in urgent scenarios, and (c) opportunities for enhancing simulation-based communication training.</div></div><div><h3>Discussion</h3><div>Significant knowledge gaps and inadequate systems hinder effective communication with women facing language barriers during obstetric emergencies.</div></div><div><h3>Conclusion</h3><div>Urgent action is needed to strengthen training in interpretation services, enhance communication infrastructure, and raise awareness among maternity teams about the critical role of communication in emergency care.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101900"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Beyond the pilot: Nursing students’ experiences with curricular integration of virtual reality simulation","authors":"Nicole Harder RN, PhD , Sufia Turner RN, MN , Kimberly Workum RN, BScN, MEd, CCNE, CHSE","doi":"10.1016/j.ecns.2025.101893","DOIUrl":"10.1016/j.ecns.2025.101893","url":null,"abstract":"<div><h3>Aim/Objective</h3><div>As immersive virtual reality (IVR) becomes more common in nursing education, curricular integration beyond pilot initiatives is essential for sustained impact. This study explores undergraduate nursing students’ perceptions and experiences of IVR when it was longitudinally integrated into a required clinical course, rather than to measure effectiveness or outcomes.</div></div><div><h3>Background</h3><div>IVR simulations provide standardized, controlled environments where students can practice clinical reasoning and decision making without risk to patients. While single-session IVR benefits have been reported, limited evidence addresses its impact when aligned with curriculum-wide simulation strategy and best practice standards.</div></div><div><h3>Design</h3><div>This qualitative study used an interpretive descriptive design.</div></div><div><h3>Methods</h3><div>Data were collected through semi-structured interviews and a focus group with 11 prelicensure students enrolled in a third-year clinical course. Thematic analysis followed Braun and Clarke’s six-step framework.</div></div><div><h3>Results</h3><div>Thematic analysis revealed that repeated exposure to IVR enhanced students' comfort with the technology, supported cognitive and emotional engagement, and fostered perceived improvements in clinical reasoning and confidence. Simulation design elements such as structured orientation, role variation, and standards-based prebriefing and debriefing were essential.</div></div><div><h3>Conclusions</h3><div>These findings suggest that IVR can support deeper learning, clinical reasoning, and learner motivation when implemented as part of a broader simulation curriculum guided by simulation best practices. One-off IVR experiences may limit educational value, whereas longitudinal integration offers a scalable, equitable strategy to prepare students for clinical complexity.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101893"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980285","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hao He , Xinhao Xu , Yuanyuan Gu , Yupei Duan , Shangman Li , Jhon Bueno Vesga
{"title":"Preparing for meeting patients: A generative AI-enhanced virtual reality patient encounter practice","authors":"Hao He , Xinhao Xu , Yuanyuan Gu , Yupei Duan , Shangman Li , Jhon Bueno Vesga","doi":"10.1016/j.ecns.2025.101889","DOIUrl":"10.1016/j.ecns.2025.101889","url":null,"abstract":"<div><h3>Background</h3><div>Human simulated patient-based patient encounter practices, though effective, are limited by factors such as training, cost, and actors’ availability. Virtual reality (VR) could be an alternative. While traditional VR practices were preprogrammed and inflexible in responding to learners’ questions, generative artificial intelligence (GenAI)-enhanced VR practices point to a new way.</div></div><div><h3>Methods</h3><div>This study adopted a GenAI-enhanced VR learning environment for nursing students to practice conversation and information-gathering skills. We examined their skill-related performance transfer from the VR practice to the in-person test.</div></div><div><h3>Results</h3><div>Participants’ skill-related performance successfully transferred from the VR practice to the in-person test.</div></div><div><h3>Conclusion</h3><div>A GenAI-enhanced VR patient encounter practice can effectively prepare nursing students for in-person patient encounters.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"111 ","pages":"Article 101889"},"PeriodicalIF":2.5,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Yihsuan Tsai BSN, RN , Chunwen Chiu PhD, MD , Shouchuan Sun MSN, RN , Hsingju Lin MSN, RN , Chihhao Lin PhD , Yawen Lee PhD, RN
{"title":"Sustaining emergency team competencies: Impact of interprofessional simulation with team resource management and structured debriefing","authors":"Yihsuan Tsai BSN, RN , Chunwen Chiu PhD, MD , Shouchuan Sun MSN, RN , Hsingju Lin MSN, RN , Chihhao Lin PhD , Yawen Lee PhD, RN","doi":"10.1016/j.ecns.2025.101880","DOIUrl":"10.1016/j.ecns.2025.101880","url":null,"abstract":"<div><h3>Background</h3><div>Effective interprofessional collaboration is essential for patient safety in emergency care. While high-fidelity simulation (HFS) enhances training, its long-term impact on Team Resource Management (TRM) behaviors and communication remains uncertain.</div></div><div><h3>Methods</h3><div>A quasi-experimental study at a Taiwanese tertiary medical center evaluated an HFS program integrating TRM principles and Gather-Analyze-Summarize (GAS) debriefing. Assessments at pretraining (T0), post-training (T1), and three months post-training (T2) measured individual knowledge and skills (T0, T1) and team-level TRM behaviors and communication (T0, T1, T2).</div></div><div><h3>Results</h3><div>Individual knowledge and skills improved significantly at T1, with nurses demonstrating substantial gains. Team TRM behaviors and communication increased from T0 to T1 and remained sustained at T2.</div></div><div><h3>Conclusion</h3><div>HFS with TRM and GAS debriefing promotes sustained emergency team competencies for at least three months, supporting the need for periodic retraining to maintain skill retention.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"110 ","pages":"Article 101880"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145840369","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Tina X. Ung PhD, Claire L. O’Reilly PhD, Rebekah J. Moles PhD, Sarira El-Den PhD
{"title":"“Play it truthfully and authentically”: An exploratory study of actors’ perspectives on role-playing psychosis-related scenarios with pharmacy students","authors":"Tina X. Ung PhD, Claire L. O’Reilly PhD, Rebekah J. Moles PhD, Sarira El-Den PhD","doi":"10.1016/j.ecns.2025.101874","DOIUrl":"10.1016/j.ecns.2025.101874","url":null,"abstract":"<div><h3>Background</h3><div>Simulated patient role-plays enable healthcare students to practice skills in a safe learning environment. However, simulated patient actors’ perspectives and experiences of being involved in this educational method are underrepresented.</div></div><div><h3>Aim</h3><div>This study explored actors’ perspectives and feedback on the training process, and experiences role-playing psychosis-related scenarios with pharmacy students.</div></div><div><h3>Methods</h3><div>Ten actors enacted 86 role-plays with final-year pharmacy students. Role-plays were based on co-designed scenarios relating to psychosis, with students assessed on their ability to provide psychosis-related care. Postrole-plays, all actors were invited to participate in focus groups to explore their perspectives and provide feedback. Focus group interviews were audio-recorded, transcribed verbatim, then independently thematically analysed by two authors. Seven actors participated in two focus groups.</div></div><div><h3>Findings</h3><div>Five themes emerged: “motivations to participate”, “actor preparation and training”, “harnessing and respecting the role”, “value for students”, “suggested enhancements to the actor experience”. Actors felt supported by the academic team to portray a range of psychosis-related experiences.</div></div><div><h3>Conclusion</h3><div>While data saturation and generalizability were not aims of this preliminary study, actors’ recommendations, such as providing opportunities to rehearse with people with lived experience prior to enactment, for authentic and respectful portrayal, may be important to consider when engaging actors in academic activities.</div></div>","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"110 ","pages":"Article 101874"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145685191","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Iman Nurjaman S. Kep., Ners., M. Kep., CWCCA., CSI
{"title":"Extending ISBAR into the digital era: Insights inspired by Brockway (2025)","authors":"Iman Nurjaman S. Kep., Ners., M. Kep., CWCCA., CSI","doi":"10.1016/j.ecns.2025.101879","DOIUrl":"10.1016/j.ecns.2025.101879","url":null,"abstract":"","PeriodicalId":48753,"journal":{"name":"Clinical Simulation in Nursing","volume":"110 ","pages":"Article 101879"},"PeriodicalIF":2.5,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145737590","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}