High-Fidelity Simulation and Virtual Technology in Nursing: Stand-Alone or Combined Approaches? A Systematic Review.

Background: High-fidelity simulation (HFS) and virtual technology (VT) are transformative in nursing education, yet their comparative effectiveness and optimal integration remain underexplored.

Purpose: This systematic review evaluated the impact of HFS and VT on nursing students' knowledge and skills, comparing stand-alone and combined approaches.

Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guidelines, we searched databases (2015-2024) using Population, Intervention, Comparison, and Outcome (PICO) criteria. Two reviewers independently screened studies, extracted data, and assessed quality.

Results: Despite only 5 qualifying studies, all demonstrated that VT (foundational) followed by HFS (practical) produced optimal results, enhancing knowledge, clinical judgment, and technical skills. HFS best developed psychomotor/teamwork abilities, while VT strengthened theory and self-directed learning. Combined approaches with case-based small groups outperformed single methods.

Conclusion: HFS and VT are complementary: integrating VT first, then HFS bridges theory to practice effectively. Nurse educators should adopt this dual-modal approach. Future research should assess long-term outcomes, cost-effectiveness, and structured implementation.