The Effect of an Artificial Intelligence-Supported Virtual Reality Simulation on Nursing Students' Holistic Care Skills

Overview

This study aims to evaluate the effect of artificial intelligence (AI)-supported virtual reality (VR) simulation on nursing students' holistic care skills. The study is a randomised controlled trial involving fourth-year nursing students, divided into an experimental and a control group. Whilst the experimental group will receive AI-supported VR simulation training, the control group will receive traditional case-based training. Outcomes to be assessed include decision-making, symptom identification, nursing diagnosis, simulation design and satisfaction with the training methods.

Detailed description

This study will evaluate the effect of an artificial intelligence-supported virtual reality (VR) simulation on nursing students' holistic care skills. The study is designed as a pre-post, parallel-group, randomised controlled trial involving 80 fourth-year nursing students (40 in the experimental group and 40 in the control group). Eligible participants will complete a demographic form and the Melbourne Decision-Making Scale at the outset. Participants will be stratified by overall academic grade point average and prior VR experience, and randomly assigned to groups by an independent statistician.

Whilst the intervention group receives AI-supported VR simulation training, the control group will receive traditional case-based training using the same case scenario to ensure comparability. Both the training case and the assessment case, along with the assessment criteria, will be developed based on expert consensus.

Two weeks after the intervention, both groups will complete a case study assessment. Data collection will include the Melbourne Decision-Making Scale, nursing diagnosis and symptom identification results, and satisfaction measures. The statistician will be blinded, and appropriate statistical tests will be applied based on the data distribution.

Interventions

• Other AI-VRS
  This intervention consists of an AI-supported virtual reality (VR) simulation designed to improve nursing students' holistic care skills. Participants interact with a virtual patient to perform patient history-taking, identify symptoms, and formulate nursing diagnoses across the dimensions of holistic care (physical, psychological, social, and spiritual). The simulation is delivered using Meta Quest 3 VR headsets and incorporates artificial intelligence to provide dynamic, responsive patient int
• Other Control
  This intervention consists of traditional case-based training delivered through presentations and question-and-answer discussions. Participants will analyse case scenarios and receive feedback from instructors. This approach provides a practical learning experience without using VR technology.

Primary outcome measures

• Nursing Diagnosis and Symptom Identification within a Holistic Care Framework [Time frame: 2 weeks post-intervention (assessment case study)]

Secondary outcome measures (3)

• Melbourne Decision-Making Scale [Time frame: Baseline (pre-intervention) and 2 weeks post-intervention (assessment case study)]
• Simulation Design Scale [Time frame: 2 weeks post-intervention]
• Satisfaction Survey Regarding Teaching Methods [Time frame: 2 weeks post-intervention]

Eligibility criteria

Inclusion criteria

• Voluntary participation in the study,
• Having enrolled for the first time in the courses HEM 402 Professional Practice I and HEM 404 Professional Practice II in the Department of Nursing, Faculty of Health Sciences,
• Absence of eye conditions affecting depth perception, such as amblyopia (lazy eye), anisometropia(different refractive errors in each eye), and strabismus (squint). (Self- report is accepted.),
• Academic performance score between 2.00 and 4.00.,

Exclusion criteria

• Having received training in holistic care skills in addition to their undergraduate nursing degree,
• Having experience with virtual simulation exercises focused on holistic care skills,
• Holding a high school, foundation year or undergraduate degree in a health-related field,
• Having difficulty understanding and speaking Turkish,

Criteria for Exclusion from the Study:

• The participant has not completed or has incompletely completed the required forms and scales,
• The participant in the experimental group had not taken part in or completed the AI-supported virtual reality simulation,
• Students in the control group did not take part in the educational case study,
• Students in the experimental and control groups did not take part in the assessment case study,
• The participant wishes to withdraw from the study,

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: No

Study design

Allocation

Randomized

Model

Parallel assignment

Masking

Open label

Primary purpose

Other

Study locations

Turkey (Türkiye) · 1 center

• Gazi University Nursing Faculty — Ankara

Publications

• Hopewell S, Chan AW, Collins GS, Hrobjartsson A, Moher D, Schulz KF, Tunn R, Aggarwal R, Berkwits M, Berlin JA, Bhandari N, Butcher NJ, Campbell MK, Chidebe RCW, Elbourne D, Farmer A, Fergusson DA, Golub RM, Goodman SN, Hoffmann TC, Ioannidis JPA, Kahan BC, Knowles RL, Lamb SE, Lewis S, Loder E, Offringa M, Ravaud P, Richards DP, Rockhold FW, Schriger DL, Siegfried NL, Staniszewska S, Taylor RS, T PMID 40228833
• INACSL Standards Committee, Decker, S., Sapp, A., Bibin, L., Chidume, T., Crawford, S. B., Fayyaz, J., Johnson, B. K., & Szydlowski, J. (2025d). Healthcare Simulation Standards of Best Practice®: The Debriefing Process. Clinical Simulation in Nursing, 105, 101775-101775. https://doi.org/10.1016/j.ecns.2025.101775
• INACSL Standards Committee, DiGregorio, H., Todd, A., Blackwell, B., Brennan, B. A., Repsha, C., Shelton, C. M., Vaughn, J., Wands, L., Wruble, E., & Yeager, C. (2025c). Healthcare Simulation Standards of Best PracticeⓇ Facilitation. Clinical Simulation in Nursing, https://doi.org/10.1016/j.ecns.2025.101776
• INACSL Standards Committee, Watts, P.I, McDermott, D.S., Alinier, G., Charnetski, M., Ludlow, J., Horsley, E., Meakim, C., & Nawathe, P. (2021b). Healthcare Simulation Standards of Best Practice® Simulation Design. Clinical Simulation in Nursing, https://doi.org/10.1016/j.ecns.2021.08.009.
• INACSL Standards Committee. (2021a). Healthcare Simulation Standard of Best Practice® Prebriefing: Preparation and briefing Persico, Lori et al. Clinical Simulation in Nursing, Volume 105, 101777. https://doi.org/10.1016/j.ecns.2025.101777 1876-1399
• INACSL Standards Committee, Persico, L., Wilson-Keates, B., DiGregorio, H., Decker, S., & Xavier, N. (2025a). Preamble: Grounded in Excellence: The Cornerstone Healthcare Simulation Standards of Best Practice®. Clinical Simulation in Nursing, https://doi.org/10.1016/j.ecns.2025.101774
• INACSL Standards Committee, Persico, L., Ramakrishnan, S., Wilson-Keates, B., Catena, R., Charnetski, M., Fogg, N., Jones, M. C., Ludlow, J., MacLean, H., Simmons, V. C., Smeltzer, S., & Wilk, A. (2025b). Healthcare Simulation Standard of Best Practice® Prebriefing: Preparation and briefing. Clinical Simulation in Nursing https://doi.org/10.1016/j.ecns.2025.101777
• Ackley, B. J., & Ladwig, G. B. (2024). Hemşirelik tanıları el kitabı: Bakım planlamasında kanıta dayalı rehber (Z. Göçmen Baykara, N. Çalışkan, E. Gülnar, E. Sarıtaş, & G. Eyüboğlu, Ed. ve çev., 13. baskı). Ankara: Nobel Tıp Kitabevleri. ISBN:978-625-6448-92-6.

Identifiers

NCT: NCT07518199 · 2025-1069 · 2025-10282

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗