Background: Traditional nursing education faces significant challenges in bridging theoretical knowledge and clinical practice, with clinical placements increasingly constrained by limited availability and patient safety concerns. Immersive virtual reality (IVR) simulation offers unprecedented sensory immersion and spatial presence as a potential solution. However, existing evidence regarding IVR's effectiveness in nursing education remains fragmented and inconclusive.
Objective: To evaluate the effectiveness of IVR simulation on nursing students' learning outcomes using Bloom's taxonomy.
Methods: This systematic review and meta-analysis followed PRISMA guidelines and included randomized controlled trials comparing IVR simulation with conventional education in nursing students. MEDLINE, Embase, CINAHL, and CENTRAL were searched from inception to March 25, 2025. Outcomes were classified into cognitive, psychomotor, and affective domains according to Bloom's taxonomy. Random-effects models were applied, with subgroup and sensitivity analyses conducted to explore sources of heterogeneity and identify potential effect modifiers. The certainty of evidence was assessed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework.
Results: Twenty RCTs involving 2063 nursing students were included. In the cognitive domain, IVR simulation significantly improved knowledge acquisition (SMD = 0.33, 95% CI: 0.04-0.61); numerical trends suggested stronger effects when debriefing was incorporated, and benefits diminished at follow-up. In the psychomotor domain, IVR simulation did not significantly enhance skill performance (SMD = 0.49, 95% CI: -0.24-1.22), despite a numerical trend favoring the intervention. In the affective domain, IVR simulation significantly improved self-efficacy (SMD = 0.38, 95% CI: 0.04-0.72) but showed no significant effects on satisfaction or confidence. Adverse effects were generally mild and consisted primarily of visual and vestibular symptoms.
Conclusion: IVR simulation may enhance knowledge acquisition and self-efficacy among nursing students. The importance of debriefing and the need for reinforcement strategies to sustain knowledge gains were highlighted. IVR's effects on skills and other affective outcomes remain inconclusive. Further high-quality RCTs with standardized protocols are required to clarify IVR's role in nursing education.
Keywords: education; learning outcomes; nursing; students; virtual reality.
Copyright © 2026 Xia Li et al. Journal of Nursing Management published by John Wiley & Sons Ltd.