TEL methods appear to improve student learning and provide safe environments for practice, and future research should examine the long-term impact of TEL on learning outcomes, its cost-effectiveness, and its implementation in resource-constrained settings.
Abstract
Technology-enhanced learning (TEL), including artificial intelligence (AI), virtual reality (VR), high-fidelity simulation (HFS), and gamification, is increasingly used in nursing education to address limitations in clinical training and support the development of students’ clinical reasoning skills. This review aimed to synthesize current evidence on the educational outcomes associated with AI, VR, HFS, and gamification in nursing education, and to identify the factors that facilitate or hinder their successful implementation.
A systematic review was conducted in accordance with PRISMA 2020 and registered in PROSPERO (CRD420251048860). Five electronic databases were searched for English-language studies published between 2015 and 2025. Studies were eligible if they involved undergraduate or postgraduate nursing students and evaluated AI, VR, HFS, or gamification in educational settings. Methodological quality was assessed using the Mixed Methods Appraisal Tool (MMAT 2018).
Forty studies met the inclusion criteria. HFS and VR were most frequently associated with improvements in knowledge, clinical judgment, and procedural skills. Gamification was associated with greater engagement, motivation, and knowledge retention. Evidence on AI was limited and preliminary, with a small number of studies suggesting possible benefits for critical thinking and problem-solving. Common barriers included technical problems, resource constraints, and inadequate faculty preparedness.
TEL methods appear to improve student learning and provide safe environments for practice. Successful integration of TEL into nursing education requires institutional support, evidence-based teaching strategies, and continuous faculty development. TEL should complement rather than replace traditional educational practices. Future research should examine the long-term impact of TEL on learning outcomes, its cost-effectiveness, and its implementation in resource-constrained settings.
AIM
To examine the current evidence regarding the combined use of virtual simulation and standardized patients in nursing education and to identify implementation patterns, educational outcomes and research gaps.
BACKGROUND
Virtual simulation and standardized patients are widely used in simulation-based nursing education, yet each approach has limitations when used alone. Their combined use may integrate the advantages of repeatable digital practice and authentic interpersonal interaction.
DESIGN
Scoping review.
METHODS
The review followed the Arksey and O'Malley framework and Joanna Briggs Institute guidance. PubMed, Web of Science, Embase, CINAHL, the Cochrane Library, CNKI, Wanfang and CBM were searched from inception to 6 May 2026. Two reviewers independently screened studies and charted data. Findings were synthesised descriptively.
RESULTS
Eight studies published between 2017 and 2025 were included. The studies focused mainly on paediatric nursing, health assessment, end-of-life communication, basic nursing skills and telehealth. Three integration patterns were identified: virtual pre-training followed by standardized-patient scenarios; high-fidelity or electronic simulation combined with standardized patients and immersive virtual reality followed by face-to-face standardized-patient simulation. At the study level, positive changes were reported for knowledge and/or skills in several studies, although the magnitude and statistical significance varied by study design and outcome measure. For example, Yang et al. (2025) reported improvements in selected learning outcomes, whereas the between-group difference in theory scores was not statistically significant. These findings should therefore be interpreted in relation to the methodological heterogeneity of the included studies.
CONCLUSIONS
Combining virtual simulation with standardized patients shows promise for strengthening clinical competence in nursing education. Future research should prioritise standardised intervention frameworks, core outcome sets, multicentre trials, longitudinal follow-up and economic evaluation.
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BACKGROUND
Immersive virtual reality (IVR) is increasingly used in nursing education to enhance experiential learning and address limitations in clinical training. However, evidence regarding its effectiveness on higher-order cognitive skills remains fragmented.
OBJECTIVES
To synthesise and critically appraise existing evidence on the effectiveness of immersive virtual technologies, including Cave Automatic Virtual Environment (CAVE) systems, in improving critical thinking, decision-making, and problem-solving among undergraduate nursing students.
METHODS
An umbrella review was conducted following Joanna Briggs Institute methodology and reported according to PRIOR guidelines. Systematic reviews published between 2016 and 2025 were identified through searches of PubMed, Scopus, CINAHL, Cochrane Library, Web of Science, and PsycINFO. Eligible reviews included undergraduate nursing students exposed to immersive technologies (virtual, augmented, mixed, or extended reality). Methodological quality was assessed using AMSTAR 2. Data were synthesised narratively due to heterogeneity.
RESULTS
Five reviews (four systematic reviews and one systematic review with meta-analysis) were included. Evidence was heterogeneous. Improvements in decision-making and problem-solving were consistently reported, particularly in interactive, scenario-based IVR interventions. Effects on critical thinking were mixed, with meta-analytic findings showing no significant advantage over traditional methods. Generally favourable findings were reported for clinical skills and knowledge acquisition. Positive effects were also observed for satisfaction, motivation, and self-efficacy. However, variability in intervention design, outcome measures, and study quality limited comparability.
CONCLUSIONS
The available evidence suggests that IVR may represent a valuable adjunct to traditional nursing education, particularly for supporting decision-making, problem-solving, and clinical skills. Its impact on critical thinking remains inconclusive. Outcomes appear to be influenced by pedagogical design, including structured debriefing and curriculum integration.
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