3.1 Characteristics of the study population (study selection)
A computer search of PubMed, Web of Science, Wiley Online Library, Zhiwang database, Wanfang database and China Biomedical Literature Service (SinoMed) retrieved 2179 papers; titles and abstracts were reviewed and 152 articles were selected considering the inclusion and exclusion criteria. After excluding 140 papers that did not meet the inclusion criteria, 12 papers were finally selected[20–31]. As shown in Fig. 2.
3.2 Characteristics of research on educational interventions using virtual reality for current and future health personnel (research characteristics)
This study includes general characteristics of 12 studies of educational interventions using virtual reality; detailed information is provided in Table 1 In terms of study design characteristics, all 12 studies were randomized controlled studies. The number of study participants was 585 for the experimental group and 582 for the control group, for a total of 1167 participants.
Table 1
Characteristics of selected 12 studies included in the systematic review.
Author (year) | country | Type of participant | Number of participants | Interventions | Outcomes |
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| | | Total | E | C | E | C | |
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José Miguel Padilha (2019) | Portuguese | nursing students | 42 | 21 | 21 | VR | traditional education | Learningsatisfaction;Knowledge;Self-efficacy perception |
Hanna Lee (2022) | South Korea. | fourth-year students across nursing colleges | 60 | 30 | 30 | VR | traditional education | Self-efficacy; clinical reasoning capacity; learning satisfaction; Knowledge |
Khaild AL-MugheedI (2022) | North Cyprus | nursing students | 122 | 63 | 59 | VR + online education | traditional education | Knowledge; Attitude |
Mi Yu (2021) | Korea | nursing students | 50 | 25 | 25 | VR | routine education | knowledge ; self-effycacy ; learning satisfaction |
Hsiang-Ying Chan (2020) | China | nursing students | 77 | 38 | 39 | VR | education documents | Knowledge; Attitude |
Ae-Ri Jung (2022) | Korea | nursing students | 60 | 30 | 30 | virtual reality (VR) nursing education program (VRP) | traditional nursing education program (VRP) | Knowledge;Attitude;Satisfaction;Motivation |
PingWang (2020) | China | nursing students | 125 | 62 | 63 | Immer VR | Non-immer VR | Knowledge ;Practical skills, reasoning ability |
Tianxiang Yuan (2019) | China | nursing students | 116 | 58 | 58 | "flipped classroom" teaching model based on virtual reality animation micro course | traditional education | Knowledge ;Practical skills |
Nan Cao (2021) | China | nursing students | 90 | 45 | 45 | VR | traditional education | Knowledge ; Practical skills, Critical thinking; clinical communication skills |
Liping Li (2017) | China | nursing students | 100 | 50 | 50 | VR | traditional education | Knowledge ;Practical skills |
Xiaoyan Wang (2023) | China | nursing students | 245 | 123 | 122 | VR | traditional education | Self-directed learning skills; critical thinking |
Hongmei Zhao (2022) | China | nursing students | 80 | 40 | 40 | VR | traditional education | Knowledge;Self-directed learning skills;critical thinking |
E = Experimental group; C = Control group; VR = Virtual reality;RCT = randomized controlled trial |
3.3.Methodological quality assessment of intervention studies
The risk of bias assessment is summarized in Fig. 3 below. 9 of the 12 studies described detailed information related to randomization, and 7 studies lacked clarity regarding allocation concealment. The detailed risk of bias assessment is shown in Fig. 4.
3.4 Meta-analysis results
3.4.1 Theoretical knowledge
Eleven studies[20–25,27−31]evaluated the effectiveness of VR technology in theoretical knowledge levels. The results showed a high heterogeneity of the included studies (p < 0.001, I2 = 92%), so a random effects model was used. The combined results showed that the use of VR technology was effective in improving students' theoretical knowledge compared to other traditional nursing teaching methods [SMD = 0.97, 95% CI (0.48, 1.46), P < 0.001,Fig. 5] .
3.4.2 Practical skills
Four studies[24, 28–29, 31]evaluated the effectiveness of VR technology in practice skills. The results showed that there was no heterogeneity in the included studies (P = 0.34, I2 = 10%), so a fixed-effects model was used. The combined results showed a statistically significant difference compared to other traditional nursing teaching methods [SMD = 0.15, 95% CI (-0.21, 0.51), P < 0.001,Fig. 6] .
3.4.3 Satisfaction
Four studies[20–21, 23, 25]evaluated the effect of VR technology on nursing teaching satisfaction, and the results showed that there was no heterogeneity in the included studies (P = 0.36, I2 = 7%), so a fixed-effects model was used. The combined results showed a significant difference in the improvement of satisfaction with nursing education with VR technology compared to the control teaching modality [SMD = 1.14, 95% CI [0.85, 1.43), P < 0.001,Fig. 7].
3.4.4 Critical thinking
Three studies[26,30−31]evaluated the effect of VR technology on the application of critical thinking among nursing students, but the results showed high heterogeneity in the included studies (P < 0.001, I2 = 93%), so a random effects model was used. The combined results showed no significant difference in the improvement of satisfaction in nursing education with VR technology compared to the control teaching modality [SMD = 0.79, 95% CI [-0.05, 0.46], p = 0.07,Fig. 8].