Mixed reality simulation to enhance neonatal care skills in nursing students

• MR is known to help nursing students build clinical skills in high-acuity training areas. • This study shows MR improves learning flow, performance confidence, and training satisfaction. • MR can offer scalable, immersive neonatal care education for diverse prelicensure students. Prelicensure nursing students may face restricted access to hands-on training in neonatal care, especially in high-risk and gender-sensitive environments. This study examined whether mixed reality (MR) simulation using HoloLens 2 could enhance engagement, performance confidence, and learning flow in neonatal nursing education. A quasi-experimental design was used with 30 nursing students assigned to intervention (MR-based training) or control (text-based learning) groups. Participants completed pre- and post-tests assessing key learning outcomes. MR-based training significantly improved learning interest ( p = 0.012), performance confidence ( p < 0.001), and postintervention learning flow ( p < 0.001) compared to the control. Significant group effects were observed for all outcomes, with performance confidence also showing a significant interaction effect ( p = 0.006). Participants reported high usability, strong immersion, and high educational satisfaction with the MR training experience. MR simulation supports immersive and equitable clinical training in neonatal care, helping to bridge theory–practice gaps in nursing education. These findings support its integration into undergraduate and prelicensure nursing curricula, including associate degree programs, to enhance skill acquisition and learner engagement.