Utilization, application and effectiveness of metaverse in simulation-based nursing education: A systematic review

<h2>Abstract</h2><h3>Background</h3> The Metaverse is an emerging technological innovation with potential applications for healthcare education. <h3>Aim</h3> The objective of this systematic review was to evaluate the utilization, application, and effectiveness of the Metaverse in simulation-based nursing education. <h3>Methods</h3> A comprehensive search was conducted across eight electronic databases, yielding 32 studies that met the inclusion criteria. The studies, conducted between 2016 and 2023, were predominantly quantitative, with some employing mixed methods and qualitative approaches. <h3>Findings</h3> The review identified two main themes: learning outcomes and learner experiences. Learning outcomes included knowledge acquisition, clinical skill development, self-efficacy, confidence, and motivation. Use of Metaverse components, particularly virtual reality (VR), generally improved knowledge and technical skill acquisition, especially in areas such as infection control and neonatal resuscitation. Gains in nontechnical skills, including problem-solving and critical thinking, were also observed. However, evidence on motivation and confidence was mixed, with some studies reporting significant improvements and others finding no difference compared to traditional teaching methods. Learner experiences encompassed satisfaction, presence and immersion, usability, acceptability, and anxiety reduction. Learner satisfaction was consistently high, with VR perceived as visually appealing, interactive, and conducive to engaging learning environments. VR also enhanced presence and immersion, creating realistic and interactive simulations. Usability was typically rated as good, though challenges such as cybersickness were noted. Overall, participants viewed Metaverse technologies positively for their ability to create immersive, enjoyable, and effective learning experiences. <h3>Conclusions</h3> This review highlights the potential of the Metaverse in nursing education, particularly for enhancing learning outcomes and learner experiences. However, the lack of studies on the full application of the Metaverse, including social connectedness, suggests the need for further research to explore its comprehensive role in simulation-based learning.