Effects of virtual reality-based simulation education for nursing students: a systematic review and meta-analysis

Purpose: This study conducted a systematic analysis of the effects of virtual reality (VR)-based simulation education on nursing students’ learning outcomes.Methods: Studies involving undergraduate nursing students who received immersive or non-immersive VR–based simulation education, compared with conventional nursing education, were identified from Cochrane CENTRAL, EMBASE, PubMed, CINAHL, ACM Digital Library, NDSL, KISS, DBpia, and RISS, from database inception through February 28, 2025. The primary outcomes were nursing skill performance and knowledge, while the secondary outcomes were self-efficacy and confidence in nursing performance. Only randomized controlled trials were included. A total of 21 studies met the inclusion criteria and were synthesized using a random-effects meta-analysis. Effect sizes were calculated as standardized mean differences (SMDs) with 95% confidence intervals (CIs).Results: Across 21 randomized controlled trials, the meta-analysis showed that VR-based simulation education had no statistically significant effects on nursing skill performance (n = 759, SMD = 0.18; 95% CI: −0.47 to 0.82) or confidence in nursing performance (n = 1,157, SMD = 0.12; 95% CI: −0.20 to 0.43). In contrast, statistically significant positive effects were observed for knowledge (n = 1,009, SMD = 0.32; 95% CI: 0.08 to 0.57) and self-efficacy (n = 696, SMD = 0.46; 95% CI: 0.11 to 0.81).Conclusion: VR-based simulation education represents an effective educational approach for improving nursing students’ knowledge and self-efficacy. Future implementations should align the type and complexity of VR simulations with specific educational goals and content, while accounting for potential variation related to instructional design, learner characteristics, and outcome measures.