Effectiveness of a virtual reality simulation based on experiential learning theory for enhancing diabetic ketoacidosis management competencies: a randomized controlled trial

Diabetic ketoacidosis (DKA) is a life-threatening complication requiring rapid assessment and specialized nursing. This study evaluated a virtual reality (VR) simulation program grounded in Kolb’s experiential learning theory to enhance nursing students’ DKA care competencies. A randomized controlled trial was conducted with 44 nursing students (experimental: n = 22, control: n = 22) recruited via convenience sampling at a university in Korea. Participants were assigned using simple randomization. The primary outcomes were problem-solving ability and performance confidence; secondary outcomes included class evaluation, simulation design evaluation, and practice immersion. The experimental group received a VR-based program (lecture, VR, PBL, debriefing), while the control group engaged in e-book-based case simulation. The intervention was explicitly designed based on the four stages of Kolb’s experiential learning theory. There were significant interaction effects between group and time for primary outcomes, indicating the experimental group had significantly greater improvements in problem-solving ability (F = 11.51, p = .002) and performance confidence (F = 4.87, p = .033) compared to the control group. For secondary outcomes, the experimental group scored significantly higher in class evaluation (t = 5.60, p < .001), simulation design evaluation (t = 5.88, p < .001), and practice immersion (t = 3.612, p = .001). The VR simulation program based on experiential learning theory was superior to e-book-based case simulation in enhancing students’ problem-solving skills and clinical confidence in DKA care. These findings support integrating VR simulation into nursing curricula as a superior pedagogical strategy to improve clinical readiness.