Design and usability of an immersive virtual reality simulation in orthopaedic nursing education: A pilot study

BACKGROUND: The increasing complexity of musculoskeletal surgical nursing education requires innovative pedagogical strategies that integrate immersive technologies with structured instructional design to enhance clinical reasoning and theory-practice integration. AIM: To design and develop a nursing process-structured immersive virtual reality simulation for orthopaedic nursing education and to pilot test its usability and educational appraisal among undergraduate nursing students. DESIGN: Pilot mixed-methods study. METHOD: The simulation, NurseTechGames, was designed as a three-dimensional orthopaedic inpatient scenario structured sequentially according to the nursing process and incorporating gamification elements to support clinical reasoning. The intervention was implemented using Meta Quest 3 head-mounted displays. Usability was assessed using the System Usability Scale, and educational appraisal was measured using the Serious Educational Game in Nursing Appraisal Scale. Open-ended responses were analysed through qualitative content analysis. Participants were monitored during and after the sessions for potential cybersickness symptoms. RESULTS: The simulation achieved a mean score of 83.15 on the System Usability Scale, indicating excellent usability. The total mean SEGINAS score was 95.58, reflecting a very high pedagogical evaluation across the dimensions of engagement, impact on learning, and content relevance. The qualitative analysis identified eight categories, with no reports of significant cybersickness symptoms: Perceived Learning Value, Clinical Transfer, Realism and Immersion, Engagement and Motivation, Technical Robustness, Development Potential, Minor Technical Issues, and Time Constraints. CONCLUSION: The immersive simulation NurseTechGames demonstrated high usability and strong pedagogical acceptance in musculoskeletal surgical nursing education. Future controlled and longitudinal studies are required to evaluate objective and sustained impact on learning outcomes.