Undergraduate nursing students’ learning experiences with mixed reality-based simulation using a complex older adult stroke scenario: A qualitative descriptive study

Purpose: This study explored undergraduate nursing students’ learning experiences with a mixed reality-based (MR-based) simulation using HoloPatient. It focused on a complex older adult scenario involving acute ischemic stroke.Methods: A qualitative descriptive design was employed. Ten second-year undergraduate nursing students who participated in an MR-based simulation integrated into a health-assessment course were recruited through convenience sampling. Data were collected via two semi-structured focus-group interviews and analyzed using Braun and Clarke’s thematic analysis.Results: Two overarching themes and six subthemes were identified. Students reported that the immersive MR-based simulation enhanced clinical observation and supported the integration of multiple clinical cues, promoting a deeper understanding of geriatric stroke care, including multimorbidity, polypharmacy, and social context. Engagement with this complex scenario facilitated the anticipation of changes in patient condition and contributed to the development of early clinical reasoning and situational awareness. However, challenges were noted, including limited interactivity, insufficient environmental realism, unfamiliarity with MR technology, and inequitable access to devices.Conclusion: The MR-based simulation using a complex older adult stroke scenario demonstrated educational value in enhancing clinical observation, fostering a holistic understanding of geriatric care, and supporting the development of early clinical reasoning among undergraduate nursing students. To optimize the effectiveness of the MR-based simulation, improvements in instructional design, environmental fidelity, and equitable access are required. Future research should examine the impact of repeated exposure and structured instructional strategies on learning outcomes in undergraduate gerontological nursing education.