Learning experiences and usability perceptions of an immersive virtual reality simulation for cardiotocography interpretation education: a qualitative-dominant mixed methods inquiry

BACKGROUND: Accurate interpretation of cardiotocography (CTG) is essential for ensuring safe intrapartum care, yet it remains challenging owing to abstract concepts and substantial inter-observer variability. Conventional classroom-based instruction often fails to bridge the gap between theoretical knowledge and clinical practice. Immersive virtual reality (IVR) offers interactive and reflective learning opportunities that may enhance clinical reasoning and decision-making. This study explored nursing students' learning experiences and perceptions of usability when engaging with IVR simulation for CTG interpretation, underpinned by Kolb's Experiential Learning Theory (ELT). METHODS: A qualitative-dominant mixed-methods design was employed. Forty-three nursing students participated in an IVR simulation focused on CTG interpretation. Usability was evaluated using the System Usability Scale (SUS), while focus group interviews and reflective narratives provided qualitative insights. Thematic analysis was undertaken, with ELT guiding the interpretive process. RESULTS: The mean SUS score was 80.17, exceeding the established benchmark of 68, thereby demonstrating high usability and acceptance. Thematic analysis generated four key themes: (1) immersive and interactive learning experience, (2) learning support and development of clinical reasoning, (3) challenges and limitations, and (4) recommendations for improvement. Students valued presence, interactivity, and real-time feedback in fostering reflection and knowledge integration. Reported challenges included technical adaptation difficulties, cognitive load, and limited clinical realism. Recommendations focused on scaffolding, expanding case diversity, and interface optimisation. CONCLUSIONS: IVR simulation demonstrated both strong usability and meaningful educational value for CTG interpretation. Informed by ELT, IVR facilitates the transformation of abstract theoretical knowledge into applied clinical reasoning, indicating its potential as a complementary tool in obstetric nursing education. CLINICAL TRIAL NUMBER: Not applicable.