Comparison of immersive virtual reality and video-based home visit simulations for developing nursing students’ perceived clinical reasoning, learning satisfaction, and engagement: a randomized controlled trial

BACKGROUND: Home visits require students to integrate clinical reasoning with environmental assessments; however, most virtual reality (VR) studies focus on hospital settings. No randomized controlled trial has also compared immersive VR with conventional video-based training in home visit contexts. Therefore, this study aimed to evaluate whether immersive VR-based home visit training improves students’ perceived clinical reasoning skills and learning experiences compared with video-based training. METHODS: A parallel-group randomized controlled trial was conducted among third-year nursing students in Tokyo. Participants were allocated to an intervention (VR-based training; n = 39) or a control (video-based training; n = 40) group. Three scenarios were used, representing an older person, an older couple, and parents with a newborn. The primary outcome was self-perceptions of clinical reasoning skills, while secondary outcomes included the Student Satisfaction and Self-Confidence in Learning Scale©, Educational Practices Questionnaire©, and Simulation Design Scale©. RESULTS: Seventy-eight female participants aged approximately 20 years were included in the analyses. Both groups showed significant within-group improvements in self-perceived clinical reasoning ability However, no significant between-group differences were observed in either domain. Similarly, no between-group differences were found in learning satisfaction, self-confidence, or overall National League for Nursing’s Scale scores. Although total Educational Practices Questionnaire© scores did not differ between the groups, the VR group rated significantly higher in active learning, collaboration, and high expectations than the control group. On the Simulation Design Scale©, the VR group rated support and problem-solving significantly higher, whereas the control group assigned higher importance ratings to support and fidelity. CONCLUSIONS: Immersive VR-based simulation did not demonstrate superiority over video-based simulation in improving self-perceived clinical reasoning or learning satisfaction. However, it was associated with enhanced learner engagement in selected domains, including active learning, collaboration, and problem-solving. Immersive VR-based simulation may enrich experiential aspects of home visit education and serve as a valuable pedagogical approach within existing community-based nursing curricula. CLINICAL TRIAL REGISTRATION: UMIN000049037 (Date of registration: September 27, 2022).(https://center6.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000055866). This study was registered with the University Hospital Medical Information Network Clinical Trial Registry before starting the study (ID: UMIN000049037; date of registration: September 27, 2022).