Effectiveness of immersive virtual reality in undergraduate nursing students for cardiopulmonary resuscitation training: A randomized controlled trial.

BACKGROUND: Immersive virtual reality (IVR) is increasingly being used in nursing education, offering interactive environments for clinical training. However, its effectiveness in cardiopulmonary resuscitation (CPR) training, compared with traditional simulation, remains uncertain. OBJECTIVE: To evaluate the effectiveness of IVR combined with manikin-based simulation, compared with manikin-based simulation alone, in CPR group training among undergraduate nursing students. METHODS: A randomized controlled trial was conducted with 246 nursing students, assigned to control group (manikin-only simulation) or an experimental group (IVR followed by manikin simulation). Primary outcomes were self-confidence and satisfaction after training. Secondary outcomes included CPR group performance, perceived usability, and tolerance to VR headset use. RESULTS: There were no significant differences between study groups in self-confidence, either before or after cluster adjustment (unadjusted effect = 0.03, 95% CI [-1.02 to 1.08], p = 0.956; adjusted effect = 0.02, 95% CI [-1.05 to 1.09], p = 0.974). Logistic regression identified tolerance of ambiguity as a predictor of higher self-confidence (OR = 1.083, 95% CI [1.03-1.14], p = 0.002). As a secondary outcome, no significant differences were observed in CPR group performance between study groups, either before or after cluster adjustment (unadjusted effect = 0.56, 95% CI [-0.21 to 1.33], p = 0.154; adjusted effect = 0.56, 95% CI [-0.21 to 1.34], p = 0.153). The experimental group reported significantly higher scores with VR training-ease of learning, usefulness, satisfaction, and ease of use (all p < 0.01). Regarding headset tolerance, 33.6% experienced occasional dizziness, 19% headaches, and 7.6% nausea. CONCLUSION: IVR training did not significantly improve self-confidence or CPR group performance after cluster-adjusted analyses, although it may still represent a useful complement to hands-on simulation. Future research should evaluate the cost-effectiveness of incorporating VR training alongside face-to-face simulation in undergraduate nursing CPR training programs.