Immersive learning in nursing - VR simulation and its impact on culturally and linguistically diverse nursing students' clinical reasoning, psychological stress and satisfaction.

AIMS: The study aimed primarily to evaluate the effects and experiences of virtual reality (VR) simulations on culturally and linguistically diverse (CALD) nursing students' clinical reasoning, confidence, satisfaction, and stress-related neurophysiological reactions. The two VR scenarios were used to provide clinically relevant learning contexts for students at different stages of nursing education. DESIGN: Within-subjects mixed-methods design with multimodal data collection. METHODS: VR technology was developed using Unreal Engine 5 and MetaHuman and included post-surgical discharge and anaphylaxis cases. CALD first- and second-year nursing students (n = 29) in English-language degree programmes participated, and 16 were interviewed. Clinical reasoning was evaluated using the Nurses' Clinical Reasoning Scale. Self-confidence, satisfaction, and perceived simulation design were evaluated using the Student Satisfaction and Self-Confidence in Learning Scale and Simulation Design Scale. Stress-related neurophysiological responses were collected using heart rate (HR) and electrodermal activity (EDA). Quantitative data were analysed using within-subject statistical tests and descriptive analyses. Students' experiences were explored through interviews and inductive content analysis. RESULTS: Clinical reasoning improved significantly in the total sample after VR simulation. Students reported high self-confidence and satisfaction, and simulation design was evaluated positively across most domains. HR and EDA fluctuated across measurement points, but stress-related neurophysiological responses did not increase significantly in the total sample. Scenario-specific findings were reported descriptively as contextual information, not as evidence of differences in scenario effectiveness. Participants described how VR learning enhanced professional competence and preparation for practice, alongside both positive and challenging effects on confidence and motivation. CONCLUSION: VR simulation appears to be a promising, safe, and student-centred educational method for supporting CALD nursing students' clinical reasoning, nursing skills, and communication skills. Findings highlight the importance of structured support, feedback, and guided reflection for learners developing clinical and language skills simultaneously.