Navigating the Pedagogical and Practical Frontiers of Immersive Virtual Reality in Nursing Education

Abstract

This commentary reflects critically on the study by Stenseth et al. regarding immersive virtual reality (IVR) use in nursing education. While students reported favorable impressions of IVR's usability and educational value, challenges remain concerning cognitive scaffolding, learner discomfort, and limited scenario diversity. Drawing on the Technology Acceptance Model and Experiential Learning Theory, this commentary highlights the need for pedagogical depth, structured facilitation, and authentic simulation design. It also calls for greater student involvement in IVR development and longitudinal assessment of its learning impact. For IVR to become a sustainable educational modality, it must transition from technological novelty to pedagogically sound practice that is inclusive, reflective, and clinically relevant.

Introduction

Immersive virtual reality (IVR) is reshaping the way nursing students engage with complex clinical scenarios. As an extension of simulation-based education, IVR creates opportunities for learners to develop assessment and decision-making skills in controlled yet realistic environments. Stenseth et al. (2025) investigated nursing students’ perceptions of IVR's ease of use and usefulness in enhancing ABCDE (Airway, Breathing, Circulation, Disability, Exposure) and NEWS2 (National Early Warning Score 2, a standardized tool for detecting patient deterioration) competencies. Their study contributes to a growing body of research promoting IVR as an effective pedagogical innovation. However, this commentary argues that while IVR offers promise, critical examination of its practical integration, instructional design, and learner experience is vital to inform sustainable and effective implementation.

Brief Review and Discussion of the Topic

The study by Stenseth et al. (2025) offers a timely and relevant contribution to the integration of IVR into nursing education by employing frameworks such as the Technology Acceptance Model and Experiential Learning Theory (ELT). These models are appropriate for gauging the perceived usability and educational value of IVR technologies, particularly as nursing programs explore digital modalities to simulate clinical environments. Students in the study expressed enthusiasm and perceived benefits regarding IVR use, especially in developing assessment skills such as ABCDE and NEWS2. However, a closer pedagogical analysis reveals that high engagement, while promising, does not necessarily equate to effective or enduring learning outcomes.

One key issue is the lack of sufficient cognitive scaffolding embedded within the IVR simulations. Although the quantitative findings demonstrate favorable responses on Likert scales, suggesting user satisfaction, the qualitative depth of learning appears constrained by insufficient instructional support during the simulation. According to ELT principles, effective experiential learning requires not only active participation but also opportunities for reflective observation and conceptual processing. Without clearly structured learning trajectories and feedback loops, students may engage in surface learning rather than deep comprehension and skill transfer.

A second concern pertains to learner well-being, as several students reported experiencing physical discomforts such as dizziness, visual strain, and emotional anxiety—symptoms commonly associated with cybersickness. These physiological responses can hinder immersion and create inequities in learning access, particularly for students with vestibular sensitivities or preexisting health conditions. The enthusiasm elicited by novel technology should not overshadow the need to create inclusive environments where all students can participate meaningfully without physiological risk. Furthermore, extended exposure without physical intermissions or adaptive settings can exacerbate these effects, undermining the educational intent of IVR implementation.

Third, the perceived authenticity of the simulation was noted by students, yet the virtual scenarios lacked sufficient diversity and ambiguity, particularly in terms of patient demographics, comorbidities, and clinical complexity. Authenticity in simulation pedagogy is not merely about visual fidelity or interactive functionality—it is also about replicating the uncertain, nuanced nature of real-world clinical reasoning. When scenarios are overly scripted or homogenized, they risk reinforcing rote responses rather than adaptive, critical thinking skills. As Bradley et al. (2024) emphasized, true fidelity involves dynamic variables that challenge learners to navigate ambiguity, prioritize interventions, and reevaluate their assumptions in real-time clinical contexts.

An equally significant dimension involves the autonomy–structure balance in learning design. While the study reports that students appreciated the freedom to engage with IVR on their own terms, autonomy without structured support mechanisms can lead to cognitive overload, particularly among novice learners unfamiliar with the clinical frameworks embedded in the scenario. As Parong and Mayer (2021) highlight, immersive learning environments should be paired with scaffolding strategies—such as cueing, prebriefing, guided prompts, and structured debriefing—to maximize knowledge retention and metacognitive development. Without these pedagogical anchors, the learner may feel overwhelmed by the simulation's realism or uncertain about how to interpret and apply their experience. This can be particularly problematic in formative learning stages, where feedback is crucial for developing clinical judgment.

Ultimately, these interconnected challenges suggest that while IVR holds considerable promise as an educational tool, its implementation must be intentional, learner-centered, and theoretically grounded. A balance must be struck between technological innovation and educational effectiveness. Designing IVR experiences that align with cognitive theory, account for learner variability, and incorporate reflective processes will ensure that simulation serves as a bridge—not a barrier—to professional competence in nursing.

Current Insights and Interpretations

Simulation fidelity must go beyond visual realism to encompass the nuanced complexity of real-world clinical practice. As Bradley et al. (2024) argue, fidelity in simulation should not be narrowly interpreted as technological sophistication alone, such as high-definition graphics or realistic avatars. Instead, it should reflect the ambiguity, unpredictability, and cognitive demands inherent in actual clinical environments. In IVR simulations, the absence of evolving patient conditions, differential diagnoses, and dynamic clinical variables may hinder the development of adaptive clinical judgment. This calls for a paradigm shift toward designing simulations that promote not only procedural competence but also flexible decision-making and reflective thinking under uncertainty.

To address this, the concept of “customizable fidelity” has emerged as a promising solution.

This approach involves tailoring the complexity of scenarios based on learners’ experience levels, learning objectives, and evolving competencies. For example, novice students may begin with structured, low-risk simulations, while advanced learners can engage with multilayered cases involving comorbidities, ethical dilemmas, or time-sensitive interventions. Customizable fidelity ensures that learners are neither underchallenged nor overwhelmed, thus enhancing both psychological safety and educational effectiveness.

Moreover, the integration of student feedback into IVR scenario design is essential for creating inclusive and responsive learning environments. Learners offer unique insights into usability, accessibility, and realism—factors that directly influence engagement and motivation. Bodur et al. (2024) emphasize the value of machine learning-enhanced systems that adapt to individual learning profiles, thereby enabling personalized learning trajectories. Such systems can analyze user interaction data to recommend appropriate scenario difficulty, feedback pacing, or content sequencing, all of which contribute to learner-centered instructional design.

Finally, while initial studies often focus on immediate knowledge gains or learner satisfaction, longitudinal assessments are critical to determining the true impact of IVR on clinical competence. Evaluating whether skills acquired through IVR are retained and effectively transferred to clinical practice will be pivotal in justifying sustained investment in these technologies and ensuring their alignment with professional readiness goals.

Conclusions/Importance to Nursing Profession

IVR represents a promising advancement in nursing education, offering learners immersive and interactive simulations to hone clinical reasoning and technical skills. However, without intentional pedagogical integration, IVR risks becoming an attractive but superficial teaching tool. Educators must ensure that IVR scenarios are supported by cognitive scaffolding, structured debriefings, and realistic challenges. Stakeholder input, particularly from students, should guide content development. As nursing education evolves in a postdigital era, IVR can serve as a critical bridge between theoretical instruction and clinical competence if it is implemented in a manner that is both deliberate and reflective. Importantly, this commentary underscores that student satisfaction and engagement, while valuable, do not necessarily equate to deep or persistent learning. Longitudinal studies are therefore essential to assess the enduring impact of IVR on clinical competence and professional practice. Longitudinal studies are therefore essential to assess the enduring impact of IVR on clinical competence and professional practice.