Helpful Resources for Understanding Virtual Reality Simulations and Application in Nursing Education

The 2020 Horizon Report by EDUCAUSE—an annual publication that outlines contemporary instructional technologies and forecasts their adoption—has included extended reality (XR) technologies as likely to have a heavy impact on teaching and learning practices in higher education. XR technologies is an umbrella term used for environments that blend virtual and real worlds. These includes augmented reality (AR), virtual reality (VR) and mixed reality (MR) environments. This research review spotlights virtual reality (VR) environments, particularly simulations in VR, as a promising medium for enhancing clinical nursing education.                  

According to the National Council of State Boards of Nursing (NCSBN), “Simulations are activities that mimic the reality of a clinical environment and are designed to demonstrate procedures, decision-making and critical thinking through techniques such as role-playing and the use of devices such as interactive videos or mannequins” (2005). VR simulations offer immersive experiences in a three-dimensional (3D) environment in which users/learners can (a) participate in a scenario with a headset that generates images and sounds like a real or imaginary world, (b) communicate with team members, (c) perform relevant actions using controllers, and (d) receive haptic feedback (Jenson & Forsyth, 2012).                                           

The following resources can help you understand VR, differentiate VR from AR and MR, explore applications of VR in education, examine research on virtual simulations in nursing education over the last 20 years, as well as learn about examples of VR simulations in nursing education.  

1. Understanding Virtual Reality: Interface, Application, and Design. Sherman, W., & Craig, A. (2018). (2nd ed.). Morgan Kaufmann Publishers, An Imprint of Elsevier.

Virtual reality (VR) is not new. However, recent technological advancements have made it possible for VR environments to facilitate disciplinary experiences and skill acquisition with unparalleled immersion and interactivity. This book by Sherman and Craig (2019) offers a comprehensive resource for an audience both new and familiar to VR. Chapters cover major topics, such as what is VR (introduction to VR, understanding the VR is a medium), VR systems (human in the loop, interfacing the participants with the virtual world, interfacing the virtual world with the participants, presenting the virtual world, and interacting with the virtual world), and applied VR (bringing the virtual world to life, applying VR to a problem, past-present-future of VR). A companion website provides additional case studies, tutorials, and instructional materials.  

2. What’s the difference between AR, VR, and MR? Gupton, N., & Kiger, P. J. (2020, January 6). Franklin Institute.

This short article offers a bite-sized distinction between the three kinds of technologies. If you are interested in further exploration, the hyperlinks to AR, VR, and MR lead you to additional brief pieces on the history, science, and applications of each technology.

3. Virtual Reality and Its Applications in Education. Kamińska, D., Sapiński, T., Wiak, S., Tikk, T., Haamer, R., Avots, E., Helmi, A., Ozcinar, C., & Anbarjafari, G. (2019). Information10(10), 318.

VR applications are now widespread in many industries—military, healthcare, retail, automotive, tourism, architecture, art and design, recruitment, and sports. In their paper, Kaminska and colleagues (2019) discuss applications of VR in education. The authors draw upon empirical examples from general education, engineering, medical education, special needs education, and healthcare. They describe types of VR environments (hardware and software) and their use for targeting specific learning goals. Kaminska and colleagues (2019) also discuss some practical considerations for incorporating VR in education.

4. Virtual Simulation in Nursing Education: A Systematic Review Spanning 1996-2018. Foronda, C. L., Fernandez-Burgos, M., Nadeau, C., Kelley, C. N., & Henry, M. N. (2020). Simulation in Healthcare: The Journal of the Society for Simulation in Healthcare15(1), 46–54.

Nursing educators have successfully adopted low- and high-fidelity simulations for clinical training. In their systematic review of literature, Foronda and colleagues (2020) examine the effectives of virtual simulations on student learning outcomes such as learning (knowledge), skill performance, learner satisfaction, critical thinking and self-confidence. Evidence suggests that virtual simulations offer an effective pedagogical approach. The authors conclude with implications for future research, including an emphasis on curricular integration, and identification of best practices to promote systematic and effective use of virtual simulations. 

5. Virtual Reality Simulation: Using Three-dimensional Technology to Teach Nursing Students. Jenson, C. E., & Forsyth, D. M. (2012). CIN: Computers, Informatics, Nursing30(6), 319–320.

Jenson and Forsyth (2012) made an early and comprehensive argument for introducing VR simulations in nursing education. They describe VR simulations for nursing education, stating “This computer-based three-dimensional educational tool simulates real-life patient experiences in a risk-free environment, allows for repeated practice sessions, requires clinical decision making, exposes students to diverse patient conditions, provides immediate feedback, and is portable.” In their paper, the authors review literature on the use of VR simulations in nursing curricula to overcome commonly reported barriers in clinical education— increasing patient acuity, high student-to-faculty ratio, patient safety concerns from faculty, and student anxiety. Jenson and Forsyth (2012) also report findings from a project describing faculty readiness and experiences of using VR simulations. They conclude with a discussion on the benefits of incorporating VR simulations for faculty and students.

6. Virtual Reality in Clinical Simulation: A Modality for Undergraduate Nursing Education. A. Ramakrishnan, A. Lleva, C. Okupniak (2020). INTED2020 Proceedings, pp. 7359-7366.

Ramakrishnan and colleagues (2020) demonstrate the application of three VR simulations designed to support students’ situational awareness, clinical judgment, clinical decision making, and understanding of patients’ perspective. The authors explore the feasibility of using VR as a complementary modality in simulation programs, and report growing interest among students to continue using VR simulations for learning and practicing clinical concepts.


According to the U. S. Bureau of Labor Statistics (2020), employment of registered nurses is projected to grow seven percent over the decade. Specifically, about 175,900 openings for registered nurses are projected each year, on average from 2019 to 2029. This growth is faster than the average for all occupations. Leaders in nursing education have urged the field to continue their commitment to quality research and education, especially in light of the global pandemic where the demand for well-trained nurses is higher (D’Antonio, Naylor & Aiken, L., 2020). However, continuing instruction and training for nursing students (as with other students) has posed new challenges (Dewart, Corcoran, Thirsk & Petrovic, 2020). Incorporating virtual reality simulations into nursing programs offers novel opportunities for educators to personalize their instruction and prepare students for the complexities of the nursing profession and patient well-being.


Brown, M., McCormack, M., Reeves, J., Brook, D.C., Grajek, S., Alexander, B., Bali, M., Bulger, S., Dark, S., Engelbert, N., Gannon, K., Gauthier, A., Gibson, D., Gibson, R., Lundin, B., Veletsianos, G. & Weber, N. (2020). 2020 Educause Horizon Report Teaching and Learning Edition. Louisville, CO: EDUCAUSE. Retrieved November 2, 2020 from

Bureau of Labor Statistics, U.S. Department of Labor. (2020). Occupational Outlook Handbook, Registered Nurses,

D’Antonio, P., Naylor, M., & Aiken, L. (2020). Nursing research is coronavirus research. Research in Nursing & Health, 43(3).

Dewart, G., Corcoran, L., Thirsk, L., & Petrovic, K. (2020). Nursing education in a pandemic: Academic challenges in response to COVID-19. Nurse Education Today, 92.

Jenson, C.E. & Forsyth, D.M.  (2012). Virtual Reality Simulation: Using Three-dimensional  Technology to Teach Nursing Students. Computers, Informatics, Nursing, 30(6), 312-318.

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