The effect of virtual reality on cognitive, affective, and psychomotor outcomes in nursing staffs: systematic review and meta-analysis

Defi Efendi, Renny Wulan Apriliyasari, Juliana Gracia Eka Prihartami Massie, Cho Lee Wong, Regina Natalia, Bejo Utomo, Chiyar Edison Sunarya, Efa Apriyanti, Kee Hsin Chen

Research output: Contribution to journalArticlepeer-review

2 Citations (Scopus)


Background: In the healthcare systems of the world, reinforcing the competence and professionalism of nurses has become a concern. Gaining clinical nursing competence in the healthcare system requires more effort, and additional training is required. Medical education and training have begun using digital technologies, such as virtual reality (VR). The purpose of this research was to examine the efficacy of VR in terms of cognitive, emotional, and psychomotor outcomes and learning satisfaction in nurses. Method: The study searched eight databases (Cochrane library, EBSCOHost, Embase, OVID MEDLINE, ProQuest, PubMed, Scopus, and Web of Science) for articles that met these criteria: (i) nursing staff, (ii) any virtual reality technology intervention for education, all levels of immersion, [1] randomized control trial and quasi-experiment study, and (iv) published articles and unpublished theses. The standardized mean difference was measured. The random effect model was applied to measure the main outcome of the study with a significance level of p <.05. The I2 statistic assessment was applied to identify the level of heterogeneity of the study. Results: A total of 6740 studies were identified, of which 12 studies with 1470 participants met the criteria for inclusion. The meta-analysis showed a significant improvement in the cognitive aspect (standardized mean difference [SMD] = 1.48; 95% CI = 0.33–2.63; p =.011, I 2 = 94.88%), the affective aspect (SMD = 0.59; 95% CI = 0.34–0.86; p <.001, I 2 = 34.33%), the psychomotor aspect (SMD = 0.901; 95% CI = 0.49–1.31; p <.001, I 2 = 80.33%), and learning satisfaction (SMD = 0.47; 95% CI = 0.17–0.77; p =.002, I 2 = 0%) aspects of the groups that received the VR intervention compared to the control groups. Subgroup analysis found that dependent variables (e.g., level of immersion) did not improve study outcomes. The quality of evidence was low which is affected by major methodological issues. Conclusions: VR may favorable as alternative method to increase nurse competencies. Randomized controlled trials (RCTs) on larger samples are needed to strengthen the evidence for the effect of VR in various clinical nurse settings. ROSPERO registration number: CRD42022301260.

Original languageEnglish
Article number170
JournalBMC Nursing
Issue number1
Publication statusPublished - Dec 2023


  • Affective
  • Cognitive
  • Learning satisfaction
  • Nursing staff
  • Psychomotor
  • Virtual reality


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