ArticleSimulation & gaming2026
Mixed Methods Examination of Challenging and Bothersome Events in Nursing Virtual Simulations: Comparing Screen-Based and Headset VR Modalities.
Article in Simulation & gaming, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper, 1 of them a synthesis that pooled it.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed, 1 synthesis or guideline pooled it.
- Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis.BMC medical education · 2023Pooled it
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Background: Virtual simulations (VSs) are increasingly utilized to train nursing students for clinical practice, yet few tools to evaluate VS quality, and little research has examined specific design elements that impact user experience across different modalities. Comparative evidence between screen-based VS and headset virtual reality (VR) within the same VS scenario is especially limited. Purpose: The primary goal of this study is to identify challenging/bothersome events in a VS, compare how these events manifest in screen-based versus headset VR, and examine their impact on electrodermal activity (EDA; physiological arousal), performance, usability, and cognitive load. Methods: A mixed-methods approach was applied to analyze audio-video and EDA data from 20 third-year nursing students during a VS. Objective performance scores were generated by the OMS software, while self-reported data on usability and cognitive load were collected through post-simulation surveys. Results: Six challenging/bothersome event categories were identified: software-related restrictions and bugs, confusion/lack of success, negative affect, technical errors, neglect of instruction, and other. Results revealed that encountering challenging/bothersome events significantly increased students' EDA (an indicator of physiological arousal), possibly reflecting frustration/confusion. Furthermore, while no single challenging/bothersome event category predicted performance or usability relative to others, we found that software-related restrictions and bugs were particularly critical, significantly increasing extrinsic cognitive load compared to technical errors. Conclusions: Our findings highlight specific VS elements that hinder students' experience, directly pointing to areas for future improvements. We also provide valuable insights for educators and developers to enhance virtual learning environments in nursing education by addressing how to reduce cognitive load and improve performance and usability. Future research should develop VS-specific usability tools and replicate this study in diverse contexts to further refine virtual learning experiences.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.