Virtual Reality Cave vs. Simulated Home for Community Nursing Education: A Crossover Trial Comparing Student Competence, Confidence, and Satisfaction

Summary

Background and Purpose

Community health nursing is essential for providing healthcare to individuals in home and neighborhood settings. As healthcare delivery shifts from hospitals to community environments, nursing students require practical training to develop competencies in conducting home visits. However, the availability of sufficient community-based training sites remains limited, and initial home visit experiences are often associated with student anxiety.

This study evaluated whether an immersive virtual reality technology, VR CAVE (Cave Automatic Virtual Environment), can provide training outcomes comparable to traditional practice conducted in a simulated home apartment. VR CAVE generates a room-sized three-dimensional environment that allows users to navigate and interact with realistic home settings without requiring physical props or dedicated space.

Methods

A crossover randomized controlled trial was conducted with 150 final-year nursing students at the University of Hong Kong from August 2024 to May 2025. Participants were randomly assigned to experience both training modalities in different sequences: one group received VR CAVE training followed by simulated home training, while the other group followed the reverse order. A three-week washout period was implemented between training sessions to minimize carryover effects.

Each training session included two realistic home visit scenarios: (1) a 70-year-old male with chronic lung disease living alone with respiratory distress and a urinary catheter, and (2) a 65-year-old female undergoing treatment for tuberculosis in a poorly ventilated apartment. Participants were required to identify environmental hazards, assess patient conditions, and formulate appropriate nursing care decisions.

The VR CAVE system projected life-sized three-dimensional home environments onto surrounding walls, incorporating approximately twenty interactive elements per scenario, such as smoke effects, labored breathing sounds, medication containers, and mobility aids. Participants navigated freely within the virtual space and interacted with objects. The traditional simulated home consisted of a physical mock apartment equipped with real props and comparable layouts.

Outcomes were measured using validated instruments assessing three domains: self-perceived clinical competence (confidence in nursing skills), self-confidence in applying learned knowledge, and satisfaction with the learning experience.

Results

Both VR CAVE and traditional simulated home training resulted in significant improvements in clinical competence, self-confidence, and satisfaction. Comparable levels of skill development were observed between participants trained using VR CAVE and those trained in the simulated home. No statistically significant difference in competence scores was identified between the two methods after completion of both training modalities (p=0.345).

Higher satisfaction and self-confidence scores were observed following VR CAVE sessions (mean scores ranging from 4.31 to 4.39 out of 5) compared to the simulated home. These findings suggest that the virtual reality approach may offer a more engaging and confidence-enhancing learning experience, despite similar effectiveness in skill acquisition.

Significance

The findings demonstrate that VR CAVE technology is comparable to traditional hands-on simulation in teaching community nursing skills. Key implications include:

Mitigation of space and resource constraints: Virtual environments allow the creation of diverse home settings without reliance on physical infrastructure or repeated reconfiguration of equipment.

Expansion of training capacity: Increased access to practice opportunities is achievable without dependence on physical space or clinical placement availability.

Enhanced learner engagement: Higher satisfaction levels indicate potential benefits in learner motivation and confidence prior to real-world placements.

Adaptability of training scenarios: Virtual environments can be readily modified to represent varied home conditions and patient cases, supporting comprehensive preparation for clinical practice.

Overall, VR CAVE represents a valuable adjunct to conventional training methods in preparing nursing students for community-based healthcare roles, particularly in contexts with limited access to real-world training environments.

Conditions

• Community Health Nursing Education
• Chronic Obstructive Pulmonary Disease
• Pulmonary Tuberculosis

Interventions

OTHER

VR CAVE Immersive Simulation for Community Health Nursing Education

Immersive virtual reality educational intervention using Cave Automatic Virtual Environment (VR CAVE) technology that projects life-sized 3D home environments onto room-scale walls. Students experience two 20-minute standardized community health nursing scenarios: (1) home visit to a 70-year-old COPD patient with Foley catheter living in public housing, and (2) home visit to a 65-year-old tuberculosis patient in poorly ventilated flat. Each virtual environment contains approximately 20 interactive clinical cues including animated smoke, ambient sounds (labored breathing, environmental noise), and responsive objects (medication packaging, mobility aids). Students physically navigate the virtual space, identify health hazards, assess patient needs, and apply community nursing principles. Sessions are followed by structured debriefing using Kolb's Experiential Learning Theory framework (Concrete Experience, Reflective Observation, Abstract Conceptualization, Active Experimentation).

OTHER

Traditional Simulated Home Environment for Community Health Nursing Training

Traditional simulation-based educational intervention conducted in a physical mock apartment laboratory setting. Students experience identical two 20-minute standardized community health nursing scenarios: (1) home visit to a 70-year-old COPD patient with Foley catheter living in public housing, and (2) home visit to a 65-year-old tuberculosis patient in poorly ventilated flat. The simulated apartment uses physical props, standardized room layouts, printed materials, and observational cues to replicate realistic home environments with the same 20 clinical elements present in the VR CAVE scenarios (medication storage, ventilation issues, mobility hazards, etc.). Students physically navigate the mock apartment space, identify environmental and health hazards, and apply community nursing assessment and intervention skills. Sessions are followed by structured debriefing using identical Kolb's Experiential Learning Theory framework as the VR CAVE intervention.

Sponsors & Collaborators

• The University of Hong Kong

  lead OTHER

Study Design

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Model

CROSSOVER

Eligibility

Min Age

18 Years

Sex

ALL

Healthy Volunteers

Yes

Timeline & Regulatory

Start

2024-08-01

Primary Completion

2025-05-30

Completion

2025-07-15

Countries

• Hong Kong

Study Locations