Integration of Virtual and Augmented Reality Into Obstetric Nursing and Midwifery Education: Systematic Review.

BACKGROUND: Technologies such as virtual reality (VR) and augmented reality (AR) have been increasingly incorporated into nursing education to support the development of cognitive, psychomotor, and behavioral competencies. In midwifery, immersive environments offer opportunities to simulate high-risk or low-frequency clinical scenarios, strengthening students' confidence and preparedness for professional practice. However, there is still significant variability in how VR and AR are pedagogically implemented, with limited understanding of their theoretical grounding, instructional design, and educational outcomes.

OBJECTIVE: This systematic review aimed to synthesize and critically evaluate the characteristics of educational programs using VR and AR to develop competencies among nursing and midwifery students and professionals.

METHODS: This review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 and Synthesis Without Meta-Analysis (SWiM) guidelines and was registered in PROSPERO (International Prospective Register of Systematic Reviews). A comprehensive search was conducted in August 2024 across PubMed, Web of Science, Scopus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases. Eligible studies were experimental, quasi-experimental, or observational, and involved undergraduate or postgraduate students in nursing, obstetric nursing, or midwifery, as well as certified midwives or nurse-midwives. Two independent reviewers conducted screening, data extraction, and quality appraisal using Joanna Briggs Institute (JBI) tools and the Medical Education Research Study Quality Instrument (MERSQI) scale. Data were synthesized narratively according to predefined thematic categories.

RESULTS: Four studies published between 2021 and 2024 met the inclusion criteria, encompassing 634 participants (360 midwifery students and 274 midwives or nurse-midwives). Two randomized controlled trials and 2 quasi-experimental studies were included. Interventions used VR in 3 studies and AR in one, simulating scenarios such as normal and complicated childbirth, neonatal resuscitation, and emergency obstetric procedures. Most interventions focused on developing technical competencies, while one also addressed teamwork and communication. Only 2 studies explicitly reported theoretical or pedagogical frameworks, and 2 mentioned alignment with the INACSL Healthcare Simulation Standards of Best Practice. Structured briefing or debriefing was rarely described. All studies assessed learning outcomes (Kirkpatrick level 2), and 3 included participants' satisfaction (level 1). Methodological quality, measured by MERSQI, ranged from 10.0 to 14.5, with a mean score of 12.9 (SD 2.0), indicating moderate to high quality.

CONCLUSIONS: Evidence suggests that VR and AR can enhance learning in obstetric nursing and midwifery education by providing safe, experiential, and interactive learning environments. However, the limited use of theoretical frameworks and structured instructional design highlights the need for more pedagogically grounded interventions. Future research should prioritize the integration of learning theories, validated assessment tools, and best-practice simulation standards to strengthen the educational impact and curricular integration of immersive technologies in nursing and midwifery education.