Application of XR in nursing skills training for nurses and nursing students: A scoping review.

BACKGROUND

Proficient nursing skills are essential for patient safety, yet limited clinical resources restrict hands-on training for nursing students and nurses. As a promising technical tool, extended reality (XR) holds great potential for nursing skills training, though a comprehensive synthesis of its applications, outcomes and barriers remains lacking.

OBJECTIVE

This scoping review aimed to map the applications of XR in nursing skills training, summarize training outcomes and barriers, evaluate outcomes using the Kirkpatrick Model, and describe their use across the three XR modalities. The Kirkpatrick Model classifies training outcomes into four levels: Level 1 Reaction, Level 2 Learning, Level 3 Behavior, and Level 4 Results.

METHODS

Following Arksey and O'Malley's framework, nine databases were searched for studies published between 2015 and 2026 on XR-based nursing skills training for nurses and nursing students. Outcomes were mapped to the Kirkpatrick Model.

RESULTS

A total of 128 studies were included. Virtual reality (VR, n = 105, 82%) dominated XR application, with augmented reality (AR, n = 15, 11.7%) and mixed reality (MR, n = 8, 6.2%) underrepresented, covering fundamental, specialized and emergency nursing skills. Skill level (n = 87, 67.9%) and satisfaction (n = 81, 63.2%) were frequently reported outcomes, with skill level corresponding to Level 2 Learning and satisfaction falling under Level 1 Reaction of the Kirkpatrick Model, while data regarding Level 3 Behavior and Level 4 Results remained scarce. Technical issues (n = 33, 25.7%), realism gaps (n = 23, 17.9%) and physical discomfort (n = 22, 17.1%) were the three most frequently reported barriers that undermine the effectiveness of XR training.

CONCLUSION

This scoping review maps current evidence on XR-based nursing skills training, with VR representing the predominant modality and AR and MR remaining comparatively underrepresented. Applications primarily focus on fundamental nursing skills, and reported outcomes are concentrated at Kirkpatrick Levels 1 and 2, whereas evidence at Levels 3 and 4 remains scarce. Technical issues, realism gaps, and physical discomfort are among the most frequently reported barriers.