Effect of Virtual Reality Simulation on Nursing Students' Knowledge and Skill Performance in Respiratory Physical Examination

Aim To compare the effects of immersive virtual reality (I-VR) and peer-assisted small-group practice on nursing students' knowledge, skill performance, and performance time in respiratory system physical examination. Background Respiratory system physical examination is a fundamental yet difficult-to-teach clinical skill in nursing education. Although I-VR has increasingly been used in physical examination teaching, existing studies have largely focused on limited examination components, most commonly inspection or auscultation. Evidence remains limited on how respiratory system physical examination can be taught as a holistic and structured clinical process within an I-VR environment. Design A single-blind, parallel-group, randomized controlled trial with a pre-test/post-test design. Methods Second-year nursing students from a university participated in the study. Participants were randomized to either the I-VR group or the peer-assisted small-group practice group. Data were collected using a knowledge test, a skill checklist, performance time measurement, and a technology acceptance questionnaire. Analyses included t-tests, chi-square tests, Pearson correlation analyses, and frequency analyses. Results Knowledge and skill scores improved in both groups, but the increase was significantly greater in the I-VR group (p \<0.001). Performance time was longer in the I-VR group (p =0.01). Students also rated the I-VR simulation highly in terms of feasibility and usability. Conclusions A systematically designed I-VR approach may be a useful instructional option for teaching respiratory system physical examination as a holistic, multi-step clinical skill in undergraduate nursing education.