Augmented Reality Virtual Patient Simulation to Enhance Social-Emotional Competence and Self-Efficacy in Nursing Students

This randomized crossover teaching practice study will be conducted among nursing students enrolled in a friendly childbirth course. All eligible participants will receive both instructional conditions, VP-I and virtual patient-based augmented reality learning (VP-AR), during two prespecified instructional periods. Participants will be randomly assigned using computer-generated stratified block randomization to one of two intervention sequences.

In the AB sequence, participants will receive VP-I during Period 1 followed by VP-AR during Period 2. In the BA sequence, participants will receive VP-AR during Period 1 followed by VP-I during Period 2. The primary outcomes are changes in students' social-emotional learning literacy and general self-efficacy. Secondary outcomes include emotion regulation strategies, scenario-based learning performance, and course learning experience.

Outcome assessments will be conducted at the prespecified baseline, period-specific, and post-intervention assessment points according to the study protocol. The study will compare participants' outcomes between the VP-I and VP-AR instructional conditions while accounting for intervention sequence and period effects.

• VP-I (Behavioral): VP-I is an instructional condition used in the friendly childbirth course. Participants complete the approved learning activities and teaching scenarios specified in the study protocol.
• VP-AR (Behavioral): VP-AR is a virtual patient-based augmented reality instructional condition integrated into the friendly childbirth course. Participants complete the approved smart technology-supported learning activities and teaching scenarios specified in the study protocol.

Primary outcomes

• Difference in Change in Social-Emotional Learning Literacy Between VP-I and VP-AR Periods [From baseline assessment at Week 4 through the end of each intervention period during Weeks 5 to 17]: Change in students' social-emotional learning literacy measured by the 21-item Social-Emotional Learning Literacy Scale for College Students. The total score is calculated according to the scale scoring instructions, with higher scores indicating higher social-emotional learning literacy.
• Difference in Change in General Self-Efficacy Between VP-I and VP-AR Periods [From baseline assessment at Week 4 through the end of each intervention period during Weeks 5 to 17]: Change in students' general self-efficacy measured by the 10-item General Self-Efficacy Scale. The total score is calculated according to the scale scoring instructions, with higher scores indicating higher general self-efficacy.

Secondary outcomes

• Change in Emotion Regulation Strategies [From baseline assessment at Week 4 through the end of each intervention period during Weeks 5 to 17]: Change in students' emotion regulation strategies measured by the 15-item Emotion Regulation Strategies Scale for College Students. Subscale and total scores are calculated according to the scale scoring instructions.
• Scenario-Based Learning Performance [During the two intervention periods from Week 5 through Week 17]: Students' performance in friendly childbirth learning scenarios, assessed using system-recorded learning performance indicators, including scenario completion, response accuracy, and related task performance.
• Course Learning Experience [At the post-intervention assessment at Week 18]: Students' perceived learning experience during the friendly childbirth course, assessed using the course learning experience questionnaire and written learning reflections.

Sex: All, ages: 18 Years to any, accepts healthy volunteers

Inclusion Criteria:

* Undergraduate nursing students enrolled in the friendly childbirth course.
* Aged 18 years or older.
* Able to understand the study information and provide informed consent.
* Able to participate in the course learning activities and complete the study assessments.

Exclusion Criteria:

* Students who do not provide informed consent.
* Students who withdraw consent before completing the study procedures.
* Students who are unable to complete the study assessments because of circumstances that substantially interfere with participation.