HMD-Based Virtual Reality Simulation in Nursing Skills Education

This study is designed to evaluate the effectiveness of head-mounted display (HMD)-based interactive virtual reality (VR) simulation in teaching ice pack application skills to undergraduate nursing students. The study aims to investigate whether immersive VR-based training provides educational benefits compared with conventional mannequin-based practical training.

The study will employ a prospective, two-arm, parallel-group randomized controlled design. Participants will be randomly allocated in a 1:1 ratio to either an HMD-based interactive VR simulation group or a conventional low-fidelity mannequin-based training group.

All participants will receive standardized theoretical instruction and an instructor-led demonstration of ice pack application before practical training. Students in the experimental group will individually practice the procedure using an interactive HMD-based VR simulation, which provides a virtual patient environment and allows active participation through hand-tracking technology. Students in the control group will practice the same procedure using a low-fidelity mannequin under standardized laboratory conditions. Both groups will receive equivalent practical training durations.

Following the educational interventions, participants in both groups will undergo a standardized practical skill assessment using the same mannequin-based evaluation procedure. The study will also examine students' anxiety, learning satisfaction, and self-confidence in relation to the educational approaches.

By comparing immersive VR simulation with conventional mannequin-based training, this study seeks to provide evidence regarding the educational value of interactive VR technologies in undergraduate nursing skills education.

• Intervention 1 - Experimental Intervention (Other): An interactive educational intervention delivered through a head-mounted display-based virtual reality simulation designed to teach ice pack application skills. Participants will perform the procedure individually for 10 minutes in an immersive virtual environment. The system provides real-time hand movement tracking, interactive procedural guidance, and immediate feedback during the simulation.
• Intervention 2 - Control Intervention (Other): A conventional simulation-based educational intervention using a low-fidelity training mannequin to teach ice pack application skills. Participants will independently perform the procedure on the mannequin for 10 minutes, following the same standardized procedural steps taught to the experimental group.

Primary outcomes

• Ice Pack Application Skill Performance Score [Immediately after the intervention, during the standardized skill performance assessment.]: Nursing students' ice pack application skills will be assessed using the 45-item Ice Pack Application Skills Checklist developed by the researchers based on the relevant nursing literature and reviewed by three experts in Fundamentals of Nursing. Each correctly performed procedural step will be scored as 1, while incorrectly performed or omitted steps will be scored as 0. Total scores range from 0 to 45, with higher scores indicating better skill performance. Participants in both groups will be evaluated using the same low-fidelity training mannequin under standardized laboratory conditions following the educational intervention.

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

Inclusion Criteria:

* Being 18 years of age or older.
* Being a first-year undergraduate nursing student enrolled in the Fundamentals and Concepts of Nursing course.
* Having no previous theoretical or practical training or experience in ice pack application.
* Voluntarily agreeing to participate in the study and providing written informed consent.
* Being willing to participate in the standardized theoretical education, demonstration, and assigned practical training sessions.

Exclusion Criteria:

* Being younger than 18 years of age.
* Having previously received theoretical or practical training in ice pack application.
* Declining to participate in the study or refusing to provide written informed consent.
* Not attending the standardized theoretical education or demonstration required before the intervention.