Virtual Patient Simulations in Nursing Education: A Descriptive Systematic Review

Background. Virtual patients commonly train students in clinical competence in nursing education. This review aimed to evaluate the sample characteristics and sampling method, technological design of the virtual patients, duration of simulation methods, comparison methods used in control groups, outcomes of simulation interventions, and quality of the included randomized controlled studies. Methods. Five databases were searched using English-language keywords between 1995 and 2019. The Turkish Quality Assessment Tool for Quantitative Studies was used to evaluate the quality of randomized controlled trials. Of the 4235 studies identified, 10 randomized controlled trials reporting virtual patients in nursing education were reviewed. Results. The total number of participants in the review was 787. The virtual patient methods used in all studies differed. The duration was different in all the studies. Standardized patients, traditional education, facilitated mannequin-based simulation, written descriptions of the skills, low-, medium-, and high-fidelity simulation, and virtual simulation without training methods were used in the control groups for the comparison. Six studies indicated that virtual patients increased students' knowledge, skills, self-efficacy, self-confidence, nursing competencies, and satisfaction levels in clinical practice, while four studies found no significant difference between the groups. The quality was poor in four of 10 studies, moderate in two of 10 studies, and strong in four of 10 studies. Conclusions. This study demonstrated that the virtual patient methods used in studies varied in terms of technological design. The duration of simulation in the studies varied from less than 30 minutes to more than two months. The virtual patients could improve knowledge, skill acquisition, self-efficacy, self-confidence, and nursing competency compared with low-fidelity simulation, didactic education, no-intervention, or no-education studies. The quality results of the studies show that most of them had weak or strong research designs.