Nursing Students' Engagement in Virtual Reality and Hybrid Simulations: A Quasi-Experimental Study

Background: Virtual reality enables reproducing scenarios that are difficult to access in clinical education. Its immersive qualities and ability to isolate students from external auditory and visual distractions may enhance engagement over other simulation modalities. Methods: This quasi -experimental study compared the effects of virtual reality and hybrid simulations (i.e., actor and manikin) on nursing students' engagement. Data on satisfaction, confidence in learning, cognitive load, mental effort, and clinical reasoning were also collected. The study included 179 nursing students who completed a post -simulation survey. Results: Participants in the hybrid group reported higher engagement, satisfaction, and mental effort than the virtual reality group. No significant differences regarding confidence, cognitive load, and clinical reasoning were found. Conclusion: Even if virtual reality emerges as a promising tool for simulation -based education, certain inherent aspects of traditional simulation modalities may contribute to enhanced engagement, such as human presence and opportunities for natural interactions.