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. 2023 Jul 24;13(7):616. doi: 10.3390/bs13070616

Table 1.

Included studies.

Authors and Year Country Aim(s) Study Design Sample MCI Setting Interventions Outcome(s) Measurements
Ferrandini Price et al. (2018) [31] Spain To determine the efficiency in the execution of the START (simple triage and rapid treatment) triage, comparing VR to CS in an MCI. To compare the stress caused by the two different situations. Quasi-experimental study Sixty-seven students attending the Official Emergency and Special Care Nursing Master’s Degree from the Catholic University of Murcia. Performing basic triage in all the victims using the START system, including life-saving maneuvers: airways opening and hemorrhage compression.

  1. Simulation with actors;

  2. Immersion with virtual reality.

  1. Stress and activation;

  2. Efficacy in the performing of the START triage.

  1. Saliva collection through a system of passive diffusion, in a tube, with an extraction time of 1 min;

  2. Analysis of the answers and teacher evaluation.
Smith et al. (2018) [32] United States To assess two levels of immersive VR simulation to teach the skill of decontamination. Quasi-experimental study Of a total of 197 senior baccalaureate nursing students from four Midwest campuses, 172 completed all three testing periods in the study. Decontamination skills.

  1. Web module + immersive HMD VR simulation;

  2. Web module + keyboard/mouse VR simulation;

  3. Web module + written instruction.

  1. To assess levels of performance and time;

  2. To assess level of knowledge;

  3. To assess participant satisfaction and experiences.

  1. Pretest: demographic questionnaire and baseline cognitive test;

  2. Post-test (after decontamination training): cognitive test and demonstration checklist;

  3. Post-test II (after 6 months from training): cognitive learning assessment and demonstration checklist.

  4. Focus group about participant’s satisfaction and experience with the two different VR simulation formats.
Smith et al. (2016) [33] United States To examine the longitudinal effects of VR simulation on learning outcomes and retention. Quasi-experimental study 108 students (57 were in the treatment group and 51 in the control group). Decontamination skills.

  1. Web training + written instruction,

  2. Web training + VR simulation.

  1. To assess accuracy and time to complete the psychomotor performance;

  2. To measure cognitive learning.

  1. Psychomotor performance (17-item performance rubric),

  2. Cognitive learning (20 multiple-choice questions).
Shujuan et al. (2022) [34] China To assess the impact of VR scenarios on disaster preparedness among nursing students. A two-arm randomized controlled trial 101 nursing students (49 in the VR group and 52 in the control group) attending the second year of a tertiary program in Sichuan, China. Twelve highly interactive disaster scenarios:

  • Earthquake

  • Fire

  • Triage

  • Wound

  • Dressing

  • Fixation

  • Hemostasis

  • Debridement

  • Cardiopulmonary resuscitation

  • Tracheal intubation

  • Transportation

  • Decontamination

  • Supportive psychological care

  1. Intervention group: usual disaster preparedness nursing course and VR training scenarios which included 12 highly interactive disaster nursing scenarios. Each scenarios included two disaster scenes (earthquake and fire), triage, wound dressing, fixation, hemostasis, debridement, cardiopulmonary resuscitation, tracheal intubation, transportation, decontamination, and supportive psychological care, and also included an instructing model, training model, and testing model.

  2. Control group: usual disaster nursing course which included 24 lectures and 4 skills laboratory manikin simulation sessions.

  1. To assess disaster preparedness in triage, communication, isolation, psychological support and decontamination, report, and access to important resources;

  2. To assess level of self-confidence;

  3. To assess the performance of simulated disaster incident.

 The following data collection were assessed at baseline and at the end of the study.

  1. DPQ (30 items using a 5-point Likert scale);

  2. Confidence (self-developed assessment cards using a scale ranged from 0 to 9);

  3. Performance (assessed by 5 examinators).
Hu et al. (2022) [35] China To explore the effectiveness of a virtual reality mobile game-based application for teaching disaster evacuation management education to nursing students. Quasi experimental study 158 nursing students (78 in the game group and 80 in the lecture group). Three disaster situations: fire scenario, earthquake scenario, first aid scenario.

  1. Game class: pre-test, basic knowledge and skills, mobile game learning (1 h basic knowledge lecture, 4 h for VR-MGBA use, 1 h learning summary), post-test, final-test, and questionnaires;

  2. Lecture class: pre-test, basic knowledge and skills, traditional lecture (6 h lecture class), post-test, final-test, and questionnaires.

  1. To assess essential disaster evacuation management educational knowledge and decision-making abilities;

  2. To assess students’ opinion.

  1. Pre-test before the educational intervention (20 multiple-choice questions);

  2. Post-test following the intervention (20 multiple-choice questions);

  3. Final-test at the end of the term (20 multiple-choice questions);

  4. Opinion survey (5-point Likert-scale-type questions).
Mills et al. (2019) [36] Australia To compare the simulation efficacy of a bespoke virtual-reality MCI simulation with an equivalent live simulation scenario designed for undergraduate paramedicine students. Quasi-experimental study 29 students of paramedical science. Car chase and shoot.

  1. VR simulation;

  2. Live simulation with actors.

 To assess: immersion, clinical decision-making, learning satisfaction, and cost.

  1. Immersion (recording heart rate at 5 s intervals and through the 20-point scales NASA-TLX across mental, physical, temporal, performance, effort, and frustration);

  2. Clinical decision-making (through educator evaluation);

  3. Satisfaction (using the 20-item SDS assessing perception of information, support, problem solving, feedback, and fidelity using a 5-point Likert scale);

  4. Focus group (two focus groups with 8 participants of both VR and live simulation groups);

  5. Cost analysis (using the Maloney and Haines methods).

Legend. CS: clinical simulation; DPQ: Disaster Preparedness Questionnaire; HMD: head-mounted display; MCI: mass casualty incident; MGBA: mobile game-based applications; NASA-TLX: National Aeronautics and Space Administration Task Load Index; SDS: simulation design scale; VR: virtual reality.