. 2022 Jun 15;69:26–39. doi: 10.1016/j.ecns.2022.05.006

Table 1.

Characteristics of 12 Included Randomized Controlled Trials (RCTS)

Author (Year)	Study Design/ Country	Participants/ Age: (Mean ± SD/Range)	Sample Size	Intervention (I)	Comparator (C)	Outcomes (Measures)	p- value	Attrition Rate (%)	ITT/MDM	Protocol/ Registration/ Funding
Bayram & Caliskan (2019)	2-arm RCT/ Turkey	Undergraduate Nursing Students (1st Year) / I: NM C: NM Overall^a: 18.97 ± 1.00	I: 43 C: 43 T: 86	Virtual Game^† (Single scenario in immersive virtual environment related to tracheostomy clinical procedural skills, followed by postscenario feedback) LD: 10 minutes	NonDigital Education (Classroom-Based Teaching)	-Applied Knowledge (Self-Developed MCQ) -Skills Demonstration (Self-Developed Performance Tool)	.568 .017	I: 13.5% C:13.5%	No/Yes	No/No/Yes
Blanié et al. (2020)	2-arm RCT/ France	Undergraduate Nursing Students (Final Year) / I: 24.0 ± 6.40 C: 25.0 ± 6.50 Overall^a: 24.5 ± NM	I: 73 C: 73 T: 146	Virtual Game^† (Multiple scenarios in nonimmersive virtual environment related to postoperative complications management, followed by postscenario feedback) LD: 120 minutes	NonDigital Education (Classroom-Based Teaching)	-Applied Knowledge (SCTs)	.43	I: 0% C: 0%	NA/NA	No/Yes/No
Cobbett & Clarke (2016)	2-arm RCT/ Canada	Undergraduate Nursing Students (Final Year) / I: NM C: NM Overall^a: 25.0 ± NM	I: 27 C: 28 T: 55	vSim^TM (Single scenario in nonimmersive virtual environment related to maternal-newborn complications management, followed by postscenario feedback) LD: 45 minutes	NonDigital Education (PS)	-Applied Knowledge (Self-Developed MCQ)	.31	I:1.8% C: 0%	No/Yes	No/No/Yes
Gu et al. (2017)	2-arm RCT/ China	Undergraduate Nursing Students (2nd Year) / I: 19.0 ± 0.58 C: 19.29 ± 0.73 Overall^a: 19.15 ± NM	I: 13 C: 14 T: 27	vSim^TM (Multiple scenarios in nonimmersive virtual environment related to fundamentals of nursing clinical procedural skills, followed by postscenario feedback) LD: 29 minutes	NonDigital Education (Lecture)	-Applied Knowledge (Self-Developed MCQ)	.032^*	I: 3.6% C: 0%	No/Yes	No/No/No
Li (2016)	2-Arm RCT/ United States	Undergraduate Nursing Students (Final Year) / I: 25.68 ± 6.80 C: 25.63 ± 4.13 Overall^a: 26.65 ± NM	I: 22 C: 27 T: 49	vSim^TM (Multiple scenarios in nonimmersive virtual environment related to management of acute and chronic diseases, followed by postscenario feedback) LD: 150 minutes	NonDigital Education (PS)	-Applied Knowledge (HSRT)	.418	I: 5.8% C: 0%	No/Yes	No/No/No
LeFlore et al. (2012)	2-Arm RCT/ United States	Undergraduate Nursing Students (Final Year) / I: NM C: NM Overall^a: 25.7 ± NM	I: 46 C: 47 T: 93	Virtual Patient Trainer (Unreal Engine 3)^† (Multiple scenarios in immersive virtual environment related to paediatric respiratory issues management, followed by scenario-embedded feedback) LD: 180 minutes	NonDigital Education (Lecture)	-Applied Knowledge (Self-Developed MCQ)	.004^*	I: 0% C: 0%	NA/NA	No/No/No
Liaw et al. (2014)	2-Arm RCT/ Singapore	Undergraduate Nursing Students (Final Year) / I: NM C: NM Overall^a: 21.86 ± 1.13	I: 31 C: 26 T: 57	e-RAPIDS (Multiple scenarios in nonimmersive virtual environment related to clinical deterioration management, followed by postscenario feedback) LD: 120 minutes	NonDigital Education (PS)	-Skills Demonstration (RAPIDS-Tool)	.94	I: 0% C: 6.6%	No/Yes	No/No/Yes
Liaw et al. (2015a)	2-Arm RCT/ Singapore	Registered Nurses/ I: NM C: NM Overall^a: 25.58 ± 3.19	I: 35 C: 32 T: 67	e-RAPIDS (Multiple scenarios in nonimmersive virtual environment related to clinical deterioration management, followed by postscenario feedback) LD: 180 minutes	No Intervention Control Group	-Skills Demonstration (RAPIDS-Tool)	<.001^*	I: 0% C: 4.3%	No/Yes	No/No/Yes
Liaw et al. (2015b)	2-Arm RCT/ Singapore	Registered Nurses/ I: 26.17 ± 3.17 C: 24.94 ± 3.14 Overall^a: 25.6 ± NM	I: 35 C: 32 T: 67	e-RAPIDS (Multiple scenarios in nonimmersive virtual environment related to clinical deterioration management, followed by postscenario feedback) LD: 180 minutes	No Intervention Control Group	-Applied Knowledge (Self-Developed MCQ) -Skills Demonstration (Modified RAPIDS-Tool)	<.001^* <.001^*	I: 0% C: 4.3%	No/Yes	No/No/Yes
Liaw et al.(2017)	2-Arm RCT/ Singapore	Enrolled Nurses/ I: 28.16 ± 4.00 C: 27.06 ± 4.30 Overall^a: 27.61 ± 4.16	I: 32 C: 32 T: 64	e-RAPIDS (Multiple scenarios in nonimmersive virtual environment related to clinical deterioration management, followed by postscenario feedback) LD: 150 to 180 minutes	No Intervention Control Group	-Applied Knowledge (Self-Developed MCQ) -Skills Demonstration (Modified RAPIDS-Tool)	.01^* .001^*	I: 3.0% C: 1.5%	No/Yes	No/No/Yes
Padilha et al. (2019)	2-Arm RCT/ Porto, Portugal	Postgraduate Nursing Students (Final Year) / I: 19.29 ± 0.46 C: 20.29 ± 2.19 Overall^a: 19.99 ± 1.99	I: 21 C: 21 T: 42	Clinical Virtual Simulator (Body Interact) (Single scenario in nonimmersive virtual environment related to management of respiratory issues, followed by postscenario feedback) LD: 45 minutes	NonDigital Education (PS)	-Applied Knowledge (Self-Developed True/False Questions And MCQ)	.001^*	I: 12.5% C: 12.5%	No/Yes	No/No/Yes
Tan et al. (2017)	2-Arm RCT/ Singapore	Undergraduate Nursing Students (Second Year) / I: 21.14 ± 2.08 C: 20.72 ± 0.96 Overall^a: 20.59 ± NM	I: 57 C: 46 T: 103	Virtual Game (3DHive)^† (Single scenario in immersive virtual environment related to blood transfusion and post -transfusion reaction management, followed by scenario-embedded feedback) LD: 30 minutes	Wait-List Control Group	-Applied Knowledge (Self-Developed MCQ) -Skills Demonstration (Self-Developed Performance Tool)	<.001^* .11	I: 4.5% C: 2.7%	No/No	No/No/No

a = total mean age of participants; C = comparator; CCTDI = California critical thinking disposition inventory; HSRT = health science reasoning test; I = intervention group; L = length of each intervention session; LD = learning duration; LEP = learning environment preferences; MCQ = multiple-choice questions; NA = not applicable; NM = not mentioned; NOS = number of intervention sessions; OD = overall duration of intervention; PS = physical simulation; RAPIDS = Rescuing a patient in deteriorating situations; SCTs = script concordance tests; T = total number of participants included in meta-analysis;

^⁎

p < .05;

^†

name of virtual simulation system not specified