Table 1.

Summary of the included records.

Reference and country of origin	Method for data collection and analysis	Participants, setting, and response rate if stated	Key findings
			Facilitators of VRa implementation	Barriers to VR implementation	Recommendations for VR implementation
D’Errico [32], 2021, the United States and Canada	N/Ab	One nursing simulation educator and a group of VR simulation software developers met within the VR environment	VR facilitates connections and collaborative engagement Joint VR experiences facilitate problem resolution and identification of what works	Equipment must be available and meet the required standards Appropriate technological infrastructure is required for new equipment to work	Using the VR environment during the implementation process is a good way to promote team collaboration, design and test realistic scenarios, and identify and resolve problems within VR
Rim and Shin [34], 2020, Republic of Korea	Two-phase methodological study design: (1) developing a preliminary template and (2) evaluating its usability through focus group interviews Content analysis	n=16 students Two focus group interviews with 8 students each	Repeated practice improves nursing ability through the following: Improved confidence Exposure to patient situations enables participants to adapt to new situations Using an active avatar provides a sense of reality	Technological difficulties Insufficient time	Secure competent human resources as well as the capabilities that they require Develop and apply templates or frameworks, including the following: Training time Determining the overall objectives through expected outcomes Prelearning, prebriefing, and debriefing sessions Evaluation Incorporate technology into VR, including artificial intelligence for programmed patients, to increase learners’ sense of presence, affordance, and immersion
Saab et al [35], 2021, Ireland	Qualitative descriptive study using thematic analysis	n=26 students Undergraduate nursing students participated in face-to-face, semistructured individual interviews and focus groups	An available human facilitator to supervise and guide students before, during, and after VR use VR used in small student groups VR equipment was available for students to borrow	Time and cost: VR takes more time with larger class sizes Cost of equipment Not suitable for several people simultaneously owing to expense Human resources required to convert the current material to VR Physical limitations to use: Sight problems, vertigo, dizziness, motion sickness, and risk of injury	Background knowledge before lecture or practice in using VR is needed Secure a sufficient number of VR headsets Create an appreciation of difficulties (eg, hearing or sight impairments): Offer VR educational experience on a standard desktop for individuals who experience motion sickness VR is suitable for supplementing conventional teaching and learning methods but not as a stand-alone approach Address issues such as technology costs, space, and training in VR use
Baniasadi et al [30], 2020, Iran	Literature review	Medical students and treatment context	Usable and user-friendly VR approaches Developing and updating related laws, guidelines, and standards Using appropriate models in design and implementation	Cost of equipment, design, and implementation Lack of knowledge about, competence in, and trust in technology Difficulties in providing content Organizational culture Lack of management support	Manuals and training for end users User participation in the design process Due to the lack of face-to-face communication between students and real patients when using VR for training, evaluations should be made in real settings to ensure efficacy
Barteit et al [31], 2021, Germany, the United States, South Africa, and Zambia	Systematic review, PRISMAc	n=27 health professionals in medical education Evaluation methods comprising practical skill tests Most included studies evaluated the head-mounted displays’ efficacy	Head-mounted displays offer the possibility of scalability and repeated practice, such as in the following: Practical procedures Anatomy Developing communication-skills	The context for effective implementation: The individual learner The learning environment The learning implementation’s context The technological environment The pedagogics involved	Implementation of Miller’s Pyramid of Professional Competence undergirds XRd-based HMD’se potential A framework or guidelines for XR-based HMD interventions are needed to guide implementations and evaluations
Kunnskapsdepartementet [33], 2021, Norway	A government document and background paper	Case drawn from an exemplary Norwegian University	The VR laboratory was open for students 24/7 VR laboratories enable students to practice examining patients and interacting with others in clinical situations	Educational institutions cannot deviate from the requirements of the EU’sf Vocational Qualifications Directive (because of the EEAg agreement); these requirements hinder replacing clinical practice with simulation in nursing education	The Norwegian government encourages more VR simulation in education regulated by the directive than what is possible today VR simulation might replace clinical practice
Hood et al [36], 2021, Australia	Case study reporting on initiation, concept design, pilot implementation, and feasibility assessment of a VR training platform	Pilot implementation at 7 hospitals User survey: n=61 in the pretraining survey and n=58 in the posttraining survey Logging use sessions	TACTICS VR was delivered in the context of a broader education implementation trial The VR training program was specifically designed to promote user interactions and active learning (eg, interactive elements and gamification) to promote user engagement and maximize the benefits of using VR technology VR deployment was supported by on-site trial coordinators at each hospital	The pilot implementation identified problems or issues with Wi-Fi connectivity across multiple hospitals’ IT systems	The Wi-Fi connectivity issue was overcome by supplying mobile Wi-Fi routers to maintain connectivity Site coordinators suggested that additional implementation approaches could increase training reach (eg, integration into the existing clinical training programs)

^aVR: virtual reality.

^bN/A: not applicable.

^cPRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

^dXR: extended reality.

^eHMD: head-mounted display.

^fEU: European Union.

^gEEA: European Economic Area.