| Purpose: The purpose of this study was to compare the impact of virtual reality (VR) and short
answer prework on senior nursing students’ self-efficacy and their perceptions of overall
simulation effectiveness.
Background: Healthcare simulation standards emphasize structured, evidence-based prebriefing.
To date, no research has examined the impact of VR as simulation prework on learner selfefficacy and simulation effectiveness.
Methods: This study used a randomized-control pretest-posttest design. Participants included
senior nursing students from a Bachelor of Science in Nursing program (n=72). Participants were
randomly assigned to complete either VR prework (n = 37) or short answer question prework (n
= 35) before an in-person high-fidelity simulation. Self-efficacy was measured using the Revised
Clinical and Simulation General Self-Efficacy Scale (CSGSES) before and after prework
completion. Simulation effectiveness was assessed using the Simulation Effectiveness ToolModified (SET-M) following the simulation experience. Data were analyzed using mixed-model
ANOVA, independent samples t-tests, and Mann-Whitney U tests.
Results: The sample was predominantly female (80.56%) and White (54.17%), with a mean age
of 23.22 years. Most participants (76.39%) had prior healthcare experience, and 93.06% reported
previous VR exposure. Randomization was effective with no significant between-group
differences found. There were statistically significant results between group and time (p = 0.008)
and a main effect of time (p < 0.001) on CSGSES scores. Both groups demonstrated significant
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increases in self-efficacy from pre- to post-prework, with the VR group showing a larger gain (p
< 0.001) compared to the short answer group (p = 0.002). A Mann-Whitney U test indicated that
the VR prework group reported significantly higher debriefing scores than the short answer
group (p = 0.039). Both the CSGSES and SET-M demonstrated excellent internal consistency
reliability, with Cronbach's alpha values ranging from 0.80 to 0.95.
Conclusion: Both prework modalities significantly enhanced self-efficacy, with VR producing
larger gains and significantly higher perceived debriefing effectiveness. VR represents a viable,
and potentially superior, alternative to traditional prework. Nurse educators should consider
incorporating VR into multimodal simulation preparation strategies while future research can
examine its impact on debriefing long-term effects.
Keywords: prebriefing, virtual reality, prework, nursing simulation, self-efficacy |