Development and Evaluation of a “Speak-Up” Program for Patient Safety: A Virtual Reality-Based Intervention for Nursing Students

Background: This study aimed to develop and evaluate the impact of a virtual reality (VR)-based speak-up program for Korean nursing students to strengthen patient safety management competencies. A nonequivalent control group pretest–posttest quasi-experimental design was employed. Methods: Fifty-six fourth-year nursing students (28 each in the experimental and control groups) were enrolled. The experimental group participated in a VR-based speak-up program, while the control group engaged in a scenario-based speak-up program. Each program consisted of a single 150 min session. The experimental group completed the program individually using a head-mounted display device, whereas the control group participated in small-group sessions. Outcome measures included speak-up, sense of safety control, confidence in clinical decision-making, and patient safety management activities. Data were analyzed using SPSS 26.0, including the χ2 test, t-test, Mann–Whitney U test, Wilcoxon signed rank test and repeated measures analysis. Results: Speak-up performance significantly improved in both groups, but the differences between the groups were not significant. In contrast, sense of safety control, confidence in clinical decision-making, and patient safety management activities improved more in the control group, which engaged in discussion-based learning. These findings suggest that VR learning effectively strengthens individual assertiveness and behavioral readiness through immersive, self-directed experiences, whereas the discussion-based approach in the control group enhances collaborative reasoning and confidence related to patient safety. Conclusions: Integrating VR-based Speak-up education with existing learning methods can establish a stepwise program that enhances nursing students’ Speak-up competency and patient safety skills. This approach may bridge the gap between theory and practice, fostering nurses who actively promote patient safety.