Nursing student anxiety in virtual reality and manikin-based simulation: A reflexive thematic analysis

Background As virtual reality (VR) nursing simulation rapidly enters curricula, it is important to understand student anxiety experienced during VR simulation for optimizing student experience and learning. Aim The purpose of this study was to compare nursing students’ perceptions about their anxiety in VR compared to past high-fidelity manikin-based simulations. Methods Using a pragmatic-constructivist qualitative approach, we conducted semi-structured interviews with prelicensure nursing students (n = 35) at a Midwestern public university following individual VR scenarios. Reflexive thematic analysis was used to map themes to modality differences and anxiety contributors. Results Students reported having lower anxiety in VR than past traditional manikin simulations, attributing this to reduced social-evaluation pressure, grading stakes, and fewer ambient distractions. A minority experienced similar overall anxiety between modalities for reasons such as technology unfamiliarity and time pressure. Conclusions While VR may mitigate social-evaluative anxiety, it can introduce distinct technology-related stressors, underscoring the importance of aligning simulation design and learner preparation with modality-specific demands.