Virtual reality simulation for high-risk neonatal emergency nursing training: a mixed-methods study on nurse competency and outcomes

BACKGROUND: Nurses in neonatal intensive care units face critical challenges in managing emergencies where timely, accurate interventions are essential for survival. Traditional nursing education often lacks the hands-on, immersive training required to build complex emergency skills, contributing to persistent neonatal mortality globally. Virtual reality (VR) simulation, grounded in Kolb's Experiential Learning Theory, offers a promising solution by replicating realistic and repeatable clinical scenarios. While VR has shown potential in nursing education, its specific impact on high-risk neonatal emergencies remains underexplored. AIM: To evaluate the effectiveness of a VR simulation program in enhancing nurse competency and improving neonatal outcomes during emergency care, grounded in Kolb's Experiential Learning Theory. METHODS: A concurrent triangulation mixed-methods design was implemented over two weeks across four pediatric hospitals. Through stratified random sampling, 128 NICU nurses were allocated to VR simulation (n = 64) or traditional training (n = 64) groups. Quantitative data were collected using validated instruments (OSCE: CVI = 0.92, MCQ: α = 0.86) measuring clinical skills, knowledge retention, and decision-making accuracy. Qualitative data were gathered through semi-structured interviews (n = 24) exploring experiential aspects. RESULTS: The VR group showed significant improvements in clinical skills (OSCE: +16.1 points, p < 0.001, d = 1.58), decision-making accuracy (+ 16.7%, p < 0.001), and reduced stabilization times (-6.2 min, p < 0.001). Patient safety events decreased by 52% (p < 0.001). Thematic analysis revealed enhanced professional competence (83%), reduced clinical anxiety (75%), and positive learning experiences (88%), despite minor technical challenges. CONCLUSION: VR simulation demonstrates superior effectiveness for neonatal emergency training, significantly improving both nurse competency and patient outcomes. While geographic specificity and brief follow-up duration limit generalizability, findings support VR's potential for enhancing emergency preparedness. Future research should address longitudinal outcomes and implementation across diverse healthcare settings. CLINICAL TRIAL NUMBER: Not applicable.