Virtual reality applications in emergency nursing education: a scoping review

BACKGROUND: Emergency nursing education demands repeated exposure to high-acuity clinical scenarios that conventional instructional approaches cannot fully provide due to safety, ethical, and resource constraints. Virtual reality (VR) has emerged as an immersive, interactive alternative capable of replicating high-stakes emergencies in a controlled environment; however, specialty-specific evidence on its educational utility in emergency nursing remains limited and fragmented across existing reviews. This scoping review addresses three questions: how VR is currently applied in emergency nursing education; what cognitive, psychomotor, and affective outcomes have been reported; and what factors moderate these outcomes across study designs and immersion levels. METHODS: Following the Arksey and O'Malley framework and PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Web of Science, CINAHL, Embase, and the Cochrane Library (to November 5, 2025), supplemented by manual reference screening. Two reviewers independently screened records and extracted data using a structured form. Outcomes were categorised across cognitive, psychomotor, and affective learning domains, and findings were interpreted through three complementary theoretical frameworks. RESULTS: Seventeen studies were included: six RCTs, nine quasi‑experimental studies, and two mixed‑methods studies across seven countries. VR was most applied to resuscitation skills, disaster preparedness, and systematic clinical assessment. Most studies reported positive findings, but the magnitude of improvements varied considerably across study designs. RCTs generally showed non‑inferiority or equivalence to traditional training, whereas quasi‑experimental studies reported larger effects. Only six studies used objective assessments; the majority relied on self-reports. Three studies assessed outcomes beyond the immediate post-test at intervals ranging from three weeks to six months; findings were mixed, with one study reporting maintained outcomes at three and six months, and two documenting attenuation of reported gains at follow-up. CONCLUSION: This scoping review maps VR applications in emergency nursing education across 17 studies, with the majority reporting positive within-group findings across cognitive, psychomotor, and affective domains. In the absence of formal quality appraisal and given the predominance of quasi-experimental designs, small sample sizes, reliance on self-report instruments, and limited longitudinal follow-up, these findings are best regarded as descriptive and directional rather than as evidence of effectiveness. Future research should prioritise adequately powered multi-site RCTs, longitudinal competency assessment, validated emergency nursing-specific outcome instruments, and interprofessional team-based VR training models.