The Effect of Virtual Reality-Based Simulation Training on Reducing Performance Anxiety in Anesthesia Nursing Students

Alizadeh, Sahar; Taghvaei, Reza; Rad, Erfan Joudaki

doi:10.5281/zenodo.21924444

The Effect of Virtual Reality-Based Simulation Training on Reducing Performance Anxiety in Anesthesia Nursing Students

Document Type : Original Article

Authors

Sahar Alizadeh ¹

Reza Taghvaei ²

Erfan Joudaki Rad ³

¹ Faculty member, Department of Anesthesiology, Nurse and Midwifery school, Shiraz University of medical sciences, Shiraz, Iran

² Department of Anesthesiology, School of Allied Medical Sciences, Qazvin University of Medical Sciences, Qazvin, Iran

³ Department of Anesthesiology, School of Nursing, Abadan University of Medical Sciences, Abadan, Iran

https://doi.org/10.5281/zenodo.21924444

Abstract

Background: Performance anxiety is a significant challenge for anesthesia nursing students transitioning to clinical practice, potentially compromising patient safety and professional development. Virtual reality (VR)-based simulation offers immersive, repeatable practice opportunities in a safe environment.

Objective: This randomized controlled trial evaluated the effectiveness of VR-based simulation training compared to traditional simulation methods in reducing performance anxiety and enhancing clinical preparedness among anesthesia nursing students.

Methods: A total of 60 second-year anesthesia nursing students were randomly assigned to either an immersive VR simulation group (n=30) or a traditional task-trainer simulation group (n=30). Outcomes were measured at baseline, immediately post-intervention, and at two-week follow-up using the State-Trait Anxiety Inventory (STAI-S), a clinical performance checklist, and a self-efficacy scale.

Results: The VR group demonstrated significantly greater reductions in state anxiety (mean difference: -8.4, p<0.001) and higher self-efficacy scores (p<0.001) compared to the control group. Clinical performance scores improved significantly in both groups, with the VR group showing superior non-technical skills including crisis management and communication (p=0.003).

Conclusion: VR-based simulation training effectively reduces performance anxiety and improves clinical preparedness in anesthesia nursing students, offering a scalable and accessible educational modality for healthcare training programs.

Graphical Abstract

Keywords

Virtual Reality

Simulation Training

Performance Anxiety

Anesthesia Nursing

Clinical Education

Subjects

Medicine

[1] Lähteen, R., et al. (2020). Mentoring in operating room clinical placement: Student nurse anaesthetists' perspectives. Journal of Clinical Nursing, 29(9-10), 1673-1683.

[2] Santos, L. C. P., et al. (2025). Impact of induction of anaesthesia simulation training on veterinary students' perceived preparedness and confidence in anaesthesia. Veterinary Anaesthesia and Analgesia, 52(4), 412-416.

[3] Zhong, Y., & Champion, J. D. (2025). Assessing the effectiveness of nursing virtual reality simulation for English as second language students to decrease anxiety in clinical courses. Journal of Nursing Education and Practice, 15(2), 46-56.

[4] Bertolizio, G., Buu, N., Paquet, C., et al. (2026). Immersive virtual reality versus high-fidelity simulation to teach anesthesiology nontechnical skills: A randomized controlled noninferiority trial. Canadian Journal of Anesthesia, 73, 261-272.

[5] Immersive virtual reality simulation in psychiatric nursing education: A systematic review. (2025). Nurse Education Today.

[6] Anesthesia simulation training for oral and maxillofacial surgery trainees. (2025). Journal of Oral and Maxillofacial Surgery.

[7] Jones, J. L., Rinehart, J., & Englar, R. E. (2019). The effect of simulation training in anesthesia on student operational performance and patient safety. Journal of Veterinary Medical Education, 46(2), 205-213.

[8] Musk, G. C., Collins, T., & Hosgood, G. (2017). Teaching Veterinary Anesthesia: A Survey-Based Evaluation of Two High-Fidelity Models. Journal of Veterinary Medical Education, 44(4), 590-602.

[9] Ott, T., Schmidtmann, I., Limbach, T., et al. (2016). Simulation-based training and OR apprenticeship for medical students. Der Anaesthesist, 65(11), 822-831.

[10] Arıcı Parlak, E., Ayhan, H., Erer, İ., & İyigün, E. (2025). The effect of virtual reality-based operating room tour on nursing students' anxiety, stress and self-confidence levels in an operating room setting: A randomized controlled trial. Nurse Education in Practice, 85, 104380.

[11] Hsieh, J.-Y., Lin, P.-C., Sun, W.-N., Lin, T.-R., Kuo, C.-C., & Hsu, H.-T. (2025). Effectiveness of immersive virtual reality in nursing education for nursing students and nursing staffs: A systematic review and meta-analysis. Nurse Education Today, 151, 106725.

[12] Huai, P., Li, Y., Wang, X., Zhang, L., Liu, N., & Yang, H. (2024). The effectiveness of virtual reality technology in student nurse education: A systematic review and meta-analysis. Nurse Education Today, 138, 106189.

[13] Woon, A. P. N., Mok, W. Q., Chieng, Y. J. S., Zhang, H. M., Ramos, P., Mustadi, H. B., & Lau, Y. (2021). Effectiveness of virtual reality training in improving knowledge among nursing students: A systematic review, meta-analysis and meta-regression. Nurse Education Today, 98, 104655.

[14] Liu, K., Zhang, W., Li, W., Wang, T., & Zheng, Y. (2023). Effectiveness of virtual reality in nursing education: A systematic review and meta-analysis. BMC Medical Education, 23, 710.

[15] Kim, Y., & Park, H.-Y. (2024). Effects of virtual reality training on clinical skill performance in nursing students: A systematic review, meta-analysis and meta-regression. International Journal of Nursing Practice, 30(6), e13284.

[16] Cho, M.-K., & Kim, M. Y. (2024). Enhancing nursing competency through virtual reality simulation among nursing students: A systematic review and meta-analysis. Frontiers in Medicine, 11, 1351300.

[17] Sinurat, S., Karo, M. B., Simbolon, R., Saragih, I. D., Tarihoran, D. E. T. A. U., Sharma, S., & Chou, F.-H. (2025). The efficacy of virtual-reality teaching and learning method in enhancing interprofessional knowledge, clinical skill performance, and self-confidence in nursing education: A systematic review and meta-analysis. Nurse Education Today, 149, 106661.

[18]Li, X., Hu, Y., Peng, H., Luo, S., Yang, C., Luo, B., Wan, X., & Li, Y. (2026). Effects of immersive virtual reality simulation on nursing students' learning outcomes: A systematic review and meta-analysis. Journal of Nursing Management.

[19] Labrague, L. J., McEnroe-Petitte, D. M., Bowling, A. M., Nwafor, C. E., & Tsaras, K. (2019). High-fidelity simulation and nursing students' anxiety and self-confidence: A systematic review.

[20] Thompson, C. E. (2021). The effects of high-fidelity simulation, low-fidelity simulation, and video training on nursing student anxiety in the clinical setting. Nursing Education Perspectives, 42(3), 162–164.

[21] Boostel, R., Bortolato-Major, C., Pedrolo, E., Vayego, S. A., Mantovani, M. F., & Felix, J. V. C. (2021). Effect of high-fidelity simulation on nursing student anxiety: Randomized clinical trial. Research, Society and Development, 10(3), e0410312875.

[22] Younghee, J. (2015). The effect of high-fidelity simulation-based education on nursing students' anxiety and self-efficacy who face with the first clinical practice. Indian Journal of Science and Technology, 8(25), 1–5.

[23] Yurt, S., Açıkgoz, G., Aksoy, Z., Saruhan Akgun, F., Demirel, A., Karaca, Ö., & Okuroğlu, G. (2026). The effect of high-fidelity simulation on nursing students' self-confidence and stress levels during patient intervention: A randomized controlled trial. BMC Medical Education, 26, 477.

[24] Wang, Y., & Sartain, A. F. (2024). Addressing nursing students' anxiety during simulation sessions: A pilot intervention study. Journal of Nursing Education, 63(9), 577–583.

[25] Traister, T. A.-A. (2023). Virtual reality simulation's influence on nursing students' anxiety and communication skills with anxious patients: A pilot study. Clinical Simulation in Nursing, 82, 101433.

[26] Gore, T., Hunt, C. W., Parker, F., & Raines, K. H. (2011). The effects of simulated clinical experiences on anxiety: Nursing students' perspectives. Clinical Simulation in Nursing, 7(5), e175–e180.

[27] Cheon, K.-I., & Hur, H. K. (2021). Relationship between simulation design characteristics and clinical reasoning competence: Multiple additive moderating effects of teaching effectiveness and students' anxiety on nursing students. Korean Journal of Adult Nursing, 33(4), 322–332.