Methods: An integrative review was conducted from three major electronic databases: Ovid MEDLINE, PubMed and the Cumulative Index of Nursing and Allied Health Literature (CINAHL) using the keywords; patient simulation, computer-user interface or computer-user training, and virtual in English. The initial review of titles and abstracts produced 170 results. Out of the initial 170 articles retrieved, 85 articles, mostly intervention studies and a few descriptive studies were analyzed. The research questions focused on the characteristics of virtual simulation approaches including the virtual type, realism methods, participant representation and outcome indicators to suggest the effective virtual simulation design for nurse educators.
Results: The literature suggests the effective use of virtual simulation approaches that allow for multi-user interaction and more accessible training opportunities for learners. Most of the studies had incorporated virtual environments in different ways involving 2D images to augmented reality. Length of the virtual simulation and type of virtual platforms were greatly varied. Use of augmented reality or screen, use of commercial platforms such as Second Life or Unity 3D or newly developed, designed feedback system or not, presence of self as an avatar or use of script are identified as design characteristics of virtual simulation approaches. Constructive educational tradition was identified as major theoretical framework of virtual simulation through experiential learning or active learning. However, knowledge acquisition and clinical reasoning rather than clinical competency and clinical outcomes had been found as major outcome indicators of virtual simulation, which represented to be inferior for training outcomes in Kirkpatrick’s model of training
Conclusions: Design characteristics for virtual simulation should be selected based on the evidence to support effective educational strategies. Effectively designed virtual simulation can lead to improvements in knowledge and clinical reasoning skills, but there is less evidence directly linking virtual simulation to improved performance and clinical outcomes.