2025 Theses Doctoral

Effects of Fully Immersive Virtual Reality on Nurses’ Knowledge, Decision-Making, Self-Efficacy, and Engagement

Tolarba, Jasper Erwin

Newly graduated nurses often face challenges in managing medical crises, including emergencies such as diabetes-related ketoacidosis (DKA). Addressing these challenges during onboarding is essential to prepare them for providing effective and timely care in acute settings. V bAs modern learners, many from Millennial and Gen Z cohorts benefit from dynamic, technology-driven educational methods. Fully immersive virtual reality (FIVR) offers an innovative approach to creating engaging learning environments, yet its use in nurse onboarding remains limited.

This study examined the impact of FIVR on knowledge, decision-making, self-efficacy, and engagement compared to traditional onboarding methods. A quasi-experimental pretest/posttest design was used with newly graduated nurses (N = 55) from two hospitals in a health care system. Participants were assigned, over alternating months, to an intervention group using FIVR or a comparison group using the traditional onboarding lecture format. The study employed three instruments: the RN Knowledge and Decision-Making Processes in the Management of DKA modified with permission for this study into the TKDM Short Form, the Learning Self-Efficacy Scale for Clinical Skills, and the Web-based Learning Tools Evaluation Scale.

Knowledge and decision-making were assessed during the pretest and posttest, while self-efficacy and engagement were measured posttest only. The study included validating the TKDM Short Form and obtaining psychometric properties. Findings from a mixed ANOVA showed that the knowledge scores of both groups increased significantly from the pretest to the posttest, but the degree of change was similar. No significant changes were observed in decision-making scores; however, the modified instrument failed to demonstrate adequate reliability. While self-efficacy scores were also similar between groups, engagement was significantly higher in the FIVR group, indicating that this method fosters greater learner involvement during onboarding.

These findings suggest that while FIVR enhances engagement, it does not significantly improve knowledge, decision-making, or self-efficacy compared to traditional methods in onboarding for DKA management. The low reliability of the TKDM Short Form was a major limitation of the study. The findings underscore the need for further research with larger, more diverse samples and varied clinical scenarios with validated instruments to determine whether FIVR can effectively improve knowledge and decision-making in nursing practice. FIVR represents a promising and engaging tool for onboarding newly graduated nurses, particularly in fostering active participation. However, its effectiveness in advancing clinical knowledge and decision-making remains inconclusive.