Accepted for/Published in: JMIR Nursing
Date Submitted: Sep 24, 2025
Date Accepted: Apr 7, 2026
Date Submitted to PubMed: Apr 8, 2026
Warning: This is an author submission that is not peer-reviewed or edited. Preprints - unless they show as "accepted" - should not be relied on to guide clinical practice or health-related behavior and should not be reported in news media as established information.
360° Immersive Simulation in Undergraduate Nursing Education: An Electroencephalography-Based Quasi-Experimental Study
ABSTRACT
Background:
Although mirroring theory has been successfully applied to various health interventions, its integration with virtual reality (VR) simulations has not been explored within nursing education.
Objective:
To evaluate whether combining 360° simulation videos with traditional classroom instruction influences nursing students' technical proficiency and neural engagement.
Methods:
In a quasi-experiment, 55 third-year nursing students (experimental n=28; control n=27) were randomly assigned to 360° video practice or traditional study. Outcomes included technical skill performance (objective checklist), self-confidence and satisfaction (validated scales), and Electroencephalography indices (power at C3, Cz, C4; mu-suppression scores). Group differences were tested with t tests and ANCOVA adjusted for baseline values.
Results:
Compared with controls, the immersive-simulation group showed higher posttest scores on the Simulation Design Scale (SDS; ANCOVA F(1,35)=7.80, p=.008; η²=.182), Educational Practices Questionnaire (EPQ; F(1,35)=6.00, p=.019; η²=.146), and Student Satisfaction and Self-Confidence in Learning Scale (SCLS; F(1,35)=7.01, p=.012; η²=.167). Within-group analyses indicated significant SDS and EPQ gains for the immersive group (both p≤.005) and a decrease in SDS for controls (p<.001). EEG analyses showed significant post-exposure reductions in power at C3, Cz, and C4 for the immersive group (all p<.001), with between-group effects at Cz (F(1,35)=425.29, p<.001; η²=.926) and C4 (F(1,35)=5.45, p=.026; η²=.138). Mu-suppression (percent change) was greater in the immersive group at Cz (mean difference=22.45; 95% CI 2.59–42.30; p=.028) and C4 (23.69; 95% CI 1.20–45.38; p=.033). No adverse events were reported.
Conclusions:
Integrating 360° immersive simulation into undergraduate nursing education was associated with improved practical readiness, confidence, and technical skills, alongside objective EEG evidence of enhanced neural engagement consistent with mirror-neuron–related activity. Multi-site randomized trials are warranted to confirm efficacy and cost-effectiveness. Clinical Trial: Chinese Clinical Trial Registry (ChiCTR2500102861); https://www.chictr.org.cn/
Citation
