Evaluating the Role of Non-Immersive Virtual Learning Environments in Nursing Education: Bridging Engagement, Learning, and Skill Acquisition

The use of virtual learning environments (VLEs), both immersive and non-immersive, has become increasingly critical in fields like healthcare education, where the stakes of practical training are exceptionally high. In non-immersive VR systems, virtual environments are displayed on standard computer monitors, and interaction typically involves devices such as a mouse, joystick, or remote control. In contrast, immersive VR systems—often featuring advanced head-mounted displays or Cave Automatic Virtual Environment (CAVE) systems—surround the user in a 3D computer-generated space, allowing for natural sensory-motor interaction using their own body (Fusco & Tieri, 2022). These technologies hold significant promise in nursing education, offering safe, controlled settings where students can practice complex procedures without endangering patients (Lavoie et al., 2025; Vogelsang et al., 2024). This is particularly critical for high-risk tasks like infusion pump operation, where errors—often resulting from inadequate training and human error—are among the most common and potentially fatal in clinical practice (Beaudart et al., 2023; Kirkendall et al., 2020). Virtual training tools can mitigate these risks by providing realistic and interactive platforms for competency development. This study examines the use of non-immersive VLEs with extended reality (XR) elements in nursing education through two structured scenarios involving 15 first-year nursing students. Recognizing that XR applications are rarely used in isolation within higher education, these tools were integrated with other technical and traditional learning methods to maximize meaningful learning opportunities (cf. Makransky & Petersen, 2021). Each scenario followed a seven-phase approach, including pre-activities, introductions, technology and scenario briefings, immersive simulations, debriefings, and post-activities (Diekmann, 2009; Keskitalo & Saukkoriipi, Accepted). The research questions are as follows: 1. How do non-immersive virtual learning environments impact nursing students' engagement and skill acquisition in interaction competence and high-risk clinical scenarios? 2. What are the perceived benefits and limitations of using non-immersive virtual learning environments for training interaction competence and infusion pump operation among nursing students? Scenario 1: Interaction Competence Training in the Context of Sending a Patient Home The first scenario began with a 30-minute introduction in a Virtual Production Studio (VPS), where the simulation theme and the "Interaction Competence" platform, featuring voice recognition capabilities, were demonstrated. Students then transitioned to the Sinco Lab for 60 minutes of hands-on discussion practice in pairs or triads, using a shared computer to interact with a virtual patient. The session concluded with a debriefing, incorporating facilitated discussions, group reflections, and a SWOT analysis to evaluate their experiences. Scenario 2: Infusion Pump Training The second scenario focused on the operation of infusion pumps. It included a 30-minute VPS session explaining the virtual pump's functionality and application. Students practiced operating the virtual pump in groups of two or three for 15 minutes, followed by a 15-minute hands-on session with a real infusion pump. As in the first scenario, the session concluded with a debriefing that included group discussions, SWOT analyses, and final feedback surveys. Findings Quantitative results were derived from pre- and post-scenario surveys analyzed on a 7-point Likert scale, with 1 being the lowest and 7 the highest score. For Scenario 1, participants rated the visual appeal and usability of the VLE highly (5.5/7), but perceived learning effectiveness (4.4/7) and motivational aspects (4.6/7) were moderate. Notably, interactivity and personalization scores fell short of expectations (post-activity scores of 2.4/7 for agency and 3.7/7 for self-expression), suggesting a desire for more dynamic and unpredictable virtual interactions. In Scenario 2, initial expectations for visual stimulation, interactivity, and learning efficiency ranged from 5.9 to 6.1. These expectations were largely met in terms of usability (5.6/7) and motivation (5.9/7). However, scores for communication and feedback mechanisms were significantly lower (3.3/7 and 2.4/7, respectively). Despite high usability, participants noted that limited interactivity and unclear feedback reduced the tool’s perceived effectiveness in fostering deeper learning. Conclusions The study highlights the need for more sophisticated and adaptive virtual learning environments in nursing education. While non-immersive VLEs effectively engaged students and supported skill development, improvements in interactivity, feedback, and scenario adaptability are necessary. Participants emphasized the value of dynamic exercises, complex patient interactions, and enhanced communication AI for a more realistic experience. Despite these challenges, VLEs with XR elements show promise in maintaining student motivation and offering user-friendly, engaging platforms. Addressing the gap between expectations and outcomes will refine these tools, enhancing their ability to foster critical thinking, decision-making, and practical skills essential for modern clinical practice. References Beaudart, C., Witjes, M., Rood, P., & Hiligsmann, M. (2023). Medication administration errors in the domain of infusion therapy in intensive care units: a survey study among nurses. 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