Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial

Background: Nurse-administered blood transfusion (BT) is a common form of medical treatment, but nursing students are often excluded from participating in and observing BTs during clinical placements. To address clinical placement limitations, nursing educators have increasingly adopted technology-guided simulation pedagogies, including virtual reality (VR) simulation, for nursing students' clinical skills education. Objectives: To develop VR simulation for BT practice and investigate its effectiveness with nursing students. Design: A single-blinded, two-arm randomised controlled trial. Settings: One university in Hong Kong. Participants: A total of 151 nursing students enrolled in a nursing undergraduate course at a university in Hong Kong were recruited via convenience sampling in March 2022. Methods: Evidence-based VR simulation videos consisting of 1) animated blood formation physiology and side effects of BT and 2) 360 degrees BT nursing practice were developed. The nursing students were randomly allocated into intervention and control groups. The intervention group (n = 75) received the usual BT education (i.e. Zoom lecture) with the developed VR video education, whereas the control group (n = 76) received the usual BT education (Zoom). The BT knowledge (RBTKQ-O), student satisfaction and self-confidence (SSSC) and selfefficacy (GSES) of BT practice were measured before and after BT education. Intention-to-treat analyses were performed. Results: The primary and secondary outcomes (RBTKQ-O, SSCS and GSES, respectively) improved over time in both groups. Analysis of covariance revealed that students who received VR simulation reported higher postintervention measurement scores in BT knowledge and SSCS than those who did not receive VR simulation. Conclusions: VR simulation-enhanced BT education effectively enhances the knowledge and SSCS of BT practice amongst nursing students. Nurse educators may adopt VR simulation to enhance the effectiveness of existing BT education for nursing students.