Fostering reflective thinking and nursing students' competence in pressure injury care through immersive virtual reality: A randomized controlled trial.

Despite extensive efforts, pressure injuries (PIs) remain a critical concern in healthcare quality. Consequently, robust training in PI prevention, assessment and management-tailored to the learning needs of new generations-is imperative for nursing undergraduates to ensure safe, effective and person-centred care delivery. To design, implement and evaluate an immersive virtual reality (IVR) training program for PI care, comparing its effects on nursing students' reflective thinking (RT) and clinical competence against conventional teaching approaches. Prospective, randomized, double-blind, parallel-group controlled trial. This study was conducted at a university in northern Spain. The study convenience sample comprised 93 second-year nursing students. The majority were female (93.4%) with a mean age of 19.3&#xa0;years. Importantly, 63.4% reported no prior experience with IVR. Six PI nursing care scenarios were designed and developed for IVR using head-mounted displays (Oculus Quest 2), in accordance with internationally recognized standards and evidence-based clinical guidelines. Key variables measured included RT capacity (using Gibbs cycle), knowledge gain, skills performance and usability and satisfaction. Data analysis involved descriptive and parametric statistics (Student's t-test) and covariance methods to compare outcomes and assess the impact between groups, using SAS v. 9.4. The intervention group (IVR&#xa0;=&#xa0;47 students) demonstrated statistically significant improvement in RT compared to the control group (46 students), particularly in the "Emotion" and "Conclusion" questions of Gibbs' cycle. Skills gain was also significantly higher in the IVR group (p&#xa0;<&#xa0;0.001). While knowledge gains were comparable (p&#xa0;=&#xa0;0.202) -indicating no additional advantage of IVR over traditional methods in this specific domain-, the IVR group reported higher satisfaction and usability levels. IVR-based applications effectively enhance nursing students' RT and skills in PI care. This technology offers a valuable educational tool for improving student competence, especially for those with lower initial skill levels, and can be considered an innovative alternative to traditional teaching methods.