Effectiveness of immersive technologies in nursing education: An umbrella review.
BACKGROUND Immersive virtual reality (IVR) is increasingly used in nursing education to enhance experiential learning and address limitations in clinical training. However, evidence regarding its effectiveness on higher-order cognitive skills remains fragmented. OBJECTIVES To synthesise and critically appraise existing evidence on the effectiveness of immersive virtual technologies, including Cave Automatic Virtual Environment (CAVE) systems, in improving critical thinking, decision-making, and problem-solving among undergraduate nursing students. METHODS An umbrella review was conducted following Joanna Briggs Institute methodology and reported according to PRIOR guidelines. Systematic reviews published between 2016 and 2025 were identified through searches of PubMed, Scopus, CINAHL, Cochrane Library, Web of Science, and PsycINFO. Eligible reviews included undergraduate nursing students exposed to immersive technologies (virtual, augmented, mixed, or extended reality). Methodological quality was assessed using AMSTAR 2. Data were synthesised narratively due to heterogeneity. RESULTS Five reviews (four systematic reviews and one systematic review with meta-analysis) were included. Evidence was heterogeneous. Improvements in decision-making and problem-solving were consistently reported, particularly in interactive, scenario-based IVR interventions. Effects on critical thinking were mixed, with meta-analytic findings showing no significant advantage over traditional methods. Generally favourable findings were reported for clinical skills and knowledge acquisition. Positive effects were also observed for satisfaction, motivation, and self-efficacy. However, variability in intervention design, outcome measures, and study quality limited comparability. CONCLUSIONS The available evidence suggests that IVR may represent a valuable adjunct to traditional nursing education, particularly for supporting decision-making, problem-solving, and clinical skills. Its impact on critical thinking remains inconclusive. Outcomes appear to be influenced by pedagogical design, including structured debriefing and curriculum integration.