The extended duration of the coronavirus disease 2019 (COVID-19) pandemic has significant impact on teaching and learning approaches across multiple fields, including nursing education. The widespread transmission of the virus severely constrained possibilities for nursing students to engage in clinical practicums, a fundamental aspect of nursing programs. Clinical practicums provide students with the critical knowledge, skills, and experiential learning essential for their professional development. Notably, the mental health nursing practicum plays a pivotal role in preparing students by enhancing their interpersonal and communication abilities, enabling them to establish positive relationships with individuals facing mental health challenges, and fostering their confidence and trust-building capabilities [1].

However, during the COVID-19 pandemic, all mental health nursing training sessions were suspended due to the heightened risk of widespread epidemics among individuals with mental health illnesses [2]. Furthermore, the shifting landscape of healthcare, which prioritizes the reinforcement of patient rights and the advancement of individualized care, has further limited the availability and scope of clinical practicum opportunities for nursing students [3].

In May 2023, the World Health Organization (WHO) declared the end of the COVID-19 pandemic [4]. However, differences in standards for responding to infectious diseases persisted across countries. In Korea, for instance, the national disaster crisis level related to infectious diseases was downgraded to its lowest level in May 2024, with quarantine measures becoming more autonomous and similar to those used for influenza [5]. Despite the declaration of the pandemic’s end and the relaxation of infectious disease response standards, clinical practice opportunities for nursing students, particularly in psychiatric nursing, remain limited due to the vulnerable environment of closed wards, which pose a higher risk for infectious diseases.

Virtual clinical training programs, particularly those incorporating immersive virtual reality (VR) and augmented reality (AR), have made substantial progress, offering various advantages such as freedom from time and location restrictions, a safe and immersive learning environment, and cost-effectiveness [6]. With the emergence of the fourth industrial revolution, virtual reality (VR) and augmented reality (AR) technologies have gained substantial interest of society. Universities and colleges are increasingly prioritizing the learning demands of the digital-native Generation MZ, who represent a key demographic in higher education and are among its primary consumers [7].

Currently, VR technology is employed in adult and pediatric clinical practicum courses, comprehensive simulations [8], and skill acquisition, such as intravenous injection training [9]. While virtual and digital learning platforms have been introduced in psychiatric nursing practicums [10,11], research on the application of VR in this area remains limited. In mental health nursing clinical practice, Simulation using virtual reality is effective in immersing learning by arousing interest. It enables complete learning for nursing students by repeatedly attempting the process of integration through the application of knowledge and feedback [12].

While virtual reality-driven training programs has demonstrated its benefits for focus and engagement, a formalized structure in nursing education has yet to be implemented [13]. There is a notable lack of research focused on the structured planning and creation of diverse learning elements grounded in theoretical frameworks. Additionally, high-quality intervention studies that use structured methodologies to assess the learning impact of VR-and AR-based online practicums remain scarce [14].

According to Ayres’ learning transfer model, Academic outcomes are primarily shaped by students' motivation to apply and convey understanding, rather than being exclusively determined by their individual attributes or the instructional material itself. The model highlights the pivotal role of students’ drive to acquire knowledge, which includes their goals, choices, and passions, in shaping educational results [15]. Transfer motivation, which denotes the aim to implement acquired expertise and abilities in professional practice, is recognized as a crucial indicator of the core objectives of clinical practicums [16]. Studies have demonstrated that online practicums effectively enhance nursing students’ motivation to learn, satisfaction with the learning experience, confidence in abilities, motivation to apply learning, and problem-solving capabilities [17]. This learning environment promotes and supports learning transfer by providing a supportive framework, either through fellow students or educators. When these essential elements successfully stimulate learning, transfer motivation increases, thereby enhancing learning outcomes.

The purpose of this study, guided by the learning transfer model [15], was to assess the impact of a VR-based psychiatric mental health nursing simulation program by evaluating key factors related to learning and transfer. Specifically, the study examines learning flow and learning self-efficacy (as indicators of learning motivation), transfer motivation (indicating the process of knowledge transfer), mental illness-related knowledge, critical thinking skills and learning satisfaction (knowledge transfer results). Additionally, the research emphasizes the structured progress of each learning component to establish VR-based clinical practicums as viable alternatives to conventional approaches, rather than merely supplementary tools.

Mental health nursing practicums demand that students work with sensitivity and attentiveness, as they include direct therapeutic interactions with patients dealing with mental health conditions.

Insufficient preparation for patients interviews may cause unfavorable results for both nursing students and clients. According to Kim & Kim [24], many nursing students experience a lack of confidence, along with anxiety and fear, during their first clinical practicums. Simulations offer a potential answer to this issue, as reviewed by Mulcahy et al. [25]. We developed a VR-based simulation for the psychiatric mental health nursing practicum to provide students with essential practical experience before starting real clinical settings. This innovative method enhances traditional nursing education by extending learning beyond classrooms and hospitals to a virtual online platform. These findings illustrate that the program successfully achieved positive educational consequences. The VR-based simulation program for psychiatric mental health nursing demonstrated significant effectiveness in boosting students’ understanding of mental disorders, fostering better learning engagement, and enhancing overall satisfaction with the learning process. The improved comprehension of mental disorders can be credited to the program’s design, which featured 11 distinct stages incorporating pre-class activities, preparation quizzes, and post-class assessments to measure knowledge acquisition after completing the program. Knowledge improvement is widely recognized as a key outcome in simulation-based education.

Learning flow also improved significantly. Kim and Kim [24] propose that the enhanced learning flow observed in virtual simulations may result from their engaging and immersive qualities. Our program incorporated interactive, game-like elements, such as true-or-false questions combined with image cards, to engage students, including those with no previous simulation experience. Furthermore, in stage 4, students engaged with a virtual patient modeled on real clinical scenarios, allowing them to practice therapeutic communication by inputting responses in a natural conversational manner. These interactive components likely played a key role in improving learning flow.

High levels of learning satisfaction following simulation-based education have been consistently reported in prior research. İsmailoğlu et al. [26] reported that participants showed high levels of satisfaction with a VR-based simulation designed for intravenous injection training. Similarly, Chae et al. [27] observed high satisfaction levels, with a score of 4.12 out of 5, among students who participated in a simulation involving a pediatric asthma patient. Studies show that greater satisfaction with simulations is linked to improved confidence in nursing practice. Based on these findings, we suggest incorporating our VR-based simulation program into mental health nursing practicums to better prepare students for clinical practice.

Although no significant changes in problem-solving and learning self-efficacy scores were detected over time, significant differences were observed between the groups. Gholami et al. [28] found that nursing students who participated in an emergency nursing simulation showed improved critical thinking skills and problem-solving abilities. This indicates that simulation-based education not only aids in developing essential nursing skills but also enhances students' cognitive abilities. Lee et al. [29] highlighted that VR-based education allows nursing students to take charge of their learning by recognizing and implementing appropriate nursing practices for specific cases, as well as assessing the results, ultimately boosting their self-efficacy.

Transfer motivation did not significantly differ between groups but varied across time points. Zulkosky et al. [30] highlighted that a major advantage of simulation-based education lies in its interactive learning environment, which delivers holistic learning outcomes across multiple areas, such as mental, cognitive, spiritual, emotional, motor, and affective domains. More recently, the use of haptic sensors in VR-based educational simulations has broadened its applications. These sensors add tactile feedback to visual and auditory stimulation, enhancing immersion and creating a more engaging learning experience.

Drawing on these findings, we emphasize the need for greater adoption of simulation-based education within nursing curricula. The advantages demonstrated by our VR-based psychiatric mental health nursing simulation program emphasize the critical role of virtual simulations in addressing the unique challenges faced in mental health nursing practicums. The limited availability of psychiatric units, coupled with the short duration of practicums-often just one or two weeks-significantly reduces students' exposure to a variety of cases. This limitation diminishes the overall quality of mental health nursing education, making virtual simulations a vital tool for enhancing students' learning experiences.

This study sought to develop a VR-based simulation program for psychiatric mental health nursing practicums using real-life clinical scenarios and assess its effects on nursing students. The findings revealed significant group and time effects across all six measured parameters. Students who participated in the VR-based simulation program demonstrated enhanced preparedness and gained more diverse experience compared to those in other clinical practicum courses. This was achieved through direct engagement with virtual patients experiencing mental illnesses and opportunities to practice therapeutic communication.

We suggest that this simulation program can function as a bridge between theoretical learning and clinical practice, providing students with an intermediary educational platform. This approach enhances students' competence and confidence in engaging with clients and providing therapeutic nursing care in real clinical settings by supporting self-directed learning before and during clinical practicums.

Building on these findings, we suggest that future research investigate the incorporation of haptic devices into mental health nursing simulations, enabling students to experience both the verbal and physical components of nursing care for a more realistic simulation of real-world situations. While this program was specifically designed for the mental health nursing practicum, future studies could focus on developing simulations aimed at improving clinical reasoning skills. These simulations should cover a diverse range of patient groups, including adults, children, older adults, and communities, while emphasizing nursing management in the scenario design process to promote a holistic approach to patient care.