This paper aims to evaluate the effectiveness of a virtual simulation-based adjunctive learning tool in enhancing nursing students’ skills, knowledge and attitudes toward recognizing and managing psychomotor agitation in mental health settings, and its efficacy in delaying knowledge decay.
This single-blind, two-arm randomized controlled trial used a repeated measures design. Sixty-one third-year undergraduate nursing students were randomly allocated to either the intervention group (virtual simulation-based adjunctive learning tool, n = 30) or the control group (case analysis, n = 31). An objective structured clinical examination (OSCE) was administered immediately following classroom instruction. Knowledge levels and attitudes were assessed at baseline (T0), immediately postintervention (T1), one-week postintervention (T2) and one-month postintervention (T3).
The intervention group achieved significantly higher mean scores at each OSCE station and overall compared to the control group (p = 0.001). Generalized estimating equations indicated statistically significant interaction effects for knowledge level and management attitude in both groups (p < 0.001, p = 0.036, respectively). The intervention group also demonstrated significantly higher classroom practice performance (p < 0.001).
This study has several limitations. First, participants were recruited from a single institution, limiting generalizability to nursing students or other healthcare practitioners in diverse settings. Second, the one-month follow-up was brief; longer-term tracking is needed to assess knowledge retention. Third, the study used only quantitative data, lacking qualitative insights into students’ perceptions, emotional responses and decision-making processes-a gap that future mixed-methods research could address. Fourth, there was a slight age difference between groups due to a few students repeating the year, but all were within the cognitively stable 19–21 age range, and we consider this impact minimal. Fifth, the simulation modules did not include sensory modulation interventions, an evidence-based approach for managing agitation. Moreover, practices such as the definition and use of “restraint” are culturally nuanced, and the current simulation may not fully capture these variations. Finally, although virtual simulation effectively built cognitive and decision-making readiness as assessed by OSCEs, how this translates into real-world clinical performance warrants further investigation.
This study supports integrating virtual simulation-based adjunctive learning tool into nursing education. As a standardized preparatory module, it can build students’ cognitive and decision-making foundations and serve as a scalable resource for ongoing clinical training. Effective implementation requires organizational support from educational administrators and clinical mentors to bridge learning and practice. Future research should explore its complementarity with high-fidelity simulation, conduct longitudinal clinical studies, and use mixed methods to examine cognitive and attitudinal changes, supporting a sustainable training system focused on competency transfer. In addition, future iterations of the training should incorporate sensory modulation interventions to align with current best practices in acute mental health care.
Nursing students using the virtual simulation-based adjunctive learning tool outperformed those using case analysis in classroom performance, practical skills, knowledge retention and managerial attitudes. The tool also improved long-term knowledge retention (one-month).
