Digital Educational Tools for Undergraduate Nursing Education: A Review of Serious Games, Gamified Applications and Non-Gamified Virtual Reality Simulations/Tools for Nursing Students

: Educational technology has advanced tremendously in recent years, with several major developments becoming available in healthcare professionals’ education, including nursing. Furthermore, the COVID-19 pandemic resulted in obligatory physical distancing, which forced an accelerated digital transformation of teaching tools. This review aimed to summarize all the available digital tools for nursing undergraduate education developed from 2019 to 2023. A robust search algorithm was implemented in the Scopus database, resulting in 1592 publications. Overall, 266 relevant studies were identified enrolling more than 22,500 undergraduate nursing students. Upon excluding multiple publications on the same digital tool, studies were categorized into three broad groups: serious games (28.0%), gamified applications (34.5%), and VR simulations and other non-gamified digital interventions (37.5%). Digital tools’ learning activity type (categories = 8), geographical distribution (countries = 34), educational subjects (themes = 12), and inclusion within a curriculum course ( n = 108), were also explored. Findings indicate that digital educational tools are an emerging field identified as a potential pedagogical strategy aiming to transform nursing education. This review highlights the latest advances in the field, providing useful insights that could inspire countries and universities which have not yet incorporated digital educational tools in their nursing curriculum, to invest in their implementation.


Introduction
Undoubtedly, technological advances can transform any industry, including education.Educational technology has advanced tremendously over recent years with several major developments becoming available for healthcare professionals' education, including nursing [1].To this end, serious games and gamification are perceived as an emerging field aiming to transform health professionals' education by improving knowledge, enhancing skills, and increasing satisfaction compared to traditional learning [2].Furthermore, nongamified virtual simulation experiences are increasingly used in academia, as they offer the perfect tool to enrich healthcare professionals' curriculum activities and practices [3].
Serious games, as defined by Alvarez, are "educational applications, whose initial intention is to combine, coherently and at the same time, serious aspects, in a non-exhaustive and non-exclusive way, teaching, learning, communication, or even information with the fun aspects of video games" [4].On the other hand, gamification can be generally described as using game design elements in non-game contexts [5] and is considered a practical educational approach that incorporates game elements and gameful experiences into the learning process [6].Furthermore, virtual simulations are described as interactive learning processes where healthcare students can use screen-based platforms/software that portray realistic clinical events [7] in order to provide realistic work experiences [8].
Implementing game features and gamification in disciplines like science has proven to improve the teaching experience and boost student motivation, engagement, and learning outcomes [9].Nevertheless, the flourishing of serious games and gamification in healthcare professionals' education is considered of higher importance, since it has the potential to provide students with unique opportunities to increase knowledge via active learning, enhance decision-making and clinical problem-solving skills, as well as to gain valuable experience by practicing their skills in risk-free environments [10].Therefore, serious games and gamification have become an essential trend in contemporary healthcare professionals' education [11].
Assuredly, nursing education has followed this trend with several studies introducing serious digital games for developing nursing competencies [12], while game-based learning is also evolving into a vital strategy for complementing simulation scenarios in practical nursing courses [13].To this end, a tenfold increase in gamified tools and interventions for healthcare education was observed a quinquennium before the COVID-19 healthcare crisis [11].Furthermore, the COVID-19 pandemic resulted in obligatory physical distancing, which forced an accelerated digitalization in nursing schools' curricula [14] that is expected to have increased the number of relevant scientific publications exponentially.
The present review aimed to summarize all the studies reporting on digital tools available for undergraduate nursing education published during the past five years.Furthermore, this review highlights the most recent advances in the field, while providing useful development and implementation insights that could inspire universities or countries all around the globe that have not yet incorporated digital educational tools in their nursing curriculum, to invest in their development.

Materials and Methods
A literature review on the implementation of serious games, gamified applications and other non-gamified virtual simulations and digital interventions for undergraduate nursing students was conducted in the Scopus database.The research questions that guided this review included the following: Question 1: How many digital tools have been developed and implemented in the past five years aiming to enhance undergraduate nursing education?Question 2: Is the digitalization of nursing tools spread evenly around the world?Which countries are pioneers in utilizing digital tools for undergraduate nursing education?Question 3: What type of digital nursing tools are implemented?Are certain types of tools more common than others?Question 4: What are the most common nursing subjects introduced by those tools?What type of curriculum courses most often utilize digital tools to enhance nursing students' learning?
To form the search algorithm that would answer the above questions, we investigated common key terms used in relevant studies, as well as algorithms developed by previous similarly themed reviews.Keywords focused on two main categories: nursing education and game-based/digital learning.As a result, a robust and high-precision search algorithm was implemented in the Scopus database targeting thoroughly all the available literature and providing a vast number of studies related to the topic under research.
According to the above, the search algorithm developed for this review was: TITLE-ABS-KEY (("nurs*" OR "nursing student*" OR "nursing") AND ("seriou* gam*" OR "online gam*" OR "computer gam*" OR "computer-based gam*" OR "mobile gam*" OR "mobile app*" OR "web-based gam*" OR "game-based" OR "game based" OR "digital gam*" OR "digital games" OR "gamif*" OR "virtual reality" OR "augmented reality" Data extraction of the included studies was performed utilizing an Excel file.All data were extracted by one author and confirmed by two other authors according to their expertise (one author verified nursing education-related data and another author confirmed digital tools-related information).Various pieces of information, including digital tool categories (serious games, gamified applications, non-gamified tools and virtual simulations), learning activity types (e.g., storytelling, role-playing games, quizzes, puzzles, simulations, etc.), country of implementation, year of publication, sample size, cycle of study of the enrolled nursing students (1st, 2nd, 3rd, 4th year), educational subject of the digital tools, nursing courses that implemented digital tools and other study design and intervention methodology related data, were extracted from the eligible studies.Data extraction of the included studies was performed utilizing an Excel file.All data were extracted by one author and confirmed by two other authors according to their expertise (one author verified nursing education-related data and another author confirmed digital tools-related information).Various pieces of information, including digital tool categories (serious games, gamified applications, non-gamified tools and virtual simulations), learning activity types (e.g., storytelling, role-playing games, quizzes, puzzles, simulations, etc.), country of implementation, year of publication, sample size, cycle of study of the enrolled nursing students (1st, 2nd, 3rd, 4th year), educational subject of the digital tools, nursing courses that implemented digital tools and other study design and intervention methodology related data, were extracted from the eligible studies.

Results
Overall, 266 studies satisfied the inclusion criteria and were included in the final review .The main characteristics of the identified studies (first author name, title, short digital intervention description, and reference) are listed in Table 2.The majority of

Results
Overall, 266 studies satisfied the inclusion criteria and were included in the final review .The main characteristics of the identified studies (first author name, title, short digital intervention description, and reference) are listed in Table 2.The majority of them were published in 2023 (n = 84), 2022 (n = 68) and 2021 (n = 59).A smaller number of studies was published in 2020 (n = 37) and 2019 (n = 18) (see Table 1).

Author
Year Title Short Intervention Description 1   Adhikari et al. [16] 2021 A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education

Immersive VR simulation
Akbari et al. [17] 2022 Comparison of the effects of virtual training by serious game and lecture on operating room novices' knowledge and performance about surgical instruments setup: a multi-center, two-arm study 2020 Is individual practice in an immersive and interactive virtual reality application non-inferior to practicing with traditional equipment in learning systematic clinical observation?A randomized controlled trial.

Immersive VR app
Berg et al. [31] 2021 The effect of self-practicing systematic clinical observations in a multiplayer, immersive, interactive virtual reality application versus physical equipment: a randomized controlled trial.Altogether, more than 22,500 undergraduate nursing students participated in the enrolled studies.This number derives from 248 studies that clearly stated the actual number of undergraduate nursing students included within their sample (enrolling nursing students solely or including both nursing students and nursing faculty members/graduate students or undergraduate students from other healthcare faculties).Moreover, two articles with zero participants were included [259,275]; however, those studies had published previous articles enrolling undergraduate nursing participants that had already been included in the present review.To calculate the overall sample size, we excluded studies that: (1) did not provide a clear number of participants [64,66,100,117,128,135,177,279], (2) utilized the same digital tool and exact same sample size as a previous publication [31,170,188,231], (3) enrolled nursing and other healthcare students or nursing faculty without clearly separating the number of participants in each group [103,179,220,238].Upon these adjustments, the exact number of enrolled nursing students was estimated at 22,768.

Immersive VR app
Furthermore, we were able to identify 173 studies that provided information about the study cycle in which the nursing students were enrolled during the digital tool intervention.Both first-year students and sophomore students were enrolled in 42 studies each.Thirdyear students participated in 22 studies, while fourth-year students were engaged in 35 studies.Moreover, 29 studies utilized participants from different nursing cycles and three studies enrolled students from all nursing studies cycles.In 93 studies, relevant information was not provided.
In addition, 39 studies utilized a varied sample of participants, not just nursing undergraduate students.More specifically, 14 studies also enrolled nursing faculty members or nursing graduate students/nursing master students.Furthermore, 25 studies were identified also involving undergraduate healthcare students from other disciplines (medicine, midwifery, social work, occupational therapy, etc.).Moreover, 23 studies emerged that were conducted among multiple nursing education sites (different universities/colleges/institutions/schools).Furthermore, as mentioned above, two studies took place among nursing schools located in different countries.
To answer the first research question, we located and removed studies (within the realm of possibility) reporting on the same digital tool in more than one publication throughout the five-year study period.Therefore, upon excluding 34 studies, we estimate that 232 different digital tools have been implemented in the past five years with the aim of enhancing undergraduate nursing education.Studies that, to the best of our judgment, were identified utilizing the same digital tool are listed in Appendix A (Table A1).Those digital tools may present small alterations among the different publications; however, the digital environment and basic concept behind the intervention remain the same (e.g., better graphics enhancement, new add-ons, different nursing scenarios, etc.).Therefore, they were excluded from this analysis in order to achieve a closer approximation to reality.
In order to answer the second research question, we categorized the studies according to their implementation sites.Consequently, 34 different countries from all five continents were identified.In Figure 2, the countries are depicted along with chromatic information regarding the number of published articles per country (the darker the color, the greater the number of publications).Among the top five countries that hailed as pioneers in utilizing digital tools for undergraduate nursing education were the USA (50 articles), South Korea (37 articles), China-including Hong Kong (20 articles), Spain (20 articles), and Taiwan (19 articles).Furthermore, two studies utilized an international sample size; one included Italian and Irish nursing students [67], and another included nursing students from Canada, the United Kingdom (including Scotland), and Australia [93].Analytical information on the number of studies each country yielded along with references to the relevant articles can be found in Appendix A (Table A2).
To answer the third research question, we categorized the emerging digital tools into three broad groups according to the game characteristics display level.Hence, the first category involves applications that were designed purely as games and can be characterized as standalone online training activities with clear serious game design elements.The tools in this category should combine all or most of the below characteristics: game environment, player/game characters, rules, storyline, challenges, achievements/points, controls, interaction, and feedback.In the second category, we placed gamified tools and applications that might display several characteristics of gamification, but their entire design and development process did not extend the notion of a discrete serious game.In this category, we included applications with various gamification characteristics and an overall game-like feeling (e.g., gamified graphics environment, decision-making actions, leaderboards, feedback) that could closely resemble serious game design.In addition, this category incorporates other digital applications displaying basic gamification elements (leveling up activities, points allocation, badges, mini quizzes, etc.).In the third category group, digital tools and virtual simulations designed to enhance nursing education presenting very limited gamification characteristics or without displaying any gamified features and techniques were included.In these applications, the user interaction with the environment was limited (e.g., 3D environments without gamified design, digital learning management systems, etc.).According to the above classification, 77 studies were characterized as "serious games" interventions, 93 studies were classified as "gamified applications", and 96 studies displayed "low or non-gamified digital interventions and VR simulations".Excluding multiple publications on the same digital tool, the results were as follows: serious games, 66 studies (28%); gamified applications, 79 studies (34.5%); and low or non-gamified digital interventions and VR simulations, 87 studies (37.5%).Table 3 presents frequency and percentage per category along with the relevant study reference number.
Regarding the fourth research question, almost every digital tool specified the nursing subject whose knowledge absorption it aimed to support and enrich.In only three studies [211,221,263] was the information insufficient to safely conclude the targeted subject.Accordingly, digital tools were categorized into 12 broad thematic categories according to their teaching subject: (1) clinical procedures-clinical practice, (2) adult nursing, (3) pedi-atric nursing, (4) women and infant care, (5) medication, (6) mental health, (7) community health and primary care, (8) disaster/emergency/first aid care, (9) intensive-critical care, (10) nursing fundamentals and core assessment skills, (11) soft skills, (12) other subjects or not specified.Table 5 summarizes these thematic groups and reports on the included subjects per category.Among the digital tools' most common teaching subjects were those related to clinical procedures and clinical practices (n = 81), subjects related to adult nursing care (n = 45) and subjects aiming to enhance nursing students' soft skills acquisition (n = 28).As regards the implementation of digital tools within a specific nursing course curriculum, 108 studies were identified providing relevant information.Upon classification, courses were categorized into 12 groups quite similar to the categories previously developed for the learning subjects.The course categories are as follows: (1) clinical procedures-practice, (2) adult nursing, (3) pediatric nursing, (4) women and infant care, (5) mental health, (6) public/community health and primary care, (7) emergency care and disaster medicine, (8) intensive-critical care, (9) nursing fundamentals and aligned core sciences, (10) medical-surgical nursing, (11) other courses, and (12) multiple courses (digital tools that were implemented simultaneously in more than one nursing course).According to the classification (Table 6), the courses that most often utilized digital tools to enhance nursing students' learning experience were nursing fundamentals and aligned core sciences (n = 27), clinical procedures and clinical placement courses (n = 19), and courses related to adult nursing (n = 12).

Discussion
To the best of our knowledge, this is the first review of nursing education digital tools utilizing such a broad search algorithm with multiple keywords and key phrases resulting in the astonishing number of 266 relevant results.The present findings suggest that nursing education digitalization has indeed played an important role in the past five years in enhancing and advancing the nursing curriculum in several countries around the globe.
Furthermore, it became evident that digital educational tools for nursing education increased tremendously, especially after 2021.According to our results, a greater than four-fold increase was observed in relevant publications between 2019 (n = 18) and 2023 (n = 84).This phenomenon is mainly attributed to the COVID-19 pandemic that forced integration of digital tools into the nursing curriculum to support distance learning for undergraduate students [282][283][284].However, we should also recognize the significant technological advancements in teaching techniques and learning methodologies that have been achieved in recent years with the aim of enhancing educational experiences [285].To this end, the latest digital technologies have caused a paradigm shift in the education system by providing knowledge but also being a co-creator of information, acting both as mentor and assessor [286].
The present review reported on three main digital educational tool types for nursing education: serious games, gamified applications, and non-gamified tools or virtual simulations.Indeed, serious games are an emerging learning approach in digital education [287] and there are recent reviews reporting on the implementation of serious games in undergraduate nursing education.However, their results were far more limited; one review reported eight relevant studies published from 2015-2021 [288], while another included 22 studies published within 2010-2021 [12].Although these studies examined multiple databases, this review searched only one and yielded 66 relevant results (upon excluding multiple publications of the same serious game).It is highly plausible that the major part of the observed difference is attributed to the implemented search algorithm, but we also cannot neglect the fact that, although the other reviews were recently published, they did not include studies published after 2022.
Furthermore, educational usage of digital simulations and gamified applications has increased worldwide, since they are considered effective educational tools that can improve learning experience at all educational levels, subjects, and contexts [289].Two previous systematic reviews on the utilization of gamification in nursing undergraduate education reported 17 relevant studies from four countries (2017-2022) [290] and 46 relevant studies from 15 countries (2000-2020) [13].According to our results, 79 gamified applications and tools were identified.Similarly to the prior observation, search algorithm quality and study period are expected to have significantly impacted the observed difference.
Moreover, our findings yielded 87 studies reporting on low or non-gamified interventions and digital simulations for undergraduate nursing education.The only similar study in the literature, the results of which can be compared to ours, is that of Dicheva et al. [284], which reviewed 78 articles on computer-aided nursing pedagogies, published between 2013 and early 2023.However, the fact that the inclusion and exclusion criteria of this review differed compared to ours (excluding studies with immersive VR/online platforms/blended learning as well as studies without a control group), while at the same time their results include serious games and gamified applications, should be taken under serious consideration.
As has emerged from the present review, several countries around the globe have designed, developed, and implemented digital educational tools into their nursing curriculum to a greater or lesser extent.Our results indicate that 34 different countries worldwide have attempted to enhance nursing undergraduate learning by utilizing at least one digital tool in the nursing curriculum.However, it became clear that digitalization of nursing tools is not spread evenly around the world; there are many developed or developing countries that have not yet invested in digital educational technology to enhance undergraduate nursing students' engagement and motivation.Those countries are located both in Europe (e.g., eastern Europe) and Latin America, as well as other less-developed world regions.Past reviews report lower geographical dispersion [13,290], while the highest geographical range previously observed is 20 countries [284].In this study, the USA, Taiwan, Spain and South Korea were also recognized as the countries with the largest distribution of relevant publications [284].
Undoubtedly, simulation type activities constitute an important teaching method and effective strategy for understanding theoretical knowledge and learning practical skills in nursing education [291].Therefore, simulation-based learning is identified as a key component in undergraduate nursing programs, as it assists in preparing nursing students for safer clinical placement [292].Particularly, virtual simulation is an emerging innovation accelerated by the COVID-19 pandemic and is now embedded in several nursing pedagogy practices [293].The present findings confirm that simulation type activities have the lion's share among the identified nursing digital tools, since almost half of the included studies (43%) were based on or included digital simulation type activities.Also, according to the present review results, quizzes are also frequently utilized in the enrolled studies to enhance nursing education experiences (16%).The literature reports that quiz type activities are readily acceptable tools which complement medical lectures and improve students' learning and comprehension by promoting healthy competition and peer-assisted learning [294].Previous studies in nursing students have established that the use of quizzes can promote academic success and enhance long-term retention of the learning material [295].Finally, decision-making activities was a common topic among the identified digital nursing tools (12.3%), since it is considered one of the most essential soft skills in nurses' daily practice [296].In a nutshell, decision-making in nursing comprises the process of selecting an action from various possible alternatives to address a clinical situation, including gathering and interpreting information, weighing the cost-benefit of each alternative, and selecting a course of action [297].The literature indicates that clinical reasoning and decision-making can be safely practiced by nursing students in a realistic and secure environment via serious games and gamified applications which can be incorporated in the nursing education curriculum [86].
As regards the most common educational subjects, the majority of the identified digital nursing tools (n = 81) were related to nursing clinical procedures and clinical practice (e.g., injection therapy, wound/ulcers treatment, proper medical equipment usage and other clinical reasoning skills).This observation was expected, since several virtual simulations have been designed and implemented with the aim of enhancing clinical reasoning in nursing education [298], especially during the COVID-19 pandemic when pivoting to virtual simulation for clinical practice was a one-way road [299].Another frequently addressed subject that emerged was adult nursing (n = 45), which is a broad category including digital tools aiming, among others, at enhancing chronic diseases management (e.g., diabetes, heart diseases, respiratory diseases, cancer), geriatric care (including Alzheimer's disease and dementia), and COVID-19 care.Finally, several of the identified tools (n = 28) were related to soft skills acquisition (such as communication skills, empathy and interprofessional teamwork competencies).Many studies have underlined the need for implementing soft skills training in undergraduate nursing programs, especially since human interaction (e.g., a subtle smile, a soothing touch) is among the few things that technology cannot replace [300].A recent review highlighted the need for incorporating soft skills learning strategies in undergraduate nursing education while it showcased that simulation-based learning strategies are widely used in order to enhance soft skills learning acquisition [296].
From the present review, it becomes evident that nursing digital learning tools have flourished during the past five years and there are now several serious games, gamified applications and digital/virtual tools designed for undergraduate nursing students.Especially after the COVID-19 pandemic, the increase is exponential and the present results showcase that every country, every university and every nurse tutor has several options to choose from in order to update and enhance the existing nursing curriculum.The aim of this review was to synthesize information from all the available digital tools, in order to inspire and stimulate the readers to actively engage and embrace digital technologies in nursing education and reap its multiple benefits.There are several ideas in this article regarding the type of learning activities, the available digital technologies, and the enrolled learning subjects and courses that can act as a useful blueprint and motivate all relevant stakeholders (ministries of education, deans of nursing schools, nurse educators) to invest in serious games, gamification and digital technologies and start developing a new digitalized nursing education era step-by-step.

Limitations
This review comes with some limitations.Initially, the fact that only one database was reviewed may have limited the number of potential results.However, we searched the most relevant scientific database utilizing a robust search algorithm that yielded an astonishing number of studies which is much higher than the findings reported in previous reviews conducted in multiple databases.Moreover, another limitation lies within the classification criteria for certain categories (game types, learning activity types, subject themes, and course categories).These categories have a scientific basis indeed; however, due to the large number of results and the heterogeneity of the reported information, we improvised to a certain extent in order to be able to report the data in homogenous categories/groups.Also, another limitation is that due to the large number of returned results (N = 1592) and included results (n = 266), slight misinterpretations or errors might have occurred during the review and data extraction process.However, since there is a large number of studies, some minor inaccuracies are not expected to have created significant imbalances within the reported information.

Conclusions
The present findings highlight that digital educational tools are an emerging field identified as a potential pedagogical strategy aiming to transform nursing education.This review underlines the latest advances in the area of nursing education, providing useful insights that could inspire countries and universities that haven't yet incorporated digital educational tools in their nursing curriculum, to invest in their implementation.However, this review did not report on the effectiveness and efficacy of the digital tools, since many individual studies or systematic reviews have concluded that it provides several advantages in improving learning outcomes and creating a more engaging and fun environment for the students.Moreover, several studies were identified reporting on the implementation of digital tools within a specific curriculum nursing course.Future research should examine long-term effects of incorporating digital tools as an integral part of the nursing curriculum.In addition, blueprint studies on developing and implementing digital educational tools in nursing schools with scarce or limited resources are needed in order to ensure that progress can be achieved in every university and benefits can be reaped by nursing students.A final suggestion for authors is to include photos from their games and applications in their articles, since they are very helpful in visualizing the information provided in their manuscripts.

Information 2024 ,
15, 410 20 of 44 presents frequency and percentage per category along with the relevant study reference number.

Figure 2 .
Figure 2. Number of studies published on digital tools for undergraduate nursing education per country.

Figure 2 .
Figure 2. Number of studies published on digital tools for undergraduate nursing education per country.

Table 2 .
Summary table of studies included in the present review.
Evaluation of a dementia awareness game for undergraduate nursing students in Northern Ireland: a Pre-/Post-Test study Serious game
[121]ilo glu et al.[118]2020Comparison of the effectiveness of the virtual simulator and video-assisted teaching on intravenous catheter insertion skills and self-confidence: A quasi-experimental studyVR simulationJeong et al.[119]2022Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study.VR simulationJohnsen et al.[120]2021Nursing students' perceptions of combining hands-on simulation with simulated patients and a serious game in preparing for clinical placement in home healthcare: A qualitative studyVideo-based serious gameJung et al.[121]2022The Effectiveness of Learning to Use HMD-Based VR Technologies on Nursing Students: Chemoport Insertion
• Virtual Reality and a High-Fidelity Simulator: Usability and Feasibility Assessment 360 • VR simulation Kim et al. [134] 2021 Adaptation of Extended Reality Smart Glasses for Core Nursing Skill Training Among Undergraduate Nursing Students: Usability and Feasibility Study AR-XR smart glass app Kirkman et al. [135] 2022 Enriching Nursing Simulation With a Threefold Hybrid Approach hybrid simulation in a gaming platform Koivisto et al. [136] 2023 Nursing Students' Scenario Performance: Game Metrics in a Simulation Game Three-dimensional computer simulation game Kor et al. [137] 2022 Exploring nursing students' learning experiences and attitudes toward older persons in a gerontological nursing course using self-regulated online enquiry-based learning during the COVID-19 pandemic: A mixed-methods study Gamified online platform Kurt et al. [138] 2021 The effect of mobile augmented reality application developed for injections on the knowledge and skill levels of nursing students: An experimental controlled study Mobile AR games Lau et al. [139] 2023 Mid-career switch nursing students' perceptions and experiences of using immersive virtual reality for clinical skills learning: A mixed methods study Lee et al. [145] 2023 Exploring the potential use of the metaverse in nurse education through a mock trial Metaverse platform-virtual world Lee et al. [146] 2023 Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial VR simulation
Implementation and Evaluation of a Virtual Reality-Based Cognitive Assessment and Rehabilitation Simulation Course in Undergraduate Nursing Students: A Pre-Post Study VR simulation Liang et al. [153] 2021 Enhancing stroke assessment simulation experience in clinical training using augmented reality MR app Liaw et al. [154] 2020 Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes Computer-based VR simulation Liaw et al. [155] 2022 Translation of an evidence-based virtual reality simulation-based interprofessional education into health education curriculums: An implementation science method VR simulation Liaw et al. [156] 2019 Design and evaluation of a 3D virtual environment for collaborative learning in interprofessional team care delivery 3D virtual simulation Liaw et al. [157] 2023 Desktop Virtual Reality Versus Face-to-Face Simulation for Team-Training on Stress Levels and Performance in Clinical Deterioration: a Randomised Controlled Trial Desktop VR simulation Liaw et al. [158] 2023 Artificial Intelligence Versus Human-Controlled Doctor in Virtual Reality Simulation for Sepsis Team Training:
1Short description according to what authors stated in title, abstract, or methods section of their studies (in the majority of cases).

Table 3 .
Classification of digital tools according to game design display level.

Table 3 .
Classification of digital tools according to game design display level.

Table 4 .
Categorization according to the type of learning activity implemented by the identified digital tool/application.

Table 5 .
Nursing subjects classified according to thematic category.

Utilizing the Same Digital Tool Studies Utilizing the Same Digital Tool & theTable A2 .
Identified studies per country.