Abstract
<title>Abstract</title> <p>Backgrounds and aims This study aimed to evaluate the educational effectiveness of a virtual reality environment using Virtual Reality Cave Automatic Virtual Environment (VR CAVE) simulation compared with a traditional simulated home in enhancing nursing students’ self‑perceived clinical competence, self‑confidence, and satisfaction in community health nursing education. Methods This crossover randomized controlled trial was conducted from August 2024 to May 2025. A total of 150 final-year undergraduate nursing students participated in a two-phase crossover trial in which they experienced both VR CAVE and simulated home environments separated by a three-week washout period; data were collected using the Clinical Competence Questionnaire (CCQ) and the Student Satisfaction and Self-Confidence in Learning Scale (SSS), and linear mixed-effects models were used to examine within- and between-group differences over time while adjusting for age, gender, and prior simulation experience. Results Both simulation modalities significantly improved students’ self-perceived clinical competence (p < 0.001). At T1, Group A (VR CAVE) showed a mean CCQ increase of 13.17 points, and Group B (Simulated Home) 23.92 points, with a significant difference favoring the simulated home (p < 0.001). After crossover, the between-group difference was nonsignificant (p = 0.345), indicating comparable efficacy. Satisfaction and self-confidence scores were consistently high across both modalities, with marginally higher ratings for VR CAVE (mean range: 4.31–4.39). Conclusions VR CAVE simulation significantly enhanced nursing students’ self‑perceived clinical competence, self‑confidence, and satisfaction, with outcomes comparable to those of a traditional simulated home. The higher satisfaction and self-confidence ratings observed after VR CAVE sessions suggest potential experiential advantages in learner engagement, although self-perceived competence outcomes were equivalent across modalities. Clinical trial registration/number ClinicalTrials.gov (NCT07595588), registered on 07 May 2026. [Retrospectively registered]</p>