Home visits are a core part of community nursing. For nursing students, they are not simply a checklist of health assessments. A home visit asks students to observe the family environment, recognize safety risks, communicate with patients and relatives, and turn classroom knowledge into practical care decisions.
Yet such situations are hard to recreate in a classroom. A real home may be cluttered. An older adult may hesitate, question the visitor, become impatient, or respond in unexpected ways. Traditional role-play can help students rehearse the process, but scripted scenarios may not fully capture the uncertainty of entering someone's home as a nurse.
A study published in the Chinese Journal of Medical Education Research explored whether a virtual–physical integrated scenario simulation could bring students closer to that reality. Researchers from Peking Union Medical College School of Nursing, Beijing Xicheng District Desheng Community Health Center, and Beijing Fengtai District Fangzhuang Community Health Center tested the approach in undergraduate nursing education. They found that the new simulation model increased students' learning immersion compared with conventional scenario simulation. However, the study did not show a clear short-term advantage in improving students' home visit attitudes or skills.
The study involved 143 third-year undergraduate nursing students enrolled in 2022 and was conducted from March to April 2025. Students were assigned to either a virtual–physical integrated simulation group or a conventional simulation group. Both groups received the same theoretical teaching on home visits, followed by three hours of experimental teaching. A total of 128 students completed both pre- and post-teaching questionnaires, and 24 students from the virtual–physical group took part in semi-structured interviews.
The teaching task was the same for both groups. Students practiced preparing for a home visit, conducting inquiry and physical assessment, measuring rapid blood glucose, providing health education, and completing post-visit summary, feedback, and documentation. The difference lay in how the scenario was built.
In the conventional group, students worked in a standard laboratory, with classmates role-playing the home visit recipient and family member according to a prepared script. In the virtual–physical group, students trained in a smart eldercare laboratory. The setting combined multimedia equipment, LED displays, physical models, and a wireless smart elderly nursing simulation system. An intelligent simulator played the role of the older adult, while a student played the family member. The system supported AI-assisted inquiry, blood pressure and glucose measurement, and transitions between a community health center and a simulated home environment.
The main quantitative finding was about immersion. Students in the virtual–physical group had a higher total learning immersion score than those in the conventional group: 72.42±8.19 versus 69.44±8.41. The virtual–physical group also scored higher in emotional buy-in and learning experience. These results suggest that the integrated simulation helped students feel more engaged with the learning task.
The interviews help explain why. Many students said the intelligent simulator made the scenario feel more realistic. It could respond to questions, show impatience, ask follow-up questions, or display emotional changes. Some students felt that this made the interaction less predictable than a classmate reading from a script. Others said the simulated home environment, including details such as scattered objects or potential safety hazards, prompted them to observe the surroundings more carefully.
Students also described the experience as more challenging. In conventional role-play, classmates may unintentionally guide or remind each other. In the virtual–physical setting, the simulator had its own response logic. That forced students to listen, adapt, and solve problems more actively. For a teaching activity designed to prepare students for real home visits, this kind of uncertainty may be educationally valuable.
But the same study also cautions against assuming that a more immersive experience automatically produces stronger skills. After teaching, the conventional group showed a small improvement in home visit skill scores compared with before teaching. However, there was no significant difference between the two groups in post-teaching home visit skill scores. The virtual–physical group scored 60.60±6.85, while the conventional group scored 60.89±6.62. The total home visit attitude-skill scores and related dimensions also did not show a clear advantage for the virtual–physical group.
The authors suggest several possible explanations. Home visit skills require repeated practice and feedback. In this study, the experimental teaching lasted only three hours, which may not have been enough time for measurable skill gains to emerge. Students in the virtual–physical group also had to learn how to interact with the smart simulation system. Its novelty and complexity may have drawn some attention away from the core home visit skills being practiced.
Technical limitations also affected the experience. In interviews, students reported delays in system responses, imperfect speech recognition, the need to press buttons during interaction, and occasional breakdowns in conversational flow. Some students felt that conventional role-play, despite being less technologically advanced, allowed more natural and warmer human interaction. The study therefore shows both promise and friction: smart simulation can make training more realistic, but the technology still needs to become smoother and easier to use.
This distinction matters for nursing education. Technology should not be adopted simply because it is new or visually impressive. In home visit teaching, the goal is to help students build observation, communication, assessment, and decision-making abilities. Virtual–physical simulation may support those goals by creating richer and less predictable scenarios, but it requires careful instructional design. Teachers need to keep the learning objectives clear, guide students' attention to core skills, and provide timely feedback after the simulation.
The study's findings should also be interpreted with caution. The sample came from a single institution and was relatively small. The home visit attitude-skill questionnaire was designed by the research team and requires further validation. The novelty of the simulation technology may also have influenced students' learning experience, creating a possible Hawthorne effect. The authors call for larger, multicenter studies using standardized tools and allowing students time to become familiar with the technology before its educational effects are evaluated.
Even with these limits, the study offers a useful lesson for digital transformation in nursing education. Smart simulation can help students feel more present in a home visit scenario. It can expose them to messier communication and environmental details than conventional role-play may provide. But immersion is only the beginning. The next question is how to turn that engagement into durable nursing competence.
Article information：
Article Title: 虚实结合情景模拟在家庭访视教学中的应用效果研究
English Title: Study on the application effects of virtual-reality integrated scenario simulation in home visit teaching
Journal: Chinese Journal of Medical Education Research
DOI: 10.3760/cma.j.cn116021-20251129-02253
Authors: Li Xiaoxue, Zhang Zheng, Wang Lingyun, Wang Li, Guo Aimin
Chinese Journal of Medical Education Research is a monthly peer-reviewed journal sponsored by the Chinese Medical Association and hosted by Chongqing Medical University, under the supervision of the China Association for Science and Technology.
Launched in 2002, the journal publishes research and practice-oriented studies on medical education, with a focus on teaching reform, clinical teaching, curriculum development, residency training, graduate education, nursing education, educational technology, and international medical education. It also features themed columns and special issues on emerging topics and institutional innovations in medical education.
The journal is recognized as a Source Journal for Chinese Scientific and Technical Papers and Citations and is included in the Chinese Science and Technology Core Journals. It is indexed in Wanfang Data, Index Copernicus, the WHO Western Pacific Region Index Medicus, and Ulrich's Periodicals Directory.
Journal page: http://yxjyts.alljournals.ac.cn/homeNav?lang=zh
