Factors For The Successful Implementation Of Extended Reality In General Nursing Education: A Qualitative Expert Study Based On The Extended TPACK Model

Abstract

Persistent global shortages of qualified nursing professionals and increasing clinical complexity place substantial pressure on nursing education systems. Extended Reality (XR), including Virtual Reality, Augmented Reality, and Mixed Reality, enables immersive and repeatable simulation of complex clinical scenarios within psychologically safe learning environments. Despite growing evidence regarding learning effectiveness, structural conditions for sustainable institutional implementation remain insufficiently examined.

This qualitative study investigates enabling factors and barriers influencing the integration of XR in general nursing education. Eight semi-structured expert interviews were analysed using structured qualitative content analysis guided by an extended Technological Pedagogical Content Knowledge (TPACK) framework incorporating ethical and organisational dimensions.

Findings indicate that sustainable XR implementation depends on systemic alignment between technological infrastructure, pedagogical integration, disciplinary authenticity, organisational capacity, ethical governance, and long-term financing. Faculty qualification, stable institutional support structures, transparent data protection frameworks, and innovation-oriented organisational cultures emerged as decisive implementation conditions. Ethical considerations, particularly regarding data governance and learners’ psychological safety, function as foundational structural requirements rather than peripheral concerns.

By extending the TPACK framework to include ethical and organisational knowledge domains, this study provides an empirically grounded implementation model for immersive healthcare education. XR is conceptualised as a governance-related transformation process with implications for workforce resilience, patient safety, and the strategic digital development of nursing education systems.