Evaluating the feasibility and impact of using virtual simulation games as presimulation preparation for verbal de-escalation education of undergraduate nursing students: A quasi-randomized controlled study

Abstract

Background: Nurses and nursing students frequently report feeling underprepared to manage aggressive patients and often lack confidence in verbal de-escalation skills. Although high-fidelity and standardized patient simulations are effective for teaching these competencies, learners may enter emotionally charged scenarios without adequate preparation. Virtual simulation games (VSGs) offer a potentially engaging, psychologically safe method of presimulation preparation, yet their impact in this context has not been examined.

Methods: A quasi-randomized controlled study compared VSG-based presimulation preparation with traditional case-study preparation among fourth-year nursing students (N = 108) at a Canadian university. Students were assigned by simulation group to the experimental (VSG) or control (case study) condition. Knowledge, self-confidence, and anxiety were measured before and after preparation, and perceived competence was assessed before and after a standardized patient de-escalation simulation. Usability, engagement, and perceived impact on learning were evaluated using the CRISP scale.

Results: Knowledge improved significantly following preparation for both groups, with the VSG group showing significantly greater gains (p = .008). Self-confidence did not change significantly in either group, while anxiety increased over time in both groups (p = .003). Perceived competence improved significantly following the live simulation for all students, regardless of preparation method. VSGs were rated significantly higher than case studies for usability, engagement, and impact on learning (all p < .01).

Conclusions: VSG-based presimulation preparation is feasible, highly acceptable, and associated with greater knowledge gains compared with traditional case-study preparation. While VSGs alone did not significantly influence self-confidence or anxiety, they appear to enhance cognitive readiness and learner engagement for emotionally demanding de-escalation simulations. Integrating VSGs into routine presimulation preparation may optimize in-person simulation efficiency and learning outcomes.