360° Contextual Simulation Video for Undergraduate Nursing Students: An Electroencephalography-Based Quasi-Experimental Study (Preprint)

Background: Screen-based 360° contextual simulation videos are being increasingly used in nursing education; however, evidence regarding their effects on learning outcomes and neural Electroencephalography (EEG) patterns remains limited. Objectives: To evaluate whether integrating 360° contextual simulation videos with traditional classroom instruction influences nursing students' perceptions of simulation design and educational practices, their levels of satisfaction and self-confidence in learning, and EEG-based neural correlates of action observation. Methods: In a quasi-experiment, 55 third-year nursing students (experimental n=28; control n=27) were assigned to 360° contextual simulation video learning (laptop; no head-mounted display) or traditional classroom-based instruction (didactic instruction, guided discussion, and 2D instructional videos). The primary outcomes were Simulation Design Scale (SDS) and Educational Practices Questionnaire (EPQ) scores. Secondary outcomes included Student Satisfaction and Self-Confidence in Learning Scale (SCLS) scores satisfaction and self-confidence) and EEG indices (power at C3, Cz, and C4; μ-rhythm suppression scores). Group differences were tested with t tests and ANCOVA adjusted for baseline values. Results: Between-group analyses (ANCOVA adjusted for baseline values) revealed higher posttest scores on the Simulation Design Scale (SDS; F(1,35)=7.80, P=.008; η²=.182), Educational Practices Questionnaire (EPQ; F(1,35)=6.00, P=.019; η²=.146), and Student Satisfaction and Self-Confidence in Learning Scale (SCLS; F(1,35)=7.01, P=.012; η²=.167) in the experimental group than the control group. Within-group analyses (paired t tests) indicated significant increases in SDS and EPQ scores for the experimental group (P<.001 and P=.005), whereas the control group showed a decrease in the SDS score (P=.001) and no significant change in the EPQ score (P=.106). The SCLS score did not significantly change in the experimental group (P=.212) and increased in the control group (P=.043). EEG analyses revealed significant postexposure reductions in power at C3, Cz, and C4 for the experimental group (all P<.001), with between-group effects at Cz (F(1,35)=425.29, P<.001; η²=.926) and C4 (F(1,35)=5.45, P=.026; η²=.138). μ-Suppression, which is an indirect EEG correlate that is often reported during action observation, was greater in the experimental group at Cz (P=.028) and C4 (P=.033) but not at C3 (P=.125). No adverse events were reported. Conclusions: Integrating 360° contextual simulation videos into undergraduate nursing education was associated with higher SDS and EPQ scores and improved self-reported satisfaction and self-confidence, in addition to EEG-based findings that may reflect neural EEG patterns associated with action observation. Larger multisite randomized trials are warranted to confirm efficacy and cost-effectiveness. This study was registered at the Chinese Clinical Trial Registry (No. ChiCTR2500102861).