The Effectiveness of Gamified Metaverse-Based Training on Patient Safety for Nursing Students: A Mixed Methods Study

Introduction: Patient safety issues, such as medication errors, healthcare-associated infections, unsafe surgical procedures, and diagnostic errors, can negatively impact the quality of healthcare and patient outcomes due to preventable risks. There is a need for innovative, interactive educational approaches to ensure the lasting acquisition of patient safety competencies in nursing students and to strengthen their transfer to the clinical environment. Aim: This study aims to evaluate the effect of gamified metaverse-based training on patient safety competencies in nursing students and to assess student opinions regarding metaverse-based training. Method: The research will be conducted using a mixed-methods design. The quantitative phase will be an experimental design including intervention and control groups, pre-test-post-test, and a one-month follow-up (retention test). The research will be conducted between February 2026 and May 2026 with second-year students studying in the Spring semester of 2025-2026 at Başkent University Nursing Department in Ankara. According to G*Power calculations, a minimum sample size of 52 was found; considering a possible 10% loss, the total sample size was planned as 60 students (intervention=30, control=30). All participants will take the Patient Safety Knowledge Level Test (pre-test) and the Patient Safety Competency Self-Assessment Tool before the training. This will be followed by 2 hours of traditional theoretical training on patient safety; the intervention group will also receive gamified metaverse-based training via Spatial.io for two weeks. Post-tests will be administered after the training and one month later. Data collection tools include the Demographic Information Form, the Patient Safety Knowledge Level Test, the Patient Safety Competency Self-Assessment Tool (PSCS), and focus group interviews to be conducted in the intervention group. Quantitative data will be analyzed through within-group and between-group comparisons; qualitative data will be analyzed using thematic analysis, and the findings will be interpreted holistically. Findings (Expected): Gamified metaverse-based training is expected to provide a greater increase in mean scores on the Patient Safety Knowledge Level Test (PSL) and total and sub-dimension scores (knowledge-skills-attitudes) of nursing students compared to the control group, and to support the retention of these results.

Conclusion: This study is expected to generate evidence regarding the effectiveness of gamified metaverse-based training in improving patient safety competencies in nursing education and to contribute to the structuring of patient safety training in a more integrated, student-centered, and sustainable manner.