This randomized controlled trial aims to evaluate the effects of VRS on decision-making skills, self-confidence levels, and anxiety of psychiatric nursing students. Students participating in the study will be divided into two groups: intervention and control groups. VRS, which includes a scenario of a patient with schizophrenia, will be applied to the intervention group at the beginning of the academic term, before students start clinical practice, and in the middle of the term. The control group will be subjected to theoretical courses and clinical practice. Data will be collected using the Clinical Decision-Making, Self-Confidence, and Anxiety Scale, Personal Information Form, and Modified Simulation Effectiveness Tool. Measurements will be performed at three time points: before the simulation, in the middle of the academic term, and at the end of the academic term. In addition, debriefing sessions will be held with students participating in VRS in groups of 4-5 within the scope of the simulation process. It is expected that the findings obtained as a result of the study will make significant contributions to the literature in understanding the effects of VRS on psychiatric nursing education. At the same time, this study aims to demonstrate that this VRS, designed specifically for the Turkish language and culture, can be an effective tool to increase the self-confidence levels of psychiatric nursing students in their clinical decision-making processes and to reduce their anxiety levels within the scope of the psychiatric nursing course. The results of the study are intended to guide the development of new approaches to the use of technology in psychiatric nursing education and the integration of technology-based VRS into the psychiatric nursing curriculum.

This randomized controlled trial aims to investigate the impact of a schizophrenia-focused virtual reality simulation (VRS) on clinical decision-making skills. This randomized controlled trial aims to investigate the impact of a schizophrenia-focused virtual reality simulation (VRS) on clinical decision-making skills, self-confidence, and anxiety levels of undergraduate psychiatric nursing students. The study will be conducted with second- or third-year nursing students enrolled in a psychiatric nursing course at a university in Türkiye.

Participants will be randomly assigned to either the intervention or control group. The intervention group will participate in VRS, which includes an interactive, gamified simulation scenario based on a patient diagnosed with schizophrenia. This simulation will be conducted twice: once at the beginning of the academic term, prior to clinical placement, and again at mid-term. Each simulation session will be followed by structured debriefing sessions held in small groups (4-5 students), led by a trained facilitator to enhance reflective learning and reinforce clinical reasoning.

The control group will receive standard psychiatric nursing education, consisting of theoretical lectures and routine clinical practice, without exposure to VRS.

Data will be collected using the Clinical Decision-Making Scale, Self-Confidence Scale, Anxiety Scale, Personal Information Form, and the Modified Simulation Effectiveness Tool (SET-M). Measurements will be taken at three time points: (1) before the first VRS session or clinical practice, (2) at mid-term, and (3) at the end of the academic term.

This study is expected to contribute significantly to the understanding of how technology-enhanced, culturally tailored simulation tools affect learning outcomes in psychiatric nursing education. Specifically, it aims to demonstrate that VRS can enhance students' self-confidence in clinical decision-making and reduce their anxiety before and during psychiatric clinical placements. The findings are anticipated to guide the future integration of digital simulation technologies into psychiatric nursing curricula in Türkiye and globally.

Inclusion Criteria:

• To be registered for the Psychiatric Nursing course in the 2024-2025 spring semester,
• To be taking the Psychiatric Nursing course for the first time,
• To attend the course regularly,
• Not to have received any training with virtual reality simulation within the scope of the Psychiatric Nursing course before,
• Not to have practiced in a Mental Health and Diseases clinic before

Exclusion Criteria:

• Not registered for a Psychiatric Nursing course.
• Having previously taken a Psychiatric Nursing course.
• Not attending class regularly.
• Having previously received training with a schizophrenia simulation.
• Having previously practiced in a Mental Health and Diseases clinic.

Orchid ID: https://orcid.org/0000-0003-0077-9264