From Passive Viewing to Clinical Decisions: A Systematic Review in Mental Health Nursing Education

Abstract

Background: Preparing students for mental health practice requires more than knowledge of diagnostic concepts. Learners must interpret subtle cues, communicate therapeutically, recognize risk, and respond without reinforcing stigma. Audiovisual and simulation approaches are increasingly used when direct clinical exposure is limited, but evidence remains dispersed across several educational formats. This review aimed to synthesize evidence on film and video cases, standardized-patient simulation, virtual and 360-degree simulation, virtual gaming, and branching video, and to identify practical design principles for interactive mental health simulation. Methods: Systematic review with narrative synthesis. Peer-reviewed studies published between January 2016 and 30 January 2026 were identified through PubMed/MEDLINE, citation tracking, and targeted supplementary searches. Eligible studies involved nursing or closely related psychiatry education and evaluated audiovisual or simulation-based learning relevant to clinical reasoning, communication, stigma, safety, competence, or practice readiness. Because the interventions, study designs, and outcomes varied substantially, findings were synthesized narratively. Results: Eighteen empirical studies were included. Film-based approaches supported understanding of psychopathology, reflection, empathy, and stigma awareness, although learners often remained observers. Standardized-patient simulation consistently strengthened communication, confidence, and selected competencies, but required substantial staff and logistical resources. Virtual and 360-degree formats broadened access to realistic scenarios, yet immersion did not always translate into active participation. Branching video added an important feature: learners had to make a decision before seeing its consequences. Across modalities, the most useful designs combined realistic cues, active response, feedback, rehearsal, debriefing, and assessment of clinical performance. Conclusions: The strongest educational signal was not technological sophistication itself, but the extent to which learners were required to notice, decide, communicate, and reflect. Mental health simulation is therefore likely to be most useful when cue-rich audiovisual cases are paired with decision points, consequence feedback, therapeutic communication practice, anti-stigma analysis, debriefing, and clinical judgment assessment. These principles informed the development of CINE-MIND.