Abstract
Background: This study extends the theoretical framework based on the Cognitive-Affective Model of Immersive Learning (CAMIL) by incorporating flow state and cognitive absorption to investigate the effectiveness of virtual reality (VR) in nursing education. Methods: A randomized experimental design was adopted. A total of 209 students from three nursing assistant training centers in Taiwan were recruited through convenience sampling and randomly assigned to either immersive virtual reality (IVR) or Desktop VR groups for nasogastric tube feeding training. Data were collected through structured questionnaires and analyzed using partial least squares structural equation modeling (PLS-SEM). Results: The results revealed that immersion, curiosity, and control significantly impacted presence, which, in turn, positively influenced the flow state (β = 0.81, p < 0.001). Flow demonstrated positive effects on intrinsic motivation (β = 0.739, p < 0.001), situational interest (β = 0.742, p < 0.001), and self-efficacy (β = 0.658, p < 0.001) while negatively affecting extraneous cognitive load (β = -0.54, p < 0.001). Multigroup analysis showed that IVR had a stronger control-presence effect (|diff| = 0.337, p = 0.016), and flow had a great effect on motivation (|diff| = 0.251, p = 0.01), interest (|diff| = 0.174, p = 0.035), and self-efficacy (|diff| = 0.248, p = 0.015). Desktop VR more effectively reduced cognitive load (|diff| = 0.217, p = 0.041). Conclusions: These findings provide theoretical insights into the role of flow in VR learning and practical guidance for implementing VR technology in nursing education.