This study investigates the effectiveness of immersive technology-enhanced learning (TEL) in supporting the development of medication numeracy skills among first-year pre-registration nursing students, situated within the broader context of digital education. Accurate medication calculation is a critical component of safe nursing practice and is closely linked to the prevention of drug administration errors. However, many students begin nurse training with measurable deficits in medication calculation skills and report low levels of confidence in performing essential numeracy tasks required for safe clinical practice. As immersive digital tools become increasingly embedded in nurse education, there is a growing need to evaluate their pedagogical value.

A randomised controlled trial (RCT) was conducted to compare three instructional modalities: traditional face-to-face teaching, 360-degree video accessed on a desktop, and the same video experienced through a virtual reality (VR) headset. These modalities were selected to reflect varying levels of technological immersion, allowing for comparative insight into both conventional and emerging approaches to TEL. In addition to measuring changes in medication calculation accuracy, the study explored whether learners’ prior healthcare experience or self-reported confidence were associated with performance outcomes. Drawing on experiential learning theory and socio-material perspectives, immersive TEL was conceptualised not simply as a content delivery mechanism, but as a context-rich environment where learning emerges through repeated engagement with realistic, simulated clinical scenarios.

A total of 87 nursing students were randomly allocated to one of the three groups. All participants completed pre- and post-intervention numeracy assessments, confidence ratings, and a background questionnaire exploring previous medication administration experience. The results revealed modest gains across all groups. The face-to-face group demonstrated the highest average improvement in numeracy accuracy (4.83%), followed by the VR group (2.07%), with no measurable change in the desktop group. Prior experience and self-reported confidence did not consistently predict improvement, suggesting that outcomes were shaped by a more complex set of learner and contextual factors.

The study’s findings revealed only modest learning gains across the three delivery modes. While face-to-face instruction yielded the highest improvement, the relatively small gains suggest that immersive TEL, particularly VR, may serve as a feasible alternative in contexts where in-person teaching is not possible or practical. These findings point to a broader insight: delivery mode alone is unlikely to drive meaningful improvements in numeracy. Instead, the success of TEL depends on its alignment with pedagogical intent, learner needs, and the complexity of the skill being developed. Immersive formats may enhance engagement and simulate realism, but these features alone do not guarantee learning. TEL approaches should therefore be embedded within structured and scaffolded learning environments that promote active engagement. This study contributes to the growing body of literature on digital pedagogy in nursing education and highlights the need for scalable, evidence-informed strategies that support clinical numeracy development, clinical readiness, and patient safety.

Keywords: Technology-Enhanced Learning (TEL), Experiential Learning, Clinical Numeracy, Nursing.