*Data Analysis and Presentation*

The characteristics of the included studies and the answers to the review question are summarised in Table 2. Of the twelve studies included in this review, one was conducted in Indonesia, six in the USA, one in Germany, one in Colombia, one in Hong Kong, and two in the Republic of Korea. The studies were published in the years 2020 (*n* = 2), 2021 (*n* = 8), and 2022 (*n* = 2).

#### **Table 2.** Articles included in the scoping review.



#### **Table 2.** *Cont.*

The first study analysed was conducted by Anggraini, Chrisnawati, andWarjiman (2022) [17] in Indonesia, targeting 30 nursing students during clinical nursing training. To continue the training of those students, they used a simulation program that proved beneficial in reviewing the theories obtained previously (Table 2).

The study by Banjo-Ogunnowo and Chisholm (2022) [18] was conducted on nursing students who were developing their learning in the maternal–pediatric course. They used virtual learning as an alternative to clinical practice in hospital settings (Table 2).

The third study [19] analyzed was developed by a team of researchers from Germany. In this study, nursing students received the interprofessional COVID-19 substitution program (I-reCovEr) during clinical teaching in a pediatric setting (Table 2).

Another study included [20] was conducted in Columbia (U.S.A.) by Bradford et al. (2021) with midwifery and women's health nurse practitioner students. Synchronous and asynchronous simulation sessions were offered for their formative learning. These simulation opportunities served as valuable adjuncts to traditional learning and provided a level of experiences to students with unequal access and capability to engage in the clinical setting (Table 2).

In the study developed by Cowperthwait et al. (2021) [21], during clinical training in psychiatric mental health nursing, eighty senior undergraduate students were allocated to a simulation that replaced the physical clinical context. The main benefits emphasized by the students were the reflection developed during the simulation sessions, the opportunity to receive feedback, and the learning acquired through the observation of other colleagues in the interaction with the same patients (Table 2).

Fung et al. (2021) [22] conducted a study in Hong Kong with 188 final-year undergraduate nursing students. In this study, a virtual simulation educational program replaced

traditional clinical practice in medical and surgical cases with debriefing. In the students' perception, this educational program was beneficial in developing clinical competence and the nursing process. However, communication and critical thinking were better applied in the traditional clinical setting (Table 2).

In a study by Hassler et al. (2021) [23], flipped clinical practice was analysed through a synchronized remote clinical experience in one clinical specialty chosen by 98 s-year nursing students. Students emphasized that they saw the methodology as successful to reinforce clinical concepts to simulate the experiences of the traditional hospital setting's clinical training (Table 2).

Another study included in this scoping review and developed by Hwang and Chun (2021) [24] put into evidence the use of clinical practice education with virtual reality in the Republic of Korea (Table 2). Fifty-nine nursing students were divided into two groups. In this study, the experimental group was exposed to the vSim nursing program as an alternative practice to the traditional clinical practice using virtual reality. Their results showed positive benefits in clinical thinking and clinical practice performance but without wide statistical significance.

From the Republic of Korea arrived the study of Kim, Kang, and Gagne (2021) [25], which highlighted the use of a six step virtual simulation alternative program to the traditional nursing clinical practice (Table 2). The proposed six step virtual simulation alternative program evidenced the difficulties perceived by the students in using a nonnative language and the impact of the specific cultural differences shown in the scenarios. On the other hand, the developed confidence and competence in providing patient-centered care were shown as benefits of virtual simulation.

The study by Revell et al. (2022) [26] disclosed the results of supplementing the traditional clinical period with an 18-h simulated experiences pack (Table 2). The authors revealed the evidence of transformative learning expressed by students. The sample of undergraduate nursing students demonstrated an evident response to the change and challenges, discovering and developing other professional competencies and skills.

In 2020, Shea and Rovera [27] developed a study with two hundred and forty-four nursing students exposed to virtual and remote simulations as telehealth with standardized patients as an alternative of half of the clinical practice hours (Table 2). During the health emergency period and the university campus closure, every effort was needed to replace clinical practice hours and stop the interruption of the nursing graduation process with simulation activities in different clinical areas.

The last analyzed study, developed by Wands, Geller, and Hallman (2020) [28], presents to the scientific community a four-week simulation program with forty-two nursing students to substitute their in-person clinical experiences (Table 2). By using four free online simulation programs, logged over 1200 h, the students referred to experiencing positive growth in different professional competencies and skills despite difficulties when trying to manage multiple devices to access the virtual sessions and materials.

Our findings show that nursing schools made an effort to replace traditional clinical training with several activities, primarily based on simulation or virtual activities, allowing students to improve their abilities in caretaking [17,18,21,24,25,27,28]. Simulation sessions were structured in steps, with suggested reading, pre- and post-simulation quizzes, interactive clinical scenarios, and reflection [25,26]. They improved communication skills by role-playing, gaining experience in practical activities, and flipping clinical practice to replicate traditional care [17,20,23]. Scholarly journals were also proposed to enhance reflection and knowledge acquisition by virtual clinical practice [26].

After simulation sessions, debriefing moments were taken where simulation and case management were analyzed [18,22] or replaced by online seminars [26].

One of the included articles, Banjo-Ogunnowo and Chisholm (2022) [18], mention as a strategy the use of a virtual platform—the i-Human platform was widely used to assess case scenarios, including patient history, physical assessment, defining nursing diagnoses, and prioritizing interventions [18,29], although other virtual platforms were used by universities [30,31].

The primary contexts varied from maternal–pediatric [18,19,23,27], women's health [20], psychiatric mental health [21,23,27], medical–surgical health [22,26,27], adult health [23], nursing fundamentals/profession stage [17,27], and community health promotion and wellness reproductive health [27].
