{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T20:55:02Z","timestamp":1791233702071,"version":"4.1.0"},"reference-count":28,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Nursing"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Interest in physical AI and robotics in health care is increasing, but the nursing literature shows that the evidence base remains early, nurse-centered applications are underdeveloped, and real-world experiential evidence is limited. Nurses are more likely to accept robots that reduce physically demanding and repetitive work while preserving the interpersonal and judgment-intensive core of nursing practice. This conceptual paper proposes a nursing-centered framework in which virtual reality functions not merely as a simulator but as a scaffolded training infrastructure for supportive physical AI systems, enabling nurse augmentation, site-specific adaptation through digital twins, and staged simulation-to-real transfer. The framework was developed through a conceptually integrative and implementation-aware synthesis drawing on nursing robotics, AI in nursing, immersive simulation, digital twins, human-in-the-loop learning, and physical AI development literature. It is organized around 5 linked elements and supported by a 4-layer technical architecture that outlines functional requirements and implementation pathways. Four key propositions ground the framework: (1) nursing robot training should focus on competency formation, not on decontextualized data accumulation; (2) training should proceed through progressive fidelity and staged autonomy; (3) digital twins should function as operational bridges for local ward adaptation; and (4) simulation-to-real transfer should be governed by explicit nursing-relevant validation criteria and retained human accountability. The proposed nurse-in-the-loop, site-specific virtual reality framework offers a nursing-centered complement to general-purpose physical AI pipelines by making workflow fit, role boundaries, local adaptation, and governed transfer explicit design requirements.<\/jats:p>","DOI":"10.2196\/96848","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T22:15:07Z","timestamp":1785276907000},"page":"e96848-e96848","source":"Crossref","is-referenced-by-count":0,"title":["Virtual Reality\u2013Enabled Physical AI Training for Supportive Nursing Robotics: Nurse-in-the-Loop, Site-Specific Conceptual Framework"],"prefix":"10.2196","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1254-2056","authenticated-orcid":false,"given":"Seungman","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"R1","doi-asserted-by":"publisher","DOI":"10.3389\/frobt.2024.1398140","article-title":"A systematic review of collaborative robots for nurses: where are we now, and where is the evidence?","volume":"11","author":"Babalola","journal-title":"Front Robot AI"},{"issue":"1","key":"R2","doi-asserted-by":"publisher","DOI":"10.1186\/s12912-025-02842-2","article-title":"Utilisation of robots in nursing practice: an umbrella review","volume":"24","author":"Adeyemo","journal-title":"BMC Nurs"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"102495","DOI":"10.1016\/j.outlook.2025.102495","article-title":"Physical artificial intelligence in nursing: robotics","volume":"73","author":"Shaw","journal-title":"Nurs Outlook"},{"key":"R4","doi-asserted-by":"publisher","DOI":"10.1016\/j.nepr.2025.104542","article-title":"Nurses\u2019 perceptions of artificial intelligence adoption in healthcare: a qualitative systematic review","volume":"88","author":"Joo","journal-title":"Nurse Educ Pract"},{"key":"R5","doi-asserted-by":"publisher","DOI":"10.2196\/69881","article-title":"The role of AI in nursing education and practice: umbrella review","volume":"27","author":"El Arab","journal-title":"J Med Internet Res"},{"key":"R6","doi-asserted-by":"publisher","DOI":"10.2196\/63335","article-title":"Examining the role of AI in changing the role of nurses in patient care: systematic review","volume":"8","author":"Al Khatib","journal-title":"JMIR Nurs"},{"key":"R7","doi-asserted-by":"publisher","DOI":"10.2196\/58629","article-title":"Nursing staff\u2019s perspectives of care robots for assisted living facilities: systematic literature review","volume":"7","author":"Trainum","journal-title":"JMIR Aging"},{"issue":"1-2","key":"R8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1561\/2300000072","article-title":"Interactive imitation learning in robotics: a survey","volume":"10","author":"Celemin","journal-title":"Found Trends Robot"},{"issue":"8031","key":"R9","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1038\/s41586-024-07697-2","article-title":"On human-in-the-loop optimization of human-robot interaction","volume":"633","author":"Slade","journal-title":"Nature"},{"issue":"2","key":"R10","doi-asserted-by":"publisher","first-page":"89","DOI":"10.1111\/j.1469-7610.1976.tb00381.x","article-title":"The role of tutoring in problem solving","volume":"17","author":"Wood","journal-title":"J Child Psychol Psychiatry"},{"issue":"1","key":"R11","doi-asserted-by":"publisher","DOI":"10.2196\/12959","article-title":"Virtual reality for health professions education: systematic review and meta-analysis by the Digital Health Education Collaboration","volume":"21","author":"Kyaw","journal-title":"J Med Internet Res"},{"issue":"1","key":"R12","doi-asserted-by":"publisher","DOI":"10.1186\/s12909-023-04662-x","article-title":"Effectiveness of virtual reality in nursing education: a systematic review and meta-analysis","volume":"23","author":"Liu","journal-title":"BMC Med Educ"},{"key":"R13","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2024.1351300","article-title":"Enhancing nursing competency through virtual reality simulation among nursing students: a systematic review and meta-analysis","volume":"11","author":"Cho","journal-title":"Front Med (Lausanne)"},{"key":"R14","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2025.106725","article-title":"Effectiveness of immersive virtual reality in nursing education for nursing students and nursing staffs: a systematic review and meta-analysis","volume":"151","author":"Hsieh","journal-title":"Nurse Educ Today"},{"key":"R15","unstructured":"National Academies of Sciences, Engineering, and Medicine. 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