Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis

The Metaverse: A New Challenge for the Healthcare System: A Scoping Review

(1) Background: The metaverse is now a reality, and it interests the scientific community, the educational setting, and medical care. Considering the number of people in front of screens, especially children and adolescents, the metaverse could and should become a place of health promotion. Consequently, the objective of the present study was to review the current literature to detect articles that connected the metaverse with prevention and treatment, education and training, and research setting. (2) Methods: Articles were searched on Pubmed, Web of Science, and Scopus, including English-written papers published until 12 August 2022. They were screened against the eligibility criteria and discussed narratively. (3) Results: The literature published is poor; only 21 articles were included, and 11 of them were added in a second moment. These articles were mainly reviews of the literature or editorials. The aspects related to this virtual world in terms of health prevention and the treatment of clinical conditions, education and training, and research have been narratively discussed. (4) Conclusions: The metaverse could be considered a useful instrument to arrive easily and quickly to the population. Given its importance, today, different studies and investments are required to develop proper health promotion programs that are feasible and valid in the metaverse.

Evaluation of nursing students' efficacy, attitude, and confidence level in a perioperative setting using virtual-reality simulation

AIMS

This study aimed to evaluate the efficacy, attitude, and level of confidence among nursing students as scrub nurses in a perioperative environment via virtual-reality simulation.

BACKGROUND

The advantages of virtual reality have been demonstrated to provide a safe and effective mechanism to educate and evaluate students' performances, but the use of virtual reality in perioperative nursing remained limited.

METHODS

Nineteen sessions were conducted in a room equipped with virtual-reality headsets and two touch controllers. The surgical workflow of a scrub nurse was developed based on qualitative perspectives from nursing faculties and hospital clinicians working in operating theaters. A survey on the efficacy, attitude, and level of confidence among the participants was conducted after the virtual-reality simulation.

RESULTS

Two hundred and seven nursing students due for their clinical posting in operating theaters completed the evaluation. More than 90% of them indicated "neutral" and above in terms of efficacy, attitude, and confidence level with Cronbach's α values exceeding .90.

CONCLUSIONS

Virtual reality offers promising potential as an alternative clinical experience to physical simulation for nursing students to increase their efficacy, attitude, and level of confidence as scrub nurses in a perioperative environment through a standardized scenario-based digital environment.

A study to investigate the effectiveness of the application of virtual reality technology in dental education

BACKGROUND

Today, the use of virtual reality (VR) technology as an educational tool in dental education has expanded considerably. This study was aimed to evaluate the effectiveness of using VR technology in teaching neutral zone and teeth arrangement.

METHODS

This randomized trial was conducted at Kermanshah University of Medical Sciences, Iran in 2019. The study sample consisted of 50 six-year dental students who were randomly divided into experimental (n = 25) and control (n = 25) groups. Students' performance in both groups was assessed using tests. A questionnaire was used to assess the usability of VR technology and students' satisfaction with it.

RESULTS

All faculty members confirmed the usability of VR technology in dental education. The majority of students (76%) were highly satisfied with the use of this technology in their learning process. The mean score of students was significantly higher in the experimental group (16.92 ± 1.12) than in the control group (16.14 ± 1.18).

CONCLUSION

In general, it can be argued that VR technology is useful and effective in the teaching-learning process. Therefore, its use in medical and dental schools can play an effective role in creating a dynamic, attractive, and successful learning environment.

Comparison of Standard Training to Virtual Reality Training in Nuclear Radiation Emergency Medical Rescue Education

OBJECTIVE

Due to the particularity of nuclear radiation emergencies, professional technical training is necessary. However, nuclear radiation emergency medical rescue nurses are not well prepared to respond in time. This study aims to explore the effect of virtual reality (VR) in training nurses for nuclear radiation emergency medical rescue.

METHODS

Thirty nurses who received traditional nuclear radiation rescue training from May 2020 to October 2020 were selected as the control group, and another 30 nurses who received VR nuclear radiation emergency medical rescue training from November 2020 to April 2021 were selected as the experimental group. The examination results, learning enthusiasm, training effect evaluation, and training satisfaction were compared between the 2 groups.

RESULTS

The experimental group had significantly higher examination score, learning enthusiasm, training effect evaluation, and training satisfaction than the control group (P < 0.05).

CONCLUSIONS

The application of VR in the training of nuclear radiation emergency medical rescue can improve the training performance, learning enthusiasm, training effect, and training satisfaction of trainees. Considering the advantages of VR, it could be widely used in the training of nuclear radiation emergency medical rescue in the future.

Learning effects of virtual versus high-fidelity simulations in nursing students: a crossover comparison

Background

Simulation is an alternative or complementary method for students who cannot obtain sufficient direct care experience, as they allow students to experience various clinical situations. Mixed learning is becoming increasingly common as a way to provide students with opportunities to experience real-life clinical scenarios. This study compared the learning effects of a virtual simulation and a high-fidelity simulation in a different order of presentation, with a focus on training for premature rupture of membranes in the field maternity nursing. Through this comparison, this study aimed to obtain evidence to support decision-making regarding the most effective way to utilize mixed simulation strategies.

Methods

A quasi-experimental, crossover-design study was performed with two randomly allocated groups of 26 junior nursing students each. The virtual simulation used the vSim® for nursing, and the high-fidelity simulation used a scenario developed by the research team. The learning effects were measured in terms of the problem-solving process, clinical reasoning, reflective thinking, satisfaction with the practicum, and self-confidence. The data collected with a structured questionnaire were analyzed using the Mann–Whitney test.

Results

The virtual simulation-first, high-fidelity simulation-second order led to significantly higher scores for reflective thinking (z = 3.53, p < .001) and self-confidence (z = 2.47, p = .013) than the other order.

Conclusions

The initial application of virtual simulation seemed to improve students’ thought processes, and then high-fidelity simulation seemed to allow them to perform actual practice better. Further trials of mixed learning methods are necessary to maximize learning effects in nursing education.

Trial registration

KCT0005767 at 2021–01-12 registered.

COVID-19: a catalyst for the digitization of surgical teaching at a German University Hospital

BACKGROUND

The summer semester 2020, had to be restructured due to the SARS-CoV-2 pandemic and the associated contact restrictions. Here, for the first time, the established lectures in lecture halls and small group seminars could not be conducted in presence as usual. A possible tool for the implementation of medical teaching, offers the use of eLearning, online webinars and learning platforms. At present it is unclear how the SARS-CoV-2 pandemic will affect surgical teaching, how digitization will be accepted by students, and how virtual teaching can be expanded in the future.

METHODS

The teaching, which was previously delivered purely through face-to-face lectures, was completely converted to digital media. For this purpose, all lectures were recorded and were available to students on demand. The seminars were held as a twice a week occurring online webinar. The block internship was also conducted as a daily online webinar and concluded with an online exam at the end. At the end of the semester, a survey of the students was carried out, which was answered by n = 192 students with an anonymized questionnaire. The questionnaire inquires about the previous and current experience with eLearning, as well as the possibility of a further development towards a purely digital university.

RESULTS

There were n = 192 students in the study population. For 88%, the conversion of classes to web-based lectures represented their first eLearning experience. For 77% of all students, the digitization of teaching led to a change in the way they prepare for class. 73% of the participating students are of the opinion that eLearning lectures should continue to be offered. 54% of the students felt that eLearning lectures made more sense than face-to-face lectures. A purely virtual university could be imagined by 41% of the students.

CONCLUSION

The conversion of teaching represented the first contact with eLearning for most students. Overall, the eLearning offering was experienced as positive. Due to the new teaching structure, the way of learning had already changed during the semester. Based on the new eLearning content, the already existing formats can be further expanded in the future. Nevertheless, it turned out that the practical-surgical contents and skills cannot be adequately represented by purely online offers; for this, the development of hybrid practice-oriented teaching concepts is necessary.

The Effectiveness of Learning to Use HMD-Based VR Technologies on Nursing Students: Chemoport Insertion Surgery

Background: The purpose of this study was to develop a mobile head mounted display (HMD)-based virtual reality (VR) nursing education program (VRP), and to evaluate the effects on knowledge, learning attitude, satisfaction with self-practice, and learning motivation in nursing students. Methods: This was a quasi-experimental study using a nonequivalent control group pretest-posttest design to evaluate the effects of HMD-based VRP on nursing students. A Chemoport insertion surgery nursing scenario was developed with HMD-based VRP. The experimental group consisting of 30 nursing students underwent pre-debriefing, followed by VRP using HMD and debriefing. The control group, consisting of 30 nursing students, underwent pre-debriefing, followed by self-learning using handouts about Chemoport insertion surgery procedures for 30 min, and debriefing. Results: The experimental group that underwent HMD-based VRP showed significantly improved post-intervention knowledge on operating nursing (p = 0.001), learning attitude (p = 0.002), and satisfaction (p = 0.017) compared to the control group. Sub-domains of motivation, attention (p < 0.05), and relevance (p < 0.05) were significantly different between the two groups, post-intervention. Conclusions: HMD-based VRP of Chemoport insertion surgery is expected to contribute to knowledge, learning attitude, satisfaction, attention, and relevance in nursing students.

Using virtual simulation to teach evidence-based practice in nursing curricula: A rapid review

BACKGROUND

Virtual simulation is an interactive teaching and learning strategy used in undergraduate nursing student education, especially since the onset of the COVID-19 pandemic. Few published studies have reviewed the impact of virtual simulation as a strategy for teaching nursing students the elements of evidence-based practice.

AIM

To describe types of virtual simulation that are relevant to nursing student education and examine how these modalities are applied to teach elements of evidence-based practice.

METHODS

A rapid review of literature was conducted to discern the use and impact of virtual simulation. Thirty-seven studies published between 2017 and May 2021 that addressed nursing students' educational outcomes were reviewed and summarized as a narrative analysis.

RESULTS

Virtual simulation and virtual reality simulation engage learners in role-plays via a computer screen or hand-held phone. Various levels of realism and immersion were apparent across different modalities and with the utilization of educational games. Most studies related to the teaching of best practice evidence-based clinical nursing topics. Twenty primary studies reported objective measures of students' improvement such as knowledge, performance, better documentation, or communication accuracy. Sixteen studies that measured knowledge identified significant knowledge gains. All studies endorsed virtual simulation as a teaching method.

LINKING EVIDENCE TO ACTION

Virtual simulation approaches offer an innovative and feasible option for teaching nursing students. Such approaches should be included in undergraduate nursing curricula. While it is apparent that evidence-based practice guidelines inform the design of the virtual simulation scenarios, the effectiveness of the modality for teaching specific elements of evidence-based practice to nursing students is not yet confirmed. Nursing curricula need to include ways of teaching nursing students to search for and critically appraise trustworthy sources of knowledge for clinical practice.

Learning Outcomes of Immersive Technologies in Health Care Student Education: Systematic Review of the Literature

BACKGROUND

There is a lack of evidence in the literature regarding the learning outcomes of immersive technologies as educational tools for teaching university-level health care students.

OBJECTIVE

The aim of this review is to assess the learning outcomes of immersive technologies compared with traditional learning modalities with regard to knowledge and the participants' learning experience in medical, midwifery, and nursing preclinical university education.

METHODS

A systematic review was conducted according to the Cochrane Collaboration guidelines. Randomized controlled trials comparing traditional learning methods with virtual, augmented, or mixed reality for the education of medicine, nursing, or midwifery students were evaluated. The identified studies were screened by 2 authors independently. Disagreements were discussed with a third reviewer. The quality of evidence was assessed using the Medical Education Research Study Quality Instrument (MERSQI). The review protocol was registered with PROSPERO (International Prospective Register of Systematic Reviews) in April 2020.

RESULTS

Of 15,627 studies, 29 (0.19%) randomized controlled trials (N=2722 students) were included and evaluated using the MERSQI tool. Knowledge gain was found to be equal when immersive technologies were compared with traditional learning modalities; however, the learning experience increased with immersive technologies. The mean MERSQI score was 12.64 (SD 1.6), the median was 12.50, and the mode was 13.50. Immersive technology was predominantly used to teach clinical skills (15/29, 52%), and virtual reality (22/29, 76%) was the most commonly used form of immersive technology. Knowledge was the primary outcome in 97% (28/29) of studies. Approximately 66% (19/29) of studies used validated instruments and scales to assess secondary learning outcomes, including satisfaction, self-efficacy, engagement, and perceptions of the learning experience. Of the 29 studies, 19 (66%) included medical students (1706/2722, 62.67%), 8 (28%) included nursing students (727/2722, 26.71%), and 2 (7%) included both medical and nursing students (289/2722, 10.62%). There were no studies involving midwifery students. The studies were based on the following disciplines: anatomy, basic clinical skills and history-taking skills, neurology, respiratory medicine, acute medicine, dermatology, communication skills, internal medicine, and emergency medicine.

CONCLUSIONS

Virtual, augmented, and mixed reality play an important role in the education of preclinical medical and nursing university students. When compared with traditional educational modalities, the learning gain is equal with immersive technologies. Learning outcomes such as student satisfaction, self-efficacy, and engagement all increase with the use of immersive technology, suggesting that it is an optimal tool for education.

Factors affecting the future employment of new graduate nurses as home-visiting nurses: a cross-sectional study in Japan

Objective: In Japan, home-visiting nurse (HVN) stations are at the frontline of providing home-based medical care and end-of-life care. The nursing authorities aim to establish an education program that allows new graduate nurses to become home-visiting nurses. However, previous studies have indicated gaps in education between new graduates recently employed as HVNs and experienced home-visiting nurses. The present study further investigates the factors influencing the recruitment of new graduates as home-visiting nurses. Methods: Self-administered questionnaires were sent to 2,000 HVN stations randomly selected from the 5,565 registered home-visiting nurse stations throughout Japan. The survey covered three main areas, namely, those concerning the respondent (6 items), the home-visiting nurse station (8 items), and the nursing services provided (12 items). Results: Four of the 26 items were statistically significant, and only one of these was determined by multivariate logistic regression analysis to be an independent factor for accepting new graduates as home-visiting nurses. This factor was undergraduate home-visiting nurse training for student nurses (OR=1.916, CI=1.124-3.267). Conclusion: To increase the recruitment of new graduates as home-visiting nurses, these findings suggest that nursing schools nationwide and home-visiting nurse stations should further cooperate with the specific aim of increasing the provision of practical training at home-visiting nurse stations for pre-graduation student nurses.

Where's the germs? The effects of using virtual reality on nursing students' hospital infection prevention during the COVID-19 pandemic

BACKGROUND

Virtual reality can be a useful substitute to improve nursing education outside of the hospital setting. In the wake of COVID-19, an opportunity to compare a virtual reality activity for nursing students in the traditional classroom and in an online environment took place.

OBJECTIVES

The goal of this study was to examine the effects of incorporating a virtual reality activity into the traditional classroom and in an online environment to enhance nursing education.

METHODS

Fifty nursing students participated in an exploratory descriptive study. Twenty-five students participated face-to-face while in the traditional classroom setting and 25-students participated in an online environment using a communication platform. Through a virtual reality activity, nursing students successfully created a tour which demonstrated identifying infectious sites in a hospital room setting.

RESULTS AND CONCLUSIONS

Results of the pre-and post-test showed students' positive perceptions and performances in both traditional classroom and online settings. However, the study revealed a statistical difference between the two group perceptions towards the use of the virtual reality tour creator. Nursing students who were in the traditional classroom group found that the use the virtual reality tour creator was easier.

IMPLICATIONS

Designing a meaningful virtual reality activity has a positive impact of the student learning experience. Students may benefit from a more through orientation to the technology prior to engaging in the activity. A carefully constructed activity can enhance student learning outside of the hospital room.

Development and evaluation of virtual reality simulation education based on coronavirus disease 2019 scenario for nursing students: A pilot study

Aim

This research is designed to establish and evaluate the effectiveness of a virtual reality simulation program using COVID‐19 scenario for nursing students.

Design

This is a quasi‐experimental study using a non‐equivalent control group pre‐test‐posttest design.

Methods

The participants were 65 students in their fourth year in nursing college. The knowledge about communicable infectious diseases in the respiratory system, self‐efficacy, clinical reasoning capacity and learning satisfaction was evaluated.

Results

The experimental group showed a significantly higher learning satisfaction (t = 3.01, p = .004). Both groups presented statistically significant differences in knowledge on infectious respiratory diseases, self‐efficacy and clinical reasoning between pre‐test and posttest. However, knowledge (t = 0.47, p = .643), self‐efficacy (t = 0.70, p = .944) and clinical reasoning were not different between the groups.

Effects of a Patient Experience-Based Virtual Reality Blended Learning Program on Nursing Students

When provided with opportunities to view the world from the patients' perspective, nursing students can experience the same practical occurrences and feelings that patients encounter, consequently becoming more aware of their discomfort and pain. This study aimed to evaluate the performance of the patient experience virtual reality blended learning program developed for nursing students. This study is significant in that it presents a program that enables nursing students to not only experience being perioperative patients themselves but also experience their conditions in places other than hospitals, which are generally used as training locations. The analytical results of this study indicated that nursing students who virtually experienced the conditions of perioperative patients through virtual reality blended learning showed increased levels of empathy, positive attitudes toward patient safety treatment, confidence in nursing care, and clinical skill performance. The developed program in this study blended various teaching methods with a virtual reality platform to help junior nursing students with practical and effective perioperative training increase their levels of empathy by simulating the experiences and perspectives of perioperative patients.

Effects of Virtual Reality Training on Upper Limb Function and Balance in Stroke Patients: Systematic Review and Meta-Meta-Analysis

Background

Virtual reality (VR) training is a promising intervention strategy that has been utilized in health care fields like stroke rehabilitation and psychotherapy. Current studies suggest that VR training is effective in improving the locomotor ability of stroke patients.

Objective

This is the first meta-meta-analysis of the effects of VR on motor function in stroke patients. This study aimed to systematically summarize and quantify the present meta-analyses results of VR training and produce high-quality meta-meta-analysis results to obtain a more accurate prediction.

Methods

We searched 4 online databases (Web of Science, Scopus, PubMed, and Chinese National Knowledge Infrastructure) for meta-analysis studies. After accounting for overlap, 10 studies (accounting for almost 550 stroke patients) were obtained. Based on the meta-meta-analysis of these patients, this study quantified the impact of VR training on stroke patients’ motor performance, mainly including upper limb function, balance, and walking ability. We combined the effects under the random effect model and pooled the estimates as standardized mean differences (SMD).

Results

The results of the meta-meta-analysis showed that VR training effectively improves upper limb function (SMD 4.606, 95% CI 2.733-6.479, P<.05) and balance (SMD 2.101, 95% CI 0.202-4.000, P<.05) of stroke patients. However, the results showed considerable heterogeneity and thus, may need to be treated with caution. Due to the limited research, a meta-meta-analysis of walking ability was not performed.

Conclusions

These findings represent a comprehensive body of high-quality evidence that VR training is more effective at improving upper limb function and balance of stroke patients.

Use of Computer-Based Scenarios for Clinical Teaching: Impact on Nursing Students' Decision-Making Skills

Computer-based learning has numerous advantages. It gives students the chance to accommodate and solve problems independently, it can increase motivation during the learning process, and it offers students direct feedback. Students will also receive an authentic learning experience, increasing their level of knowledge retention. It can assist nursing educators in improving learning outcomes. Aim: This study aimed to investigate and evaluate the impact of computer-based scenarios on undergraduate nursing students’ decision-making skills. Sample: There was a total sample of 112 nursing students who were enrolled in a critical care nursing course at the College of Applied Medical Sciences in Saudi Arabia. These students were divided into two groups. Methods: The two groups were taught the same topic for one week. Two case scenarios were given to each group during the clinical rotation. The study group used the computer-based case scenario, and the control group used the paper-based case scenario. The two groups were compared regarding their decision-making skills. The student’s feedback about the computer-based case scenarios was also investigated. Results: The study group scored significantly higher in their decision-making skills when compared to the control group. In addition, the study group reported that they highly agreed that their general learning and specific nursing abilities improved after using computer-based case scenarios.

The Effectiveness of Using Augmented Reality for Training in the Medical Professions: A Meta Analysis (Preprint)

Background

Augmented reality (AR) is an interactive technology that uses persuasive digital data and real-world surroundings to expand the user's reality, wherein objects are produced by various computer applications. It constitutes a novel advancement in medical care, education, and training.

Objective

The aim of this work was to assess how effective AR is in training medical students when compared to other educational methods in terms of skills, knowledge, confidence, performance time, and satisfaction.

Methods

We performed a meta-analysis on the effectiveness of AR in medical training that was constructed by using the Cochrane methodology. A web-based literature search was performed by using the Cochrane Library, Web of Science, PubMed, and Embase databases to find studies that recorded the effect of AR in medical training up to April 2021. The quality of the selected studies was assessed by following the Cochrane criteria for risk of bias evaluations.

Results

In total, 13 studies with a total of 654 participants were included in the meta-analysis. The findings showed that using AR in training can improve participants' performance time (I²=99.9%; P<.001), confidence (I²=97.7%; P=.02), and satisfaction (I²=99.8%; P=.006) more than what occurs under control conditions. Further, AR did not have any effect on the participants’ knowledge (I²=99.4%; P=.90) and skills (I²=97.5%; P=.10). The meta-regression plot shows that there has been an increase in the number of articles discussing AR over the years and that there is no publication bias in the studies used for the meta-analysis.

Conclusions

The findings of this work suggest that AR can effectively improve performance time, satisfaction, and confidence in medical training but is not very effective in areas such as knowledge and skill. Therefore, more AR technologies should be implemented in the field of medical training and education. However, to confirm these findings, more meticulous research with more participants is needed.

Effectiveness of simulation-based peripheral intravenous catheterization training for nursing students and hospital nurses: A systematic review and meta-analysis

BACKGROUND

Peripheral intravenous catheterisation (PIVC) is a complex procedure.

AIM

This study reviewed studies evaluating the effects of different simulators in comparison with traditional methods used in PIVC training for nursing students and hospital nurses.

DESIGN

A systematic review and meta-analysis of randomised (RCT) and non-randomised controlled (N-RCT) studies.

METHODS

MEDLINE, Cochrane, Scopus, ERIC, Web of Science, and ScienceDirect were searched using PIVC, simulation and nursing education. The quality of evidence was assessed using the GRADE system; the risk of bias was assessed using the RoB 2 (for RCTs) and A Cochrane Risk of Bias Assessment Tool for N-RCTs. The study was conducted as per the PRISMA guidelines.

RESULTS

In total, 2,812 records were identified, and 12 studies published between 2002 and 2018 were finally included. Most studies included Virtual IV simulator and the plastic IV arm model in PIVC training for hospital nurses and nursing students, reported on outcomes such as PIVC-related knowledge, skills, confidence, state/trait anxiety and satisfaction. Seven studies were included in the meta-analysis, the effect sizes for all the outcomes ranged from small to moderate. However, the effect sizes were non-significant for all outcomes. The quality of evidence was assessed as being low for skills, knowledge, satisfaction, and trait/state anxiety, and moderate for confidence.

CONCLUSIONS

The effect of Virtual IV training on PIVC-related skills, knowledge, satisfaction and anxiety among nursing students and hospital nurses, in comparison with the plastic arm training method, remains unclear. However, Virtual IV training was found to increase PIVC confidence.

RELEVANCE TO CLINICAL PRACTICE

There is a small effect in favour of VR in PIVC education although non-significant. More evidence is needed to determine the superiority of simulation methods. In PIVC training of nurses and nursing students, hospitals and schools can choose a method in accordance with their resources.

TRIAL REGISTRATION

PROSPERO 2019 CRD42019124599.

Nursing Students' Perceptions and Experiences of Using Virtual Simulation During the COVID-19 Pandemic

Background

This study aimed to understand prelicensure nursing students’ perceptions and experiences of using virtual simulation as an alternative to clinical practice during the coronavirus 2019 (COVID-19) pandemic in South Korea.

Methods

A total of 20 students from a 4-year baccalaureate nursing program participated in this descriptive qualitative study. Six focus group interviews using Zoom video communications were conducted with three to four participants to understand their experiences. Data were analyzed using an inductive content analysis approach.

Results

The following three major themes emerged: (a) difficulties encountered in using virtual simulation, (b) benefits to student confidence and competence to provide patient-centered care, and (c) gaps in satisfaction due to needed improvements.

Conclusions

Virtual simulation could be beneficial for improving prelicensure nursing students’ confidence and competence; however, improvements to virtual simulation realism and engagement are needed to maximize user satisfaction and performance.

The effectiveness of virtual reality simulation as learning strategy in the acquisition of medical skills in nursing education: a systematic review

PURPOSE

This review was aimed to evaluate the effectiveness of virtual reality simulation as a teaching / learning strategy on the acquisition of clinical skills and performance, self-confidence, satisfaction and anxiety level in nursing education.

METHODOLOGY

The Preferred Reporting Items for Systematic Reviews guidelines, using the PICO model that is based on an evidence-based practice process was matched. A total of twenty-three studies included six themes: performance skills (n = 13), self-confidence (n = 8), satisfaction (n = 10), anxiety level (n = 3), self-efficacy (n = 4), and knowledge (n = 15). Experimental randomised control trials and quasi-experimental studies from 2009 to 2019, conducted in English, were included. Nursing students (n = 1797; BSN, ADN, MSc, LPN) participated.

RESULTS AND CONCLUSION

This review was indicated that virtual reality simulation provides learning strategy to acquire clinical skills, improve knowledge acquisition, increase self-confidence, self-efficacy, and satisfaction level, and decrease anxiety levels among nursing students.

Virtual Experience of Perioperative Patients: Walking in the Patients' Shoes Using Virtual Reality and Blended Learning

PURPOSE

This study examined the significance, nature, and structure of the virtual experience of perioperative patients as undergone by nursing students during their practical training through VR and blended learning.

METHODS

Data were collected through a focus group interview (FGI) of 21 nursing student participants from November 2019 to December 2019 and analyzed through Colaizzi's phenomenological method.

RESULTS

Seven theme clusters were organized that described nursing students' experiences. They are "placed in a passive position," "facing the limits of communication," "thinking of developing and improving competency as a nurse," "recognizing the importance of interacting with their patients", "learning vividly through experience", "engaging in a new type of participatory learning", and "designing nursing knowledge."

CONCLUSION

Patient-centered care can be achieved in the nursing school curriculum through "patient experiences." Additionally, the feedback from research participants who have "become keenly aware of the need for patient experiences" shows that empathizing with the "patient experience" is an essential quality to acquire by prospective medical professionals before they are introduced to the nursing field. We suggest future studies that expand on nursing students' patient experience in various teaching methods and curriculums.

Virtual reality simulations in nurse education: A systematic mapping review

OBJECTIVES

Simulation-based learning is widely used in nurse education, including virtual reality (VR) methods which have experienced a major growth lately. Virtual reality offers risk free and contactless learning. Currently, little is known about what topics of nursing are adopted for VR simulations and how their design meets various educational goals. This review aims to scope existing articles on educational VR nursing simulations, and to analyse approaches from didactic and technical perspectives.

METHOD

A systematic mapping review following the PRISMA-ScR guideline and PICo search strategy was conducted. Peer reviewed articles in English and German were searched across Scopus, CINAHL, PsycINFO, PSYNDEX, PsycARTICLES, PubMed, ERIC and The Cochrane Library. Studies had to include at least one immersive head-mounted display VR simulation in the field of nursing education. Data extraction and analysis was performed in a narrative, graphical and tabular way.

RESULTS

Twenty-two articles were identified. There is a large variety in the use and definition of VR simulation for educational purposes. Simulations were classified into four main educational objectives: procedural skills training to improve technical knowledge and proficiency; emergency response training that focusses on confidence; soft skills training that teaches empathy; and finally, psychomotor skills training. Various approaches and simulation designs were implemented to achieve these educational outcomes. A few of them were highly innovative in providing an immersive experience to learn complex tasks, e.g. auscultation, or foster empathy by mimicking life with dementia.

CONCLUSIONS

Despite an increase in the use of state-of-the-art VR nursing simulations, there is still a paucity of studies on immersive HMD based VR scenarios. Researchers designing educational VR packages need to be clear on terminology. In order to make full use of VR, designers should consider including haptic devices to practise psychomotor skills and include social interaction to teach soft skills.

Training situational awareness for scrub nurses: Error recognition in a virtual operating room

Virtual reality simulation provides interesting opportunities to train nurses in a safe environment. While the virtual operating room has proven to be a useful training tool for technical skills, it has been less studied for non-technical skills. This study aimed to assess "Error recognition in a virtual operating room", using a simulation scenario designed to improve situation awareness. Eighteen scrub-nurse students and 8 expert scrub-nurses took part in the experiment. They were immersed in a virtual operating room and reported any errors they observed. There were nineteen errors with various degrees of severity. Measures were retrieved from logs (number of errors, time for detection, movements) and from questionnaires (situation awareness, subjective workload, anxiety and user experience). The results showed that the participants who detected most errors had a higher level of situation awareness, detected high-risk errors faster and felt more immersed in the virtual operating room than those detecting fewer errors. They also felt the workload was lighter and experienced more satisfaction. Students explored the operating room more than experts did and detected more errors, especially those with moderate risk. Debriefings confirmed that virtual simulation is acceptable to trainees and motivates them. It also provides useful and original material for debriefings.

Use of artificial intelligence and virtual reality within clinical simulation for nursing pain education: A scoping review

OBJECTIVES

To explore and map the evidence for virtual reality and artificial intelligence in simulation for the provision of pain education for pre and post registration nurses.

DESIGN

A scoping review of published and unpublished research from 2009 to 2019.

DATA SOURCES

Nine electronic databases and hand-searching of reference lists.

REVIEW METHODS

Studies were included if virtual reality or artificial intelligence interventions were used for education on pain care provision in nursing. Data were extracted and charted using an extraction tool and themes were explored using narrative analysis.

RESULTS

The review process resulted in the inclusion of four published studies. All studies used mixed methods and used artificial intelligence within clinical simulations as an intervention. No studies using virtual reality for pain education met the inclusion criteria. Participants of three studies were undergraduate nursing students in universities and participants in the fourth study were registered nurses within a hospital. Outcomes measured were user acceptance of the technology and feasibility in all studies. The context was hospital located and focused on acute pain episodes, with one exception being sickle cell pain. Three studies had adult patients and the other pediatric patients. The exclusion of input from a patient perspective was notable, as was a lack of interdisciplinary involvement.

CONCLUSION

Nurses are integral to the assessment and management of pain in many care settings requiring comprehensive communication and clinical skills. There is a paucity of research on the use of virtual reality or artificial intelligence in pain education for nurses. Current studies are preliminary in nature and/or pilot studies. Further empirical research, with robust design is required to inform nursing education, practice, and policy, thereby supporting the advancement of nursing pain education.

Role of Three-Dimensional Visualization Modalities in Medical Education

For the past two decades, slide-based presentation has been the method of content delivery in medical education. In recent years, other teaching modalities involving three-dimensional (3D) visualization such as 3D printed anatomical models, virtual reality (VR), and augmented reality (AR) have been explored to augment the education experience. This review article will analyze the use of slide-based presentation, 3D printed anatomical models, AR, and VR technologies in medical education, including their benefits and limitations.