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

A 3-D interactive microbiology laboratory via virtual reality for enhancing practical skills

Virtual Reality (VR) laboratories are a new pedagogical approach to support psychomotor skills development in undergraduate programmes to achieve practical competency. VR laboratories are successfully used to carry out virtual experiments in science courses and for clinical skills training in professional courses. This paper describes the development and evaluation of a VR-based microbiology laboratory on Head-Mounted Display (HMD) for undergraduate students. Student and faculty perceptions and expectations were collected to incorporate into the laboratory design. An interactive 3-dimensional VR laboratory with a 360° view was developed simulating our physical laboratory setup. The laboratory environment was created using Unity with the (created) necessary assets and 3D models. The virtual laboratory was designed to replicate the physical laboratory environment as suggested by the students and faculty. In this VR laboratory, six microbiology experiments on Gram staining, bacterial streaking, bacterial motility, catalase test, oxidase test and biochemical tests were placed on the virtual platform. First-year biomedical science students were recruited to evaluate the VR laboratory. Students' perception of the virtual laboratory was positive and encouraging. About 70% of the students expressed they felt safe using the VR laboratory and that it was engaging. They felt that the VR laboratory provided an immersive learning experience. They appreciated that they could repeat each experiment multiple times without worrying about mistakes or mishaps. They could personalise their learning by concentrating on the specific experiments. Our in-house VR-based microbiology laboratory was later extended to other health professions programmes teaching microbiology.

Virtual Reality Simulation in a Health Assessment Laboratory Course: A Mixed-methods Explanatory Study Examining Student Satisfaction and Self-confidence

BACKGROUND

The purpose of this mixed-methods study was to examine the relationship between virtual reality simulation (VRS) and student satisfaction and self-confidence in a health assessment laboratory course.

METHODS

Second-year students (n = 37) completed a postoperative respiratory distress scenario using Elsevier's Simulation Learning System with Virtual Reality. All participants completed the Satisfaction and Self-Confidence in Learning Scale; a subset participated in 1:1 semistructured interviews.

RESULTS

Satisfaction and self-confidence scores were strongly correlated. VRS experiences of fidelity, communication confidence and competence, learning with peers, integrated learning and critical thinking, and a safe space to learn were related to students' satisfaction and self-confidence.

CONCLUSIONS

VRS experiences are correlated with high student satisfaction and self-confidence.

Assessing the virtual reality perspectives and self-directed learning skills of nursing students: A machine learning-enhanced approach

AIM

This study aims to investigate nursing students' perspectives on virtual reality technologies and their self-directed learning skills, specifically focusing on how these variables interact and influence each other in the context of nursing education. We also discern potential disparities in these skills based on descriptive characteristics, using both traditional statistical and advanced machine learning approaches for a comprehensive analysis.

BACKGROUND

Rapid developments in technology, particularly during the Covid-19 pandemic, have brought virtual reality technologies to the forefront of nursing education. However, there is a gap in understanding how nursing students' perceptions of these technological relate to their development of self-directed learning skills.

DESIGN

A descriptive and cross-sectional study design is employed to both quantify nursing students' perspectives on virtual reality in their education and assess their self-directed learning skills. This approach integrates traditional statistical methods with advanced machine learning techniques, with the intention of offering a comprehensive and nuanced analysis to inform future teaching strategies in nursing.

METHODS

The study used a blend of survey scales and a tree-based machine learning model to measure and analyze nursing students' views, attitudes and self-directed learning levels. This dual approach allows for a more detailed assessment of the factors influencing self-directed learning abilities. Traditional statistical techniques were also applied to assess the reliability of the machine learning findings.

RESULTS

Findings reveal that nursing students generally held positive views towards virtual reality technologies and exhibited a high level of self-directed learning skills. Notable differences in self-directed learning skills were influenced by gender on the overall scale (p <0.001), with male students scoring higher than their female counterparts in both specific sub-dimensions and on the overall scale, but not by academic year. The machine learning analysis provided deeper insights into these variations, highlighting subtle distinctions in student demographics that traditional statistical methods did not fully capture.

CONCLUSIONS

The study offers valuable insights into interconnected nature of nursing students' views on virtual reality technologies and their self-directed learning skills. The results support the integration of virtual reality in nursing curriculum programs and underscore the importance of customizing teaching strategies based on insights gained from machine learning analyses. This approach has the potential to substantially improve both the learning experience and the overall quality of nursing education.

Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial

BACKGROUND

Nurse-administered blood transfusion (BT) is a common form of medical treatment, but nursing students are often excluded from participating in and observing BTs during clinical placements. To address clinical placement limitations, nursing educators have increasingly adopted technology-guided simulation pedagogies, including virtual reality (VR) simulation, for nursing students' clinical skills education.

OBJECTIVES

To develop VR simulation for BT practice and investigate its effectiveness with nursing students.

DESIGN

A single-blinded, two-arm randomised controlled trial.

SETTINGS

One university in Hong Kong.

PARTICIPANTS

A total of 151 nursing students enrolled in a nursing undergraduate course at a university in Hong Kong were recruited via convenience sampling in March 2022.

METHODS

Evidence-based VR simulation videos consisting of 1) animated blood formation physiology and side effects of BT and 2) 360° BT nursing practice were developed. The nursing students were randomly allocated into intervention and control groups. The intervention group (n = 75) received the usual BT education (i.e. Zoom lecture) with the developed VR video education, whereas the control group (n = 76) received the usual BT education (Zoom). The BT knowledge (RBTKQ-O), student satisfaction and self-confidence (SSSC) and self-efficacy (GSES) of BT practice were measured before and after BT education. Intention-to-treat analyses were performed.

RESULTS

The primary and secondary outcomes (RBTKQ-O, SSCS and GSES, respectively) improved over time in both groups. Analysis of covariance revealed that students who received VR simulation reported higher post-intervention measurement scores in BT knowledge and SSCS than those who did not receive VR simulation.

CONCLUSIONS

VR simulation-enhanced BT education effectively enhances the knowledge and SSCS of BT practice amongst nursing students. Nurse educators may adopt VR simulation to enhance the effectiveness of existing BT education for nursing students.

Practical infection control training for Victoria's aged care workforce at the time of COVID-19 pandemic: a community case study

The need to improve career development and training for residential aged care workers in Australia to achieve required essential competencies, including infection prevention and control competencies, has been repeatedly highlighted. In Australia long-term care settings for older adults are known as residential aged care facilities (RACFs). The COVID-19 pandemic has brought to light the lack of preparedness of the aged care sector to respond to emergencies, and the urgent need to improve the infection prevention and control training in residential aged care facilities. The government in the Australian State of Victoria allocated funds to support older Australians in RACFs, including funds toward infection prevention and control training of RACF staff. The School of Nursing and Midwifery at Monash University addressed some of these challenges in delivering an education program on effective infection prevention and control practices to the RACF workforce in Victoria, Australia. This was the largest state-funded program delivered to RACF workers to date in the State of Victoria. The aim of this paper is to provide a community case study, where we share our experience of program planning and implementation during early stages of the COVID-19 pandemic and lessons learned.

The Use of Metaverse in Nursing Education: An Umbrella Review

BACKGROUND

Given the wide range of metaverse technologies, there is a need to synthesize evidence of metaverse pedagogy used effectively for nursing education.

PURPOSE

This umbrella review synthesized systematic reviews on the use of metaverse in nursing education.

METHODS

A search was performed in MEDLINE, EMBASE, CINAHL, Web of Science, and Education Full Text. This umbrella review was conducted with reference to the Joanna Briggs Institute (JBI) Reviewer's Manual and reported using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The JBI Critical Appraisal Checklist for Systematic Review was used to assess the quality of studies.

RESULTS

The final review comprised 15 articles published between 2013 and 2021, most of which indicate that metaverse interventions support increased knowledge, self-confidence, engagement, satisfaction, and performance in nursing students. Several articles in this review presented mixed findings related to certain learning outcomes.

CONCLUSION

This umbrella review supports the viability and effectiveness of metaverse in nursing education.

Exploring the Development of Nursing Clinical Judgment Among Students Using Virtual Reality Simulation

BACKGROUND

Virtual reality simulation (VRS) is an emerging pedagogy in nursing education.

PURPOSE

The purpose of this qualitative exploratory study was 2-fold: to determine nursing students' learning experiences when engaged in VRS, and to explore learners' problem-solving/clinical reasoning approach after participation in a VRS clinical scenario. This article reports student descriptions of clinical reasoning/clinical judgment when considering their VRS experience.

METHODS

Qualitative description provided a methodological orientation for the study. Widely accepted frameworks for nursing clinical judgment provided a theoretical basis.

RESULTS

Focus group participant narratives reveal evidence about nursing clinical judgment when applied to established descriptions and phases.

CONCLUSION

Study findings suggest that VRS experiences promote development of nursing clinical judgment among students.

Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis

Several studies have examined the effect of virtual reality (VR) education. However, they are mostly systematic reviews or meta-analyses focusing on doctors and residents; they fail to consider VR medical education for a broader range of learners. We evaluated the effectiveness of VR education for health professionals and identified the essential features of education. Randomized controlled trials published from January 2000 to April 2020 were identified from PubMed, Embase, CINAHL, and the Cochrane Library (n = 299). The randomized studies' bias risk was evaluated using Cochrane's Risk of Bias tool. Meta- and subgroup-analyses were conducted using Review Manager 5.4.1. The overall effect was measured using Hedges' g and determined using Z-statistics (p < 0.05). Heterogeneity was assessed using X² and I² statistics. Among the identified records, 25 studies were selected through systematic review, and 18 studies were included in the meta-analysis. We identified a significant improvement in the VR group's skill and satisfaction levels, and that less immersive VR was more efficacious for knowledge outcomes than fully immersive VR. Maximizing the advantages of VR will increase learning opportunities and complement the limited clinical experience, thus improving medical services. A systematic and efficient VR medical education program will greatly enhance learners' core competencies.

Developing a Virtual Reality Simulation Program for Improving Nursing Students' Clinical Reasoning Skills in Home Settings: A Protocol Paper

Most nursing simulation programs focus on persons' healthcare needs in hospital settings, and little is known about how to identify them in home settings. This study aims to develop and validate a virtual reality (VR) simulation program for nursing students to improve their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings. We developed a VR simulation program based on a literature review and expert discussion. In Phase 1, home visit nurses or public health nurses will validate the program through their interviews in 2022. In Phase 2, we will conduct a pilot and main single-blinded randomized trial for nursing students to confirm the effectiveness from 2022 and 2023. Participants will be randomly allocated into an intervention group using VR simulations and a control group receiving videos regarding three kinds of community residents' lives [1:1]. After obtaining informed consent, the students will submit their anonymous data to the researchers to prevent associating their grade evaluation. The primary outcome will be their clinical reasoning skills. The second outcome will include their satisfaction and self-confidence. This study will examine the effectiveness of improving their clinical reasoning skills and confidence in assessing persons' healthcare needs in home settings.

Navigating nursing curriculum change during COVID-19 pandemic: A systematic review and meta-synthesis

Aim

To consolidate the evidence around the experiences of nursing undergraduates and faculty members navigating through remote and online education during the COVID-19 pandemic.

Background

The Coronavirus disease 2019 caused by the SARS-CoV-2 Virus (COVID-19) has placed massive pressure on healthcare, economic and education systems globally. Restrictive social distancing policies and public health measures necessitated educational institutions to switch from face-to-face to remote and online education to sustain the learning process. These changes have created an uncertain path and undue stress for healthcare learners and faculty, especially for professional roles that traditionally require more hands-on and access to clinical practice particularly pre-licensure nursing students. As such, there is an urgent need to consolidate evidence on the experiences of nursing undergraduates and faculty members as they navigate the rapid transition from face-to-face to remote and online education to ensure continuity of learning in achieving optimal learning outcomes and to support them during current and future public health crises.

Design

A systematic review and meta-synthesis of the qualitative literature was undertaken using Sandelowski and Barroso’s approach.

Methods

Six electronic databases, CINAHL, Embase, ERIC, PsycINFO, PubMed and Scopus, were searched systematically using the eligibility criteria from December 2019 to September 2022. The Critical Appraisal Skills Program checklist for qualitative studies was used to conduct the critical appraisal of the selected articles.

Results

Forty-seven studies were included in this review, which encapsulates the experiences of 3052 undergraduates and 241 faculty members. An overarching meta-theme ‘Remote and online education: a rollercoaster ride’, emerged along with three main meta-themes: (1) Transition to remote and online education: A turbulent road, (2) Acceptance of the untravelled road, (3) Hopes and recommendations for the road ahead.

Conclusion

To improve nursing undergraduates’ and faculty member’s navigation of remote and online education, more institutions should move towards establishing hybrid education as the new ‘normal’ and exercise prudence in the organisation and delivery of curriculum, teaching, well-being and clinical attachment contingencies of their healthcare courses.

Restructuring education activities for full online learning: findings from a qualitative study with Malaysian nursing students during Covid-19 pandemic

The COVID-19 pandemic and Movement Control Order have restricted learning activities from traditional face-to-face classrooms attendance shifted to full online learning in the student's environment. The present study is aimed to explore pertaining issues on full online learning among nursing students and offer a contingency solution. Nursing students from one Malaysian public institution were recruited. The sessions were conducted online via teleconference and were recorded. The data were analysed using thematic analysis with the assistance of QDA Miner Lite software. Twenty-one students participated, resulting in four focus group discussions and three in-depth interviews. Three themes with a total of ten sub-themes were generated: (i) Full online learning has ramifications on life (it is about life; blurred division on education life and personal life; non-conducive environment for learning; health and well-being; human is an adaptable being while the transition takes time), (ii) full online learning is a medium of teaching and learning delivery but with several concerns (the boon and bane of fully online learning; challenges associated with full online learning; coping strategy in handling full online learning), and (iii) Foundation in teaching and learning is the key (role of the educator; teaching and learning approaches; motivation and regulation). A model of practice for full online learning was developed, consisting of some modifications to create a conducive and healthy learning environment. This study embarks on a more structured and standard online learning practice for making the Internet of Things and Industrial Revolution 4.0 concept a contemporary and mainstream education practice.