The Effects of Virtual Reality Simulation as a Teaching Strategy for Skills Preparation in Nursing Students

Using Virtual Reality Simulation for Screening Brief Intervention and Referral to Treatment

BACKGROUND

This study examined the effects of virtual reality on students' confidence and knowledge in Screening, Brief Intervention, and Referral to Treatment (SBIRT), and understanding of substance use disorders (SUDs) in mental health and primary care settings.

METHOD

Using a pre- and postdesign, questionnaires were distributed before, immediately after, and 3 months after the simulation.

RESULTS

Data analysis revealed significant increases in SBIRT characteristics, screening tools, and alcohol consumption guidelines from pre- to postsimulation (p < .05) among the participants (n = 380). Confidence levels improved significantly (p < .001), with no notable difference between post-simulation and follow-up surveys.

CONCLUSION

Simulation training with structured prebriefing and debriefing sessions facilitated the application of learned skills during the simulation, boosting students' self-efficacy and readiness. [J Nurs Educ. 2024;63(7):453-459.].

Teaching Psychomotor Skills in Undergraduate Nursing Education: An Integrative Review

BACKGROUND

Psychomotor skills, a cognitive and fine motor process, are an essential component to undergraduate nursing education. Currently, no national guidelines exist to guide nursing programs on the best way to educate students to ensure competent and safe practice of psycho-motor skills in the clinical setting. This review sought to determine what methods of education, training, and practice of psychomotor skills enhanced psychomotor skill competency in undergraduate nursing students.

METHOD

An integrative review was conducted to determine teaching and practice strategies to support psychomotor skill competence.

RESULTS

Four significant categories were identified and included (1) simulation; (2) technology; (3) deliberate practice; and (4) theoretical and collaborative instruction. Overall, simulation and technology were found to be the most effective in psychomotor skill competence.

CONCLUSION

Additional research is needed to identify which teaching strategies best support nursing students' long-term knowledge acquisition and competency as they transition into professional practice. [J Nurs Educ. 2024;63(7):421-426.].

Cognitive and physiological evaluation of virtual reality training in nursing

Virtual reality (VR) has increasingly been used in several disciplines, including nursing, a profession in high demand that is now facing a shortage. This study investigated the effectiveness and efficacy of VR hybrid training over traditional training (TR) methods. Sixteen college students were recruited and randomly assigned to get 100% TR or 50% TR and 50% VR (VR50). Participants attended a three-day program with a registered nurse, consisting of lectures and practical lab sessions. Participants' performance, training time, cognitive development, physical development, mental workload, user experience, Students' Satisfaction and Self-Confidence, and team learning were evaluated. The results showed that the VR50 performed as well as, and sometimes even better than the TR group (p-value = 0.043). VR50 group significantly had higher cognitive development and found VR easy to use and attractive (p-value < 0.05). VR-integrated training makes nurses' training more affordable and accessible while providing instant and relevant feedback.

Practitioner Summary: This study assessed employment-integrated virtual training in nursing, particularly peri-care, by comparing the performance, cognitive, physical, and mental workload of traditional and integrated VR training groups. The findings of this study provide significant support for incorporating VR training into educational settings.

Using immersive virtual reality technology to enhance nursing education: A comparative pilot study to understand efficacy and effectiveness

The U.S. faces a national shortage of nurses. The emergence of human-centered digital technologies has directly impacted nursing education. Using immersive Virtual Reality related digital technology to assist and enhance nurse education is promising but not yet fully understood. This study aims to understand the effectiveness and efficacy of immersive Virtual Reality nursing education approaches through a comparative pilot study. Three immersive Virtual Reality scenarios based on basic nursing skills were developed. A traditional video lecture approach including the same contents was used as a comparable approach to investigate the effectiveness and efficacy performance of the proposed immersive Virtual Reality approach. 22 participants were recruited from a college. Effectiveness was measured through motivation and knowledge gain, while efficacy was evaluated through simulation sickness, user experience, and system usability. The results showed that the VR approach has above "acceptable" efficacy performance, which indicates participants are willing to accept this novel education approach. The effectiveness results indicate that the VR approach has similar performance with the video approach in delivering nursing contents. One limitation of this investigation is that the sample size is relatively small and further larger sample sizes are needed for future analysis.

Application of mobile-based web app to enhance simple suturing skills of nurse practitioners

BACKGROUND

Suturing is a crucial clinical skill for nurse practitioners (NPs), but the effectiveness of traditional training methods (e.g., physical suture kits combined with video content) is low.

OBJECTIVE

This study compared the effectiveness and usability of a mobile-based web app (MoWa) developed for NPs to learn simple suturing skills with those of traditional instructional video-based training.

METHODS

The MoWa system utilizes mobile devices to simulate hands-on suturing and provides learning guidance and feedback to support self-learning with a physical suturing kit. Fifty-four suturing novices (NPs) were recruited as participants, divided into an experimental group (EG: 28 participants) and a control group (CG: 26 participants), and instructed to self-learn for 3 weeks. Learning effectiveness and system usability were evaluated through a pretest and posttest.

RESULTS

The EG exhibited significant improvements in learning outcomes, self-confidence, self-efficacy, and learning anxiety and expressed satisfaction with the MoWa system. Furthermore, the EG also considerably enhanced learning outcomes, self-efficacy, and learning anxiety compared to the CG, with no significant difference in self-confidence.

CONCLUSION

The MoWa system combined with deliberate practice is an effective strategy for supporting suturing skills training.

Developing student nurses' evaluative judgement in clinical practice tertiary education: A systematic scoping review of teaching and assessment methods

OBJECTIVES

This review aimed to systematically scope undergraduate or postgraduate tertiary higher education nursing students' clinical practice teaching and assessment methods to identify features that align with promoting students' evaluative judgement.

INTRODUCTION

Evaluative judgement is a new concept to nursing tertiary education. Currently, there are no published reviews of evaluative judgement in nursing clinical practice education. This review aims to assist nursing educators to operationalise the concept of evaluative judgement in clinical practice education. As such the starting point was to determine features of evaluative judgement in current clinical teaching and assessment designs.

INCLUSION CRITERIA

Peer reviewed qualitative or quantitative studies that have evaluated teaching and/or assessment of tertiary (university/higher education) pre-registration (undergraduate) or post-registration (postgraduate) nursing students' clinical practice.

METHODS

The systematic scoping review was prospectively registered systematic review (OSF DOI 10.17605/OSF.IO/PYWZ6) reported using PRISMA guidelines. A systematic search of five databases (Medline, Scopus, Web of Science, ProQuest, CINAHL) was conducted, limited from 1989 onwards and in English. Two reviewers independently screened titles and abstracts, then full text, with disagreements resolved with a third independent author. Data were extracted, including the frequency and methods of developing students' evaluative judgement across the categories of discerning quality, judgement process, calibration and feedback. A narrative synthesis was performed.

RESULTS

Seventy-one studies were included (n=53 teaching, n=18 assessment). Most of the included studies, included some, but not all, of the features to develop nursing students' evaluative judgment. For teaching methods, the most identified evaluative judgement features in the included studies were discerning quality (n=47), feedback (n=41) and judgement process (n=21). Only three studies included a method of calibration. For the assessment methods, feedback (n=16), discerning quality (n=15), judgement process (n=9) and calibration (n=4) were included. Many clinical practice teaching and assessment methods in nursing included features that develop students' evaluative judgement, with methods relating to discerning quality and feedback well embedded. Further adjustments are required to include methods to assist students to judge and calibrate their own performance.

CONCLUSION

This systematic scoping review identified that evaluative judgement in current nursing clinical teaching and assessment is not an overt aim. With minor adjustment to teaching and assessment design, nursing students could be better supported to develop their ability to judge the value of their own work.

The effectiveness of high-fidelity simulation methods to gain Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students: A randomized controlled trial

BACKGROUND

The use of high-fidelity simulation (HFS) methods provides probable benefits and advantages for nursing students to retain knowledge, acquire skills, improve satisfaction, and gain self-confidence in a safe, realistic and supportive environment.

OBJECTIVES

To evaluate the effect of HFS methods to develop Foley catheterization knowledge, skills, satisfaction and self-confidence among novice nursing students when compared to low-fidelity simulation (LFS). The specific aim was to examine the effects of outcome variables between the intervention group and the control group, through multi-group path analysis.

DESIGN

A randomized controlled trial was designed.

SETTINGS AND PARTICIPANTS

80 nursing students were randomly assigned to the HFS group (high-fidelity manikin and scenario) and the LFS group (female catheterization simulator) at a nursing faculty between May and July 2019 in Türkiye.

METHODS

The intervention group experienced HFS and the control group experienced LFS in order to learn Foley catheterization. Students' knowledge was evaluated before and after the intervention, while affective and psychomotor skills, and satisfaction and self-confidence in learning were evaluated after the intervention.

RESULTS

The HFS group had better skill performance and significantly higher self-confidence in learning than the LFS group. While each group had a high level of knowledge, affective skills and satisfaction, there was no significant difference between the groups' mean scores.

CONCLUSIONS

The HFS and scenario improved the knowledge, affective and psychomotor skills, satisfaction and self-confidence of novice nursing students on Foley catheterization. When compared to LFS, HFS had more advantages for the development of psychomotor skills and self-confidence in learning.

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.

Innovative digital technology adapted in nursing education between Eastern and Western countries: a mini-review

Advanced digital technologies have overcome the limitation of on-site teaching, especially after the COVID-19 epidemic. Various newly-developed digital technologies, such as e-learning, virtual reality, serious games, and podcasts, have gained renewed interest and come into the spotlight. Podcasts are becoming increasingly popular in nursing education as they provide a convenient and cost-effective way for students to access educational content. This mini-review article provides an overview of the development of podcasts in nursing education in Eastern and Western countries. It explores potential future trends in the use of this technology. The literature review demonstrates that nursing education in Western countries has already integrated podcasts into curriculum design, using the podcast to convey nursing education knowledge and skills and to improve students' learning outcomes. However, few articles address nursing education in Eastern countries. The benefits of integrating podcasts into nursing education appear far greater than the limitations. In the future, the application of podcasts can serve not only as a supplement to instructional methodologies but also as a tool for clinical practicing students in nursing education. In addition, with the aging population increasing in both Eastern and Western countries, podcasts have the potential to serve as an effective delivery modality for health education in the future, particularly for the older adult, whose eyesight declines with age, and those populations with visual impairments.

Efficacy of Virtual Reality Simulation in Teaching Basic Life Support and Its Retention at 6 Months

Educational efficiency is the predetermining factor for increasing the survival rate of patients with cardiac arrest. Virtual reality (VR) simulation could help to improve the skills of those undergoing basic life support-automated external defibrillation (BLS-AED) training. Our purpose was to evaluate whether BLS-AED with virtual reality improves the skills and satisfaction of students enrolled in in-person training after completing the course and their retention of those skills 6 months later. This was an experimental study of first-year university students from a school of health sciences. We compared traditional training (control group-CG) with virtual reality simulation (experimental group-EG). The students were evaluated using a simulated case with three validated instruments after the completion of training and at 6 months. A total of 241 students participated in the study. After the training period, there were no statistically significant differences in knowledge evaluation or in practical skills when assessed using a feedback mannequin. Statistically significant results on defibrillation were poorer in the EG evaluated by the instructor. Retention at 6 months decreased significantly in both groups. The results of the teaching methodology using VR were similar to those obtained through traditional methodology: there was an increase in skills after training, and their retention decreased over time. Defibrillation results were better after traditional learning.

Effectiveness of immersive virtual reality training in nasogastric tube feeding education: A randomized controlled trial

BACKGROUND

Given rapidly aging societies worldwide, improving the quality of long-term care through the cultivation of immense nursing assistants is critical. Accordingly, developing a satisfactory learning model to improve the learning outcomes of nursing assistant students is imperative.

OBJECTIVE

This study tested the hypothesis that students in long-term care departments who underwent immersive virtual reality (IVR) training would have significantly (1) higher levels of knowledge about the skills of nasogastric tube feeding, (2) higher learning motivations (i.e., intrinsic and extrinsic motivations, task values, and self-efficacy), (3) lower cognitive load, and (4) higher satisfaction than a control group.

DESIGN

A randomized controlled trial with pretest and posttest design.

SETTINGS AND PARTICIPANTS

We randomly assigned 107 students from the long-term care departments of two universities in central Taiwan to the IVR group (n = 54) or the control group (n = 53).

METHODS

The IVR group learned the procedure of nasogastric tube feeding through IVR, whereas the control group watched a 15-min 2D video. The participants filled pretest and posttest questionnaires on nasogastric tube feeding knowledge. After the experiment was completed, the participants answered another questionnaire on their learning motivations, cognitive load, and learning satisfaction.

RESULTS

The nasogastric tube feeding knowledge improved significantly in the IVR and control groups after the intervention, with no significant between-group differences. The IVR group scored significantly higher than the control group on extrinsic goals, task value, and satisfaction; nevertheless, they also experienced a significantly higher cognitive load.

CONCLUSIONS

Both the IVR training and the traditional 2D video improved the learning outcomes of the nursing assistant students. The students were more satisfied with IVR than with the conventional learning model and indicated that IVR inspired their extrinsic learning motivations and perceived task value. However, IVR incurred a high cognitive load, which must be addressed in future course designs.

Effect of Immersive Virtual Reality on Post-Baccalaureate Nursing Students’ In-Dwelling Urinary Catheter Skill and Learning Satisfaction

A fundamental skill required from nursing students is how to manage the insertion of in-dwelling urinary catheters, and this skill is a core competency for nurses. However, practice with conventional test models is insufficient for learning this skill and leads to inadequate proficiency among students. To address this problem, this study created an immersive virtual reality (IVR) scheme, based on the theory of situated learning, to simulate clinical situations. Innovative approaches were adopted to design clinical cases, construct three-dimensional environments, design character dialogs, and integrate artificial intelligence voice recognition. The effect of these design elements on students’ in-dwelling urinary catheter skills and learning satisfaction was explored. First, nursing experts assessed the quality of the IVR scheme. Over a 4-week period, 43 students in a post-baccalaureate nursing program used conventional test models to practice the management of in-dwelling urinary catheters in female patients, and their learning was supplemented by at least two practice sessions with IVR. Data were collected from in-class observation records, a questionnaire survey on student satisfaction, and focused group interviews. The results showed that the participating students were highly satisfied with the IVR scheme and stated that it provided a pleasurable learning experience and exerted a positive impact on them. The IVR scheme provided situations closely resembling real clinical environments, helping the students to memorize the steps for catheter management. The students also noted that the IVR scheme should incorporate other nursing skills, such as empathetical and solicitous care and patient companionship. This enables nursing students to fulfill their role and care for patients in clinical settings.

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.

Effectiveness and Utility of Virtual Reality Infection Control Simulation for Children With COVID-19: Quasi-Experimental Study

BACKGROUND

It is essential that nurses quickly learn the proper methods for preventing and controlling nosocomial infection and managing intensive care patients during the COVID-19 pandemic, including the donning and doffing of personal protective equipment (PPE). Virtual reality (VR) simulation offers the advantage of learning in a safe environment with a sense of realism similar to that of an actual clinical setting and has been reported to enhance self-efficacy in infection control, safety performance, and learning satisfaction among students.

OBJECTIVE

This study aims to develop a virtual reality infection control simulation (VRICS) program regarding donning and doffing of PPE and respiratory care for pediatric patients admitted to an isolation unit for COVID-19 and to identify the effects of the program on PPE knowledge, infection control performance, and self-efficacy for nursing students. Additionally, the realism of the VRICS program and the students' level of satisfaction with the program were assessed.

METHODS

This was a quasi-experimental study based on a controlled pretest-posttest design. Third- and fourth-year nursing students were divided into an experimental group (n=25) who participated in a VRICS program and a control group (n=25) with no participation. Data were collected from November 13 to December 10, 2021, and analyzed using descriptive statistics and the t test, paired t test, Mann-Whitney U test, and Wilcoxon matched-pair signed-rank test. The VRICS program consisted of a prebriefing, including direct practice of donning and doffing PPE, VR simulation, and debriefing. The VR simulation comprised 3 sessions: donning and inspection of PPE in the dressing room before entering the negative-pressure isolation unit; assessing for suction care, nasopharyngeal suctioning, and checking of COVID-19 patients in the negative-pressure isolation unit; and doffing PPE in the dressing room. The total execution time for the program was 180 min.

RESULTS

Compared with the control group, the experimental group showed significantly greater improvements in PPE knowledge (z=-3.28, P<.001), infection control performance (t48=4.89, P<.001), and self-efficacy (t36.2=4.93, P<.001). The experimental group's mean scores for realistic immersion and learner satisfaction were 4.49 (SD 0.50) points and 4.75 (SD 0.38) points (on a 5-point Likert scale), respectively.

CONCLUSIONS

The VR simulation training program involving pediatric COVID-19 patients combined skills training effectively and enhanced theoretical knowledge, respiratory care skills, and infectious disease preparedness. Thus, it could be applied to training nurses to respond more effectively to public health situations involving infectious diseases, including the COVID-19 pandemic.

Global Trends and Hot-Spots in Research on Virtual Simulation in Nursing: A Bibliometric Analysis From 1999 to 2021

Background

Virtual simulation has been widely used in nursing education and nursing training. This study aims to characterize the publications in terms of countries, institutions, journals, authors, collaboration relationships, and analyze the trends of virtual simulation in nursing research.

Methods

Publications regarding virtual simulation in nursing were retrieved from Web of Science core collection. Microsoft Excel 2010, VOSviewer were used to characterize the contributions of the authors, journals, institutions, and countries. The trends, hot-spots and knowledge network were analyzed by Citespace and VOSviewer.

Results

We identified 677 papers between 1999 and 2021. The number of publications grew slowly until 2019, after that, it got a sharp increase in 2020 and 2021. The USA, Canada and Australia were three key contributors to this field. Centennial College and University of San Paulo, University of Ottawa and Ryerson University were top major institutions with a larger number of publications. Verkuyl M was the most productive and highest cited author. Clinical Simulation in Nursing, Nurse Education Today, Journal of Nursing Education were the three productive journals. The foundational themes of virtual simulation research in nursing are “virtual learning during COVID-19, clinical nursing care, education in nurse practitioners, education technology”.

Conclusion

Virtual simulation in nursing field has attracted considerable attention during COVID-19 pandemic. The research hotspot is gradually shifting from clinical nursing care to studies of nursing education using different virtual simulation technologies

To social with social distance: a case study on a VR-enabled graduation celebration amidst the pandemic

This paper introduces a timely case study on a 3D virtual reality-enabled graduation celebration project that provided an alternative approach to celebrating university graduation amidst the COVID-19 pandemic. The project was carefully designed with fun, engaging, and interactive activities to compensate for the cancelation of the conventional commencement in spring 2020 due to the pandemic. More than 20 graduating students, faculty and staff members participated in a 2-h virtual reality live event appearing as 3D avatars on their own computers. Quantitative and qualitative data collected from 10 participants were analyzed for user experience, cognitive contribution, technology acceptance, and the feasibility. Results revealed that such a project was technologically sound, functionally acceptable, user-friendly, and practically implementable. The results also informed the lessons learned from the current design and the places to improve.

Supplementary Information

The online version contains supplementary material available at 10.1007/s10055-022-00646-2.

Virtual Reality in Nursing Education 3D Intravenous Catheterization E-Learning: A Randomized Controlled Trial

BACKGROUND

The use of virtual reality in nursing student training for intravenous catheterization and fluid delivery was investigated.

METHODS

In this experimental study, 29 students were part of the experimental group while 27 were in the control group. The application was presented to the experimental group using virtual reality technology and to the control group using an intravenous injection arm model.

RESULTS

A statistically significant difference was found between the Intravenous Catheter Application and Fluid Delivery Skills Checklist scores of the students in the experimental and control groups. According to the Bondy Evaluation Scale, there was a statistically significant difference between the students who were at the "supervised" level in the experimental and control groups.

CONCLUSION

Virtual reality technology was found effective as a teaching method in the development of intravenous catheter application and fluid delivery skills. An increase in its use in nursing training is recommended.

Factors Influencing Nursing Students' Immersive Virtual Reality Media Technology-Based Learning

Background/objectives: This study aims to identify the effects of cognitive and emotional variables related to immersive virtual reality media technology on learning for nursing students. Methods/Statistical analysis: The subjects of this study were 121 nursing students from a university in area D. After experiential learning with virtual reality from 6–8 June 2019, data was collected through questionnaires. For virtual reality learning, VIVE’s hTC VIVE ECO CE model was used. The collected data was analyzed using the IBM SPSS 26.0 program. Multiple Regression Analysis was used to analyze the factors influencing the subject’s virtual reality learning effects. Findings: The learning effects of the virtual reality medium had a statistically significant positive correlation with the virtual reality technology recognition, sensory immersion, realism, learning satisfaction, learning necessity, and continuous use intention (p < 0.001) scores. In personality traits, only Openness, Extraversion (p < 0.01), and Conscientiousness (p < 0.05) had a statistically significant positive correlation. As a result of regression analysis, the explanatory power of the learning effect of the virtual reality medium was 63.9% (F = 53.61, p < 0.001), with learning satisfaction, sensory immersion, continuous use intention, and Extraversion being significant influencing factors (p < 0.05). Improvements/Applications: This study is meaningful in the sense that it provided strategic implications for the teaching and learning method of virtual reality technology-based learning by considering the insights necessary to develop a learning program using virtual reality technology, according to the characteristics of virtual reality technology, and the learner’s cognitive and psychological variables.

Incorporating virtual reality in nurse education: A qualitative study of nursing students' perspectives

BACKGROUND

Recent challenges to nurse education have resulted in an increased use of virtual reality which serves as an immersive and effective medium for skill and knowledge acquisition. Virtual reality technology is being included in nurse curricula at undergraduate level. This technology remains a relatively new experience for many nursing students with limited evidence regarding students' perspectives regarding virtual reality.

OBJECTIVE

To explore nursing students' perspectives of incorporating virtual reality in nurse education.

DESIGN

Qualitative descriptive study using thematic analysis.

SETTING

Public university in Ireland.

PARTICIPANTS

Undergraduate nursing students were recruited using purposive and snowball sampling.

METHODS

Students (n = 26) participated in face-to-face semi-structured individual interviews and focus groups in January and February 2020. Data were analysed using inductive thematic analysis.

RESULTS

Three themes were constructed from the interviews: captivating, innovative, and empowering nature of virtual reality; contextual transfer; and challenges and threats to actualisation. Participants believed that virtual reality affords a novel, fun, memorable, inclusive, and engaging means of learning. Many believed that virtual reality would complement current teaching and learning approaches, help build learners' confidence, and provide nursing students with a safe space for trial, error, and problem-solving. The use of virtual reality was recommended to practise various nursing skills and learn about human anatomy, physiology, problem-solving, and clinical decision-making. Participants identified the resources incurred by the technology as challenges to implementing virtual reality in nurse education and stressed the need for continuous face-to-face feedback.

CONCLUSIONS

Findings suggest that virtual reality technology has the potential to facilitate learning, complement current educational approaches, and provide nurse educators with novel and engaging means of content delivery.

[Development and Effects of Head-Mounted Display-Based Home-Visits Virtual Reality Simulation Program for Nursing Students]

PURPOSE

This study aimed to evaluate the effects of head monted display based home-visits virtual reality simulation (HVRS) program developed for undergraduate nursing students.

METHODS

A nonequivalent control group with a non-synchronized design was utilized and 84 participants (experimental group, 44; control group, 40) were recruited from August 31, 2020 to November 8, 2020 in Gwangju metropolitan city. The HVRS program consisted of scenarios of three nursing cases, hypertension, diabetes mellitus, and stroke. Data were analyzed SPSS version 25.0 for Windows.

RESULTS

At the completion of HVRS, significant differences were found between groups in knowledge of home-visits (t = 4.73, p < .001), self-confidence (t = 6.63, p < .001), self-efficacy (t = 3.13, p = .002), and clinical competency (t = 4.13, p < .001). No significant difference was shown between groups in nursing knowledge about strokes, a subcategory of knowledge pertaining to home visits.

CONCLUSION

The HVRS program developed for undergraduate nursing students is effective in improving knowledge of home-visits, self-confidence, self-efficacy, and clinical competency for nursing students.

The effects of an immersive 3d interactive video program on improving student nurses' nursing skill competence: A randomized controlled trial study

BACKGROUND AND OBJECTIVE

Acquired accurate clinical nursing skills are among the most important core nursing competencies for nursing students, as nursing students' inadequate skill capacities might endanger patients safety. Therefore, it is essential to develop teaching strategies to strengthen students' nursing skills. This study examined the effects of an immersive three-dimensional (3D) interactive video program on improving nursing students' nasogastric tube feeding skill competence.

DESIGN

A randomized controlled trial research design.

SETTINGS AND PARTICIPANTS

Forty-five nursing students from a university in northern Taiwan.

METHODS

The students were randomly assigned to an intervention group (n = 22) and a comparison group (n = 23). The intervention group received the immersive 3D interactive video program on nasogastric tube feeding, whereas the comparison group watched a regular demonstration video. The questionnaire was used to collect data before the intervention, immediately after the intervention, and one month after the intervention.

RESULTS

Nursing students' knowledge and confidence in nasogastric tube feeding were significantly improved after the intervention in both groups. Although there were no significant differences in students' knowledge, skill, and confidence between the two groups, participants' average satisfaction score with the immersive 3D interactive video program in the intervention group was significantly higher than in the comparison group that watched a regular video (t = 2.302, p = 0.026).

CONCLUSIONS

The findings of this study showed that both immersive 3D interactive video program and regular demonstration video could improve nursing students' learning outcomes. The higher satisfaction score in the intervention group indicates that learning through immersive 3D interactive video is acceptable and satisfactory. This study provides useful information for nursing faculty members for designing and developing teaching methods for the acquisition of nursing skills. It can also serve as a reference for further studies relating to AR, VR, or immersive learning materials.

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.

Effects of Virtual Reality Simulation Program Regarding High-risk Neonatal Infection Control on Nursing Students

PURPOSE

Virtual reality simulation can give nursing students a safe clinical experience involving high-risk infants where access to neonatal intensive care units is limited. This study aimed to examine the effects of a virtual reality simulation program on Korean nursing students' knowledge, performance self-efficacy and learner satisfaction.

METHODS

A nonequivalent control group design was applied. Senior nursing students were divided into an experimental group (n = 25) experiencing virtual reality simulation and routine neonatal intensive care unit practice and a control group (n = 25) having routine neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management and skin care and environmental management for prevention of neonatal infection. The total execution time for the three scenarios was 40 minutes. The simulation created immersive virtual reality experiences using a head-mounted display with hand-tracking technology. Data were collected from December 9, 2019, to January 17, 2020, and were analyzed using descriptive statistics and the t-test, paired t-tests, Mann-Whitney test and Wilcoxon signed-ranks test.

RESULTS

Compared to the control group, the experimental group showed significantly greater improvements in high-risk neonatal infection control performance self-efficacy (t = -2.16, p = .018) and learner satisfaction (t = -5.59, p < .001).

CONCLUSION

The virtual reality simulation program can expand the nursing students' practice experience in safe virtual spaces and enhance their performance self-efficacy and learning satisfaction.

The use of virtual reality simulation among nursing students and registered nurses: A systematic review

BACKGROUND

Due to technological advancements and the current generation being more tech-savvy, the use of virtual worlds in nursing education and clinical practice is increasingly popular. We performed a systematic review on randomised controlled trials and quasi-experimental studies to examine the current evidence on the use of virtual worlds as a teaching tool and to ascertain the outcomes measured.

DESIGN

Systematic review of randomised controlled trials and quasi-experimental studies.

DATA SOURCES

Six electronic databases (PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PsycINFO, Web of Science, and ProQuest) were searched by title and abstract from each database's date of inception to December 2019.

REVIEW METHODS

The Joanna Briggs Institute's Critical Appraisal Tool was used to conduct critical appraisal of the selected articles.

RESULTS

Eighteen studies were included in the narrative summary. Studies were mostly conducted in developed countries and focused on nursing students. Advantages of virtual worlds include higher time-cost-effectiveness as compared to mannequin-based simulations and face-to-face lectures. Two major disadvantages were technological issues and the lack of realism.

CONCLUSIONS

Among the three learning outcomes (skills-based, cognitive, and affective), virtual worlds are the most effective in improving cognitive outcomes such as theoretical knowledge. This suggests that virtual worlds may be used as an alternative or complementary method to teach theoretical knowledge in nursing education.

Smart home R&D system based on virtual reality

Smart home products and equipment are relatively expensive while using specific physical objects to prove functional characteristics, the cost is high, and it is difficult to meet the personal needs of customers. Based on the above background, the purpose of this research is the application and design of a smart home R&D system based on virtual reality. This study proposes the concept of introducing virtual reality methods into the control scene given the shortcomings of the existing smart home control interface interaction methods. From the perspective of being more suitable for the user’s needs, the virtual reality method is used to optimize the smart home interaction methods. Through the analysis of the user’s lifestyle and needs, the functional module model of applying virtual reality to the smart home control scheme is established. Then, by collecting data, use Sketchup software to build and optimize the model of the simulation system to build a realistic family scene model. Finally, through the integrated use of the Unity 3D rendering engine and the virtual simulation system technology, the intelligent simulation of the interior functions of the house is realized. Experimental results show that using virtual reality to optimize the interaction of smart homes, the control method is relatively simple, and the cost can be reduced by about 20%.

Face-to-Face and blended methods to improve oral competence in nursing students through simulation

Communication and interpersonal skills are relevant to the health professions, so it is important to promote these competencies at university. This research assesses the effectiveness of teaching oral competence through simulation using face-to-face and blended methods. A public speaking workshop was conducted in a group of 144 first year nursing students. Three groups were obtained according to the teaching method (Group 1: traditional method-3 sessions, Group 2: traditional method-2 sessions, Group 3: blended method-2 sessions). Public speaking confidence was measured at the beginning and end of the training, and oral competence was assessed at the end. As a result, all groups achieved a good level of oral competence after the training. However, while students in Group 1 showed greater oral competence, with regard to confidence in public speaking, students in Group 1 showed significantly worst results than those in Group 3. We concluded that simulation is a useful strategy to improve cognitive learning, and behavioural and practical competencies such as public speaking. As for the teaching method, although blended learning did not offer better results than traditional learning, it seems useful provide there is at least one face-to-face session so that the student can perform a speech and receive corrective feedback.

"It is much more real when it comes from them": The role of experts by experience in the integration of mental health nursing theory and practice

PURPOSE

To examine nursing students' perceptions of Experts by Experience impact on theoretical and practical learning.

DESIGN AND METHODS

Qualitative exploratory study involving focus groups with undergraduate nursing students from five European countries and Australia. Data were analyzed thematically.

FINDINGS

Participants described positive impacts as: bridging the theory and practice gap through first-hand experience, including sub-themes: bringing theory to life; can't be taught any other way, and innovative teaching methods fueling curiosity.

RELEVANCE TO CLINICAL PRACTICE

Integrating theory and practice is key for quality mental health nursing practice. Experts by experience can potentially contribute to reducing this enduring gap.

Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis

BACKGROUND

Virtual reality (VR) is the use of computer technology to create an interactive three-dimensional (3D) world, which gives users a sense of spatial presence. In nursing education, VR has been used to help optimize teaching and learning processes.

OBJECTIVE

The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time.

METHODS

We conducted a meta-analysis of the effectiveness of VR in nursing education based on the Cochrane methodology. An electronic literature search using the Cochrane Library, Web of Science, PubMed, Embase, and CINAHL (Cumulative Index to Nursing and Allied Health Literature), up to December 2019 was conducted to identify studies that reported the effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time. The study selection and data extraction were carried out by two independent reviewers. The methodological quality of the selected studies was determined using the Cochrane criteria for risk-of-bias assessment.

RESULTS

A total of 12 studies, including 821 participants, were selected for the final analysis. We found that VR was more effective than the control conditions in improving knowledge (standard mean difference [SMD]=0.58, 95% CI 0.41-0.75, P<.001, I2=47%). However, there was no difference between VR and the control conditions in skills (SMD=0.01, 95% CI -0.24 to 0.26, P=.93, I2=37%), satisfaction (SMD=0.01, 95% CI -0.79 to 0.80, P=.99, I2=86%), confidence (SMD=0.00, 95% CI -0.28 to 0.27, P=.99, I2=0%), and performance time (SMD=-0.55, 95% CI -2.04 to 0.94, P=.47, I2=97%).

CONCLUSIONS

The results of this study suggest that VR can effectively improve knowledge in nursing education, but it was not more effective than other education methods in areas of skills, satisfaction, confidence, and performance time. Further rigorous studies with a larger sample size are warranted to confirm these results.

Simulation Modeling as a Novel and Promising Strategy for Improving Success Rates With Research Funding Applications: A Constructive Thought Experiment

Writing a successful grant or other funding applications is a requirement for continued employment, promotion, and tenure among nursing faculty and researchers. Writing successful applications is a challenging task, with often uncertain results. The inability to secure funding not only threatens the ability of nurse researchers to conduct relevant health care research but may also negatively impact their career trajectories. Many individuals and organizations have offered advice for improving success with funding applications. While helpful, those recommendations are common knowledge and simply form the basis of any well-considered, well-formulated, and well-written application. For nurse researchers interested in taking advantage of innovative computational methods and leading-edge analytical techniques, we propose adding the results from computer-based simulation modeling experiments to funding applications. By first conducting a research study in a virtual space, nurse researchers can refine their study design, test various assumptions, conduct experiments, and better determine which elements, variables, and parameters are necessary to answer their research question. In short, simulation modeling is a learning tool, and the modeling process helps nurse researchers gain additional insights that can be applied in their real-world research and used to strengthen funding applications. Simulation modeling is well-suited for answering quantitative research questions. Still, the design of these models can benefit significantly from the addition of qualitative data and can be helpful when simulating the results of mixed methods studies. We believe this is a promising strategy for improving success rates with funding applications, especially among nurse researchers interested in contributing new knowledge supporting the paradigm shift in nursing resulting from advances in computational science and information technology.

Virtual Reality and Avatars in Health care

The editorial summarizes the evolution of virtual reality and its application in a variety of healthcare contexts to improve nursing education, research, and clinical practice. The use of digital avatars in conjunction with virtual reality systems is also discussed, along with the benefits and risks of this emerging technology.

Exploring the application of mixed reality in Nurse education

The aim of this study was to explore the contemporary application, inclusive of advantages and challenges, of mixed reality (MR) technology in the education of nursing students and, its contribution to enhanced learning. A descriptive evaluation design was undertaken to explore the learning experience of second year students enrolled in a 3 year Bachelor of Nursing programme. One hundred per cent of the students stated that the experience assisted them in their learning. The key themes of engagement in learning, and developing clinical judgement emerged from students' responses, and demonstrated ways in which students felt MR enhanced their learning. This emerging technology has the potential to assist in enhancing clinical judgement and developing skills in noticing physical cues in patients. The implementation of MR may also enhance student motivation and engagement with learning.

Agent-Based Modeling: A Method for Investigating Challenging Research Problems

BACKGROUND

For all our successes, many urgent health problems persist, and although some of these problems may be explored with established research methods, others remain uniquely challenging to investigate-maybe even impossible to study in the real world because of practical and pragmatic obstacles inherent to the nature of the research question.

OBJECTIVES

The purpose of this review article is to introduce agent-based modeling (ABM) and simulation and demonstrate its value and potential as a novel research method applied in nursing science.

METHODS

An introduction to ABM and simulation is described. Examples of current research literature on the subject are provided. A case study example of community nursing and opioid dependence is presented.

RESULTS

The use of ABM and simulation in human health research has increased dramatically over the past decade, and meaningful research is now commonly found published widely in respected, peer-reviewed journals. Absent from this list is innovative ABM and simulation research published by nurse researchers in nursing-specific journals.

DISCUSSION

ABM and simulation is a powerful method with tremendous potential in nursing research. It is vital that nursing embrace and adopt innovative and advanced research methods if we are to remain a progressive voice in health research, practice, and policy.

How does virtual reality simulation compare to simulated practice in the acquisition of clinical psychomotor skills for pre-registration student nurses? A systematic review

INTRODUCTION

Simulated practice, both face-to-face and computer-based, is well established within healthcare education, allowing rehearsal and refinement of clinical skills. Virtual reality is a new and relatively untested method of delivering simulation learning.

AIMS

This project aims to systematically review, critically appraise and synthesise the published evidence in order to answer the question 'How does virtual reality simulation compare to simulated practice in the acquisition of clinical psychomotor skills for pre-registration student nurses?'

METHODS

The databases CINAHL, Medline, Psychinfo, PubMed and the University of Portsmouth 'Discover' database were searched between 4th June 2018 and 7th July 2018 using the terms; pre-registration, pre-licensure, "pre-registration", "pre licensure", trainee, student, students, nurs*, virtual-reality, VR, "virtual reality", "augmented reality", clinical, skil*, competenc* and mastery. Inclusion and exclusion criteria relating to type of paper, population, intervention, comparison and outcome were applied. Selected articles were appraised using the Centre for Reviews and Dissemination guidelines. As clinical psychomotor skill mastery requires the application of theoretical knowledge to a motor skill in a range of contexts, outcomes relating to these elements (namely knowledge, cognitive gain, skill performance, skill success and time to complete) were analysed.

FINDINGS

Nine studies were included in the review. All studies employed a quasi-experimental design but were of mixed methodological quality. There was significant heterogeneity in methods and missing data, limiting synthesis and precluding meta-analysis. Virtual reality groups performed favourably in comparison to simulation groups in posttest knowledge scores, cognitive gain, skill performance scores and skill success rate. There was divergence of results in relation to time taken to complete the skill.

DISCUSSION

Whilst the results are generally favourable for virtual reality, variation in devices, data collection tools and outcome measurements mean that caution must be used in their interpretation. Outcomes relating to psychomotor skill performance support the use of virtual reality as an educational intervention. Time taken to undertake and complete the skill is questioned as a valid outcome measurement due to the potential to forgo skill accuracy in favour of speed.

CONCLUSION

Virtual reality is an emerging technology with a limited body of evidence, which is of variable methodological quality. It appears that virtual reality leads to educational outcomes similar or superior to traditional simulated practice. Consensus in definitions is needed along with further research to advance knowledge of this developing area of practice. Such research is needed to justify the cost of investing in this new technology.

Evaluating the Usability of a Second-Generation Virtual Reality Game for Refreshing Sterile Urinary Catheterization Skills

BACKGROUND

Virtual reality (VR) allows risk- and anxiety-free practice, mediated by consistent objective feedback.

PURPOSE

This study evaluated the usability of a VR game system for sterile catheterization practice. Participant enjoyment, engagement, likelihood to practice, and comfort using VR are reported.

METHODS

Thirty-one students and faculty tested a VR game using Oculus Rift devised to allow practice of placing a urinary catheter in a virtual patient. Data were collected via an electronic survey using the System Usability Survey (SUS) and a User Reaction Survey (URS).

RESULTS

The SUS score was 64.03. Seventy-five percent of participants rated the game as positive overall on the URS. Left-handed players had more difficulty playing the game. Players with prescription glasses could not comfortably place the Oculus Rift over their glasses to play.

CONCLUSIONS

The VR game shows promise for refreshing sterile catheterization skills.

Effect of a game-based virtual reality phone application on tracheostomy care education for nursing students: A randomized controlled trial

BACKGROUND

A game-based virtual reality phone application is used as a simulation to teach psychomotor skills in nursing education.

OBJECTIVE

This study aims at determining the effect of a game-based virtual reality phone application on tracheostomy care education for nursing students.

DESIGN

Single-blind randomized controlled trial conducted from March-April 2017.

SETTING

Department of Nursing, Faculty of Health Sciences, Central Anatolia of Turkey.

PARTICIPANTS

A total of 86 first-year nursing students registered in Fundamentals of Nursing-II were included in this study. The students were divided at random into two groups, control (n = 43) and experimental (n = 43).

METHOD

The data were collected with an informative features form, a tracheostomy care knowledge test and skill checklists, and a performance assessment form. The control group commenced the study first so that the students did not affect each other. After the students completed the theoretical class, laboratory class, and small group study, they had their knowledge test and skills evaluation. The application featured tracheostomy care and was designed in support of formal education. It was uploaded to the mobile phones of the experimental group at a different phase of the study from the control group. After the experimental group made use of this application for seven days, their last knowledge test and skills evaluation were conducted.

RESULTS

The results of this study determined that the suctioning a tracheostomy tube and peristomal skin care average final test scores of the students in the experiment group were higher than the average scores of the students in the control group; this was statistically significant (p = 0.017, p = 0.003).

CONCLUSION

The game-based virtual reality phone application was effective in teaching the skill of suctioning a tracheostomy tube for nursing students in the short term, and it is recommended that this application be used in psychomotor skill training.

Acquisition of Fire Safety Knowledge and Skills With Virtual Reality Simulation

BACKGROUND

Prelicensure nursing students seeking to enter perioperative nursing need preparatory fire safety knowledge and skills training to participate as a member of an operating room (OR) team.

PURPOSE

This pilot study examined the effectiveness of the Virtual Electrosurgery Skill Trainer (VEST) on OR fire safety skills among prelicensure nursing students.

METHODS

An experimental pretest-posttest design was used in this study. Twenty nursing students were randomized to a control or an intervention group. Knowledge and skills acquisition of OR fire safety were assessed.

RESULTS

There were no statistically significant findings in knowledge for either group. Fisher exact test demonstrated significant relationships between the skills performance criteria of following emergency procedures for a fire and demonstrating PASS (pull-aim-squeeze-sweep) technique (P = .001).

CONCLUSIONS

Academic and hospital educators may consider incorporating virtual reality simulation to teach fire safety education or reinforce general fire safety practices to nursing students and novice nurses.

Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation

Nurses serve a valuable role in the healthcare industry. Nurses are trained with the skills and knowledge to thrive in a fast-paced, evolving environment. In order to meet the complex and diverse needs of patients, nurses must be able to assess and prioritize care to produce safe and high-quality outcomes. Simulation is an established method of educating nursing students and preparing nurses to respond appropriately to situations they are likely to encounter in practice. Traditional nursing simulation devices are prohibitively expensive for many nursing education institutions. The development of augmented, mixed, and virtual reality simulation delivery offers a new platform for simulation, known as immersive simulation. Immersive simulation can virtually place nursing students in situations that are difficult to arrange in actual clinical practicums or that occur rarely but for which nurses need to be prepared. Additionally, the hardware required to deliver immersive simulation is much cheaper than that of traditional nursing simulation devices. This chapter describes the virtual standardized patient application delivered via mixed reality immersive simulation. This chapter also discusses the research initiative currently underway to assess student perceptions to this modality of health training simulation.

Evaluating competence and confidence using simulation technology

This article discusses the role of simulation training in educating nurses and reducing clinical errors and describes a research project designed to determine the effectiveness of deliberate practice and simulation technology.