Virtual and augmented reality: Implications for the future of nursing education

Effect of using gamification and augmented reality in mechanical ventilation unit of critical care nursing on nurse students' knowledge, motivation, and self-efficacy: A randomized controlled trial

BACKGROUND

Gamification and augmented reality (AR) are innovative teaching modalities. Research on the effects of combining these two strategies in nursing education is scarce.

OBJECTIVES

To examine the effect of the combined use of gamification and AR in teaching mechanical ventilation (MV) on nurse students' knowledge, motivation, self-efficacy, and satisfaction.

DESIGN

Randomized controlled trial.

SETTING

A conveniently selected faculty of nursing in Egypt.

PARTICIPANTS

A total of 410 nurse students.

METHODS

Participants were randomly assigned to the intervention or control group (205 in each). Kahoot games and AR were used in the intervention group, whereas a traditional lecture was applied in the control group. The outcomes included levels of students' knowledge, learning motivation, self-efficacy, and satisfaction.

RESULTS

Mixed design repeated-measures ANOVA test revealed a statistically significant difference in knowledge test scores within-subject over time (p-value [effect size]: <0.001 [0.515]), between-subject due to the main effect of interventions (<0.001 [0.146]), and within-between interaction effect of group and time (<0.001 [0.515]). After using Kahoot and AR, the total mean self-efficacy score was significantly higher in the intervention group than in the control group (<0.001 [0.662]). The total median motivation score was significantly higher for the Kahoot and the AR groups compared with the traditional lecture (<0.001 [0.558]).

CONCLUSION

Kahoot games and AR significantly increased nurse students' knowledge, motivation, and self-efficacy compared with traditional MV learning classes. Nursing educators need to incorporate Kahoot and AR in their pedagogies to enhance nurse students' satisfaction and development.

Adapting Novel Augmented Reality Devices for Patient Simulations in Medical Education

Extended reality (XR) simulations are becoming increasingly common in educational settings, particularly in medical education. Advancing XR devices to enhance these simulations is a booming field of research. This study seeks to understand the value of a novel, non-wearable mixed reality (MR) display during interactions with a simulated holographic patient, specifically in taking a medical history. Twenty-one first-year medical students at the University of North Carolina at Chapel Hill participated in the virtual patient (VP) simulations. On a five-point Likert scale, students overwhelmingly agreed with the statement that the simulations helped ensure they were progressing along learning objectives related to taking a patient history. However, they found that, at present, the simulations can only partially correct mistakes or provide clear feedback. This finding demonstrates that the novel hardware solution can help students engage in the activity, but the underlying software may need adjustment to attain sufficient pedagogical validity.

Development and Effectiveness Evaluation of 360-Degree Virtual Reality-Based Educational Intervention for Adult Patients Undergoing Colonoscopy

Providing patients with accurate and organized information about colonoscopy, while reducing anxiety, is critical to the procedure's success. This study evaluated the impact of an immersive 360° virtual reality (VR)-based educational intervention for first-time adult colonoscopy patients regarding anxiety, attitudes, knowledge, compliance with bowel preparation, and bowel cleanliness. A quasi-experimental design with a non-equivalent control group and non-synchronized pretest-post-test clinical trial was conducted with 40 patients in the experimental group and 40 in the control group. The 360° VR intervention included two sessions: precautions before colonoscopy and the colonoscopy process. The control group received education through individual verbal explanations with written materials. The findings indicated that the VR intervention significantly improved patients' colonoscopy-related anxiety, attitudes, adherence to bowel preparation instructions, and bowel cleanliness. Utilizing 360° VR as an educational tool has the potential to enhance the effectiveness of educational programs by providing realistic information and engaging patients. These findings suggest that 360° VR has the capacity to enhance screening rates and clinical outcomes by reducing negative perceptions associated with colonoscopy. Furthermore, the application of this method can extend to diverse diagnostic testing-related nursing situations in clinical settings.

Innovative Learning: Implementing Virtual Reality in a Large Class of Prelicensure Students Using Limited Equipment, Time, and Resources

ABSTRACT

The development of critical thinking and decision-making skills is essential to link knowledge to practice in prelicensure nursing education. Immersive virtual reality (VR) is a teaching modality that provides students with an interactive way to develop their knowledge and skills. Faculty at a large mid-Atlantic university developed an innovative strategy to deploy immersive VR in a senior-level advanced laboratory technologies course with 110 students. Implementation of this approach to VR was intended to augment clinical learning in a safe learning environment.

Integrated virtual simulation and face-to-face simulation for clinical judgment training among undergraduate nursing students: a mixed-methods study

BACKGROUND

Virtual simulation and face-to-face simulation are effective for clinical judgment training. Rare studies have tried to improve clinical judgment ability by applying virtual simulation and face-to-face simulation together. This study aimed to evaluate the effect of an integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program on enhancing nursing students' clinical judgment ability and understanding of nursing students' experiences of the combined simulation.

METHODS

A sequential exploratory mixed-methods study was conducted in a nursing simulation center of a university in Central China. Third-year nursing students (n = 122) taking clinical training in ICUs were subsequentially assigned to the integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program arm (n = 61) or the face-to-face simulation-only arm (n = 61) according to the order in which they entered in ICU training. Clinical judgment ability was measured by the Lasater Clinical Judgment Rubric (LCJR). Focus group interviews were conducted to gather qualitative data.

RESULTS

Students in both arms demonstrated significant improvement in clinical judgment ability scores after simulation, and students in the integrated arm reported more improvement than students in the face-to-face simulation-only arm. The qualitative quotes provided a context for the quantitative improvement measured by the LJCR in the integrated arm. Most of the quantitative findings were confirmed by qualitative findings, including the domains and items in the LJCR. The findings verified and favored the effect of the combination of non-immersive virtual simulation and high-fidelity face-to-face simulation integrated program on enhancing nursing students' clinical judgment ability.

CONCLUSIONS

The integrated virtual simulation and face-to-face simulation program was feasible and enhanced nursing students' self-reported clinical judgment ability. This integrated non-immersive virtual simulation and high-fidelity face-to-face simulation program may benefit nursing students and newly graduated nurses in the ICU more than face-to-face simulation only.

AR-AI assisted ophthalmic nursing: Preliminary usability study in clinical settings

Objective

Ophthalmic ward nursing work is onerous and busy, and many researchers have tried to introduce artificial intelligence (AI) technology to assist nurses in performing nursing tasks. This study aims to use augmented reality (AR) and AI technology to develop an intelligent assistant system for ophthalmic ward nurses and evaluate the usability and acceptability of the system in assisting clinical work for nurses.

Methods

Based on AR technology, under the framework of deep learning, the system management, functions, and interfaces were completed using acoustic recognition, voice interaction, and image recognition technologies. Finally, an intelligent assistance system with functions such as patient face recognition, automatic information matching, and nursing work management was developed. Ophthalmic day ward nurses were invited to participate in filling out the System Usability Scale (SUS). Using the AR-based intelligent assistance system (AR-IAS) as the experimental group and the existing personal digital assistant (PDA) system as the control group. The experimental results of the three subscales of learnability, efficiency, and satisfaction of the usability scale were compared, and the clinical usability score of the AR-IAS system was calculated.

Results

This study showed that the AR-IAS and the PDA systems had learnability subscale scores of 22.50/30.00 and 21.00/30.00, respectively; efficiency subscale scores of 29.67/40.00 and 28.67/40.00, respectively; and satisfaction subscale scores of 23.67/30.00 and 23.17/30.00, respectively. The overall usability score of the AR-IAS system was 75.83/100.00.

Conclusion

Based on the analysis results of the System Usability Scale, the AR-IAS system developed using AR and AI technology has good overall usability and can be accepted by clinical nurses. It is suitable for use in ophthalmic nursing tasks and has clinical promotion and further research value.

Prebrief Time for Immersive Virtual and Augmented Reality Simulation: An Integrative Review

BACKGROUND

Virtual reality and augmented technology are rapidly advancing and hold the potential to transform nursing education by offering a convenient, efficient, learner-centered way to educate students. A comprehensive and time-oriented prebrief is essential to the process.

PURPOSE

This review analyzes the status of scientific exploration regarding the prebrief and time allotments for virtual and augmented reality simulation.

METHODS

Whittemore and Knafl's 5-stage method guided this integrative review. The authors searched 6 databases and selected 7 articles based on inclusion criteria.

RESULTS

The findings from this review demonstrated objectives, a safe learning environment, orientation, preparation materials, and time in the prebrief; yet, inconsistencies persist in the virtual and augmented reality prebrief.

CONCLUSIONS

Defining a comprehensive and consistent prebrief is essential for high-quality simulation. A more standardized process, including time allotments, must be established for virtual and augmented reality.

Virtual reality and critical care education in nursing: A cross-sectional study

BACKGROUND

The nursing care of a critically ill patient in the intensive care unit requires specific training. Virtual reality can facilitate the nursing assessment of critically ill patients.

OBJECTIVE

To evaluate the utility of virtual reality as a tool for teaching nursing assessment of critically ill patients.

DESIGN

This is a cross-sectional study.

SETTING

University of the Balearic Islands (Spain) during the 2022 academic year.

PARTICIPANTS

Third-year nursing students.

METHODS

A specific environment was designed for virtual reality immersion using a BNEXT head-mounted display. Data were collected using three questionnaires: perception of self-efficacy regarding skill-acquisition in the nursing care process; immersivity; utility and tool satisfaction.

RESULTS

A total of 111 undergraduated nursing students responded, 86.8 % of whom had no previous intensive care units experience. They rated the virtual reality experience positively for learning the nursing care process, emphasising the need for skin and mucosal hygiene, patient mobilisation and family care, as well as an understanding of the therapeutic technology required. A total of 67.6 % felt as though they were physically present. They reported a high degree of acceptance and satisfaction.

CONCLUSIONS

Virtual reality has facilitated the exposure of students to an unfamiliar environment such as the intensive care units, proving to be useful, satisfying, and motivating in teaching the nursing care process.

The use of smart glasses in nursing education: A scoping review

AIM

The aim of this scoping review was to give an overview of the usability and feasibility of smart glasses in nursing education. In addition, this study will highlight nursing students' experiences of using smart glasses in learning situations.

BACKGROUND

Healthcare is becoming increasingly complex and technological and so is nursing education. Technology enhanced learning aims to enhance the teaching-learning process through use of technology, for example through smart glasses.

DESIGN AND METHODS

A literature review using a scoping review methodology was conducted. Qualitative content analysis was performed to analyse data. 14 references were included in the analysis. References were found using the databases PubMed, SCOPUS and ERIC.

RESULTS

The analysis resulted in three categories; (1) Situations in which smart glasses have been used in nursing education, (2) Learning experiences from using smart glasses in nursing education, and (3) User experiences from using smart glasses in nursing education. Smart glasses were used in different learning situations and were in general positively evaluated by nursing students. Although, drawbacks of using smart glasses were noted which could negatively effect student learning.

CONCLUSIONS

Smart glasses have been used in a variety of learning situations in nursing education and enabled new learning situations. Students found smart glasses beneficial for their learning and smart glasses motivated and engaged students in the learning situation. Although, this was both user- and situation dependent. Technical issues could cause students to lose focus and there is need for technical support to facilitate the learning curve. By learning from others' experiences unnecessary drawbacks can be avoided.

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.

Virtual Reality Simulation Applications in Pre-Licensure Psychiatric Nursing Curricula: An Integrative Review

The integrative review's objective is to determine the effectiveness of incorporating virtual reality (VR) simulation teaching methods in pre-licensure psychiatric nursing curricula. While the demand for skilled nurses has increased, the COVID-19 pandemic exacerbated nursing educational resource shortages and reduced the number of qualified applicants accepted into nursing schools. Psychiatric assessment and communication skills are difficult to obtain. VR simulation may present an effective solution to enhancing nursing students' psychiatric education. The integrative review was the study design. Tailored search terms were applied to the following databases: PubMed, PsycINFO, ERIC, and CINAHL Plus with Full Text. The databases were searched by title and abstract during the period January 1, 2011, through October 14, 2021. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to search strategies and results. The selected articles were evaluated using the Johns Hopkins research evidence appraisal tool. Eleven studies met the inclusion criteria for the integrative review. Study results were categorized into two main themes: (a) pedagogical approach and (b) usability. Three sub-themes emerged: (a) knowledge, (b) attitudes, and (c) skills. VR was found to be effective in increasing nursing students' knowledge; improving communication and decision-making skills; and impacting attitudes toward patients living with mental illness. VR was found to be the same as or superior to traditional and other simulation methods in teaching psychiatric nursing education to pre-licensure students. While convenient, virtual reality use involves managing technical difficulties and considering safety. VR simulation is an effective pedagogical approach for psychiatric nursing curricula and offers a potentially cost-effective alternative to traditional learning and other simulation methods.

Text Network Analysis of Research Topics and Trends on Simulations Using Virtual Patients in Nursing Education

Simulations using virtual patients have been utilized as an effective method in nursing education. However, keyword network analyses and topic modeling on simulations using virtual patients in nursing education have not yet been performed. In this study, 213 articles were retrieved from online research article databases. Abstracts from these articles were extracted, and network analysis was conducted using NetMiner version 4.3 (Cyram Inc, Seongnam, South Korea). Based on the study's analysis, scenario, communication, system, assessment, person, disaster, and management were identified as the keywords with high centrality values. Therefore, they were determined to be influential in the network. After topic modeling, 10 topics were derived as dementia care competency, pain assessment, airway placement management, operating procedure, presence and satisfaction, communication and attitude improvement, platform world, disaster response, game and video usability, and system for confidence. The identified trends in this study will help grasp the trends and insight to guide future research directions on simulations using virtual patients in nursing education.

Online (versus face-to-face) augmented reality experience on nursing students' leg ulcer competency: Two quasi-experimental studies

AIM

The aim of this study was two-fold. Firstly, to describe the influence of an augmented reality (AR)-based online educational experience on the academic performance and learning determinants of nursing students related to the study of leg ulcer care. We also set out to compare these online results with those obtained in the same experience developed a year before but in a face-to-face design.

BACKGROUND

Undergraduate education in nursing aims to train students towards an acceptable level of competence for professional practice. Sometimes, some essential clinical areas of knowledge are particularly challenging for both students and nurse educators. One of these is the care of chronic wounds, particularly in leg ulcers where nurses play a key role. Currently face-to-face teaching methods are evolving to more active contexts and alternative means such as online learning and AR are becoming widely used, garnering encouraging results.

DESIGN

A quasi-experimental design was used. Two experiments were carried out to meet the aims of the study, the first one was a pre-test post-test design in one group and the second one a post-test two experimental groups design.

METHODS

Participants were undergraduate nursing students from the School of Nursing of the University of Santiago de Compostela (Spain). The two experimental groups received the same training but in different environments: online during 2019/2020 (n = 111) and onsite during 2018/2019 (n = 72). The instruments selected were a knowledge and skills test and two validated questionnaires.

RESULTS

Regarding academic performance, the study demonstrated significant differences towards learning after the AR-based online experience (Z = -9.074; p ≤ 0.001). The participants also showed good results in relation to the learning determinants studied. Compared with students receiving AR-based face-to-face teaching, the students with the online learning approach scored better in the dimensions Autonomous Learning (U=3104.5; p = 0.020) and 3D Comprehension (U=3167.0; p = 0.035). However, the participants in the onsite experience scored higher in the Attention dimension (U=3163.0; p = 0.035).

CONCLUSIONS

AR positively influences academic performance and diverse educational variables when this experience is carried out online. Since both the online and face-to-face experience show statistically significant benefits in different dimensions of the learning determinants, the need to improve the AR learning experience through blended-learning environments should be promoted.

Nursing students’ experience of using HoloPatient during the COVID-19 pandemic: A qualitative descriptive study

Background

Due to the COVID-19 pandemic, nursing schools have implemented alternative approaches to teaching clinical competency. This study examined nursing students’ experiences of using HoloPatient to learn COVID-19-related patient care.

Methods

In this qualitative descriptive study, focus group interviews were held virtually with 30 nursing student participants in South Korea. Data were collected from January 25 to February 8, 2022 and analyzed using a mixed content analysis.

Results

Participants shared their experiences of using the HoloPatient, addressing advantages, challenges, and concerns associated with this new approach. Overall, they reported satisfaction associated with having gained patient assessment and critical thinking skills, self-confidence, and knowledge about the care of patients with COVID-19. Barriers identified included the program's novelty, inadequate number of devices, instructions in English, learning environment, and issues such as poor Wi-Fi access.

Conclusion

HoloPatient in nursing education can improve learning motivation, critical thinking skills, and confidence. Efforts should be made to engage users by providing an orientation, supplementary materials, and an environment conducive to learning.

The effects of an augmented reality application developed for paediatric first aid training on the knowledge and skill levels of nursing students: An experimental controlled study

BACKGROUND

The purpose of the present research was to develop an augmented reality paediatric first aid training system to investigate the effects of such a system on the knowledge, skill levels, and self-confidence of nursing students in first-aid practices.

OBJECTIVE

This controlled experiment was conducted at a junior college. Ninety-five fourth-year nursing students participated in this study; 46 in the experimental group and 49 in the control group.

DESIGN AND METHODS

Data were collected using the Paediatric First Aid Knowledge Scale, Visual Analogue Scale of Self-Confidence and First Aid Practice Evaluation Checklist and pre- and post-test analyses were performed. The experimental group used the augmented reality application for paediatric first aid training, while the control group used a traditional method.

RESULTS

There was no statistically significant difference between the students' pre-test scores in both groups, indicating that the students had similar levels of knowledge of paediatric first aid before the intervention. The post-test of the paediatric first aid knowledge results showed that students in the experimental group significantly outperformed those in the control group (p < .05). A significant difference was found in the first aid skills between the groups (p < .001). Additionally, the students in the experimental group stated that the augmented reality application significantly improved their self-confidence in performing paediatric emergency care (p < .001).

CONCLUSIONS

The augmented reality application had a positive effect on the knowledge and skill levels of nursing students regarding first aid practices. This study suggests that augmented reality is a valuable teaching tool in many areas of nursing education.

Effectiveness of augmented reality in learning about leg ulcer care: A quasi-experimental study in nursing students

BACKGROUND

Chronic wounds are a serious public health problem worldwide. Providing optimal treatment to patients suffering from leg ulcers is a priority for nursing. Therefore, nursing students need to acquire the necessary competencies to provide evidence-based care. Augmented Reality (AR) is an emerging technology in health science education which can help nursing students achieve these skills if it is promoted by both institutions and educationalists.

OBJECTIVES

To test the effectiveness of an AR-based methodology for teaching-learning aspects of the nursing curriculum (leg ulcer care), as well as to describe how AR influences different learning determinants of nursing students.

DESIGN

A quasi-experimental study was carried out.

PARTICIPANTS/SETTINGS

The participants of the study were 137 s-year nursing students from the School of Nursing of the University of Santiago de Compostela (Spain) (average age = 21.59 years, 80.29 % females). Of them, 65 comprised the control group (Non-AR-based teaching) and 72 comprised the experimental group (AR-based teaching).

METHODS

Pre-post tests were used to measure knowledge and skills about leg ulcer care in both groups. Additionally, two validated questionnaires were selected to identify the influence of AR on learning determinants in the experimental group. The study took place during the 2018/2019 academic year.

RESULTS

Significantly higher scores (7.68 vs. 6.14) were found in the knowledge post-test in the experimental group (p ≤ 0.001), while the pre-test did not show differences between groups (4.43 vs. 4.32). Also, nursing students indicated high scores in attention, autonomous learning, understanding and motivation to carry out learning objectives using AR.

CONCLUSIONS

AR is a tool that improves performance related to the specific aspects of the nursing academic curriculum (leg ulcer care), while encouraging positive attitudes towards the teaching-learning process. These findings reinforce the need to include innovative methodologies in nursing classrooms.

Nursing Students' Home Care Learning Delivered in an Innovative 360-Degree Immersion Experience

BACKGROUND

Health care is delivered to patients in the community, frequently in their own homes. New graduates need to be prepared for this unique nursing role to care for patients in the home health setting.

PURPOSE

The purpose of this study was to assess student satisfaction with an innovative pedagogy to teach home health nursing using an immersion experience. The immersion experience delivered the home health nursing activity using 360-degree footage and zoom in pictures presented via a web platform.

METHODS

This study used a descriptive cross-sectional design with convenience sampling of 81 nursing students enrolled in the third semester of an associate degree program. Data were collected through an online survey eliciting anonymous feedback.

RESULTS

Participant feedback revealed this new pedagogy engaged nursing students and received overwhelmingly positive responses. A review of student feedback through written comments provided further support that this immersion experience exceeded expectations.

CONCLUSION

The 360-degree immersion home care experience provided problem-based learning that positively impacted student self-reported satisfaction and perceived learning.

Establishment and application of information-based training and assessment platform for clinical nursing operation technology

Background

The paper version of the training assessment was time-consuming and labor-consuming. It is an inevitable trend to change the appraisal method utilizing information technology. This study aimed to realize convenient and rapid management of the whole process of clinical nursing operation technology through information-based training and assessment platform.

Methods

Combined with the operation mode of clinical nursing operation skills and set the basic functions of the information platform of clinical nursing operation training and assessment, the information-based training and evaluation platform for clinical nursing operation skills was established. The platform was officially operated in a tertiary level A general hospital in Shandong Province in 2018.

Results

The information-based training and assessment platform is composed of Management Center (Computer Terminal) and a client terminal (APP terminal). The computer terminal contains 11 modules, and the APP terminal contains 8 modules. By December 2020, a total of 12,619 nurses had completed the training in nursing operation skills, and a total of 11,986 nurses had completed the examination. The examination results of nursing operation skills of the same nurses in 2018 were significantly higher than those in 2017(P < 0.05), and the error rate was significantly lower (P < 0.05). From 2016 to 2020, the scores of nasal feeding, CPR, and respiratory airbag of N1 level nurses significantly increased after using the information-based training and Assessment Platform (P < 0.05).

Conclusion

Based on the information terminal training assessment can realize the management of the whole process of clinical nursing operation technology training and assessment, which is better than the traditional method, and is a very practical and convenient clinical training and assessment method.

Supplementary information

The online version contains supplementary material available at 10.1186/s12912-022-01053-3.

Effectiveness of scenario-based learning and augmented reality for nursing students' attitudes and awareness toward climate change and sustainability

Background

Mainstreaming sustainable healthcare into the curricula of health professions is a key action to raise awareness and change attitudes. Therefore, the present study aimed to assess the contribution of scenario-based learning and augmented reality to the environmental awareness and attitudes toward climate change and sustainability among undergraduate nursing students.

Methods

This study was designed as a time-series analysis. Undergraduate nursing students in their 3 years were introduced to sustainability and climate change in the context of healthcare through scenario-based learning sessions. Questionnaires were used to collect data on participants’ attitudes towards sustainability and climate change, the usefulness of the educational sessions and the extent to which students changed their clinical practice. A data summary, related sample Friedman and Wilcoxon signed-rank tests were used to test for differences in survey scores.

Results

Attitudes and environmental awareness toward climate change and sustainability increased significantly as students received the learning sessions over the 3 years. After their first clinical training period, students already showed a high awareness of unsustainable practices in their working environment; however, they still struggled to apply sustainability and address unsustainable practices in healthcare settings. Most students felt that the scenarios helped them to make links between climate change, resources, and health.

Conclusions

The scenario-based learning and augmented reality increase environmental awareness and attitudes toward climate change and sustainability among nursing students. Students are very aware of unsustainable practices in their work environment, but more work needs to be done on the application of sustainability principles to nursing practice.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-01023-9.

A Scoping Review of Deep Learning in Cancer Nursing Combined with Augmented Reality: the Era of Intelligent Nursing is Coming

Artificial intelligence has been developing greatly in the field of medicine. As a new research hotspot of artificial intelligence, deep learning (DL) has been widely applied in the fields of cancer risk assessment, symptom recognition, and cancer detection. Therefore, nursing care issues in terms of consuming time and energy, lower accuracy, and lower efficiency can be solved with applying DL in caring cancer patients. In addition, augmented reality (AR) has great navigation potential through combining computer-generated virtual elements with the real world. Thus, DL ​+ ​AR may facilitate patients with cancer to possess a brand-new model of nursing care that is more intelligent, mobile, and adapted to the information age, compared to traditional nursing. With the advent of the era of intelligent nursing, future nursing models can not only learn from the DL ​+ ​AR model to meet the needs of patients with cancer but also reduce nursing workload, save healthcare resources, and improve work efficiency, the quality of nursing care, as well as the quality of life for cancer patients.

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

Assessing acceptance of augmented reality in nursing education

The Covid-19 pandemic has negatively affected every aspect of human life. In these challenging times nursing students, facing academic and psychological issues, are advised to use augmented reality applications in the field of health sciences for increasing their motivations and academic performances. The main motive of the study was to examine the acceptance status of nursing students in implementing augmented reality technology in their education and training. The study is a quantitative research study, and it uses the causal-comparative screening method. The data used in the study was collected online from 419 nursing students. The hybrid method was preferred. First, the hypotheses based on the linear relationships were defined between the variables which were then tested by the method of structural equation modeling. Second, the method of artificial neural networks was used to determine the non-linear relationships between the variables. The results show that the nursing students have a high intention of using augmented reality technology as a way of self-learning. It was also found that the most emphasized motive behind this intention is the expectation that using augmented reality technology will increase their academic performance. They also think that AR technology has many potential benefits to offer in the future. It was observed that a considerable number of students already use augmented reality technology for its usefulness and with a hedonic motivation. In conclusion, nursing students have a high acceptance of using augmented reality technology during their education and training process. Since we live in a world where e-learning and self-learning education/training have become widespread, it is estimated that students will demand augmented reality applications as a part of holistic education, and as an alternative to traditional textbooks.

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.

Influence of Virtual Reality Technology on Clinical Thinking Cultivation of Medical Students

Clinical thinking is not only the basis and premise of clinical reasoning and decision-making, but the necessary quality to cultivate reliable, responsible, and emotional excellent doctors. Virtual reality technology provides a real clinical learning environment for medical students, which can bridge the gap between medical theory and medical practice and save educational resources. Virtual reality is helpful to cultivate medical students' clinical thinking and prepare for their clinical practice. Through the deconstruction of clinical thinking, this paper determines the connotation and constituent elements of clinical thinking, puts forward the model framework for virtual reality technology to promote the development of medical students' clinical thinking, and explains the impact of virtual reality technology on the development of medical students' clinical thinking, clinical reasoning, and critical thinking from the aspects of virtual reality situation, teaching activities, and virtual reality characteristics.

The effect of mobile augmented reality application developed for injections on the knowledge and skill levels of nursing students: An experimental controlled study

OBJECTIVE

To evaluate the effect of Mobile Augmented Reality (MAR) educational materials on the knowledge and skill levels of nursing students on injection practices.

METHOD

This controlled experimental study was carried out with 122 first-year nursing students, 64 of whom were included in the experimental group and 58 in the control group. Data were collected between March and April 2018 using an information form, a pre-test, a post-test, a persistence test, and injection evaluation checklists. In the study, the experimental group used MAR applications and the control group used traditional teaching methods in learning injection practices.

RESULTS

There was no statistically significant difference between the pre-test scores of the students in the experimental and control groups, which determined the knowledge level of subcutaneous, intramuscular, and intravenous injections before the lesson (p > 0.05). After the lesson, it was found statistically significant that the post-test and persistence test scores of students in the experimental group were higher than the control group (p < 0.05). In the first and second/persistence skill evaluations, the injection skill scores of the students in the experimental group were higher than the control group (p < 0.05), which was also statistically significant. In addition, the students in the experimental group stated that MAR applications increased their motivation and self-confidence and reduced their concerns.

CONCLUSION

It was determined that MAR applications had a positive effect on the knowledge and skill levels of nursing students regarding injection practices and provided persistence in the learned knowledge and skills.

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 effects of a virtual simulation-based, mobile technology application on nursing students' learning achievement and cognitive load: Randomized controlled trial

BACKGROUND

The use of virtual simulation methods in nursing education offers potential advantages for students to experience and learn in a safe and realistic environment by acquiring skills and attitudes to prepare for clinical experiences.

OBJECTIVE

The study's aim was to test the hypothesis that nursing students who used a mobile learning app would have significantly (1) higher levels of knowledge about medication administration and nasotracheal suctioning, (2) better development of skill performances on medication administration and nasotracheal suctioning, (3) higher satisfaction, and (4) lower cognitive load than a control group.

DESIGN

A randomized experimental study with pretest and posttest design.

SETTINGS AND PARTICIPANTS

One hundred nursing students were randomly assigned to an experimental or control group at a Southern Taiwan university's school of nursing.

METHODS

The experimental group received the virtual simulation-based mobile learning app and the control group used traditional paper materials. Participants were assessed on knowledge before and after the intervention. Skill performance and intrinsic and extraneous cognitive load were measured after the intervention.

RESULTS

The experimental group who used the mobile app had significantly higher knowledge scores, significantly lower intrinsic and extraneous cognitive load, better skill performance, and higher satisfaction than the control group.

CONCLUSIONS

The implementation of a mobile app for simulation learning had a positive impact on nursing students' knowledge and skill performances as well as the reduction of learning cognitive loading. Nurse educators and researchers should collaborate in developing virtual learning resources to support clinical nursing education. Tweetable abstract: The mobile app for learning achieved higher knowledge and satisfaction scores, demonstrated better skill performance without increasing cognitive load.

The integration of immersive virtual reality simulation in interprofessional education: A scoping review

BACKGROUND

Contemporary healthcare systems are in dire need of teamwork and interprofessional collaboration, however, existing curricula of health education programs offer few opportunities to build these capabilities. Virtual simulations enable interaction and cooperative learning for students pursuing health majors.

OBJECTIVE

To explore the effectiveness of immersive virtual reality simulation (IVRS) in interprofessional education (IPE) and the experience of students from various disciplines in a virtual clinical environment.

DESIGN, DATA SOURCES AND METHODS

A scoping review was conducted. Literature was systematically searched from CINAHL, EMBASE, ERIC, MEDLINE/PubMed, ProQuest, PsycINFO, Scopus, Science Direct, Cochrane Library and Open Grey databases. Among 2352 records, 12 research articles were found and analyzed.

RESULTS

The experiences of students participating in IVRS centered on enhanced cooperation and communication across their disciplines. They obtained a more accurate picture of the patient and developed an interdisciplinary care plan. After the IPE session, they had greater appreciation of the importance of a team approach and shared learning. Students acknowledged the usability of virtual worlds (VWs) and appreciated the immersive learning experience that was offered. They gained valuable insight into mutual roles and believed that this experience would benefit their role as a health care team member.

CONCLUSIONS

This study supports the usability of VWs for IPE. As a new teaching modality, the IVRS experience effectively promotes interprofessional collaboration and communication. Future advances in the use of these technologies are expected to revolutionize health science education.

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.

Transitioning from direct care to virtual clinical experiences during the COVID-19 pandemic

When the COVID-19 pandemic forced university campuses and healthcare agencies to temporarily suspend both undergraduate and graduate direct care educational experiences, nursing programs had to formulate alternative plans to facilitate clinical learning. Texas Woman's University used this opportunity to assemble a faculty group tasked with creating a set of college-wide guidelines for virtual simulation use as a substitution for traditional face-to-face clinical. The process included completing a needs assessment of both undergraduate and graduate level programs across three campuses and identifying regulatory requirements and limitations for clinical experiences. The task force utilized the information gathered to develop evidence-based recommendations for simulation hour equivalence ratios and compiled a list of virtual activities and products faculty could use to complete clinical experiences. Undergraduate and graduate student surveys were conducted to determine the effectiveness of the transition to virtual clinical experiences. Overall, the majority of survey results were positive regarding virtual simulation experiences providing students with valuable opportunities to enhance their learning. Negative comments regarding the impact of COVID-19 on a personal level included issues involving internet access and web conferencing logistics, lack of motivation to study, family difficulties, and faculty inexperience teaching in an online environment. Undergraduate pre-licensure students were provided with opportunities to successfully complete all remaining required clinical hours virtually, while graduate students were allowed to complete non-direct care hours as applicable using virtual clinical experiences.