Learning and Retention Using Virtual Reality in a Decontamination Simulation

Virtual Reality Technology in Nursing Education: A Qualitative Study

Virtual reality (VR) technology plays a significant role in nursing education by enhancing the quality of training by applying knowledge, decision‐making, intervention completion and feedback. This study aims to examine nursing students' experiences and perceptions regarding the ventrogluteal injection training provided through VR technology. Conducted between May and June 2022, this qualitative descriptive phenomenology study took place at a state university in Turkey, involving 70 students who participated in Ventrogluteal Drug Administration training using VR glasses. The sample included 12 students selected via the Criterion Sampling Method. Data collection tools comprised the ‘Descriptive Information Form’ and a ‘Semi‐Structured Questionnaire’. Qualitative data were analysed using the Content Analysis Method, while quantitative data were assessed through descriptive statistical methods (frequency, percentage, mean). The study identified 13 codes, four sub‐themes and two main themes from the students' evaluations. The first main theme, ‘Weaknesses of Virtual Simulation’, included two sub‐themes: ‘Due to its Nature’ and ‘Due to its Technique’, resulting in five codes. The second main theme, ‘Strengths of Virtual Simulation’, was divided into two sub‐themes: ‘Permanence, Integrity, and Applicability’ and ‘Emotions towards Virtual Simulation’, with eight codes identified. The findings indicate that students view VR technology positively in their education. However, they also highlighted specific issues related to the simulation's technique and inherent nature.

Extended reality training for mass casualty incidents: a systematic review on effectiveness and experience of medical first responders

INTRODUCTION

Mass casualty incidents (MCI) are unforeseeable and complex events that occur worldwide, therefore enhancing the training that medical first responders (MFRs) receive is fundamental to strengthening disaster preparedness and response. In recent years, extended reality (XR) technology has been introduced as a new approach and promising teaching technique for disaster medicine education.

OBJECTIVE

To assess the effectiveness of XR simulation as a tool to train MFRs in MCIs, and to explore the perception and experience of participants to these new forms of training.

DESIGN

Systematic review.

METHODS

This systematic review was conducted in accordance with the "Preferred reporting items for systematic reviews and meta-analyses" (PRISMA) statement. Four databases were searched (MEDLINE, EMBASE, CINAHL and LILACs) using a comprehensive search strategy to identify relevant articles, and MetaQAT was used as a study quality assessment tool. Data from included studies was not pooled for meta-analysis due to heterogeneity. Extracted data was synthesised in a narrative, semi-quantitative manner.

RESULTS

A total of 18 studies were included from 8 different countries. Studies encompassed a variety of participants (e.g., nurses, paramedics, physicians), interventions (virtual, mixed and augmented reality), comparators (comparison between two groups and single groups with pre-post evaluation), and outcomes (effectiveness and MFR perception). The synthesis of data indicated that XR was an effective tool for prehospital MCI training by means of improved triage accuracy, triage time, treatment accuracy, performance correctness and/or knowledge acquired. These XR systems were well perceived by MFRs, who expressed their interest and satisfaction towards this learning experience and emphasized its usefulness and relevance.

CONCLUSION

This research supports the usefulness and significance of XR technology that allows users to enhance their skills and confidence when facing forthcoming disasters. The findings summarize recommendations and suggestions for the implementation, upgrade and/or assessment of this novel and valuable teaching method.

The Effectiveness of Immersive Virtual Reality Simulation as an Innovative Learning Strategy for Acquisition of Clinical Skills in Nursing Education: Experimental Design

Background: A transformation of learning in nursing is necessary to prepare students for developing complex clinical environments. The essential aim of clinical nursing learning is to enhance the integration of theoretical knowledge in the clinical environment by using various innovative strategies, such as immersive virtual reality (VR) simulation to develop a learning process that allows students to gain knowledge and perform skills in a visually attractive way, which enhances the quality and safety of clinical learning through repeated exposure to educational content that supports students' cognitive and psychomotor skills. Objective: This study was aimed at determining the effectiveness of immersive VR simulation as a learning strategy on the acquisition of intramuscular injection skills in nursing education and the performance level of nursing students compared with a physical learning environment (low-fidelity simulation). Materials and Metods: The experimental design (pre-post-test) was used among first-year nursing students (N = 66) (control group = 33, hip model and experimental group = 33, VR simulation) of the summer semester of 2019-2020 in the Faculty of Nursing at Near East University in Cyprus. Results: There is a significant difference between both groups in performance psychomotor skills scores, and the mean was higher in the experimental group (P = 0.002) and a significantly longer period of time than in the control group (P < 0.05). Conclusion: Immersive VR simulation is a supplementary tool and useful teaching-learning strategy for training in nursing education alongside physical laboratory (hip-model and mannequin) and psychomotor skills requiring the ordering of skill steps in teaching, and it provides realistic experiences in a safe environment instead of the unavailability of actual customers in clinical settings.

Multidisciplinary Design-Based Multimodal Virtual Reality Simulation in Nursing Education: Mixed Methods Study

BACKGROUND

The COVID-19 pandemic underscored the necessity for innovative educational methods in nursing. Our study takes a unique approach using a multidisciplinary simulation design, which offers a systematic and comprehensive strategy for developing virtual reality (VR) simulations in nursing education.

OBJECTIVE

The aim of this study is to develop VR simulation content for a pediatric nursing module based on a multidisciplinary simulation design and to evaluate its feasibility for nursing education.

METHODS

This study used a 1-group, posttest-only design. VR content for pediatric nursing practice was developed by integrating the technological characteristics of a multimodal VR system with the learning elements of traditional nursing simulation, combining various disciplines, including education, engineering, and nursing. A user test was conducted with 12 nursing graduates (preservice nurses) followed by post hoc surveys (assessing presence, VR systems, VR sickness, and simulation satisfaction) and in-depth, one-on-one interviews.

RESULTS

User tests showed mean scores of 4.01 (SD 1.43) for presence, 4.91 (SD 0.81) for the VR system, 0.64 (SD 0.35) for VR sickness, and 5.00 (SD 1.00) for simulation satisfaction. In-depth interviews revealed that the main strengths of the immersive VR simulation for pediatric pneumonia nursing were effective visualization and direct experience through hands-on manipulation; the drawback was keyword-based voice interaction. To improve VR simulation quality, participants suggested increasing the number of nursing techniques and refining them in more detail.

CONCLUSIONS

This VR simulation content for a pediatric nursing practice using a multidisciplinary educational design model was confirmed to have positive educational potential. Further research is needed to confirm the specific learning effects of immersive nursing content based on multidisciplinary design models.

Effect of Virtual Game-Based Integrated Clinical Practice Simulation Program on Undergraduate Nursing Students' Attitude Toward Learning

Game-based virtual reality simulation programs can capitalize on the advantages of non-face-to-face education while effectively stimulating the interest of trainees and improving training efficiency. This study aimed to develop a game-based virtual reality simulation program for nervous system assessment and to evaluate the effects of the program on the learning attitudes of nursing students. Using a one-group pretest-posttest design, 41 senior nursing students were enrolled, and their learning attitudes (self-directed learning attitude, academic self-efficacy, flow-learning experience, and learning presence) were evaluated. The effect of the program was statistically significant in self-directed learning attitude ( t = -2.27, P = .027) and learning presence ( t = -3.07, P = .003), but the difference was not statistically significant in academic self-efficacy ( t = -1.97, P = .054) and learning flow ( t = -0.74, P = .459). The virtual gaming simulation program can be used to effectively replace field training in situations wherein field training is limited, such as during the COVID-19 pandemic.

Using High-Fidelity Virtual Reality for Mass-Casualty Incident Training by First Responders - A Systematic Review of the Literature

INTRODUCTION

First responders' training and learning regarding how to handle a mass-casualty incident (MCI) is traditionally based on reading and/or training through computer-based scenarios, or sometimes through live simulations with actors. First responders should practice in realistic environments to narrow the theory-practice gap, and the possibility of repeating the training is important for learning. High-fidelity virtual reality (VR) is a promising tool to use for realistic and repeatable simulation training, but it needs to be further evaluated. The aim of this literature review was to provide a comprehensive description of the use of high-fidelity VR for MCI training by first responders.

METHODS

A systematic integrative literature review was used according to Whittemore and Knafl's descriptions. Databases investigated were PubMed, CINAHL Complete, Academic Search Ultimate, Web of Science, and ERIC to find papers addressing the targeted outcome. The electronic search strategy identified 797 potential studies. Seventeen studies were deemed eligible for final inclusion.

RESULTS

Training with VR enables repetition in a way not possible with live simulation, and the realism is similar, yet not as stressful. Virtual reality offers a cost-effective and safe learning environment. The usability of VR depends on the level of immersion, the technology being error-free, and the ease of use.

CONCLUSIONS

This integrative review shows that high-fidelity VR training should not rule out live simulation, but rather serve as a complement. First responders became more confident and prepared for real-life MCIs after training with high-fidelity VR, but efforts should be made to solve the technical issues found in this review to further improve the usability.

Evaluation of a Virtual Reality-Based Open Educational Resource Software

OBJECTIVES

Virtual reality (VR) teaching methods have potential to support medical students acquire increasing amounts of knowledge. EVENT (Easy VR EducatioN Tool) is an open educational resource software for immersive VR environments, which is designed for use without programming skills. In this work, EVENT was used in a medical student VR course on pancreatic cancer.

METHODS

Medical students were invited to participate in the course. Before and after VR simulation, participants completed a multiple-choice knowledge assessment, with a maximum score of 10, and a VR experience questionnaire. The primary endpoint compared pre- and post-VR simulation test scores. Secondary endpoints included usability and factors that could affect learning growth and test results.

RESULTS

Data from 117 of the 135 participating students was available for analysis. Student test scores improved by an average of 3.4 points (95% CI 3.1-3.7, P < 0.001) after VR course. The secondary endpoints of gender, age, prior knowledge regarding the medical subject, professional training completed in the medical field, video game play, three-dimensional imagination skills, or cyber-sickness had no major impact on test scores or final ranking (top or bottom 25%). The 27 students whose post-VR simulation test scores ranked in the top 25% had no prior experience with VR. The average System Usability Scale score was 86.1, which corresponds to an excellent outcome for user-friendliness. Questionnaire responses post-VR simulation show students (81.2% [95/117]) interest in more VR options in medical school.

CONCLUSIONS

We present a freely available software that allows for the development of VR teaching lessons without programming skills.

Virtual Reality and Augmented Reality Training in Disaster Medicine Courses for Students in Nursing: A Scoping Review of Adoptable Tools

Nurses and paramedics play a pivotal role when mass casualty incidents (MCI) occur, yet they often feel unprepared for such events. Implementation strategies for training activities, including virtual reality (VR) and augmented reality (AR) simulations, offer realistic and immersive learning experiences, enhancing skills and competencies for nursing students. The aim of this work was to investigate the adopted tools in studies on VR and AR simulations for training nursing and paramedic students in managing MCI. A scoping review was performed following the PRISMA-ScR statement, and the search strategy was conducted through five electronic databases from December 2022 to March 2023. Of 162 records identified, 27 full texts were screened and, six studies were included in this review. These studies involved students who were assigned to different training methods, including immersive VR simulation, written instruction, and traditional lecture. VR and AR and immersive simulation generally show promising evidence in enhancing practical skills and knowledge in MCI management. VR and AR showed to be promising in disaster education and preparedness training, offering different levels of immersiveness and engagement, encouraging active and experiential learning. Further research is needed to determine their long-term effectiveness. The choice of training method should consider program goals, target population, and available resources.

Does multisensory stimulation with virtual reality (VR) and smell improve learning? An educational experience in recall and creativity

Purpose

The purpose of this paper is to derive into practical recommendations from multisensory stimulation with virtual reality (VR) and scent to help educators develop effective teaching strategies geared toward aspects of the learning experience, recall, and creativity in a stereotypical learning context.

Design/methodology/approach

The paper is based on a randomized experiment in which student participants were subdivided into three treatment groups and one control group. Each group was stimulated by a different combination of visual, auditory, and olfactory stimuli (2D SMELL, VR, and VR SMELL) and the outcomes were compared against those of the control group (2D). Consistent with the Cognitive Theory of Multimedia Learning, hypotheses were constructed to study the effect of different combinations of stimuli on the learning experience and learning outcomes related to recall and creativity in a stereotypical learning context.

Findings

Traditional video content alone and bundled with a coherent olfactory stimulus prompted higher self-reported ratings of perceived quality of the sensory experience. Olfactory stimulus in combination with either VR or a traditional video prompted higher self-reported ratings on perceived immersion. In a stereotypical learning context, the highest recall scores were achieved with traditional video alone. Both VR alone and bundled with an olfactory stimulus resulted in enhanced creativity.

Research limitations/implications

The findings of this study should be interpreted in the context of adopting multisensory stimulations combined with VR technology as part of stereotypical learning contexts. Most professional educators do not have robust knowledge or experience in using build-on-purpose multisensory stimuli but are increasingly engaged in using multisensory tools such as VR, as part of their teaching practice. In relation to recall, the results are consistent with the hypothesis that in a stereotypical learning context, a multisensory experience involving VR and olfactory stimuli can be related to an undesired cognitive load for learners. There exists a possibility that the low-technical version of the VR goggles used, as well as the contents of the instructional video may have influenced the learning outcomes in terms of recall. Hence, future research should consider such aspects and focus on richer learning contexts.

Originality/value

This work offers practical recommendations for instructional design strategies aiming to create multisensory stimulations with VR and olfactory components to foster a richer learning experience and enhanced learning outcomes, under the assumptions of a stereotypical learning context.

Effects of Digital Learning and Virtual Reality in Port-A Catheter Training Course for Oncology Nurses: A Mixed-Methods Study

In-service education for oncology nurses usually adopts didactic teaching. This study investigated the effects of virtual reality (VR) and a digital learning-based Port-A-catheter educational course for oncology nurses. A mixed-methods research design was employed, with a convenience sample of 43 nurses from a regional teaching hospital in Taiwan participating. Measurements were taken at three time points: pre-test, 1st post-test, and 2nd post-test. The data was analyzed using descriptive statistics and repeated ANOVA tests. Results showed significant improvement in Port-A-catheter knowledge and skill levels (p < 0.0001) and high learning attitude and satisfaction scores of 4.29 ± 0.46 and 4.31 ± 0.58 points, respectively. Five qualitative themes emerged, highlighting the realistic VR scenarios, VR practice’s usefulness, willingness to learn with VR, VR system limitations, and the potential for future courses. The study concluded that a VR-based educational course effectively enhanced nurses’ knowledge, skills, learning attitude, and satisfaction, recommending the inclusion of diverse clinical scenarios for practical learning.

Effects of Health Education Using Virtual Reality for Adolescents: A Systematic Review and Meta-Analysis

PURPOSE

This study aimed to evaluate the effects of health interventions using virtual reality (VR) on improving knowledge, attitudes, and skills; and inducing behavioral change among adolescents.

METHODS

This study is a systematic review and meta-analysis following PRISMA guidelines. We searched Cochrane, MEDLINE, Embase, CINAHL, Scopus, Web of Science, and Korean databases between database inception and April 10, 2021. Based on heterogeneity, a random- or fixed-effects model was used, as appropriate, to calculate effect sizes in terms of the standardized mean difference (SMD) and odds ratio (OR). Studies were selected if they verified the effects of health education using VR on adolescents; there was an appropriate control group; and if the effects of education were reported in terms of changes in knowledge, attitudes, skills, or behaviors.

RESULTS

This analysis included six studies (n = 1,086). The intervention groups showed greater responses in knowledge and attitudes (SMD = 0.57, 95% confidence interval (CI) [0.12 to 1.02]), skills related to health behavior (SMD = -0.45, 95% CI [-0.71 to -0.19]), and behavioral change after 12 months (OR = 2.36, 95% CI [1.03 to 5.41]).

CONCLUSION

The results confirm the effectiveness of health interventions using virtual reality (VR). Although the analysis include a small number of studies, a case can be made for health interventions using VR to be utilized as educational methods and strategies to prevent risky behaviors among adolescents.

Effectiveness of the virtual reality chemical disaster training program in emergency nurses: A quasi experimental study

BACKGROUND

In Taiwan, 50 % of the chemical disasters in the last decade were industrial accidents. The leakage of industrial toxic chemical substances may cause significant environmental pollution and harms. Taiwan's chemical disaster education and training mainly rely on simulation, which is labor-intensive, time-consuming, and costly. Tabletop drills are often used to as a substitute for simulations. However, tabletop drills lack a realistic presence. The 360° virtual reality (VR) transforms knowledge of disaster preparedness into audio-visual and other sensory experiences and allows participants to be physically immersed in an environment.

PURPOSE

This study examined effectiveness of a "360° VR chemical disaster training program" on disaster preparedness and self-efficacy in ER nurses.

METHOD

This study used convenience sampling and quasi-experimental design with two-group repeated measures. Seventy-seven ER nurses were recruited with the experimental group (n = 32) receiving chemical disaster training through 360° VR and the control group (n = 35) receiving training through tabletop drills. Data were collected before, one week after and three weeks after the intervention.

RESULT

Participants in the experimental group were significantly younger and less experienced in disaster management than those in the control group. There were no between-group differences in the participants' self-assessment of chemical disaster preparedness and self-efficacy before the intervention. The intervention group showed significantly higher self-assessment chemical disaster preparedness scores than the comparison group (p < .05) one week after the intervention. However, no significant differences were found three weeks after the intervention.

CONCLUSION

This study found that both 360° VR and tabletop drills improved preparedness and self-efficacy in chemical disasters among ER nurses. VR could be used for disaster preparedness training for nurses without prior disaster response experiences/ drills, whereas tabletop drills were more suitable for nurses with prior experiences. Both methods may effectively promote nurses' learning effectiveness and self-efficacy in chemical disaster preparedness.

Objects May Be Farther Than They Appear: Depth Compression Diminishes Over Time with Repeated Calibration in Virtual Reality

Prior research in depth perception and perceptuo-motor calibration have primarily focused on participants completing experiments in single sessions and therefore do not empirically evaluate changes over time. Further, these studies do not typically take into account the amount of experience that the participants have in virtual reality (VR) prior to participation, the role of experience during participation, or calibration that may occur throughout the experiment session. In this contribution, we conducted a novel empirical evaluation of how calibration affects perception-action coordination over time. We recruited novice VR users and they completed eight sessions of a depth perception reaching experiment over the course of 12 weeks. During these experiments, we examined how participants' ability to estimate depth in a virtual environment changed as they gradually gained experience. While previous literature has shown that participants tend to underestimate distances, we found that this underestimation diminished over time as they gained experience in the virtual environment. Our study highlights the need for carrying out VR studies over time and the influence that longitudinal calibration can have on spatial perception in long-term VR experiences.

Effectiveness of Digital Simulation on Student Nurses' Knowledge and Confidence:An Integrative Literature Review

Digital simulation is an emerging innovation with the potential to address the limitations to traditional clinical simulation. The pandemic has accelerated teaching on digital platforms, which is now embedded in pedagogic practice. This integrative review will evaluate the effectiveness of digital simulation on nursing students' knowledge and/or confidence. The electronic database search carried out between October 3 and 7, 2021. We included primary research articles published in English language between January 2012 and October 2021. From 14,369 citations, 10 full-text documents were included in our final analysis and synthesis. Results suggest that digital simulation with realistic, immersive and interactive characters had a positive impact on students' learning outcome in terms of knowledge acquisition and self-confidence. Therefore, combining digital simulation with face-to-face simulation will enhance learning.

Development of CryoVR, a virtual reality training system for hands-on cryoEM operations

Cryogenic electron microscopy (cryoEM) has emerged as a revolutionary method for solving high-resolution structures and studying the dynamics of macromolecular complexes and viruses in near-native states. However, the availability of the equipment, and the time and cost needed for training, severely limit the opportunities for training. To solve these problems, a virtual reality-based training system, CryoVR, has been developed to prepare trainees before operating real-world cryoEM equipment. This paper describes the design and assessment of CryoVR (available at https://www.purdue.edu/cryoVR), which helps users learn cryoEM experimental procedures in a virtual environment, allowing immersive training with step-by-step tutorials with vivid visual, audio and text guidance. Implemented as a training step before a novice user interacts with the expensive real-world cryoEM equipment, CryoVR can help users to become familiar with hands-on operational procedures through multiple training modules and earning certificates after passing the built-in Exam mode. Qualitative evaluation and feedback of CryoVR from users with various levels of cryoEM experience indicate the substantial value of CryoVR as a tool for a comprehensive cryoEM procedural training.

Scrum VR: Virtual Reality Serious Video Game to Learn Scrum

Education is crucial for the growth of society, and the usage of effective learning methods is key to transmit knowledge to young students. Some initiatives present Virtual Reality technologies as a promising medium to provide active, effective, and innovative teaching. In turn, the use of this technology seems to be very attractive to students, making it possible to acquire knowledge through it. On the other hand, agile methodologies have taken an essential role within information technologies and they are key in Software Engineering education. This paper combines both areas and presents prior research about Virtual Reality experiences with educational purposes and introduces a serious VR video game that aims to promote the learning of agile methodologies in Software Engineering education, specifically the Scrum methodology. This application tries to bring students closer to their first days of work within a software development team that uses the Scrum methodology. Two evaluation processes performed with university teachers and students indicate that the developed video game meets the proposed objectives and looks promising.

A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education

BACKGROUND

Virtual Reality (VR) simulation has been a topic of interest in recent years as an innovative strategy for healthcare education. Although there are a handful of studies evaluating VR simulation on knowledge, motivation, and satisfaction; there is a paucity of evidence to evaluate the effectiveness, acceptability and usability of 'Immersive' VR (IVR) simulation in nursing students.

OBJECTIVES

A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses' self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education.

METHODS

The IVR simulation intervention was designed in collaboration with serious game specialists. Stage one collated pre and post-intervention self-efficacy scores with 19 pre-registration nurses using the validated instrument, Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM©) scale. Stage two used a descriptive qualitative approach to explore student nurses' perceptions of the game.

RESULTS

In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four over-arching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game.

CONCLUSION

IVR simulation show promise as an adjunct for nurse simulation and it appears to increase self-efficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.

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.

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.

Positive Outcomes of Rapid Freeware Implementation to Replace Baccalaureate Student Clinical Experiences

BACKGROUND

Loss of in-person clinical experiences due to the COVID-19 pandemic created the need for a rapid transition to online clinical education using virtual simulation, which has been shown to be an effective teaching-learning method. Standards of best practice for simulation provide a framework for implementation.

METHOD

Using free online simulation programs, 15 faculty members offered 3-hour synchronous sessions covering 20 different topics via an online meeting platform to 42 senior nursing students. Students were invited to complete an evaluation following each session.

RESULTS

Students collectively logged over 1,200 hours of simulation time attending approximately 100 sessions. Postsimulation evaluations captured students' responses to sessions. Students appreciated the opportunity to review content covered in previous semesters and engaged most when simulations followed a consistent structure, were interactive, and contained visually engaging materials.

CONCLUSION

Resourceful faculty responded quickly and creatively to the urgent need to transition to online clinical learning and created positive experiences for students. [J Nurs Educ. 2020;59(12):701-704.].

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.

Exploring User Needs in the Development of a Virtual Reality-Based Advanced Life Support Training Platform: Exploratory Usability Study

BACKGROUND

Traditional methods of delivering Advanced Life Support (ALS) training and reaccreditation are resource-intensive and costly. Interactive simulations and gameplay using virtual reality (VR) technology can complement traditional training processes as a cost-effective, engaging, and flexible training tool.

OBJECTIVE

This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms.

METHODS

Semistructured interviews were conducted with experienced clinicians (n=10, median age=40.9 years) following a single playthrough of the application. All clinicians have been directly involved in the delivery of ALS training in both clinical and educational settings (median years of ALS experience=12.4; all had minimal or no VR experience). Interviews were supplemented with an assessment of usability (using heuristic evaluation) and presence.

RESULTS

The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles.

CONCLUSIONS

This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.

Education and visual neuroscience: A mini-review

Neuroscience, especially visual neuroscience, is a burgeoning field that has greatly shaped the format and efficacy of education. Moreover, findings from visual neuroscience are an ongoing source of great progress in pedagogy. In this mini-review, I review existing evidence and areas of active research to describe the fundamental questions and general applications for visual neuroscience as it applies to education. First, I categorize the research questions and future directions for the role of visual neuroscience in education. Second, I juxtapose opposing views on the roles of neuroscience in education and reveal the "neuromyths" propagated under the guise of educational neuroscience. Third, I summarize the policies and practices applied in different countries and for different age ranges. Fourth, I address and discuss the merits of visual neuroscience in art education and of visual perception theories (e.g., those concerned with perceptual organization with respect to space and time) in reading education. I consider how vision-deprived students could benefit from current knowledge of brain plasticity and visual rehabilitation methods involving compensation from other sensory systems. I also consider the potential educational value of instructional methods based on statistical learning in the visual domain. Finally, I outline the accepted translational framework for applying findings from educational neuroscience to pedagogical theory.

Effectiveness of Two Varying Levels of Virtual Reality Simulation

AIM

The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination.

BACKGROUND

Little is known about the use of VRS in providing disaster education, including retention.

METHOD

Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months.

RESULTS

Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive.

CONCLUSION

VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

The Student Experience With Varying Immersion Levels of Virtual Reality Simulation

With increasing use of virtual reality simulation (VRS) in nursing education and given the vast array of technologies available, a variety of levels of immersion and experiences can be provided to students. This study explored two different levels of immersive VRS capability. Study participants included baccalaureate nursing students from three universities across four campuses. Students were trained in the skill of decontamination using traditional methods or with VRS options of mouse and keyboard or head-mounted display technology. Results of focus group interviews reflect the student experience and satisfaction with two different immersive levels of VRS.