The Effects of Computer-Based Simulation Game and Virtual Reality Simulation in Nursing Students' Self-evaluated Clinical Reasoning Skills

Games to support teaching clinical reasoning in health professions education: a scoping review

INTRODUCTION

Given the complexity of teaching clinical reasoning to (future) healthcare professionals, the utilization of serious games has become popular for supporting clinical reasoning education. This scoping review outlines games designed to support teaching clinical reasoning in health professions education, with a specific emphasis on their alignment with the 8-step clinical reasoning cycle and the reflective practice framework, fundamental for effective learning.

METHODS

A scoping review using systematic searches across seven databases (PubMed, CINAHL, ERIC, PsycINFO, Scopus, Web of Science, and Embase) was conducted. Game characteristics, technical requirements, and incorporation of clinical reasoning cycle steps were analyzed. Additional game information was obtained from the authors.

RESULTS

Nineteen unique games emerged, primarily simulation and escape room genres. Most games incorporated the following clinical reasoning steps: patient consideration (step 1), cue collection (step 2), intervention (step 6), and outcome evaluation (step 7). Processing information (step 3) and understanding the patient's problem (step 4) were less prevalent, while goal setting (step 5) and reflection (step 8) were least integrated.

CONCLUSION

All serious games reviewed show potential for improving clinical reasoning skills, but thoughtful alignment with learning objectives and contextual factors is vital. While this study aids health professions educators in understanding how games may support teaching of clinical reasoning, further research is needed to optimize their effective use in education. Notably, most games lack explicit incorporation of all clinical reasoning cycle steps, especially reflection, limiting its role in reflective practice. Hence, we recommend prioritizing a systematic clinical reasoning model with explicit reflective steps when using serious games for teaching clinical reasoning.

Nursing Students' Experiences of Empathy in a Virtual Reality Simulation Game: A Descriptive Qualitative Study

Empathy is significant in nursing, and showing empathy toward a patient positively impacts a patient's health. Learning empathy through immersive simulations is effective. Immersion is an essential factor in virtual reality. This study aimed to describe nursing students' experiences of empathy in a virtual reality simulation game. Data were collected from nursing students (n = 20) from May 2021 to January 2022. Data collection included individual semistructured interviews; before the interviews, the virtual reality gaming procedure was conducted. Inductive content analysis was used. Nursing students experienced compassion and a feeling of concern in the virtual reality simulation game. Students were willing to help the virtual patient, and they recognized the virtual patient's emotions using methods such as listening and imagining. Students felt the need to improve the patient's condition, and they responded to the virtual patient's emotions with the help of nonverbal and verbal communication and helping methods. Empathy is possible to experience by playing virtual reality simulation games, but it demands technique practicing before entering the virtual reality simulation game.

Methodological approaches and competence areas of nursing students in virtual reality simulation research - A scoping review

OBJECTIVES

To analyze methodological approaches (theoretical frameworks, study designs, methods) and competence areas of nursing students in research on virtual reality simulations (VRS) with a high level of immersion.

METHODS

A scoping review was performed. A systematic search of the literature was conducted on MEDLINE, CINAHL and ERIC databases on 30/11/22. In addition, a manual search was utilized. The extracted data relating to the research questions was descriptively analyzed and results were narratively summarized.

RESULTS

In total 23 studies were included in the review. Selected studies employed a wide range of theoretical frameworks and research designs. The studies aimed to develop competences both through complex interventions where team-based skills are required in acute situations, and they described basic nursing interventions where individual skills are required in non-acute nursing care.

CONCLUSIONS

A significant amount of the selected studies did not utilize a learning theory or an instructional design framework as a basis for their research. More knowledge was found on training specific skills compared to facilitating the attitudes and values of the participants. Therefore, there is a need for further research on whether nursing students' attitudes and values can be supported through VRS with a high level of immersion.

Association between game metrics in a simulation game and nursing students' surgical nursing knowledge - a quasi-experimental study

BACKGROUND

Simulation games are effective for acquiring surgical nursing knowledge during education by offering possibilities to learn theoretical knowledge through practical patient scenarios, thus preparing students for demanding surgical nursing care. Game metrics stored in the game system enable assessment of students' behaviour while gameplaying. Combining game metrics with the assessment of a student's surgical nursing knowledge allows versatile information to be obtained about the student's learning outcomes. However, studies on game metrics stored in systems and their relationship with learning outcomes are scarce.

METHODS

The aim here was to evaluate the association between game metrics in a simulation game and nursing students' surgical nursing knowledge. Nursing students from three universities of applied sciences in Finland participated in a one-week simulation gameplaying intervention that included five surgical nursing scenarios. Students' surgical nursing knowledge was investigated with a quasi-experimental, one-group, pre- and post-test design using a surgical nursing knowledge test. In total, 280 students filled in the knowledge tests. In addition, cross-sectional game data were collected at a single time point between pre- and post-tests. The data were analysed with descriptive statistics and multivariate analysis methods.

RESULTS

Students' surgical nursing knowledge improved with the intervention. The total number of playthroughs was 3562. The mean maximum score was 126.2 (maximum score range 76-195). The mean playing time of all playthroughs by all players was 4.3 minutes (SD = 81.61). A statistically significant association was found between mean score and knowledge test total score (p < 0.0072), but no significant association emerged between mean playing time and knowledge test total score.

CONCLUSION

The results indicated that the higher the mean score the better the students' surgical nursing knowledge in the knowledge test. This study did not show that the time spent playing had an impact on students' post-playing knowledge. Our findings support the idea that game metrics can be used in performance evaluation and the results can be used to improve nursing students' readiness for challenging preoperative and postoperative clinical situations.

Translation, Reliability, and Validity of the Japanese Clinical Reasoning Skills Self-Evaluation Scale: An Instrument Design Study

BACKGROUND

Currently, little evidence supports the notion that improved practical skills through simulation education are reflected in actual clinical practice and ultimately lead to positive outcomes for participants. However, by clarifying the relationship between the simulation foundation and its practicality, insights can be gained to develop educational programs to improve clinical reasoning skills. However, no clear scale is currently available in Japan.

AIMS

To create a valid Japanese version of the clinical reasoning skills self-evaluation scale and evaluate its reliability and validity.

METHODS

This instrument design study included 580 nursing students and nurses surveyed online from February to March 2023. The clinical reasoning skills self-evaluation scale was translated into Japanese using a back-translation method, and semantic equivalence and content validity were assessed. The content validity index was assessed using a pilot test involving 26 clinical nurses, 25 nursing students, and an expert panel. Validity and reliability were tested using a convenience sample of 580 nursing students and nurses. Reliability was assessed using internal consistency and test-retest reliability. Construct validity was assessed using confirmatory factor analysis.

RESULTS

Cronbach's alpha for all dimensions was >0.7, and the questionnaire showed acceptable internal consistency. Test-retest reliability was evaluated using the intraclass correlation coefficient (0.674-0.797, all dimensions); the lowest value at a 95% confidence interval was 0.504 (at least moderate reliability).

CONCLUSION

Our scale has acceptable validity and reliability. It may help in clinical reasoning skill assessment for nurses and nursing students and aid in examining and supporting these skills.

Development and Effects of a Virtual Reality Simulation Nursing Education Program Combined With Clinical Practice Based on an Information Processing Model

The need to strengthen patient human rights and create a patient-centered healthcare environment is growing. Also as science and technology develop, new educational methods using virtual reality in nursing education are emerging. This study aimed to develop a virtual reality simulation nursing education program related to postoperative patient nursing based on an information processing model and to verify its effectiveness. Clinical practice-linked virtual reality simulation nursing education was conducted for a total of 4 weeks. Nursing students were divided into an experimental group (n = 22) experiencing virtual reality simulation combined with clinical practice and a control group (n = 22) having routine clinical practice. The analytical results of this study indicated that the information processing model-based virtual reality simulation nursing education program was effective in improving nursing students' performance confidence and clinical decision-making ability. Therefore, the virtual reality simulation program developed in this study can provide basic data for the development of a simulation curriculum in the future and can contribute to the development of clinical competency as a professional nurse by improving the performance confidence and clinical decision-making ability of nursing students.

Health Care and Social Work Students' Experiences With a Virtual Reality Simulation Learning Activity: Qualitative Study

BACKGROUND

Virtual reality is used to an increasing extent in various fields and is now making inroads into health and social education. Virtual reality simulation can provide a safe and controlled environment for students to practice and master skills that are transferable to real-world situations without putting patients, clients, or themselves at risk of any harm. Virtual reality simulation using 360° videos represents a novel approach to simulation in health care and social work education, and this inspired our interest in exploring students' experiences with such a learning activity.

OBJECTIVE

The aim of this study was to explore occupational therapy, social education, nursing, and social work students' experiences with virtual reality simulation as a learning activity in an interdisciplinary subject.

METHODS

The data were collected through 6 semistructured focus groups with 28 students. We conducted the focus groups after the students from the 4 education programs had participated in the virtual reality simulation at 3 campuses at a specialized university in Norway. Each focus group interview was facilitated by 1 moderator and 1 facilitator, a combination of experienced researchers and novices. We followed a qualitative design using the 6-step thematic analysis described by Braun and Clarke.

RESULTS

The analysis revealed 3 overall themes for students' experiences with the virtual reality simulation. The first theme, 360° videos provide observations for individual learning, illustrates how learning can take place through the students' experiences with sensory inputs and observations from the 360° videos. Students experienced that the video enabled them to individually reflect and achieve learning from what was considered a clinically relevant video. The second theme, 360° videos activate emotional learning, demonstrates how the students experienced emotional engagement when watching the 360° videos. The degree of realism provided in the video was considered as important for the students' learning. The last theme, Debrief sessions enhance comprehensive learning, pinpoints how the students experienced learning through reflective discussions with other students after watching the 360° videos. Students claimed this process to be a vital part of the learning activity.

CONCLUSIONS

Virtual reality simulation represents a promising learning activity to enhance the professional learning of health care and social work students. It offers opportunities for individualized learning through observations, and it also engages students emotionally in the learning process. The combination of 360° videos and group discussions in virtual reality appears promising to enhance professional learning outcomes and competence, which may contribute to improved health care and social work services.

Developing online simulated practice placements: a case study

The Nursing and Midwifery Council recognises that using simulated practice learning within the pre-registration nursing curriculum is a valuable way for students to develop nursing knowledge and skills. The University of Huddersfield developed simulated placements in the pre-registration nursing curriculum in 2021. Simulated placements are now embedded within all fields of the BSc and MSc programmes, providing structured, innovative learning experiences that embrace online technology in supporting the development of skills and knowledge relevant to all fields of nursing. Developing these placements has provided an opportunity for faculty staff to work collaboratively with clinical colleagues, service users and carers, academics and technologists. This article offers an overview of that work, addressing challenges, operational issues, and insight into some of the activities developed to support students' learning.

Nursing Students' Scenario Performance: Game Metrics in a Simulation Game

AIM

The purpose of this study was to examine nursing students' scenario performance in a simulation game by utilizing game metrics.

BACKGROUND

A significant advantage of simulation games is that they can store large amounts of data. Although game metrics enable the objective evaluation and analysis of performance, their use in the evaluation of students' performance is limited.

METHOD

Nursing students (N = 376) played a simulation game at home for 1 week. The resulting data consisted of game metrics stored in the game: number of playthroughs, mean scores, and mean playing times.

RESULTS

The total number of playthroughs was 1,923. Statistically significant differences were found between different scenarios regarding the mean score (p < .0001). Mean playing time was significantly associated with the mean score (p < .05).

CONCLUSION

Game metrics demonstrate nursing students' scenario performance in clinical reasoning skills in different scenarios in a simulation game.

Metaverse applied to musculoskeletal pathology: Orthoverse and Rehabverse

The Metaverse is 'an integrated network of 3D virtual worlds.' It incorporates digitally created realities into the real world, involves virtual copies of existing places and changes the physical reality by superimposing digital aspects, allowing its users to interact with these elements in an immersive, real-time experience. The applications of the Metaverse are numerous, with an increasing number of experiences in the field of musculoskeletal disease management. In the field of medical training, the Metaverse can help facilitate the learning experience and help develop complex clinical skills. In clinical care, the Metaverse can help clinicians perform orthopedic surgery more accurately and safely and can improve pain management, the performance of rehabilitation techniques and the promotion of healthy lifestyles. Virtualization can also optimize aspects of healthcare information and management, increasing the effectiveness of procedures and the functioning of organizations. This optimization can be especially relevant in departments that are under significant care provider pressure. However, we must not lose sight of the fundamental challenges that still need to be solved, such as ensuring patient privacy and fairness. Several studies are underway to assess the feasibility and safety of the Metaverse.

Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review protocol

Background: Education is recognised as a constitutional right, however, access to and participation in higher education can be challenging for some students. This has led to the development of various international and local initiatives promoting inclusion, which has increased student representation from marginalised groups. In order to support growing student diversity, teaching and learning (T&L) strategies must encompass inclusive pedagogical principles. Technological advancements have improved opportunities for online T&L strategies and these are becoming an integral component of curricula in undergraduate nursing programmes. Online simulation-based learning (SBL) has gathered momentum in nursing education over the past twenty years. However, it is unclear from the evidence-base how inclusive this educational approach is, and how it can best support the growing diversity among nursing students. This paper outlines the protocol for a scoping review that aims to systematically and comprehensively map the available published and unpublished literature on inclusive pedagogy in online SBL in undergraduate nursing education.  Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for systematic review protocols (PRISMA-P) guided this protocol. Arksey and O'Malley (2005) six-stage methodology framework, the Joanna Briggs Institute (JBI) guidelines (Peters et al., 2020) and the PRISMA extension for scoping reviews (PRISMA-ScR) will guide the proposed scoping review (Tricco et al., 2018). Conclusion: It is envisaged that this scoping review will give a broad overview of the evidence for inclusive pedagogy in online SBL at this point. The findings of this review will be used to inform future policy and the pedagogical and technological design of online SBL activities and assist nurse educators to meet the current requirement of inclusive practice.

Understanding Clinical Reasoning through Visual Scanpath and Brain Activity Analysis

This paper presents an experimental study that analyzes learners’ visual behaviour and brain activity in clinical reasoning. An acquisition protocol was defined to record eye tracking and EEG data from 15 participants as they interact with a computer-based learning environment called Amnesia, a medical simulation system that assesses the analytical skills of novice medicine students while they solve patient cases. We use gaze data to assess learners’ visual focus and present our methodology to track learners’ reasoning process through scanpath pattern analysis. We also describe our methodology for examining learners’ cognitive states using mental engagement and workload neural indexes. Finally, we discuss the relationship between gaze path information and EEG and how our analyses can lead to new forms of clinical diagnostic reasoning assessment.

Systematic Bibliometric Analysis of Research Hotspots and Trends on the Application of Virtual Reality in Nursing

Background

With the emergence of the metaverse, virtual reality, as a digital technology, must be getting hotter. High quality virtual reality related nursing knowledge scene learning is gradually replacing traditional education and intervention skills.

Objective

This systematic study aimed to gain insights into the overall application of virtual reality technology in the study of nursing.

Methods

Citations downloaded from the Web of Science Core Collection database for use in VR in nursing publications published from January 1, 2012, to December 31, 2021, were considered in the research. Information retrieval was analyzed using https://bibliometric.com/app, CiteSpace.5.8. R3, and VOS viewer.

Results

A total of 408 institutions from 95 areas contributed to relevant publications, of which the United States is the most influential country in this research field. The clustering labels of cited documents were obtained from the citing documents. Virtual simulation, virtual learning, clinical skills, and dementia are the clustering labels of co-cited documents. The burst keywords represented the research frontiers in 2020–2021, which were knowledge and simulation.

Conclusion

Virtual nursing has had an impact on both nurses and clients. With the emergence of the concept of the metaverse, the research and application of virtual reality technology in nursing will gradually increase.

Inclusive pedagogy in online simulation-based learning in undergraduate nursing education: A scoping review protocol

Background: Education is recognised as a constitutional right, however, access to and participation in higher education can be challenging for some students. This has led to the development of various international and local initiatives promoting inclusion, which has increased student representation from marginalised groups. In order to support growing student diversity, teaching and learning (T&L) strategies must encompass inclusive pedagogical principles. Technological advancements have improved opportunities for online T&L strategies and these are becoming an integral component of curricula in undergraduate nursing programmes. Online simulation-based learning (SBL) has gathered momentum in nursing education over the past twenty years. However, it is unclear from the evidence-base how inclusive this educational approach is, and how it can best support the growing diversity among nursing students. This paper outlines the protocol for a scoping review that aims to systematically and comprehensively map the available published and unpublished literature on inclusive pedagogy in online SBL in undergraduate nursing education.  Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses Extension for systematic review protocols (PRISMA-P) guided this protocol. Arksey and O'Malley (2015) six-stage methodology framework, the Joanna Briggs Institute (JBI) guidelines (2005) and the PRISMA extension for scoping reviews (PRISMA-ScR) will guide the proposed scoping review. Conclusion: It is envisaged that this scoping review will give a broad overview of the evidence for inclusive pedagogy in online SBL at this point. The findings of this review will be used to inform future policy and the pedagogical and technological design of online SBL activities and assist nurse educators to meet the current requirement of inclusive practice.