Virtual reality simulation: using three-dimensional technology to teach nursing students

Effects of Immersive Technology-Based Education for Undergraduate Nursing Students: Systematic Review and Meta-Analysis Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Approach

BACKGROUND

The adoption of immersive technology in simulation-based nursing education has grown significantly, offering a solution to resource limitations and enabling safe access to clinical environments. Despite its advantages, there are still diverse reports regarding the effectiveness of immersive technology. It is crucial to verify the effectiveness of immersive technology in nursing education to inform future educational programs.

OBJECTIVE

This systematic review aimed to identify the contents of immersive technology-based education for undergraduate nursing students and evaluate the effectiveness of immersive technology compared to traditional teaching methods.

METHODS

A literature search was performed using 4 databases: PubMed, CINAHL, Embase, and Web of Science; the latest search was completed on January 19, 2023. The inclusion criteria were as follows: participants were undergraduate nursing students; studies were published in Korean or English; designs included randomized controlled trials (RCTs) or nonrandomized studies; and interventions involved virtual reality (VR), augmented reality (AR), mixed reality, or extended reality. Quality assessment was conducted using Cochrane Risk-of-Bias Tool version 2 for RCTs and the Risk-of-Bias Assessment Tool for Nonrandomized Studies. The main outcomes of the included studies were classified according to the New World Kirkpatrick Model (NWKM), ranging from level 1 (reaction) to level 4 (results). Meta-analysis was conducted using RevMan 5.4 software, and subgroup analysis was conducted due to heterogeneity of the results of the meta-analysis. The Grading of Recommendations, Assessment, Development, and Evaluation approach was adopted for assessing certainty and synthesizing results of the relevant literature.

RESULTS

A total of 23 studies were included, with participant numbers ranging from 33 to 289. Of these, 19 (82.6%) studies adopted VR to simulate various nursing scenarios, including disaster training, resuscitation, health assessments, and home health care; 4 (17.4%) studies used AR technologies; and 15 (65.2%) studies involved virtual patients in their scenarios. Based on the NWKM, the main outcome variables were classified as level 1 (usability and satisfaction), level 2 (knowledge, motivation, confidence, performance, attitude, and self-efficacy), and level 3 (clinical reasoning); level 4 outcomes were not found in the selected studies. Results of the subgroup analysis showed that immersive technology-based nursing education is more effective than traditional education in knowledge attainment (standard mean difference [SMD]=0.59, 95% CI 0.28-0.90, P<.001, I2=49%). Additionally, there were significant difference differences between the experimental and control group in confidence (SMD=0.70, 95% CI 0.05-1.35, P=.03, I2=82%) and self-efficacy (SMD=0.86, 95% CI 0.42-1.30, P<.001, I2=63%).

CONCLUSIONS

These findings support the effectiveness of immersive technology-based education for undergraduate nursing students, despite heterogeneity in methods and interventions. We suggest that long-term cohort studies be conducted to evaluate the effects of immersive technology-based nursing education on NWKM level 4.

CyPVICS: A framework to prevent or minimise cybersickness in immersive virtual clinical simulation

Cybersickness is a global issue affecting users of immersive virtual reality. However, there is no agreement on the exact cause of cybersickness. Taking into consideration how it can differ greatly from one person to another, it makes it even more difficult to determine the exact cause or find a solution. Because cybersickness excludes so many prospective users, including healthcare professionals, from using immersive virtual reality as a learning tool, this research sought to find solutions in existing literature and construct a framework that can be used to prevent or minimise cybersickness during immersive virtual clinical simulation (CyPVICS). The Bestfit Framework by Carrol and authors were used to construct the CyPVICS framework. The process started by conducting two separate literature searchers using the BeHEMoTh (for models, theories, and frameworks) and SPIDER (for primary research articles) search techniques. Once the literature searches were completed the models, theories and framework were used to construct a priori framework. The models' theories and frameworks were analysed to determine aspects relevant to causes, reducing, eliminating, and detecting cybersickness. The priori framework was expanded by, first coding the findings of the primary research study into the existing aspects of the priori framework. Once coded the aspects that could not be coded were added in the relevant category, for example causes. After reviewing 1567 abstracts and titles as part of the BeHEMoTh search string,19 full text articles, a total of 15 papers containing models, theories, and frameworks, were used to construct the initial CyPVICS framework. Once the initial CyPVICS was created, a total 904 primary research studies (SPIDER) were evaluated, based on their titles and abstracts, of which 100 were reviewed in full text. In total, 67 articles were accepted and coded to expand the initial CyPVICS framework. This paper presents the CyPVICS framework for use, not only in health professions' education, but also in other disciplines, since the incorporated models, theories, frameworks, and primary research studies were not specific to virtual clinical simulation.

Reflections on training and teaching modes for anesthesia monitoring nurses in China

Objective

The purpose of this scoping review was to map and identify studies describing the current state of research and teaching methods and evaluation systems for nurse anesthetists within China.

Design

A wide-ranging search of multiple databases and gray literature was performed according to JBI criteria, employing predefined selection criteria and following PRISMA guidelines.

Methods

This scoping review included studies published between 1988 and 2021 that explored the current state of clinical training and teaching methods for nurse anesthetists nationally and internationally. These articles were reviewed by four reviewers and content analysis was performed.

Results

Fifty-two articles were included in the review. The results suggest that both simulation teaching in nursing education and Kolb's experiential learning cycle theory improve nursing staff teamwork, develop critical thinking skills, and improve core nursing competencies.

Conclusions

High-fidelity simulation teaching based on Kolb's experiential learning cycle theory may be an effective teaching method to develop and improve the competence of nurse anesthesia monitors.

The impact of virtual clinical simulation on nursing students' palliative care knowledge, ability, and attitudes: A mixed methods study

BACKGROUND

Palliative care is fraught with numerous challenges when it comes to conducting practical teaching as it involves caring for people facing the complexities of end-of-life and death. Insufficient clinical practice hinders nursing students from mastering knowledge, attitude and ability of hospice care. Virtual clinical simulation has demonstrated its effectiveness as a valuable educational tool in nursing. However, there is a dearth of evidence supporting its utilization in the context of palliative care practice education.

OBJECTIVE

To develop a virtual clinical simulation education system and assess its impact on enhancing nursing students' knowledge, ability, and attitudes toward palliative care.

DESIGN

A single-group pretest-posttest design and focus group interviews were employed.

SETTING

The study was conducted at a medical university in southwest China.

PARTICIPANTS

A total of 76 third-year nursing students participated.

METHODS

Participants underwent a 1-hour learning session using the virtual clinical simulation education system. Pre-test and post-test evaluations were conducted to assess the participants' knowledge, ability, and attitudes toward palliative care. Survey questionnaire was administered to gauge the students' acceptance and perception of virtual clinical simulation. Focus group interviews were integrated to gain insight into students' subjective perceptions and feedback on the virtual clinical simulation.

RESULTS

There were notable enhancements in the students' overall scores of palliative care knowledge, ability, and attitudes after the learning session. Students positively evaluated the usefulness and usability of virtual clinical simulation. Students' feedback regarding virtual clinical simulation can be categorized into four themes: the value of virtual clinical simulation education system, its role as a complement to clinical practice teaching, the enjoyment and accessibility of learning, and the technological challenges encountered.

CONCLUSION

Virtual clinical simulation is an effective learning tool in palliative care practice education, which has the potential to enhance students' knowledge, ability, and attitudes toward palliative care.

Game on: immersive virtual laboratory simulation improves student learning outcomes & motivation

The use of gamified learning interventions is expanding in postsecondary education as a means to improve students' motivation and learning outcomes. Virtual laboratory simulations have been used in science education to supplement students' learning, as well as to increase engagement with course material. Due to COVID-19, many instructors sought to replace or supplement hands-on 'wet-lab' work in an online environment. In this paper, we explored how the use of head-mounted display technology in two laboratory simulations impacts learner motivation and learning outcomes. We used a mixed-methods approach to analyze the experience of 39 undergraduate participants, examining test scores pre- and postsimulation, qualitative feedback, and quantitative experience ratings. The head-mounted display technology was described as easy to use, with eye strain identified as a common occurrence. Participants had increased test scores following the laboratory simulations, with no significant difference between simulation groups. Very positive self-reported measures of motivation and learner engagement were documented. Ninety-one percent of participants agreed that virtual reality laboratory simulation would be a good supplement to regular teaching modalities. Overall, our results suggest that immersive virtual reality laboratory simulations experienced through head-mounted display technology can be used to enhance learning outcomes and increase learner motivation.

Experiences of simulation-based learning among undergraduate nursing students: A systematic review and meta-synthesis

OBJECTIVES

We aimed to examine the experiences of simulation-based learning (SBL) among undergraduate nursing students.

DESIGN

We conducted a systematic review and meta-synthesis on the experiences among undergraduate nursing studies who received SBL.

DATA SOURCES

We searched through six databases namely PubMed, CINAHL, Scopus, Web of Science, Embase, ProQuest, for qualitative studies published from January 2011 to January 2022.

REVIEW METHODS

A meta-synthesis was conducted according to the three-stage framework outlined by Thomas and Harden (2008). Critical appraisal was performed using the Critical Appraisal Skills Program (CASP) checklist. A standardised data extraction form was developed with reference from JBI Qualitative Assessment and Review Instrument Data Extraction Tools for Qualitative Research (JBI-QARI) checklist for data extraction.

RESULTS

Fifteen studies were included, and four themes emerged from the synthesis: (1) acquiring knowledge and skills through SBL; (2) positive experiences of using high-fidelity simulation (HFS) and virtual reality simulation (VRS) methods; (3) challenges encountered while using SBL methods and (4) drawing parallels between simulation and real clinical settings.

CONCLUSION

SBL allowed undergraduate nursing students to gain knowledge, acquire skills and have a positive SBL experiences. However, the provision of innovative strategies and resources for nursing students to overcome SBL-based challenges are still needed.

An Analysis of Priorities in Developing Virtual Reality Programs for Core Nursing Skills: Cross-sectional Descriptive Study Using the Borich Needs Assessment Model and Locus for Focus Model

BACKGROUND

There are limitations to conducting face-to-face classes following the recent COVID-19 pandemic. Web-based education is no longer a temporary form of teaching and learning during unusual events, such as pandemics, but has proven to be necessary to uphold in parallel with offline education in the future. Therefore, it is necessary to scientifically organize the priorities of a learner needs analysis by systematically and rationally investigating and analyzing the needs of learners for the development of virtual reality (VR) programs for core nursing skills (CNS).

OBJECTIVE

This study aimed to identify the priorities of learners' needs for the development of VR programs for CNS using the Locus for Focus Model and Borich need assessment model.

METHODS

The participants included nursing students in South Korea who were in their second year or higher and had taken courses in fundamental nursing or CNS-related classes. The survey took place from May 20 to June 25, 2021. A total of 337 completed questionnaires were collected. Of these, 222 were used to conduct the final analysis. The self-report questionnaire consisted of 3 parts: perception of VR programs, demand for developing VR programs, and general characteristics. The general characteristics of the participants were analyzed using descriptive statistics. To determine the priority of the demand for developing VR programs for CNS, the Locus for Focus Model and the Borich priority formula were used.

RESULTS

In all, 7 skills were identified as being of the top priority for development, including intramuscular injection, intradermal injection, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction.

CONCLUSIONS

The analysis showed that nursing students generally needed and prioritized the development of VR programs for the nursing skills involving invasive procedures. The results of this study are intended to help in various practical education classes using VR programs in nursing departments, which are currently facing difficulties in teaching CNS on the web owing to COVID-19.

Effectiveness of game-based virtual reality phone application and online education on knowledge, attitude and compliance of standard precautions among nursing students

Game-based virtual reality phone applications can create a realistic environment to prepare for clinical applications and improve students’ knowledge of and compliance with standard precautions. An experimental study was performed among 126 nursing students’ from the third and fourth nursing levels to determine the effect of online education and game-based virtual reality phone applications related to standard precautions. Students were divided randomly into two groups; the experimental group used online education and game-based virtual reality phone applications, while the control group used traditional education. The study was performed between July and August 2019 to prevent clashes with lectures and midterm and final examinations. A tool package including knowledge, attitude, and compliance with standard precautions was used in pre-and post-tests among nursing students. The results showed that the knowledge of, attitudes towards, and compliance with standard precautions differed between the two groups. The performance of the experimental group of nursing students significantly improved with online instruction and game-based virtual reality phone applications. This study demonstrated the effectiveness of online education and game-based virtual reality phone application among nursing students.

Effects of a virtual reality intervention on dementia care education among acute care nurses in Japan: A non-randomised controlled trial

This study aimed to evaluate the effects of a virtual reality intervention for dementia care education in Japanese acute care nurses. Non-randomised controlled trial was used to assess the effectiveness of the intervention pre- and post-intervention and at a 1-month follow-up. This study enrolled 20 and 19 nurses in the intervention and control groups, respectively. Generalized estimating equation analyses revealed significant differences in scores on the Dementia Nursing Competency Scale in Acute Hospitals and Staff Experiences of Working with Dementia Residents questionnaire in the intervention group. A post hoc test revealed significantly higher scores on the Dementia Nursing Competency Scale in Acute Hospitals at 1 month after compared with pre-intervention. Staff Experiences of Working with Dementia Residents questionnaire scores were significantly lower at pre- than that at post-intervention and 1 month after intervention. These findings could improve competency of dementia nursing care and attitudes toward people with dementia.

Virtual simulation studies in nursing education: A bibliometric analysis of the top 100 cited studies, 2021

OBJECTIVES

Bibliometrics is an emerging science in nursing. Quantitative methods were used to conduct a bibliometric analysis of highly cited virtual simulation nursing education articles to describe rank order, breadth of topics and authorship patterns.

DESIGN AND DATA SOURCES

A desktop analysis of publication performance was conducted using the Scopus database as the source of article citation data.

RESULTS AND DISCUSSION

The top 100 cited articles clustered over 14-years, 2008 to 2021. Citations per paper ranged from 88 to a low of 3 (median 18, mean 22.1) and in the top 10 studies, from 88 to 41. The citation trajectory was moderately correlated with article maturity (r = -.384, p ≤0.001). Article citations in subsequent publications commenced the first year after publication and three-year-old papers reached the mean citation rate of 22. Nurse Education Today was the most cited journal. There was no significant impact of article type (72% primary research, 17% literature reviews, 11% descriptive papers) (p = 0.755). International representation was strong, as first authors in 21 countries were cited - many (43%) from USA. One highly cited author (M. Verkuyl) from Canada led six papers, with six other authors each leading two studies. Virtual simulation modalities included virtual simulation, virtual reality simulation, 3D virtual reality simulation, virtual games and virtual worlds. The top 10 articles offer a diverse resource for faculty and educators who wish to consider using virtual simulation.

CONCLUSION

Virtual simulation studies in nursing education cover an emerging field of research that has relatively low citation rates. Nursing researchers and faculty need to understand the usefulness and limitations of bibliometric analysis as this methodology can make a unique contribution to research, policy, and funding decisions, and enable productivity assessments of faculty staff and departments.

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

Learning effects of virtual versus high-fidelity simulations in nursing students: a crossover comparison

BACKGROUND

Simulation is an alternative or complementary method for students who cannot obtain sufficient direct care experience, as they allow students to experience various clinical situations. Mixed learning is becoming increasingly common as a way to provide students with opportunities to experience real-life clinical scenarios. This study compared the learning effects of a virtual simulation and a high-fidelity simulation in a different order of presentation, with a focus on training for premature rupture of membranes in the field maternity nursing. Through this comparison, this study aimed to obtain evidence to support decision-making regarding the most effective way to utilize mixed simulation strategies.

METHODS

A quasi-experimental, crossover-design study was performed with two randomly allocated groups of 26 junior nursing students each. The virtual simulation used the vSim® for nursing, and the high-fidelity simulation used a scenario developed by the research team. The learning effects were measured in terms of the problem-solving process, clinical reasoning, reflective thinking, satisfaction with the practicum, and self-confidence. The data collected with a structured questionnaire were analyzed using the Mann-Whitney test.

RESULTS

The virtual simulation-first, high-fidelity simulation-second order led to significantly higher scores for reflective thinking (z = 3.53, p < .001) and self-confidence (z = 2.47, p = .013) than the other order.

CONCLUSIONS

The initial application of virtual simulation seemed to improve students' thought processes, and then high-fidelity simulation seemed to allow them to perform actual practice better. Further trials of mixed learning methods are necessary to maximize learning effects in nursing education.

TRIAL REGISTRATION

KCT0005767  at 2021-01-12 registered.

The Effectiveness of Learning to Use HMD-Based VR Technologies on Nursing Students: Chemoport Insertion Surgery

Background: The purpose of this study was to develop a mobile head mounted display (HMD)-based virtual reality (VR) nursing education program (VRP), and to evaluate the effects on knowledge, learning attitude, satisfaction with self-practice, and learning motivation in nursing students. Methods: This was a quasi-experimental study using a nonequivalent control group pretest-posttest design to evaluate the effects of HMD-based VRP on nursing students. A Chemoport insertion surgery nursing scenario was developed with HMD-based VRP. The experimental group consisting of 30 nursing students underwent pre-debriefing, followed by VRP using HMD and debriefing. The control group, consisting of 30 nursing students, underwent pre-debriefing, followed by self-learning using handouts about Chemoport insertion surgery procedures for 30 min, and debriefing. Results: The experimental group that underwent HMD-based VRP showed significantly improved post-intervention knowledge on operating nursing (p = 0.001), learning attitude (p = 0.002), and satisfaction (p = 0.017) compared to the control group. Sub-domains of motivation, attention (p < 0.05), and relevance (p < 0.05) were significantly different between the two groups, post-intervention. Conclusions: HMD-based VRP of Chemoport insertion surgery is expected to contribute to knowledge, learning attitude, satisfaction, attention, and relevance in nursing students.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Immersive Virtual Reality in Alleviating Pain and Anxiety in Children During Immunization in Primary Care: A Pilot Randomized Controlled Trial

BACKGROUND

Pediatric immunization is often associated with significant fear and anxiety among the children and their parents. Their distress may potentially affect their adherence to the childhood immunization schedule and the acceptance of other recommended vaccines by physicians.

OBJECTIVE

The study primarily aimed to assess the feasibility of using immersive virtual reality (VR) during immunization in children in primary care. The secondary aim was to determine the effectiveness of immersive VR in alleviating pain and anxiety among children, reduction of anxiety of their parents and attending nurses during immunization compared to usual care without VR.

METHODS

A pilot open-label randomized control trial was conducted at a public primary care clinic in Singapore. Thirty children, aged 4-10 years were randomized to an intervention group (n = 15) using VR and a control group (n = 15) without VR during immunization. Feasibility was assessed by the response rate to the use of VR. The Faces Pain Scale-Revised (FPS-R) and the Children's Fear Scale (CFS) were used to determine their pain and anxiety, respectively. The anxiety level of their accompanying parents and attending nurses were evaluated using Visual Analog Scale (VAS) prior and post-immunization of these children. The FPS-R and CFS scores, and anxiety assessment for parents and nurses were assessed using Mann-Whitney U test. Wilcoxon signed rank test was used to assess the difference in the nurses' experience of using the VR application.

RESULTS

One child refused to use the VR equipment, constituting a rejection rate of 6.7% (1/15) but no adverse event occurred in the intervention arm. The overall response rate of 88% (30/34) when the parents were approached to participate in the study, indicating feasibility of using VR in childhood immunization. In the intervention group compared to the control group, the change in scores for CFS (median -1, IQR -2 to 0; P = 0.04), parental VAS (median -4, IQR -5 to -1; P = 0.04) were significantly decreased. After immunization, nurses scored favorably for VR, in terms of simplicity (median 9.5, IQR 5.72 to 10; P = 0.01), acceptability (median 10, IQR 5 to 10; P = 0.005) and willingness to use VR in the future (median 10, IQR 5 to 10; P = 0.02).

CONCLUSION

Immersive VR is feasible, safe and effective in alleviating anxiety among the children and parents. Nurses viewed the application of VR in childhood immunization favorably.

CLINICAL TRIAL REGISTRATION

[https://clinicaltrials.gov/ct2/show/NCT04748367], identifier [NCT04748367].

Implementation and Assessment of a Urology Education Curriculum for Nursing Residents

BACKGROUND

Urethral catheter placement is a common hospital procedure, and the urology service is often consulted for difficult catheterizations. Simulation-based education is used to improve procedural proficiency and could be used to increase confidence and comfort with difficult catheter placement. This study provides simulation-based education to help new nursing residents learn to perform independent Foley catheter placement and maintenance.

METHOD

All incoming nursing residents at our institution prospectively participated in this curriculum beginning in January 2020 (n = 291). Participants watched an instructional video and participated in a hands-on simulation.

RESULTS

Nursing trainees rated pre- to post-curriculum gains in content knowledge (p < .001) and confidence (p < .001). Participants reported that the curriculum increased their understanding of the procedure (p < .001) and that they would recommend it to peers (p < .001).

CONCLUSION

This educational initiative is a partnership between the Department of Urology and Department of Nursing to introduce and reinforce best practices for the care of patients who need Foley catheter placement and maintenance. [J Contin Educ Nurs. 2021;52(11):511-516.].

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.

Exploring Differences in Student Learning and Behavior Between Real-life and Virtual Reality Chemistry Laboratories

Recent global events and educational trends have led schools to heavily rely on digital media to educate their students. Science classes, in particular, stand to lose substantial learning opportunities without the ability to provide physical laboratory experiences. Virtual reality (VR) technology has the potential to resolve this issue, but little is known if VR environments can produce similar results to real-life (RL) science learning environments. This 2 × 1, between-subjects study compares students' learning results and safety behaviors in VR and RL chemistry laboratories. The study attempts to identify differences in learning experience (i.e., general chemistry content, experiment comprehension, laboratory safety knowledge) and laboratory safety behavior. Results indicate learning general content knowledge, laboratory skills, and procedure-related safety behaviors were comparable between RL and VR conditions, but clean-up behaviors were less frequent in VR. Also, the exploratory, risk-free nature of VR environments may have allowed the learners to elaborate and reflect more on general chemistry content and laboratory safety knowledge than in the RL environment.

Undergraduate nursing students' experience of learning respiratory system assessment using flipped classroom: A mixed methods study

BACKGROUND

Knowledge and skill acquisition to perform an accurate respiratory system assessment is a key competency expected in undergraduate nursing students. Learning physical assessment requires the integration of multiple knowledge bases and skills; hence, applying an innovative teaching approach, such as the flipped-classroom (FC) approach, fosters an active and student-centered learning environment for physical assessment class.

OBJECTIVES

This study evaluated FC's feasibility in delivering respiratory system assessment content in a health assessment course and explored the changes in nursing students' perceptions regarding student-centeredness and active learning environments before and after applying FC.

DESIGN

A single group pre- and post-test concurrent mixed-methods design was used.

SETTINGS

This study was conducted in a private nursing college in South Korea.

PARTICIPANTS

A convenience sample of 91 second year undergraduate nursing students enrolled in a health assessment course.

METHODS

FC was offered at one didactic session of a physical assessment course. In the FC, students completed a self-directed pre-class activities using online lecture videos and reading materials prior to the class and participated in interactive team-based learning activities inside the classroom. Skills lab practicum took place after the FC. Students' perceptions regarding student-centeredness and active learning environments, in terms of teaching, social, and cognitive presences were measured before (T1) and after (T2) conducting the FC. Qualitative data were obtained at T2 using free-response questions, which required students to comment on their FC experience.

RESULTS

Participants' perceptions of student-centeredness significantly increased from T1 to T2. Although student-perceived teaching and social presence in their learning environment showed upward trends from T1 to T2, these changes were not statistically significant. Students considered FC an acceptable approach to foster active learning in a supportive learning environment.

CONCLUSIONS

This study revealed that incorporating FC to deliver respiratory system assessment content was feasible and considered acceptable by undergraduate nursing students.

Exploring the experiences of nursing students in using immersive virtual reality to learn nursing skills

BACKGROUND

In recent years, virtual reality teaching applications exhibited exponential development in numerous fields. An increasing number of virtual reality application cases and modules have been developed in the nursing education field to verify their effectiveness.

OBJECTIVE

The research objective is to understand the experience of nursing students in using virtual reality skill learning process.

DESIGN

This study is a qualitative research that adopts focus group research methods. The participants were able to freely describe their subjective feelings toward the virtual reality skill learning process.

PARTICIPANTS/SETTINGS

This research was conducted in a nursing school in Taiwan. Purposive sampling was adopted to select 60 nursing students who participated in the Adult Nursing and Practice course. The participants were divided into six focus groups containing 10 participants each.

METHOD

Aside from learning with traditional practice equipment, the students also experienced the virtual reality nasogastric tube care skill learning system. Focus group interviews were held from March 25 to 27, 2019. During the interview, we inquired about the students' subjective feelings toward the virtual reality skill learning system and reflected on its influence on the students' learning process.

RESULTS

An analysis of the focus group interview content of 60 students, revealed that the students' experience toward the virtual reality skill learning process could be classified into five themes, namely "convenient to practice, but requires adaptation," "fast skill learning process," "stress-free learning environment," "environmentally friendly," and "lacks a sense of reality."

CONCLUSIONS

Instead of replacing conventional skill teaching methods, future applications of the virtual reality nursing skill education support system shall serve as a student self-learning supporting tool. Additionally, the research and development of the virtual reality nursing skill education support system should focus on its stereognosis aspect and include an interactive function to upgrade the system into a practical teaching and learning support material.

A Virtual Reality Simulation Method for Crowd Evacuation in a Multiexit Indoor Fire Environment

Evacuation simulations in virtual indoor fire scenes hold great significance for public safety. However, existing evacuation simulation methods are inefficient and provide poor visualized when applied to virtual reality (VR) simulations. Additionally, the influences of the interaction of evacuation processes on the choice of multiple exits have not been fully considered. In the paper, we propose a VR simulation method for crowd evacuation in a multiexit indoor fire environment. An indoor 3D scene model and character model, for studying the environmental factors that affect the multiexit selection of personnel during the fire process, are combined with environmental factors to enhance the evacuation route planning algorithm to improve the efficiency of the VR simulation of evacuation in the scene. In addition, a prototype system that supports multiple experience modes is proposed, and case experiment analyses are performed. The results show that the method described in this paper can effectively support the real-time simulation of indoor fire evacuations in virtual scenes, providing both reliable simulation results and good visualization effects.

Usability of mental illness simulation involving scenarios with patients with schizophrenia via immersive virtual reality: A mixed methods study

Objectives

Schizophrenia is one of the most prevalent mental illnesses contributing to national burden worldwide. It is well known that mental health nursing education, including clinical placement, is still insufficient to reach the optimal level of competency in nursing students. This study suggests a new form of mental health virtual reality (VR) simulation that is user-friendly and engaging to improve education about schizophrenia, thereby improving its treatment.

Method

A mixed-methods study was conducted with a total of 60 nursing students, using 360-degree videos of five different scenarios reflecting clinical symptoms of schizophrenia patients and related treatment tasks delivered via head-mounted displays (HMDs). We used a 17-item quantitative questionnaire and a 7-item open-ended qualitative questionnaire to evaluate the ease of use and usefulness of the VR simulation program and to identify areas where further improvement is required.

Results

The VR simulation program was perceived as useful and exciting. Participants stressed that the high realism of the simulation increased their engagement in and motivation to learn about mental health nursing. Some participants made suggestions, such as further refining the picture and sound quality in order to achieve satisfactory educational outcomes.

Conclusion

VR simulation using 360-degree videos and HMDs could serve as an effective alternative form of clinical training in mental health nursing. Education could be enhanced by its benefits of being engaging and exciting, as reported by this study’s participants.

3D Technology Development and Dental Education: What Topics Are Best Suited for 3D Learning Resources?

The aim of this study is to identify topics (knowledge and skills) from the dental curricula that would benefit from having a 3D learning resource using an exploratory sequential design method. The first phase targeted stakeholders from a Scottish dental school. Seven focus groups and three interviews disclosed 97 suitable topics for 3D technology development. These results were used to construct a survey that was sent to final year dental students, newly dental graduates and academics from three Scottish universities. The survey asked participants to rank each item based on the perceived benefit that a 3D learning resource would have for dental education. Results revealed that detailed anatomy of the temporomandibular joint, dental anaesthesiology, dental clinical skills techniques, dental occlusion and mandibular functioning were top priorities. Gender differences only appeared in relation to ‘Extraction techniques: movements and force’ (p < 0.05), this topic was considered to be more beneficial by females than by males. No statistical difference was found when comparing results of graduates with undergraduates. These results serve as a starting point when developing a new 3D technology tool for dental education, considering users demands and perceived needs has the potential to benefit dental students and dental education directly.

The Use of Immersive and Virtual Reality Technologies to Enable Nursing Students to Experience Scenario-Based, Basic Life Support Training-Exploring the Impact on Confidence and Skills

The link between effective basic life support and survival following cardiac arrest is well known. Nurses are often first responders at in-hospital cardiac arrests and receive annual basic life support training to ensure they have the adequate skills, and student nurses are taught this in preparation for their clinical practice. However, it is clear that some nurses still lack confidence and skills to perform basic life support in an emergency situation. This innovative study included 209 participants, used a mixed-methods approach, and examined three environments to compare confidence and skills in basic life support training. The environments were nonimmersive (basic skills room), immersive (immersive room with video technology), and the Octave (mixed reality facility). The skills were measured using a Laerdal training manikin (QCPR manikin), with data recorded on a wireless Laerdal Simpad, and confidence levels before and after training were measured using a questionnaire. The nonimmersive and the immersive rooms were familiar environments, and the students felt more comfortable, relaxed, and, thus, more confident. The Octave offered the higher level of simulation utilizing virtual reality technology. Students felt less comfortable and less confident in the Octave; we assert that this was because the environment was unfamiliar. The study identified that placing students in an unfamiliar environment influences the confidence and skills associated with basic life support; this could be used as a way of preparing student nurses with the necessary emotional resilience to cope in stressful situations.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

The VR game shows promise for refreshing sterile catheterization skills.

Neuro-Advancements and the Role of Nurses as Stated in Academic Literature and Canadian Newspapers

Neurosciences and neurotechnologies (from now on called neuro-advancements) constantly evolve and influence all facets of society. Neuroethics and neuro-governance discourses focus on the impact of neuro-advancements on individuals and society, and stakeholder involvement is identified as an important aspect of being able to deal with such an impact. Nurses engage with neuro-advancements within their occupation, including neuro-linked assistive technologies, such as brain-computer interfaces, cochlear implants, and virtual reality. The role of nurses is multifaceted and includes being providers of clinical and other health services, educators, advocates for their field and their clients, including disabled people, researchers, and influencers of policy discourses. Nurses have a stake in how neuro-advancements are governed, therefore, being influencers of neuroethics and neuro-governance discourses should be one of these roles. Lifelong learning and professional development could be one mechanism to increase the knowledge of nurses about ethical, social, and legal issues linked to neuro-advancements, which in turn, would allow nurses to provide meaningful input towards neuro-advancement discussions. Disabled people are often the recipients of neuro-advancements and are clients of nurses, therefore, they have a stake in the way nurses interact with neuro-advancements and influence the sociotechnical context of neuro-advancements, which include neuro-linked assistive devices. We performed a scoping review to investigate the role of narrative around nurses in relation to neuro-advancements within academic literature and newspapers. We found minimal engagement with the role of nurses outside of clinical services. No article raised the issue of nurses having to be involved in neuro-ethics and neuro-governance discussions or how lifelong learning could be used to gain that competency. Few articles used the term assistive technology or assistive device and no article covered the engagement of nurses with disabled people within a socio-technical context. We submit that the role narrative falls short of what is expected from nurses and shows shortcomings at the intersection of nurses, socio-technical approaches to neuro-assistive technologies and other neuro-advancements and people with disabilities. Neuro-governance and neuroethic discourses could be a useful way for nurses and disabled people to co-shape the socio-technical context of neuro-advancements, including neuro-assistive technologies. Lifelong learning initiatives should be put in place to provide the knowledge necessary for nurses to take part in the neuroethics and neuro-governance discussion.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

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

SETTING

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

PARTICIPANTS

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

METHOD

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

RESULTS

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

CONCLUSION

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

Virtual reality applications for chronic conditions management: A review

Background: Virtual Reality (VR) as a computer technology that simulating real environments and situations exploited in numerous healthcare areas such as chronic diseases. The significance of timely treatment and rehabilitation of patients with chronic conditions is high due to the long lasting nature of these conditions. This paper sought to perform a review of published works in the field of VR application in chronic conditions for treatment and rehabilitation purposes.

Methods: We searched the MEDLINE database through PubMed in April 2016 for retrieving published papers from January 2001 to December 2015. From 117 retrieved papers, 52had the inclusion criteria, and their full texts were accessible. Data were extracted from papers based on following items: the name of the first author, year of the study, applied VR methods, type of condition and disease, number of subjects that participated in the study, and finally the status of success and failure of VR application. Data were analyzed using descriptive analysis.

Results: Results of the reviewed investigations have been considered in two main categories including treatment oriented papers (n=38, 73%) while twenty of these papers have been conducted on phobias (53%); also, there are rehabilitation-oriented experiments (n=14, 27%) while thirteen of these papers have been performed on stroke. In 40 papers (77%), the VR technology application reported proper and in 11 papers (21%) the application of VR resulted in relatively proper outcomes and only there is a work (2%) with poor results for VR intervention.

Conclusion: VR technology has been increasingly used in recent years for treatment and rehabilitation purposes among patients affected by chronic conditions in order to motivate them for more successful management.

Web-based virtual patients in nursing education: development and validation of theory-anchored design and activity models

Background

Research has shown that nursing students find it difficult to translate and apply their theoretical knowledge in a clinical context. Virtual patients (VPs) have been proposed as a learning activity that can support nursing students in their learning of scientific knowledge and help them integrate theory and practice. Although VPs are increasingly used in health care education, they still lack a systematic consistency that would allow their reuse outside of their original context. There is therefore a need to develop a model for the development and implementation of VPs in nursing education.

Objective

The aim of this study was to develop and evaluate a virtual patient model optimized to the learning and assessment needs in nursing education.

Methods

The process of modeling started by reviewing theoretical frameworks reported in the literature and used by practitioners when designing learning and assessment activities. The Outcome-Present State Test (OPT) model was chosen as the theoretical framework. The model was then, in an iterative manner, developed and optimized to the affordances of virtual patients. Content validation was performed with faculty both in terms of the relevance of the chosen theories but also its applicability in nursing education. The virtual patient nursing model was then instantiated in two VPs. The students’ perceived usefulness of the VPs was investigated using a questionnaire. The result was analyzed using descriptive statistics.

Results

A virtual patient Nursing Design Model (vpNDM) composed of three layers was developed. Layer 1 contains the patient story and ways of interacting with the data, Layer 2 includes aspects of the iterative process of clinical reasoning, and finally Layer 3 includes measurable outcomes. A virtual patient Nursing Activity Model (vpNAM) was also developed as a guide when creating VP-centric learning activities. The students perceived the global linear VPs as a relevant learning activity for the integration of theory and practice.

Conclusions

Virtual patients that are adapted to the nursing paradigm can support nursing students’ development of clinical reasoning skills. The proposed virtual patient nursing design and activity models will allow the systematic development of different types of virtual patients from a common model and thereby create opportunities for sharing pedagogical designs across technical solutions.