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

Using Immersive Environments in E-Mental Health Rehabilitation Programs Directed to Future Health Professionals to Promote Empathy and Health Literacy about Schizophrenia

Rehabilitation involves all types of patients, including people with schizophrenia. Schizophrenia is considered a complex syndrome characterized in general by fundamental and characteristic distortions of thinking and perception. The quality of life of a person with schizophrenia can be compromised by difficulty in carrying out their daily tasks and by the social stigma of their condition. The importance of training and sensitizing students in rehabilitation areas to this type of problem to improve the rehabilitation processes in which they will participate as future professionals involves empathy and the ability to communicate with these populations. It is possible through virtual reality to create immersive environments to simulate some psychotic symptoms characteristic of people with schizophrenia, such as visual hallucinations and hearing voices. The aim of this study was to test the effect of exposure to experiences characteristic of schizophrenia through two different types of immersive environments, graphical computational virtual reality and 360° video, on students from areas of social rehabilitation regarding empathy, social distance, and attitudes towards people with schizophrenia. Although the results were positive for the three parameters under study, no significant differences were found for each of them between the environments to which the participants were exposed. This study concluded that the choice between the two types of immersive environments should be based on the project's objectives, the target audience's needs, and available resources, rather than the type of environment itself, as their impact was similar.

Advancing nursing education through wearable electronic devices: A scoping review

AIM

To examine the incorporation of wearable electronic devices in the education of undergraduate nursing students.

BACKGROUND

The advancement of technology has influenced nursing education and will continue to do so in the future. Wearable technologies are electronic devices that can be worn as an accessory and expand the possibilities in nursing education with increased engagement in the learning process.

DESIGN

A scoping review was conducted following JBI and reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines.

METHODS

The search was performed on August 25th, 2023, in the databases: MEDLINE via PubMed, ISI Web of Science, ERIC, EBSCOhost CINAHL, EBSCOhost Academic Search Premier, EBSCOhost Health Source Nursing, EMBASE, Scopus, BVShost LILACS and ProQuest. Literature that examined the application of wearable electronic devices in the education of undergraduate nursing students was included.

RESULTS

This scoping review study included a total of 21 records published between 2014 and 2023. The analysis showed that smart glasses are the most common wearable electronic device used in nursing education, followed by smartwatches. The devices provide an opportunity for competencies development, especially when applied in the simulation environment, such as physical examination and medication administration. Wearable technologies are potentially useful and feasible as learning tools in nursing education, increasing nursing students' motivation, confidence and satisfaction.

CONCLUSIONS

In the technological revolution, educators must consider the potential of innovative teaching strategies, such as wearable electronic devices, to advance nursing education. Wearables can contribute to developing competencies required for the professionalism of undergraduate nursing students.

Use and Design of Virtual Reality-Supported Learning Scenarios in the Vocational Qualification of Nursing Professionals: Scoping Review

BACKGROUND

Numerous reviews advocate using virtual reality (VR) in educational contexts. This medium allows learners to test experiences in realistic environments. Virtually supported scenarios offer a safe and motivating way to explore, practice, and consolidate nursing skills in rare and critical nursing tasks. This is also cited as one of the reasons why VR can significantly increase the knowledge acquisition of nursing students. Nevertheless, studies are limited in their significance owing to the chosen design. Despite great interest, this results in a low level of confidence in VR as a curricular teaching method for nursing education. Therefore, defining concrete design and didactic-methodological parameters that support teachers in the use and implementation of VR is more relevant.

OBJECTIVE

This scoping review aims to provide an overview of significant design aspects for VR scenario conception and its transfer to generalist nursing education to generate value for the development of teaching scenarios and their sustainable implementation in teaching.

METHODS

A comprehensive literature search was performed using the MEDLINE (via PubMed) and CINAHL databases, and the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist was applied. The search was conducted from May to July 2022, using a specific search principle corresponding to the focus and the growing study corpus. A previously defined "population, concept, and context" scheme was employed as the basis for the double-blind review of all relevant international German and English publications released up to May 1, 2022.

RESULTS

In accordance with the predefined selection procedure, 22 publications were identified. The identified aspects aided in the development of design, didactic, and research recommendations. The intuitive operation of realistically designed VR scenarios, which are standardized, reliable, and modifiable, as well as clear instructions and specific multimodal feedback functions were described positively. The same applied to the linear structure of the sequences with graduated demands and high image quality for increased immersion with low sensory overload. Changes in perspectives, multiuser options, dialogs, and recording functions can contribute to an interactive care practice. On the research side, it is advisable to define VR terminologies. In addition to considering larger samples, varying settings, and financial issues, it is recommended to conduct long-term studies on knowledge acquisition or improved patient outcomes.

CONCLUSIONS

VR scenarios offer high potential in the context of nursing education if teachers and learners develop them co-creatively according to design features and implement them by means of a well-conceived concept. VR enables trainees to develop practical skills continuously in a standardized way. In addition, its deployment supports the sensitization of trainees to digital nursing technologies and the expansion of their digital skills in a practical setting. Furthermore, it allows sustainability issues to be addressed.

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.

Positioning virtual reality as means of clinical experience in mental health nursing education: A quasi-experimental study

PURPOSE

Virtual reality technology has been used to establish a risk-free environment in which students can practice psychiatric nursing. A quasi-experimental study was conducted to examine the effects of a virtual reality (VR) based mental health nursing simulation on practice performance of undergraduate nursing students.

METHODS

A quasi-experimental, pre- and post-test design was used. A total of 68 students were randomly assigned to an experimental group (n = 32) and a control group (n = 36). The control group received conventional simulation using text scenario-based role play. The intervention group received VR software consisting of 360° video clips and related quiz questions.

RESULTS

The self-reported perceived competency in nursing performance showed no statistically significant improvement in the experimental group, whereas the control group showed a statistically significant improvement in symptom management (t = 2.84, p = 0.007) and nurse-patient interaction (t = 2.10, p = 0.043). Scores from the assessor showed better performance scores in the experimental group in symptom management (t = -2.62, p = 0.011), violence risk management (t = -3.42, p = 0.001), and nurse-patient interaction (t = -3.12, p = 0.003).

CONCLUSIONS

The findings of this study indicate the potential of using VR for optimized mental health nursing simulation. VR technology allowed realistic experiences which may ensure students have a more comprehensive understanding of mentally ill patients and in doing so, overcome barriers of traditional simulation, resulting in better learning outcomes.

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.

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

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

Constructing a Mixed Simulation With 360° Virtual Reality and a High-Fidelity Simulator: Usability and Feasibility Assessment

Virtual reality technology has been adopted to overcome barriers of conventional simulation. This study was conducted to determine the impact of mixed simulation (a 360° virtual reality and a high-fidelity simulator) on learning how to provide nursing care for patients with arrhythmia. A total of 49 students were randomly assigned to intervention (n = 25) and control (n = 23) groups. They were given four arrhythmia cases with a 360° virtual reality system first followed by a manikin-based simulation. The mixed simulation group showed greater improvement in knowledge, higher decision-making competency in "knowing and acting" ( P = .025) and "seeking information from instructors" ( P = .049), and lower anxiety in "using resources to gather information" ( P = .031). Study participants achieved a good level of empathy (3.28 ± 0.72) and liked the program (4.56 ± 0.60). They were satisfied with the program (4.48 ± 0.65). These findings provide new insight into learning through blending of new technology. When the 360° virtual reality was used with existing manikin-based simulation, they effectively reinforced one another. The 360° virtual reality can be an effective strategy to ensure active participation to gain a comprehensive understanding of and empathy for patients.

Come and see through my eyes: A systematic review of 360-degree video technology in nursing education

OBJECTIVES

Viewers can watch 360-degree videos from any angle, like a panorama, and experience the virtual environment directly. Recently, there has been a growing interest in immersive and interactive technologies in education, and the use of 360-degree videos has become popular. This systematic review was conducted to present the current use of 360-degree videos in nursing education.

DESIGN

Systematic review.

DATA SOURCES

In addition to screening the Google Scholar, MEDLINE, SCOPUS, and EBSCO databases, we also performed hand searching.

REVIEW METHODS

Relevant keywords were used to identify trials published in the above-mentioned databases from inception to March 1, 2023. In the first step, the titles, abstracts, and full texts of the retrieved studies were independently reviewed by two authors according to the inclusion criteria. Studies on which there was disagreement were reviewed by all authors, and a consensus decision was reached. The data from the studies included in the review were analyzed and reported using the PRISMA 2020 checklist.

RESULTS

Twelve articles that met the inclusion criteria were reviewed. It was determined that 360-degree video scenarios used in nursing education were mostly related to mental health nursing, and the videos were mostly viewed through head-mounted displays, without any interactive features. Most difficulties encountered in the use of these videos were related to motion sickness. The main implications of the reviewed studies were that 360-degree videos contributed to the development of students' knowledge, skills, and attitudes and that the use of these videos was recommended.

CONCLUSIONS

As an innovative application the use of 360-degree videos in nursing education was examined from various perspectives in this review. The results showed that the use of such videos was convenient and effective for nursing education.

Development of a virtual reality program in South Korea for the measurement of vital signs in children: a methodological study

PURPOSE

We developed a virtual reality (VR) program for use in pediatric nursing practicums to help nursing students learn to measure vital signs in children.

METHODS

The analysis, design, development, implementation, and evaluation model was employed between July 2021 and December 2021 at a university in South Korea. In the analysis phase, in-depth interviews were conducted with four nursing students, two nursing school graduates, and four experts. The topic and contents of the VR program were settled in the design phase. The VR program was developed and subsequently used and evaluated by 20 nursing students and four experts.

RESULTS

The contents of the VR program for pediatric nursing practicums included the measurement of vital signs in a newborn baby and a young child, as well as an evaluation system. The mean score for the nursing students' satisfaction with practice was 4.02 out of 5 points. The mean scores for overall satisfaction with the VR program were 4.15 and 4.79 out of 5 points for nursing students and experts, respectively.

CONCLUSION

The VR program developed in this study allows nursing students to practice measuring vital signs in children, thus improving the students' clinical performance in pediatric nursing.

A pediatric seizure management virtual reality simulator for nursing students: A quasi-experimental design

BACKGROUND

Seizures are a common neurologic disorder observed in children. A virtual reality (VR) simulator trains nursing students to understand and respond to pediatric seizures.

OBJECTIVES

The aim of this study was to examine knowledge acquisition and acceptance of a pediatric seizure management VR simulator.

DESIGN

A quasi-experimental design was used to study the effectiveness of VR in nursing education.

PARTICIPANTS

Two out of nine possible third-year Pediatric Nursing classes were assigned by the office of academic affairs. A total of 105 students participated. The two classes were randomly allocated into the intervention (n = 53) and control (n = 52) groups.

METHODS

The intervention group was taught using a pediatric seizure management simulator; the control group was taught by in-person lecture. The Seizure Management Knowledge Test was administered to all participants before each group underwent their VR simulator and lecture respectively. The Pediatric Seizure Management Virtual Reality Acceptance Questionnaire and the Virtual Reality Sickness Questionnaire were given to participants in the intervention group. Independent t-tests and chi-square tests were used to test differences in knowledge acquisition between the two groups.

RESULTS

The posttest knowledge score in the intervention group was significantly higher than that in the control group (t = 5.05, p < .001). The intervention group had a mean cybersickness score of 18.17 of 100. The average score of the acceptance questionnaire for perceived usefulness was 3.26 of 4; ease of use was 3.09 of 4; attitude toward use was 3.26 of 4; and willingness to use was 3.32 of 4. Over 90 % of participants expressed willingness to use the VR simulator.

CONCLUSIONS

The newly developed pediatric seizure management VR simulator is acceptable and worthwhile for training nursing students to develop their skills and professionalism. Follow-up research is needed to evaluate the long-term effect of VR education in nursing practice.

Effectiveness of Immersive Virtual Reality in Nursing Education: Systematic Review

BACKGROUND

Digital education using immersive virtual reality (VR) technology is available in nursing. Evidence of its effectiveness is essential.

PURPOSE

This review analyzed the effectiveness of and barriers to using immersive VR in nursing education.

METHODS

A structured search was performed in PubMed, Cumulative Index to Nursing and Allied Health Literature, EMBASE, PsycINFO, Web of Science, and ProQuest Nursing & Allied Health Database. The Medical Education Research Study Quality Instrument was used to assess the quality of studies.

RESULTS

The final review was composed of 9 studies of moderate to high quality published between 2018 and 2020. The review indicated that immersive VR increased learning, cognitive, and psychomotor performance. Most participants of the studies preferred using immersive VR in education and with a variety of experiential scenarios. Barriers were associated with technological hardware and software (eg, simulation sickness, lack of visual comfort).

CONCLUSION

The review supports the viability of immersive VR technology in nursing education.

Uporaba virtualnih simulacij ali virtualnih pacientov pri izobraževanju študentov v zdravstveni negi

Uvod: Epidemija covida-19 je omejila praktično usposabljanje študentov zdravstvene nege. V zdravstveni negi simulacije niso novost, razmeroma novo področje izobraževanja pa so virtualne simulacije ali virtualni pacienti. Namen pregleda je bil preučiti najnovejše empirične ugotovitve o učinkovitosti oziroma uspešnosti uporabe virtualnih simulacij ali virtualnih pacientov pri študiju zdravstvene nege po svetu.Metode: Pregledani so bili znanstveni članki, objavljeni med letoma 2016 in 2021 v bibliografskih bazah CINAHL, MEDLINE, ERIC ter v kataložno-bibliografski bazi podatkov COBIB. Proučevani so bili članki, ki so obravnavali študente zdravstvene nege, pri katerih sta bila virtualna simulacija ali virtualni pacient uporabljena za način učenja in ne kot način preverjanja usvojenega znanja druge učne metode. Sinteza rezultatov je bila narejena s tematsko analizo.Rezultati: Vključenih je bilo 12 raziskav, ki so bile večinoma opravljene v razvitih državah. Rezultati so pokazali pozitiven vpliv virtualnih simulacij ali virtualnih pacientov na kognitivno in afektivno domeno znanja, praktično izvedbo intervencij, oceno samoučinkovitosti, kompetentnosti in zadovoljstva študentov.Diskusija in zaključek: Kadar kliničnega usposabljanja za študente zdravstvene nege ni mogoče zagotoviti, so virtualne simulacije ali virtualni pacienti lahko eno izmed možnih okolij za trening kliničnih odločitev, ki bi jih študent sicer pridobil v klinični praksi, ne morejo pa nadomestiti kliničnega usposabljanja in izkušenj, ki jih študent pridobi ob pacientu. 

Exploring undergraduate nursing students' experiences towards home-based learning as pedagogy during the COVID-19 pandemic: a descriptive qualitative exploration

Background

The global COVID-19 pandemic has led to the need for educators to explore online platforms in delivering lessons to students. Home-based learning is one of the most commonly-used teaching methods that allow learning to take place despite a physical separation between the students and the educators.

Methods

A descriptive qualitative approach was used to explore the experiences of nursing undergraduates when using home-based learning as a pedagogy during the COVID-19 pandemic. Data were collected from twenty-three nursing students (n = 14 in year one; n = 9 in year two) of their full-time pre-registration nursing program in a public-funded university in Singapore. Semi-structured interviews using an interview guide was conducted through Zoom-based video-conferencing from November 2020 to January 2021. The interview lasted between 45 and 65 min (median = 45 min). Data collection took place concurrently with thematic analysis through Braun and Clarke’s six-step approach. This study was reported according to the Consolidated Criteria for Reporting Qualitative Research.

Results

Three main themes identified during the data analysis were: (1) challenges of home-based learning, where students detailed their experiences and difficulties encountered during the process; (2) the effectiveness of home-based learning, which explored the pedagogy’s impact on the students’ learning experience; and (3) students’ motivation to learn, where the effects on student morale and motivation in partaking in learning tasks were discussed.

Conclusions

Results from this study suggested that universities should incorporate more home-based learning opportunities as home-based learning to continue playing a crucial role in the foreseeable future. Universities should continue to incorporate more home-based learning opportunities into the existing nursing curriculaa in order to test their capacities and address technical challenges in online learning. Future studies should also consider incorporating other pedagogical strategies when conducting lessons online.

Use of modern technology in psychiatry training in a middle-income country

Recent advances in information technology (IT) provided us with novel teaching solutions, with the potential of a new enhanced learning experience, that is, more adapted to the needs and preferences of the younger generations of psychiatric trainees. These tools include the use of online/virtual whiteboards, live surveys/polls, live quizzes, virtual classrooms, and virtual reality. In the present paper, we describe the implementation of modern technology in psychiatric training in Tunisia, a North-African middle-income country. We discuss the potential benefits arising from this implementation, and we report the challenges and difficulties. Overall, the implementation of these modern technology-based tools in psychiatric training has been successful, with a very few obstacles. It seems that the integration of these novel approaches is possible even in middle and low-income countries without much hassle. These tools can enhance trainees' participation, motivation, and engagement, thereby potentially improving learning outcomes. Most disadvantages are related to potential technical glitches, and are likely to improve as technology progresses. Teaching is the art of tailoring the educational tools to the learning objectives and to the learners' characteristics and preferences. To achieve optimal learning outcomes, it is often needed to use a mixture of different "modern" and "less modern" techniques.

Fine nursing model combined with psychological intervention on patients after eyeball enucleation due to ocular trauma

PURPOSE

To study the effect of fine nursing model combined with psychological intervention on quality of life and psychological state of patients after eyeball enucleation due to ocular trauma.

METHODS

80 patients with eyeball enucleation due to ocular trauma admitted to our hospital from January 2017 to July 2019 were randomly selected and divided into control group and experimental group by coin tossing, with 40 patients in each group. Patients in the control group received routine nursing care, and patients in the experimental group received refined nursing with psychological intervention. Quality of life index (QLI) score, pittsburgh sleep quality index (PSQI) quality of sleep score, mental state assessment scale (MSSNS) score, self-rating anxiety scale (SAS), self-rating depression scale (SDS) score, nursing efficiency, nursing satisfaction were compared between the two groups.

RESULTS

The experimental group showed a statistically significant increase in the QLI quality of life scores as compared with the control group (P < 0.05); The PSQI quality of sleep score, MSSNS psychological status score, SAS, SDS anxiety, depression scale scores were found to be markedly lower in the experimental group than those observed in the control group, and the difference was proven to be statistically significant (P < 0.05); The nursing satisfaction and nursing efficiency were reported at a notably higher rate in the experimental group compared to what were observed in the control group, and the difference indicated a statistical significance (P < 0.05).

CONCLUSION

Fine nursing combined with psychological intervention could significantly improve quality of life of patients, improve their psychological state and sleep quality, and help to raise nursing satisfaction and nursing efficiency. Therefore, fine nursing combined with psychological intervention has a higher application value in patients with traumatic eyeball extraction.