Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis

Virtual Reality Simulation Integration in a Prelicensure Nursing Program: Lessons Learned

BACKGROUND

Simulation, whether conducted live or through virtual technologies, provides students with experiential learning by replicating realistic clinical experiences that can develop learner competencies in a safe environment. Virtual reality simulation may provide the same level of effective and engaging experiential learning in a fully immersive learning environment without many of the limitations inherent to traditional live simulation environments, such as simulation equipment and designated labs.

PROBLEM

While there are vendor-provided resources and a new tool kit covering immersive technology simulation implementation in nursing, a lived example to contextualize the implementation process is missing from the literature.

APPROACH

This article discusses the selection and implementation of virtual reality simulations in a nursing undergraduate program and lessons learned in the process.

CONCLUSIONS

Nurse educators seeking such experiences for their students may benefit from the insights shared in this article.

Pressure Ulcer Management Virtual Reality Simulation (PU-VRSim) for Novice Nurses: Mixed Methods Study

BACKGROUND

Pressure ulcers (PUs) are a common and serious complication in patients who are immobile in health care settings. Nurses play a fundamental role in the prevention of PUs; however, novice nurses lack experience in clinical situations. Virtual reality (VR) is highly conducive to clinical- and procedure-focused training because it facilitates simulations.

OBJECTIVE

We aimed to explore the feasibility of a novel PU management VR simulation (PU-VRSim) program using a head-mounted display for novice nurses and to investigate how different types of learning materials (ie, VR or a video-based lecture) impact learning outcomes and experiences.

METHODS

PU-VRSim was created in the Unity 3D platform. This mixed methods pilot quasi-experimental study included 35 novice nurses categorized into the experimental (n=18) and control (n=17) groups. The PU-VRSim program was applied using VR in the experimental group, whereas the control group received a video-based lecture. The PU knowledge test, critical thinking disposition measurement tool, and Korean version of the General Self-Efficacy Scale were assessed before and after the intervention in both groups. After the intervention, the experimental group was further assessed using the Clinical Judgment Rubric and interviewed to evaluate their experience with PU-VRSim.

RESULTS

The results compared before and after the intervention showed significant improvements in PU knowledge in both the experimental group (P=.001) and control group (P=.005). There were no significant differences in self-efficacy and critical thinking in either group. The experimental group scored a mean of 3.23 (SD 0.44) points (accomplished) on clinical judgment, assessed using a 4-point scale. The experimental group interviews revealed that the VR simulation was realistic and helpful for learning about PU management.

CONCLUSIONS

The results revealed that PU-VRSim could improve novice nurses' learning of PU management in realistic environments. Further studies using VR for clinical training are recommended for novice nurses.

Development of neonatal Apgar scoring training program utilizing contactless hand tracking in immersive virtual reality

BACKGROUND

The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations.

AIM

This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory.

DESIGN

A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted.

SETTINGS

The study was conducted at two nursing schools from July to October 2023.

PARTICIPANTS

Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible.

METHODS

The participants were divided into three groups: the VR group (n = 27) received contactless hand-tracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-to-face Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0.

RESULTS

The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group.

CONCLUSIONS

The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited.

Application of immersive virtual reality (IVR) for the care of common diseases of older adults course: A mixed methods study

OBJECTIVE

This study aimed to enhance understanding, engagement, and learning efficiency in the course "The Care of Common Diseases of Older Adults" using a developed Immersive Virtual Reality(IVR) system.

METHODS

A mixed-methods study with 32 students was conducted. The quantitative part involved a randomized controlled trial, and the qualitative part included thematic interviews with students and teachers.

RESULTS

The intervention group using the IVR system showed significant improvements in positivity and performance evaluation scores (P < 0.05) compared to the control group. Negative affect scores also decreased significantly (P < 0.05). Qualitative data from interviews supported the quantitative findings, highlighting increased curiosity, learning enthusiasm, and academic performance.

CONCLUSION

IVR significantly enhances learning by stimulating curiosity and active participation, making education more accessible and improving student performance. Future IVR enhancements should focus on user-friendliness and empathetic feedback in adult care.

Evolution of Chatbots in Nursing Education: Narrative Review

Background

The integration of chatbots in nursing education is a rapidly evolving area with potential transformative impacts. This narrative review aims to synthesize and analyze the existing literature on chatbots in nursing education.

Objective

This study aims to comprehensively examine the temporal trends, international distribution, study designs, and implications of chatbots in nursing education.

Methods

A comprehensive search was conducted across 3 databases (PubMed, Web of Science, and Embase) following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) flow diagram.

Results

A total of 40 articles met the eligibility criteria, with a notable increase of publications in 2023 (n=28, 70%). Temporal analysis revealed a notable surge in publications from 2021 to 2023, emphasizing the growing scholarly interest. Geographically, Taiwan province made substantial contributions (n=8, 20%), followed by the United States (n=6, 15%) and South Korea (n=4, 10%). Study designs varied, with reviews (n=8, 20%) and editorials (n=7, 18%) being predominant, showcasing the richness of research in this domain.

Conclusions

Integrating chatbots into nursing education presents a promising yet relatively unexplored avenue. This review highlights the urgent need for original research, emphasizing the importance of ethical considerations.

Designing and implementing a training program on surgical hand scrubbing, wearing surgical cap and surgical mask, gowning, and gloving using HMD-based virtual reality technologies for nursing students: an exploration of student perceptions

Objective

The aim of this study is to determine the steps of a training program utilizing Head-Mounted Display (HMD) based Virtual Reality Technology to enhance nursing students' skills in surgical hand scrubbing, wearing surgical cap and surgical mask, gowning and gloving, and to evaluate students' perceptions toward the program.

Methods

The study aimed to investigate the potential applications of HMD-Based Virtual Reality Technology in Surgical Hand Scrubbing, Wearing Surgical Cap and Surgical Mask, Gowning and Gloving Program for nursing students, as well as students' perceptions toward this technology. The research was conducted with a focus group consisting of second-year nursing students in Osmaniye/Turkey, between January and June 2022, and the training program was implemented in five stages: Analysis, Design, Development, Implementation, and Evaluation. The program was evaluated with a focus group of nursing students. Focus group discussions were conducted to provide insights into students' experiences, feedback, and perceptions of the program.

Results

A vast majority of participants (92.5%) reported feeling fully immersed in the operating room environment during the virtual reality (VR) experience. Notably, all students acknowledged the potential of HMD-Based Virtual Reality Technology to enrich their understanding of surgical hand scrubbing, wearing surgical cap and surgical mask, gowning and gloving procedures, surpassing conventional instructional models. While many participants found the experience exhilarating (85.1%), a considerable portion reported a decline in engagement after repeated exposures (88.8%). Overall, participants welcomed the integration of VR technology into education, expressing optimism about its capacity to facilitate additional instructional modules (74.4%). Moreover, they conveyed satisfaction with the opportunity to engage with the VR application, emphasizing its significant educational value (81.4%).

Conclusion

Based on these findings, we can suggest that virtual reality technology has the potential to have an impact on nursing students' education. The majority of students expressing a sense of presence in the operating room highlights the value of this method in education. However, the reported boredom after repeated experiences by most participants underscores the importance of diversifying the program and introducing innovative approaches to keep students engaged.

Benefits and Barriers of Using Virtual Reality in Teaching Undergraduate Nursing Students: A Scoping Review

BACKGROUND

Although studies have been conducted using virtual reality (VR) in nursing education, evidence distinguishing the benefits and barriers of adopting VR pedagogical methods to teach undergraduate nursing students is not well-defined in nursing literature.

PURPOSE

To identify current evidence on the benefits and barriers of adopting VR as a pedagogical method in nursing education.

METHODS

A scoping review of 6 databases using PRISMA-ScR reporting guidelines. Data were managed using Covidence® software. Table of Evidence illustrates the themes.

RESULTS

Seventeen articles identified 5 thematic benefits of VR (knowledge acquisition, student engagement, improved self-confidence, teaching strategy, and cost factors) and 4 barriers (physical discomfort, learning outcome challenges, challenges to integrating into curricula, and technology challenges).

CONCLUSIONS

VR is an effective teaching-learning strategy to reinforce nursing concepts and build competencies. It is not a substitute for clinical education.

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.

The effect of virtual reality technology in exercise and lung function of patients with chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Chronic obstructive pulmonary disease (COPD) is a serious chronic disease worldwide, with significant negative impacts on the quality of life, family economic burden, and social healthcare burden of patients.

AIMS

The aim of this study was to explore the effects of virtual reality technology on exercise function and lung function in COPD patients.

METHODS

A meta-analysis of randomized controlled trials was utilized. PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, Medline, Scopus, China National Knowledge Infrastructure (CNKI), Wanfang Database, Weipu Database (VIP), and Chinese Biomedical Database (CBM) were systematically searched. We included randomized controlled trials published from the establishment of the database to August 10, 2022, on virtual reality technology in COPD patients. Literature retrieval and screening was carried out independently by two reviewers to obtain literature that met our inclusion and exclusion criteria and to extract relevant data. Two reviewers assessed the risk of bias in the included literature. A meta-analysis was performed using Revman 5.4 Software.

RESULTS

A total of 10 randomized controlled trials with 539 participants were included. The results showed that virtual reality technology significantly improved the lung function of COPD patients, such as forced expiratory volume (FEV1; MD = 7.29, 95% CI [4.34, 10.24], p < .01) and forced expiratory volume/forced vital capacity (FEV1/FVC; MD = 6.71, 95% CI [4.72, 8.71], p < .01). The combined intervention with different virtual reality technology had different effects on motor function. Compared with endurance training (ET) alone, virtual reality technology combined with ET had no significant effect on the 6-minute walk test (6WMT) in COPD patients (p > .05). Compared with pulmonary rehabilitation (PR) alone, virtual reality technology combined with PR was more effective in increasing 6WMT in COPD patients (MD = 30.80, 95% CI [10.85, 50.74], p < .01).

LINKING EVIDENCE TO ACTION

Virtual reality technology can help to improve lung function in COPD patients, and virtual reality combined with PR can improve exercise tolerance in COPD patients. However, due to the limited number of included studies, large-sample, multicenter, high-quality randomized controlled trial studies are needed to provide clear evidence.

Effects of virtual reality OSCE on nursing students' education: a study protocol for systematic review and meta-analysis

INTRODUCTION

Virtual objective structured clinical examination (OSCE) has been shown to influence the performance of nursing students. However, its specific effects, particularly students' competence, stress, anxiety, confidence, satisfaction with virtual reality OSCE and examiners' satisfaction, remain unclear.

METHOD AND ANALYSIS

This study aims to assess the effects of virtual reality OSCE on nursing students' education. The study follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocol guidelines. A literature search is performed on electronic databases, namely, PubMed, Web of Science, CINAHL, EBSCO, EMBASE and the Cochrane Library. The inclusion criteria adhere to the PICOS principle, encompassing nursing students, including those studying in school and those engaged in hospital internship. This review includes studies on the use of virtual reality OSCE as an assessment tool, compared with traditional clinical examinations, such as in-person OSCE. The outcome assessments encompass (1) competence, (2) stress, (3) anxiety, (4) confidence, (5) student satisfaction with virtual reality OSCE and (6) examiners' satisfaction. These studies are designed as randomised controlled trials (RCTs) or quasi-experimental research. The search time is from the inception of each database to 30 June 2023, without language restriction. Studies for inclusion are screened by two reviewers for data extraction dependently. Any dispute is resolved through discussion. Unresolved disputes are decided by consulting a third author. For the risk of bias (ROB) assessment, the Cochrane ROB tool for RCTs and the risk of bias in non-randomised studies of intervention tool are used. Moreover, RevMan V.5.3 is used for meta-analysis.

ETHICS AND DISSEMINATION

This study protocol does not include any clinical research and thus does not require ethical approval. Research findings are published in a peer-reviewed journal.

PROSPERO REGISTRATION NUMBER

CRD42023437685.

Clinical trial on nurse training through virtual reality simulation of an operating room: assessing satisfaction and outcomes

INTRODUCTION

Virtual reality (VR) provides a firsthand active learning experience through varying degrees of immersion. The aim of this study is to evaluate the use of VR as a potential tool for training operating room nurses to perform thoracic surgery procedures.

METHODS

This is an open parallel-group randomized clinical trial. One group received basic formation followed by an assessment module. The experimental group received the same basic formation, followed by thoracic surgery training and an assessment module.

RESULTS

Fifty-six nurses participated in the study (51 females), with a mean age of 41.6 years. Participants achieved a median evaluation mode score of 480 points (IQR = 32 points). The experimental group (520 points) achieved an overall higher score than the control group (440 points; P = .04). Regarding age, women in the second quartile of age among the participants (35-41 years) achieved significantly better results than the rest (P = .04). When we evaluated the results based on the moment of practice, exercises performed in the last 10 min obtained better results than those performed in the first 10 min (1064 points versus 554 points; P < .001). Regarding adverse effects blurred vision was the most frequent. The overall satisfaction rating with the experience was 8.5 out of 10.

CONCLUSION

Virtual reality is a useful tool for training operating room nurses. Clinical trial with ISRCTN16864726 registered number.

Application effect of BOPPPS teaching model on fundamentals of nursing education: a meta-analysis of randomized controlled studies

Background

BOPPPS (bridge-in, learning objective, pretest, participatory learning, posttest, and summary) is a student-centered, closed-loop teaching model that emphasizes real-time communication and feedback.

Objectives

The purpose of this study was to review and evaluate the effect of BOPPPS teaching model in "Fundamentals of Nursing" teaching.

Methods

We conducted a meta-analysis of randomized controlled trials (RCTs) based on the BOPPPS teaching model in "Fundamentals of Nursing" teaching. To review domestic and foreign databases for the period 2010 to September 2023. Finally, 13 RCTs were included and the teaching outcomes were measured and analyzed. Two researchers independently identified, selected, and extracted data from the study and examined the risk of bias. The primary outcomes were students' examination scores (theoretical scores: scores obtained in the nursing fundamentals course, reflecting students' understanding and mastery of the course content; practical scores: assessment results based on practical application or experimental skills, evaluating students' practical skill level). The secondary outcomes were self-learning ability score: indicators assessing students' self-directed learning ability, reflecting their competence in independent learning and autonomous exploration; and satisfaction rate of teaching effect: the overall satisfaction rate of students with the teaching effects experienced during teaching process reflects the proportion of students' acceptance and satisfaction with the teaching program. The results were evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) profiler software. The GRADE profiler software is used to assess and grade the recommendations according to the GRADE (Grading of Recommendations Assessment, Development, and Assessment) criteria.

Results

A total of 13 studies were included, consisting of 2,991 nursing students. Among them, 1,465 students were in the BOPPPS teaching group, while 1,526 students were in the traditional teaching group. The summary analysis of the main outcomes showed that the BOPPPS teaching model had significantly higher scores in theoretical score (MD = 3.35, 95% CI: 2.35-4.35, Z = 6.56, p < 0.00001), practice score (MD = 4.50, 95% CI: 1.95-7.05, Z = 3.45, p = 0.0006), and self-learning ability score (MD = 6.76, 95% CI: 5.38-8.14, Z = 9.60, p < 0.00001) compared to the traditional teaching group. The satisfaction rate of students in the BOPPPS teaching group regarding teaching effectiveness was 89% (95% CI = 0.84-0.93). The differences were statistically significant (p < 0.05). The GRADE evidence level for theoretical score and satisfaction rate of teaching effect is low. The evidence level for practice score is very low, and for self-learning ability score is moderate.

Conclusion

The BOPPPS teaching mode is helpful to improve the theoretical score, practice score, and self-learning ability score of "Fundamentals of Nursing," and improve the satisfaction rate of students to the teaching effect. The teaching effect is better than the traditional teaching method.

Enhancing nursing competency through virtual reality simulation among nursing students: a systematic review and meta-analysis

Aim

Studies on the effectiveness of virtual reality (VR) in nursing education have explored its impact on learning outcomes, emotional immersion and engagement, learner self-confidence, and satisfaction, generally showing positive aspects. However, there is a need for a systematic review to examine the specific influence of VR-based education on nursing students' practical competency.

Method

According to the PRISMA 2020 guidelines, 22 studies were selected based on inclusion criteria from 579 articles, published from January 1, 2018, to March 31, 2024, across nine major databases including PubMed and EMbase. The target population comprised nursing students, and the intervention focused on VR-based simulations aimed at enhancing competency, compared to control groups receiving either no intervention or conventional non-virtual simulation. The primary outcome, nursing competency, was analyzed using MIX 2.0 Pro (Ver. 2.0.1.6, BiostatXL, 2017) to calculate pooled effect sizes.

Result

The pooled effect size for nursing competency was determined to be large, with Hedge's g = 0.88 (95% CI, 0.47 to 1.29). Meta-regression analysis identified several factors associated with an increase in nursing competency. These included studies published after 2022, approval of an IRB, absence of funding, randomized controlled trials (RCTs), interventions reported as shorter than 4 weeks or not reported, sessions fewer than 4 or not reported, session duration under 1 h or not reported, and observational measurement methods. Additional factors enhancing nursing competency were the inclusion of a pre-briefing before simulations, the absence of a debriefing afterward, and the exclusion of other activities during the simulation.

Conclusion

By combining the results of the included studies, the systematic review and meta-analysis accounted for variations in sample size, study methodology, and independent intervention effects, providing an overall evaluation of the effectiveness of simulation-based education in improving nursing students' competency.

Limitation

The selection criteria for the studies analyzed, which included only those published in English or Korean and reported precise means, standard deviations, and sample sizes, could lead to selection bias and limit the generalization of our study results.

Systematic review registration

PROSPERO International Prospective Register of Systematic Reviews: http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023446348.

The effect of combining an e-learning module with s Virtual Dementia Tour® on knowledge and attitudes toward person-centered dementia care in prelicensure nursing education

BACKGROUND

Due to the global prevalence of dementia the U. S. Department of Health and Human Services' National Plan to Address Alzheimer's Disease recommended that healthcare professionals prepare to address the complex needs of people with dementia. To address this gap, nursing programs adopted experiential learning methods. While such methodologies are increasingly used, limited evidence exists to inform best teaching practices.

PURPOSE

This study evaluated the combined effect of an e-learning module with a virtual simulation on nursing students' knowledge and attitudes of dementia.

METHODS

The study followed quasi-experimental design with a cross-over and pretest/posttest design. A convenience sample of nursing students was recruited from three public universities in the Southeast United States.

RESULTS

Significant improvements in attitudes toward people with dementia were found in students with previous dementia care experience or those employed to provide services to people with dementia. Experience was a stronger predictor of attitudes than education. However, the reliability of the Dementia Knowledge Assessment Scale was not sufficient in this study.

SIGNIFICANCE

The findings may inform best practices in nursing education to prepare graduates to provide quality care for people with dementia.

The effect of flipped learning on nursing students' Asepsis knowledge and learning skills: A randomized controlled study

AIM

This study was conducted to evaluate the effect of the flipped learning model on nursing students' asepsis knowledge and learning skills.

BACKGROUND

The flipped learning model enables students to pursue their learning with online support whenever and wherever they want. Students have the responsibility for their learning activities. The flipped learning model is an effective method to improve nursing students' knowledge and skills related to the principles of asepsis with online innovative approaches.

DESIGN

This study has a pre-test post-test open-label, randomized controlled design.

METHOD

The study sample consisted of 107 first-year nursing students randomized into experimental (n = 53) and control (n = 54) groups. The experimental group students were trained utilizing the flipped learning model. The data were collected through the "Descriptive Characteristics Form of Nursing Students ", the "Principles of Asepsis Knowledge Test" and the " Self-directed Learning Skills Scale".

RESULTS

It was determined that the post-test knowledge score of the experimental group was statistically significantly higher (p=0.000) than the control group and the median of the retention test knowledge score was statistically significantly higher (p=0.000) than the control group. There was a statistically significant increase (p<0.05) in the median score of the self-directed learning skills scale "self-control" sub-dimension of the experimental group.

CONCLUSION

Flipped learning increased nursing students' knowledge related to the principles of asepsis and enabled them to take responsibility for learning. This model had a positive effect on students' higher order thinking skills such as critical organization and decision making. It is recommended to use the flipped learning within the scope of nursing education and especially in gaining basic skills.

TWEETABLE ABSTRACT

A success in today's education; flipped learning.

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

ABSTRACT

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

Development and effectiveness of a metaverse reality-based family-centered handoff education program in nursing students

PURPOSE

Effective patient handoffs are vital in pediatric populations. This study aimed to develop and identify the impact of a metaverse-based handoff program using ZEPETO on nursing students' handoff competence, handoff self-efficacy, learning realism, and satisfaction.

DESIGN AND METHODS

This study used a non-randomized, pre-post nonequivalent group design to develop, implement, and verify a metaverse-based handoff simulation program in a nursing school in South Korea. We assigned 69 senior nursing students from a university to an experimental group or a control group. We developed a metaverse-based, handoff simulation program of family-centered care by building a pediatric intensive care unit (PICU) using ZEPETO. The program included an online lecture, a metaverse rounding discussion, and a metaverse-based handoff simulation of postoperative care for infants with congenital heart disease. We measured handoff competence, handoff self-efficacy, learning realism, and learning satisfaction pre- and post-program.

RESULT(S)

The experimental group showed significantly higher handoff self-efficacy than the control group (t = 3.17, p = 0.002). No significant differences were found in handoff competency, learning realism, or learning satisfaction between the groups.

CONCLUSION(S)

This study confirmed that a family-centered care-based handoff metaverse simulation program based on the experiential learning theory enhanced nursing students' handoff self-efficacy. The program equipped students to conduct safe and effective handoffs in real-world clinical settings by providing an immersive learning experience and emphasizing patient-centered communication.

PRACTICAL IMPLICATIONS

Based on these results, family-centered, handoff education programs are recommended to be developed that focus on learning realism and learning satisfaction to enhance nursing students' handoff competence.

Analysis of Knowledge and Satisfaction in Virtual Clinical Simulation among Nursing Students: A Mixed Study

Virtual simulation offers a powerful educational tool with considerable, albeit underexplored potential. This technology immerses students in lifelike digital scenarios, fostering the acquisition of knowledge and skills necessary for their future careers. This study aimed to assess knowledge acquisition and satisfaction outcomes among students using a virtual simulation teaching approach. The specific objectives were (1) to compare pre-and posttest knowledge acquisition, (2) to investigate the influence of prior professional experience on knowledge, and (3) to explore satisfaction levels with virtual simulation. One hundred and fifty-nine nursing students participated in a virtual simulation-based clinical intervention, entailing the resolution of a virtual adult patient hospitalized with respiratory pathology. Sociodemographic data and prior professional experience were collected, and knowledge was evaluated through pre-to-post tests. Satisfaction levels were assessed using open-ended questions. Quantitative data were analyzed using descriptive statistics, Wilcoxon, Mann-Whitney U, and Cohen's tests, while qualitative data underwent keyword-in-context analysis. Significant differences were noted between pre- and posttest knowledge levels, with prior experience showing no significant impact on knowledge acquisition. Participants reported high levels of satisfaction. Lexicometric analysis identified four clusters of words related to the key terms "simulation", "learn", "activity", and "knowledge". Virtual clinical simulation effectively enhances knowledge acquisition and fosters satisfaction, with students recognizing the positive impact of this approach on their learning. Consequently, virtual simulation contributes to the training of competent health professionals.

Investigation of the possibility of using an augmented reality-based endotracheal aspiration simulation tool for nursing education

AIM

We developed an augmented reality technology-based endotracheal aspiration simulation tool (the AR tool) consisting of three modes: a mode for nursing students to learn endotracheal aspiration by themselves (learning mode); a mode for repeated practice (practice mode); and a mode for confirmation testing (test mode). This study aimed to compare the learning outcomes of the AR tool with traditional training mannequins and identify potential uses and improvements of the AR tool.

METHODS

We invited students, and faculty members from the three universities who agreed to cooperate in conducting this study. Fifty-four students and nine faculty members agreed to participate in this study. The students were divided into two groups. One group was to study with the AR tool and the other group was to study with the traditional half-body training mannequin for suction. The students in both groups were asked to demonstrate endotracheal aspiration on another full-body type training mannequin which could be used as a patient with a tracheostomy (Skill test). Group interviews with faculty members focused on the topic of the AR tool's potential use in nursing education and improvement needed.

RESULTS

There was little significant difference in the skill test results of endotracheal aspiration of students in both groups. The students and faculty members both expressed an interest in the AR tool. They said it was suitable for self-study of endotracheal aspiration.

CONCLUSIONS

This AR tool is an effective teaching tool for learning the sequence of endotracheal suctioning, although there are some areas that need improvement.

[Virtual reality in teaching using mentally ill patient avatars]

BACKGROUND

Medical interaction and exploration techniques are the most important tools that medical students have to acquire in the subject of psychiatry and psychotherapy. The new digital technologies currently available, such as virtual reality (VR), as important supplements can contribute to a significant improvement in the teaching of psychiatric-psychopathological learning content as well as, in particular, the technique of ascertaining the psychiatric history and diagnosis.

OBJECTIVE

Evaluation of the Bochum Avatar Exploration Project (AVEX) as part of the curricular course in medical studies at the Ruhr University Bochum for its possibilities to convey learning content and techniques of anamnesis and diagnosis in the subject of psychiatry and psychotherapy.

METHODS

In AVEX, a total of 87 medical students in the clinical study section have so far been able to enter into a dialogue with "mentally ill" avatars and gain experience with VR technology as a learning and teaching method in the subject of psychiatry and psychotherapy.

RESULTS

Despite the limited possibilities for interaction with the digital avatars, it is possible to achieve a substantial transfer of learning content in psychiatry; however, the students must be well supported by the lecturers.

CONCLUSION

The AVEX project already shows promising possibilities for supplementing the teaching of medical students, even if the fit of questions and replies in dialogue with the virtual avatars still needs to be improved. As advances in the linguistic communication of emotions and the visual effects of the avatar representation can be predicted, the significance of this technology will continue to increase.

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

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

Evaluating a virtual reality dementia training experience using psychophysiological methods: A randomised controlled study

OBJECTIVES

Virtual reality (VR) is increasingly used for training the dementia care workforce. It is unknown whether VR is superior to traditional training techniques in improving dementia care amongst practicing nurses. This study compared the impact of a VR application on nurses' knowledge and attitudes towards people living with dementia, to video-based, non-immersive training.

METHODS

Twenty-two registered and enrolled nurses were randomised to either interactive VR experience or video footage captured from within the app. Participants completed surveys pre- and post-training to assess their knowledge of dementia, attitudes towards dementia and person-centredness. Engagement with training was assessed objectively using facial electromyography, and subjectively with self-reported scales.

RESULTS

Virtual reality evoked objectively significant greater positive and negative emotional responses than video (positive emotion fEMG: VR mean .012 mV vs. video .005 mV, F[1, 20] = 8.70, p = .01; negative emotion fEMG: VR mean .018 mV vs. video .008 mV, F[1, 20] = 18.40, p < .001). Self-ratings of engagement and emotional state were similar. There was little change in the VR group's knowledge of, and attitudes towards, dementia; the video group's dementia knowledge improved (total DKAS mean differences: VR .1 t = .07, df = 9, p = .95 vs. video -2.3 t = -2.265, df = 11, p = .045).

CONCLUSIONS

Virtual reality is more engaging than traditional training in highly experienced dementia care practitioners. Despite this, VR may not be superior to traditional training techniques to improve knowledge and attitude for many learners. A focus of future research in the area should be on how to capitalise on VR's greater emotional engagement so that Australia's nursing workforce is better equipped to care for the increasing number of people living with dementia.

Virtual reality experiential learning improved undergraduate students' knowledge and evaluation skills relating to assistive technology for older adults and individuals with disabilities

BACKGROUND

The aging population has caused assistive technology (AT) to receive attention. Thus, ensuring accurate user comprehension of AT has become increasingly crucial, and more specialized education for students in relevant fields is necessary. The goal of this study was to explore the learning outcomes in the context of AT for older adults and individuals with disabilities through the use of VR experiential learning.

METHODS

A parallel-group design was used. Sixty third-year university students studying gerontology and long-term-care-related subjects in Taiwan were enrolled, with the experimental (VR) and control (two-dimensional [2D] video) groups each comprising 30 participants. Both groups received the same 15-minute lecture. Subsequently, the experimental group received experiential learning through a VR intervention, whereas the control group watched a 2D video to learn. The students' knowledge of AT was assessed using a pretest and posttest. Additionally, their skills in evaluation of residential environments were assessed using the Residential Environment Assessment (REA) Form for Older Adults. All data analyses were performed with SPSS version 22.

RESULTS

In the posttest conducted after the intervention, the experimental group exhibited a significant 20.67 point improvement (p < 0.05), whereas the control group only exhibited improvement of 3.67 points (p = 0.317). Furthermore, the experimental group demonstrated a significantly higher score (+ 2.17 points) on the REA Form for Older Adults than did the control group (p < 0.05).

CONCLUSION

VR experiential learning can significantly improve undergraduate students' knowledge and evaluation skills in relation to AT for older adults and individuals with disabilities.

Impact of an immersive virtual reality simulator education program on nursing students' intravenous injection administration: A mixed methods study

BACKGROUND

Undergraduate nursing students often face limited opportunities to gain hands-on experience in performing invasive procedures and techniques. Immersive media tools may be helpful in training and enhancing skill development among nursing students.

OBJECTIVES

The specific aims of this study were threefold: (1) to describe the development process of an intravenous injection virtual reality simulator (IIVRS) program, (2) to determine the effect of the IIVRS program on intravenous injection knowledge, and (3) to examine the acceptability, learning motivation, and experience of the IIVRS program among nursing students.

METHODS

This study is a mixed method design, encompassing a one-group pre- and post-test approach and the utilization of reflection logs among 128 second-year nursing students enrolled at a university in northern Taiwan. An innovative gamification IIVRS program was developed by our research team. Knowledge of intravenous injection was assessed using a point visual analog scale at pre-and post-testing. Acceptability and motivation were assessed using items on a 5-point Likert scale. The IIVRS program experience was evaluated using open-ended questions of reflection. A paired t-test was used for comparing knowledge at pre-and post-tests, independent t-tests were conducted to compare levels of acceptance and learning motivation among different students' characteristics, and content analysis was used for qualitative data.

RESULTS

Students' knowledge of intravenous injection was significantly improved (Pre-test Mean = 3.08 vs. Post-test Mean = 4.96, p < 0.001). Students reported high levels of acceptance (Mean = 4.65) and learning motivation (Mean = 4.69). Students reported three themes of their experience: (1) attracts my attention and stimulates my motivation to learn, (2) enhanced memorization of the skill and process, and (3) a sense of presence and realism/unrealism.

CONCLUSION

The virtual reality program for intravenous injection administration can be an effective education tool, fostering students' motivation to learn and a heightened sense of accomplishment.

Exploring the Evolution of Nursing Procedurals Skills, Mastery, and Competence Through Online Learning Among Students: A Qualitative Study

Introduction

Online learning has changed the educational environment and may influence the development of nursing skills, mastery, and competence in students.

Objective

The study aimed to investigate how nursing students acquire procedural skills, achieve mastery, and build competence through online learning, considering the growing use of technology in healthcare education.

Methods

This study utilized a qualitative descriptive research approach to investigate the experiences of 32 nursing students from the Nursing Department who had undergone online procedural learning. Semistructured interviews were conducted to collect in-depth insights. Purposive sampling was used to gather data with a profound understanding of the phenomenon. The data analysis encompassed a methodical content analysis coding procedure. Independent researchers reviewed the results to validate the findings.

Results

Content analysis of the data identified three key themes: achieving nursing procedural knowledge through online learning, achieving nursing procedural skills with the power of online learning, and gaining procedural competence through online social and collaborative learning.

Conclusions

Online learning played a significant role in shaping and enhancing nursing procedural knowledge, skills, and competence, emphasizing the importance of integrating technology training modules and staying updated with emerging technologies.

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.

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

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

The effect of using desktop VR to practice preoperative handovers with the ISBAR approach: a randomized controlled trial

AIM

The aim was to investigate whether second-year undergraduate nursing students practicing the Identification-Situation-Background-Assessment-Recommendation (ISBAR) communication approach in a desktop virtual reality (VR) application had a non-inferior learning outcome compared with the traditional paper-based method when sorting patient information correctly based on the ISBAR structure.

METHODS

A non-inferior parallel group assessor blinded randomized controlled trial, conducted in simulation sessions as part of preparation for clinical placements in March and April 2022. After a 20-minute introductory session, the participants were randomized to self-practice the ISBAR approach for 45 minutes in groups of three in either an interactive desktop VR application (intervention) or traditional paper-based (TP) simulation. The primary outcome concerned the proportion of nursing students who sorted all 11 statements of patient information in the correct ISBAR order within a time limit of 5 min. The predefined, one-sided, non-inferiority limit was 13 percentage points in favor of traditional paper-based simulation.

RESULTS

Of 210 eligible students, 175 (83%) participated and were allocated randomly to the VR (N = 87) or TP (N = 88) group. Practicing in the desktop VR application (36% of everything correct) was non-inferior to the traditional paper-based method (22% everything correct), with a difference of 14.2 percentage points (95% CI 0.7 to 27.1) in favor of VR. The VR group repeated the simulation 0.6 times more (95% CI 0.5 to 0.7). Twenty percent more (95% CI 6.9 to 31.6) of the students in the VR group reported liked how they practiced. All the other outcomes including the System Usability Scale indicated non-inferiority or were in favor of VR.

CONCLUSIONS

Self-practicing with the ISBAR approach in desktop VR was non-inferior to the traditional paper-based method and gave a superior learning outcome.

TRIAL REGISTRATION NUMBER

ISRCTN62680352 registered 30/05/2023.

Virtual reality simulation for nursing education: effectiveness and feasibility

Virtual Reality simulation (VRS) is an innovative and emerging technology that has the potential to offer increased numbers of pre-registration students authentic learning experiences compared to traditional simulation- based education (SBE) with simulated participants. The aim was to evaluate learner outcomes of SBE compared to 4 fully immersive VRS scenarios, for vocational and higher education nursing students at a training and further education institute in Melbourne, Australia. A mixed methods quasi-experimental design study was conducted over two semesters from 2019 to 2020. Participants were 675 pre-registration nursing students. The intervention group (VRS n = 393) received 4 three-dimensional, immersive VRS modules. The control group (SBE n = 282) received 4 face-to-face large group immersive simulations. In the VRS group 95% of students actively participated, compared to SBE (on average 15%). Knowledge test scores were initially significantly greater (p < 0.01) for VRS versus SBE students, but not maintained post clinical placement. Intervention students found VRS to be realistic and prepared them for clinical practice. Some technical difficulties were identified with VRS. VRS was found to be more cost effective than SBE. VRS fostered critical thinking and provided an efficient and sustainable platform for learning about complex clinical situations.

Exploring facilitation in virtual simulation in nursing education: A scoping review

Objective

To systematically map existing research regarding the reflective feedback in virtual simulation in undergraduate nursing education.

Methods

A scoping review was conducted based on the Arksey and O'Malley framework and the PRISMA-ScR.

Results

We included 41 studies from 15 different countries. The simulation interventions allowed for interaction between the student and the virtual patient, the software, faculty, peers, or a combination of two or more of these. Students valued reflective feedback during and after the simulation.

Conclusions

Our review emphasizes the importance of a human in the loop. Feedback before, during, and after the simulation is possible in virtual simulation where the facilitator can pause the virtual scenario and stimulate reflections during the simulation to obtain deep learning. Virtual simulation provides opportunities to give feedback from the software, such as cues or direct feedback.

Innovation

There is a lack of focus on the feedback process and there is a need to revitalize the role of facilitators in a virtual simulation to determine their relative contribution in this process. Several studies reported the usefulness or the effect of virtual simulation on learning processes, but most lacked emphasis on investigating the significance of including a human in the loop.

The state of clinical education and factors affecting effective clinical education: the point of view of nursing and midwifery students

BACKGROUND

Clinical education is the basis of education in medical sciences. Clinical education, as the essence of education in nursing and midwifery, promotes social health, improves health care, and reduces mortality. Considering the position of nursing and midwifery, investigating the views of students in this field can be an effective step in improving clinical education. Therefore, the present study was conducted to investigate the status of clinical education and the factors affecting effective clinical education from the point of view of nursing and midwifery students.

METHODS

A descriptive-analytical study was conducted among nursing and midwifery students at Qazvin University of Medical Sciences in 2022-2023. Using available sampling, 242 students were included in the study. Students were included in the study if they completed at least one unit of in-person internship. Refusing to continue the study for any reason and having a practical nurse certificate were the criteria for exclusion from the study. The data collection tools included a demographic information questionnaire, a questionnaire to assess the status of clinical education, and a questionnaire on factors affecting effective clinical education. The data were analysed with descriptive and inferential statistics and SPSS 20 software.

RESULTS

The mean age of the participants in this study was 21.66 ± 2.25. A total of 180 (74.4%) of the participants were women, and the rest were men. The results showed that the general condition of clinical education is at an average level (103.16 ± 19.21). It was also found that the clinical education status of midwifery students was better than that of nursing students, and this difference was significant (p = 0.003). Among the fields of clinical education, the highest score belonging to the field of objectives and planning was reported on the average level (34.39 ± 6.66). Among the factors affecting effective clinical education, the highest score was given to the field of personal characteristics of the student (33.97 ± 5.99). The results showed that there is a significant relationship between the grades of the general state of clinical education with the academic semester (p = 0.001) and interest in the field of study (p < 0.040).

CONCLUSIONS

Based on the findings of the present study, clinical education is at an average level. Among the factors affecting effective clinical training, the field of personal characteristics of the student is more effective in clinical training. Providing educational facilities according to the number of students, using modern teaching methods, and determining and communicating the duties of professors and students can help to improve clinical education.

TACTICS VR Stroke Telehealth Virtual Reality Training for Health Care Professionals Involved in Stroke Management at Telestroke Spoke Hospitals: Module Design and Implementation Study

BACKGROUND

Stroke management in rural areas is more variable and there is less access to reperfusion therapies, when compared with metropolitan areas. Delays in treatment contribute to worse patient outcomes. To improve stroke management in rural areas, health districts are implementing telestroke networks. The New South Wales Telestroke Service provides neurologist-led telehealth to 23 rural spoke hospitals aiming to improve treatment delivery and patient outcomes. The training of clinical staff was identified as a critical aspect for the successful implementation of this service. Virtual reality (VR) training has not previously been used in this context.

OBJECTIVE

We sought to develop an evidence-based VR training module specifically tailored for stroke telehealth. During implementation, we aimed to assess the feasibility of workplace deployment and collected feedback from spoke hospital staff involved in stroke management on training acceptability and usability as well as perceived training impact.

METHODS

The TACTICS VR Stroke Telehealth application was developed with subject matter experts. During implementation, both quantitative and qualitative data were documented, including VR use and survey feedback. VR hardware was deployed to 23 rural hospitals, and use data were captured via automated Wi-Fi transfer. At 7 hospitals in a single local health district, staff using TACTICS VR were invited to complete surveys before and after training.

RESULTS

TACTICS VR Stroke Telehealth was deployed to rural New South Wales hospitals starting on April 14, 2021. Through August 20, 2023, a total of 177 VR sessions were completed. Survey respondents (n=20) indicated a high level of acceptability, usability, and perceived training impact (eg, accuracy and knowledge transfer; mean scores 3.8-4.4; 5=strongly agree). Furthermore, respondents agreed that TACTICS VR increased confidence (13/18, 72%), improved understanding (16/18, 89%), and improved awareness (17/18, 94%) regarding stroke telehealth. A comparison of matched pre- and posttraining responses revealed that training improved the understanding of telehealth workflow practices (after training: mean 4.2, SD 0.6; before training: mean 3.2, SD 0.9; P<.001), knowledge on accessing stroke telehealth (mean 4.1, SD 0.6 vs mean 3.1, SD 1.0; P=.001), the awareness of stroke telehealth (mean 4.1, SD 0.6 vs mean 3.4, SD 0.9; P=.03), ability to optimally communicate with colleagues (mean 4.2, SD 0.6 vs mean 3.7, SD 0.9; P=.02), and ability to make improvements (mean 4.0, SD 0.6 vs mean 3.5, SD 0.9; P=.03). Remote training and deployment were feasible, and limited issues were identified, although uptake varied widely (0-66 sessions/site).

CONCLUSIONS

TACTICS VR Stroke Telehealth is a new VR application specifically tailored for stroke telehealth workflow training at spoke hospitals. Training was considered acceptable, usable, and useful and had positive perceived training impacts in a real-world clinical implementation context. Additional work is required to optimize training uptake and integrate training into existing education pathways.

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.

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

BACKGROUND

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

OBJECTIVE

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

DESIGN

This is a cross-sectional study.

SETTING

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

PARTICIPANTS

Third-year nursing students.

METHODS

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

RESULTS

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

CONCLUSIONS

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

The status of virtual simulation experiments in medical education in China: based on the national virtual simulation experiment teaching Center (iLAB-X)

BACKGROUND

Virtual simulation experiments have been rapidly applied to medical education curricula in recent years. China constructed a national virtual simulation experimental teaching center (iLAB-X), and this platform covered almost all of the virtual simulation experiment curricula of domestic colleges or universities. We aimed to comprehensively assess the characteristics and usages of virtual simulation experiments in medical education based on iLAB-X.

METHODS

A total of 480 virtual simulation experiment courses had been constructed on iLAB-X (https://www.ilab-x.com/) by December 20, 2022, and the curriculum level, type and design were all searched in this platform. We also conducted an evaluation of curriculum usage and online tests, including the page view, frequency of participation, number of participants, duration of experimental learning and passing rate of the experimental test.

RESULTS

The national and provincial high-quality virtual simulation experiment curricula accounted for 33.5% (161/480) and 35.8% (172/480), respectively. The curricula were mainly set as basic practice experiments (46.5%) and synthetic designing experiments (48.8%). Significantly, forensic medicine (100%), public health and preventive medicine (83%) and basic medical sciences (66%) focused on synthetic design experiments. In terms of usage experiments, the average duration of experimental learning was 25 minutes per course, and the average number of participants was just 1257. The average passing (score ≥60) rate of online tests was 80.6%, but the average rate of score ≥ 85 was only 58.5%. In particular, the average page views, the number of participants, the duration of learning and the test passing rate of clinical medicine were relatively low.

CONCLUSIONS

The curriculum design features, construction level and utilization rate varied in different medical majors. Virtual simulation experiments are particularly underutilized in clinical medicine. There is a long way for virtual simulation experiments to go to become a supplement or alternative for traditional medical education in the future.

Enhancing professional competency in clinical procedures using head-mounted display virtual reality - a mixed method study

BACKGROUND

The maintenance of nursing professional competency is essential to ensure patients' health outcomes. With the current shortage of nursing workforce, a novel approach is necessary to refresh clinical skills and update practice.

OBJECTIVE

This study aims to examine the effectiveness of using head-mounted display virtual reality to refresh knowledge and skills and explore nurses' perceptions towards using this technology for refresher training.

DESIGN

A pre-test post-test mixed-method experimental design was employed.

RESULTS

Participants (n = 88) were registered nurses with a diploma in nursing. The intravenous therapy and subcutaneous injection procedures were implemented using head-mounted display virtual reality. The study showed significant improvement in knowledge for the procedures, cognitive absorption, online readiness, self-directed learning, and motivation for learning. In the qualitative focus group discussions, three themes were identified using thematic analyses: enjoyable way to refresh clinical knowledge; learning outside classroom and limitations in maneuver.

CONCLUSION

Using head-mounted display virtual reality is promising in refreshing clinical skills for nurses. Training and refresher courses can explore using this novel technology, which may be a viable alternative to ensure professional competence with reduced manpower and resources used by the healthcare institution.

Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses

Background

Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied.

Objective

We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes.

Methods

We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ≤2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality.

Results

In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as "high" based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ≥4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively.

Conclusions

VR in nursing has positive effects-relieving patients' pain, anxiety, and depression and improving cognitive function-despite the included studies' limited quality. However, applying VR in nursing to improve patients' motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed.

Comparative study of 360° virtual reality and traditional two-dimensional video in nonface-to-face dental radiology classes: focusing on learning satisfaction and self-efficacy

BACKGROUND

Acquiring adequate theoretical knowledge in the field of dental radiography (DR) is essential for establishing a good foundation at the prepractical stage. Currently, nonface-to-face DR education predominantly relies on two-dimensional (2D) videos, highlighting the need for developing educational resources that address the inherent limitations of this method. We developed a virtual reality (VR) learning medium using 360° video with a prefabricated head-mounted display (pHMD) for nonface-to-face DR learning and compared it with a 2D video medium.

METHODS

Forty-four participants were randomly assigned to a control group (n = 23; 2D video) and an experimental group (n = 21; 360° VR). DR was re-enacted by the operator and recorded using 360° video. A survey was performed to assess learning satisfaction and self-efficacy. The nonparametric statistical tests comparing the groups were conducted using SPSS statistical analysis software.

RESULTS

Learners in the experimental group could experience VR for DR by attaching their smartphones to the pHMD. The 360° VR video with pHMD provided a step-by-step guide for DR learning from the point of view of an operator as VR. Learning satisfaction and self-efficacy were statistically significantly higher in the experimental group than the control group (p < 0.001).

CONCLUSIONS

The 360° VR videos were associated with greater learning satisfaction and self-efficacy than conventional 2D videos. However, these findings do not necessarily substantiate the educational effects of this medium, but instead suggest that it may be considered a suitable alternative for DR education in a nonface-to-face environment. However, further examination of the extent of DR knowledge gained in a nonface-to-face setting is warranted. Future research should aim to develop simulation tools based on 3D objects and also explore additional uses of 360° VR videos as prepractical learning mediums.

Effectiveness of Virtual Reality Simulation Among BSN Students: A Meta-analysis of Randomized Controlled Trials

This study aimed to evaluate the effect of virtual reality simulation in nursing education in five domains: knowledge, skill performance, self-confidence, self-efficacy, and satisfaction. Randomized controlled trials were obtained from the databases SCOPUS, Web of Science, PubMed, and EBSCO from inception until September 2021. The standardized mean differences with 95% confidence intervals were determined for the main variables, and heterogeneity was analyzed using the I2 test. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) Checklist was used. Meta-analysis was performed using the Stata 15.0 software. Among the 2074 records identified, 18 trials were included. The meta-analysis of these trials indicated that virtual reality simulation caused a significant improvement in knowledge with a moderate effect, skill performance with a moderate effect, and satisfaction with a moderate effect compared with the control group. However, virtual reality simulation did not significantly influence self-confidence and self-efficiency. The findings of this study suggested that virtual reality simulation might significantly benefit knowledge, skill performance, and satisfaction but not self-confidence and self-efficiency. Further well-designed randomized controlled trials with a larger sample size are recommended to confirm these findings.

CardioVerse: The cardiovascular medicine in the era of Metaverse

The recent pandemic launched an acceleration in adopting telemedicine by cardiovascular health and triggered the flourishing of technological advancements, such as the metaverse, which is a novel interactive mix of digital worlds that leverages augmented reality with virtual reality. The CardioVerse represents a theoretical term for the embracement of the metaverse by cardiovascular medicine, encompassing the endless possibilities as well as the challenges that it holds and introduces new dimensions to disease education, prevention and diagnosis. Its applications are numerous, notably in enhancing medical visits, assisting cardiovascular interventions and reshaping the way medical education is provided. Although obstacles are expected in diverse domains such as security, technical, legislative and regulatory, the utilization of non-fungible tokens as a security asset for patient data appears as potential solution.

Virtual reality used in undergraduate orthodontic education

INTRODUCTION

Undergraduate dental students frequently have reduced clinical experience which presents a challenge for their dental education. Previously, we developed a virtual reality (VR) simulating the whole clinical treatment process of a patient with angle Class II division 1 malocclusion, and the VR also helped to explain some important orthodontic concepts. As a novel teaching tool, this study aims to compare the effects of VR versus traditional case analysis by Power Point (PPT) in inspiring student learning motivation and evaluating learning experience.

MATERIALS AND METHODS

A randomized, cross-over, stratified sampling method was taken to divide the fourth-year undergraduate dental students equally into two groups. The two groups were crossed over to use VR and PPT.

RESULTS

For the whole study, results indicated that students in the VR group showed higher learning motivation (including attention, relevance, confidence and satisfaction) than in the PPT group, but the differences between VR and PPT groups were not very big, and the median of the differences located at 0. For learning experience, students thought VR to be more useful, more enjoyable and more engaging, but the median of differences also located at 0. Notably, the majority of students had higher recommendations for VR than PPT, and the median difference located at 1. However, when the two phases were analysed separately, some items showed no significant differences between VR and PPT learning.

CONCLUSION

VR is a very useful adjunct to education compared to traditional case analysis by PPT, but we cannot exaggerate its benefits. Educators should make good use of VR to solve the difficult problems in education.

Design and evaluation of blended teaching in the smart classroom combined with virtual simulation training in basic nursing courses

OBJECTIVE

This study explored the application effect of smart classrooms combined with virtual simulation training in basic nursing courses for nursing undergraduates.

METHODS

In this quasi-experimental study, a total of 135 undergraduate nursing students in the 2021 matriculating cohort were selected as the research subjects. The experimental group of Class 1 had 71 students, and a blended teaching design utilizing a smart classroom and virtual simulation training was adopted. The control group of Class 2 had 64 students, and traditional lecture-based teaching design was adopted. After the course, the independent learning ability scale, test scores and teaching effectiveness questionnaire were used to evaluate the teaching effect. All tests had a maximum score of 100.

RESULTS

Nursing undergraduates in the experimental group had scores of 86.32 ± 8.25 for virtual simulation training and 84.82 ± 9.04 for peer-assisted learning. The scores of the theoretical examination, experimental examination, and subjective questions in the experimental group were significantly higher than those in the control group (P < 0.05). The approval rate of nursing undergraduates in the experimental group was significantly higher than that of the control group for four items (Ps < 0.05). Among the 71 students, most students (91.55%) claimed that the use of instructional designs increased the fun of the classroom. In addition to the dimension of information literacy, the total score of independent learning ability and the other three dimensions of the experimental group were significantly higher than those of the control group (P < 0.05).

CONCLUSION

The teaching design combining smart classrooms and virtual simulation training can be applied to realize online blended teaching and classroom informatization, improving the academic performance and independent learning ability of nursing undergraduates, and thus achieving good teaching effects.

Virtual reality simulation-enhanced blood transfusion education for undergraduate nursing students: A randomised controlled trial

BACKGROUND

Nurse-administered blood transfusion (BT) is a common form of medical treatment, but nursing students are often excluded from participating in and observing BTs during clinical placements. To address clinical placement limitations, nursing educators have increasingly adopted technology-guided simulation pedagogies, including virtual reality (VR) simulation, for nursing students' clinical skills education.

OBJECTIVES

To develop VR simulation for BT practice and investigate its effectiveness with nursing students.

DESIGN

A single-blinded, two-arm randomised controlled trial.

SETTINGS

One university in Hong Kong.

PARTICIPANTS

A total of 151 nursing students enrolled in a nursing undergraduate course at a university in Hong Kong were recruited via convenience sampling in March 2022.

METHODS

Evidence-based VR simulation videos consisting of 1) animated blood formation physiology and side effects of BT and 2) 360° BT nursing practice were developed. The nursing students were randomly allocated into intervention and control groups. The intervention group (n = 75) received the usual BT education (i.e. Zoom lecture) with the developed VR video education, whereas the control group (n = 76) received the usual BT education (Zoom). The BT knowledge (RBTKQ-O), student satisfaction and self-confidence (SSSC) and self-efficacy (GSES) of BT practice were measured before and after BT education. Intention-to-treat analyses were performed.

RESULTS

The primary and secondary outcomes (RBTKQ-O, SSCS and GSES, respectively) improved over time in both groups. Analysis of covariance revealed that students who received VR simulation reported higher post-intervention measurement scores in BT knowledge and SSCS than those who did not receive VR simulation.

CONCLUSIONS

VR simulation-enhanced BT education effectively enhances the knowledge and SSCS of BT practice amongst nursing students. Nurse educators may adopt VR simulation to enhance the effectiveness of existing BT education for nursing students.

Research Trends and Hot Topics on Virtual Reality in Nursing: A Bibliometric Analysis Using CiteSpace

This bibliometric analysis was conducted to provide a comprehensive overview of the development of virtual reality in nursing, and to identify the research trends and hot topics in this field. Data were collected from the Web of Science Core Collection database in May and June 2022, and analyses were performed using CiteSpace 6.1.R2. A total of 885 studies on virtual reality were included in the bibliometric analysis; 3570 authors from 1283 institutions and 60 countries contributed, and the studies were published in 356 different journals. It will be important for researchers and health professionals to determine the research trends, current issues, and research gaps on virtual reality in nursing.

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.

Virtual reality: a technology to promote active learning of physiology for students across multiple disciplines

The usefulness of virtual reality (VR) technology in physiology education is largely unexplored. Although VR has the potential to enrich learning experience by enhancing the spatial awareness of students, it is unclear whether VR contributes to active learning of physiology. In the present study, we used a mixed-method research approach to investigate students' perceptions of physiology learning based on VR simulations. Quantitative and qualitative data indicate that the implementation of VR learning environments improves the quality of physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. In the Technology-Enabled Active Learning Inventory, which consisted of 20 questions to which students responded along a 7-point Likert scale, the majority of students agreed that VR learning of physiology not only stimulated their curiosity (77%; P < 0.001) but also allowed them to obtain knowledge through diverse formats (76%; P < 0.001), participate in thought-provoking dialogue (72%; P < 0.001), and interact better with peers (72%; P < 0.001). Positive responses in the social, cognitive, behavioral, and evaluative domains of active learning were received from students across different disciplines, including medicine, Chinese medicine, biomedical sciences, and biomedical engineering. Their written feedback showed that VR enhanced their interest in physiology and facilitated the visualization of physiological processes to improve their learning. Overall, this study supports that the integration of VR technology into physiology courses can be an effective teaching strategy.NEW & NOTEWORTHY Virtual reality (VR) improves physiology education by promoting active learning in terms of interactive engagement, interest, problem-solving skills, and feedback. Positive responses toward multiple components of active learning were received from students across different disciplines. The majority of students agreed that VR learning of physiology not only stimulated their curiosity but also allowed them to obtain knowledge through diverse formats, participate in thought-provoking dialogue, and interact better with peers.

Design and Evaluation of Using Head-Mounted Virtual Reality for Learning Clinical Procedures: Mixed Methods Study

BACKGROUND

The capacity of health care professionals to perform clinical procedures safely and competently is crucial as it will directly impact patients' outcomes. Given the ability of head-mounted virtual reality to simulate the authentic clinical environment, this platform should be suitable for nurses to refine their clinical skills for knowledge and skills acquisition. However, research on head-mounted virtual reality in learning clinical procedures is limited.

OBJECTIVE

The objectives of this study were (1) to describe the design of a head-mounted virtual reality system and evaluate it for education on clinical procedures for nursing students and (2) to explore the experience of nursing students using head-mounted virtual reality for learning clinical procedures and the usability of the system.

METHODS

This usability study used a mixed method approach. The stages included developing 3D models of the necessary instruments and materials used in intravenous therapy and subcutaneous injection procedures performed by nurses, followed by developing the procedures using the Unreal Engine (Epic Games). Questionnaires on the perception of continuance intention and the System Usability Scale were used along with open-ended questions.

RESULTS

Twenty-nine nursing students took part in this questionnaire study after experiencing the immersive virtual reality (IVR) intervention. Participants reported largely favorable game perception and learning experience. Mean perception scores ranged from 3.21 to 4.38 of a maximum score of 5, while the mean system usability score was 53.53 of 100. The majority found that the IVR experience was engaging, and they were immersed in the game. The challenges encountered included unfamiliarity with the new learning format; technological constraints, such as using hand controllers; and physical discomfort.

CONCLUSIONS

The conception of IVR for learning clinical procedures through deliberate practice to enhance nurses' knowledge and skills is promising. However, refinement of the prototypes is required to improve user experience and learning. Future research can explore other ways to use IVR for better education and health care purposes.

Exploring factors that influence the behavioural intention of medical students to use 3D gastroscopic model to learn how to operate gastroscope using UTAUT Model

BACKGROUND

The application of virtual reality (VR) in gastroscopic operation teaching can be safe and effective, but the advantages can be realized only when students accept and use it. This study aims to identify the factors influencing Chinese clinical medical postgraduates on their intention to use the 3D gastroscopic model constructed based on VR technology using Unified Theory of Acceptance and Use of Technology (UTAUT) model. Students' demographic factors are also taken into consideration.

METHODS

All methods were carried out in accordance with relevant guidelines. Data were collected from clinical medical postgraduates students in China using stratified sampling. A total of 292 questionnaires including valid responses were used in this study. Data were processed using Amos 24.0 and SPSS 26.0 software and the statistical analysis technique was based on structural equation modeling (SEM).

RESULTS

The results showed that different from the mediator of home location and year of clinical learning, mediator of gender, university kind and graduate degree did not affect the behavioral intention. In addition, performance expectancy, facilitating condition, and social influence directly and indirectly have effect on behavioral intention. Also, the significance between social influence and performance expectancy, social influence and effort expectancy were verified.

CONCLUSIONS

This study manifested that the proposed framework based on the UTAUT had explanatory power to identify the factors influencing the students' behavioral intention to use the 3D gastroscopic model constructed based on VR technology. Whereas, an important variable of effort expectancy in the frame of the SEM were not certified, thereby indicating that particular attention should be paid to this variable by universities and teachers before applying 3D gastroscopic model constructed based on VR technology in teaching. Added preparatory work is required such as explaining the basic knowledge of the operating steps of VR model and make students adequately understand its accessibility, which can probably improve the intentions of them to use it. The positive effects of social influence on performance expectancy and effort expectancy we proposed was also verified in this study, which provided a direction for future research.