Integration of Extended Reality and a High-Fidelity Simulator in Team-Based Simulations for Emergency Scenarios

Advancing nursing education through wearable electronic devices: A scoping review

AIM

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

BACKGROUND

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Smart glasses use experience of nursing graduate students: qualitative study

BACKGROUND

Immersive technologies such as smart glasses can benefit nursing training and clinical practice. In this paper, we explore the views of nursing graduate students about their experience with smart glasses.

METHODS

Nursing graduate students (n = 13) were recruited using purposeful sampling. First, a virtual reality intervention for hyperglycemia in nursing care was shown. This was an attempt to introduce people to the technology and start discussions about how it might be used in nursing care. After that, participants underwent online interviews. Thematic analysis was used to examine the data.

RESULTS

The study findings indicated that the use of smart glasses as an enjoyable learning experience and immersive games positively affects nursing students. In addition, it was determined that they had negative experiences such as costs, lack of infrastructure, and smart glass side effects.

CONCLUSIONS

Smart glasses indicate good usability and availability in nursing education and potential for use in hospital nursing practice.

Validity and reliability of positive attitudes toward and perceived importance of wearable display technology as an effective learning tool among nursing students

AIM

This study aims to verify the validity and reliability of two separate instruments used for measuring nursing students' positive attitudes toward and perceived importance of wearable display technology as an effective learning tool.

BACKGROUND

Healthcare professionals and undergraduates, including nursing students, use wearable display technologies, such as smart glasses and head-mounted displays, as learning tools. However, the validation of the instruments used to evaluate the perception of such use is insufficient.

DESIGN

This methodological study assessed an instrument used to measure nursing students' positive attitudes toward and perceived importance of wearable display technology.

METHODS

In total, 284 students from eight universities in six regions across South Korea participated in this study. The collected data were analyzed using SPSS/WIN 25.0 and Amos 22.0. The construct validity (exploratory factor analysis, confirmatory factor analysis and group comparison) and reliability (internal consistency) were analyzed.

RESULTS

Three factors and thirteen items related to positive attitudes toward wearable displays were extracted through exploratory factor analysis, with a cumulative explanatory power of 66.22%. One factor and six items were extracted, with an explanatory power of 74.61% for the perceived importance of the wearable display subscale. In the group comparison, differences in the positive attitudes toward and perceived importance of wearable display technology were observed according to the level of satisfaction with college life, level of satisfaction with the nursing major, whether the participants owned a wearable display and whether they would consider purchasing a wearable display. Each factor loading was adequate, according to the confirmatory factor analysis results. Cronbach's α for positive attitudes toward wearable displays was.79, while that for perceived importance of wearable displays was.93.

CONCLUSION

The developed instrument can be used to evaluate nursing students' positive attitudes toward and perceived importance of wearable display technology as an effective learning tool in the future. This study can serve as a basis for developing and applying wearable display technologies in nursing education.

The use of smart glasses in nursing education: A scoping review

AIM

The aim of this scoping review was to give an overview of the usability and feasibility of smart glasses in nursing education. In addition, this study will highlight nursing students' experiences of using smart glasses in learning situations.

BACKGROUND

Healthcare is becoming increasingly complex and technological and so is nursing education. Technology enhanced learning aims to enhance the teaching-learning process through use of technology, for example through smart glasses.

DESIGN AND METHODS

A literature review using a scoping review methodology was conducted. Qualitative content analysis was performed to analyse data. 14 references were included in the analysis. References were found using the databases PubMed, SCOPUS and ERIC.

RESULTS

The analysis resulted in three categories; (1) Situations in which smart glasses have been used in nursing education, (2) Learning experiences from using smart glasses in nursing education, and (3) User experiences from using smart glasses in nursing education. Smart glasses were used in different learning situations and were in general positively evaluated by nursing students. Although, drawbacks of using smart glasses were noted which could negatively effect student learning.

CONCLUSIONS

Smart glasses have been used in a variety of learning situations in nursing education and enabled new learning situations. Students found smart glasses beneficial for their learning and smart glasses motivated and engaged students in the learning situation. Although, this was both user- and situation dependent. Technical issues could cause students to lose focus and there is need for technical support to facilitate the learning curve. By learning from others' experiences unnecessary drawbacks can be avoided.

Effect of Mixed Reality on Delivery of Emergency Medical Care in a Simulated Environment: A Pilot Randomized Crossover Trial

Importance

Mixed-reality (MR) technology has the potential to enhance care delivery, but there remains a paucity of evidence for its efficacy and feasibility.

Objective

To assess the efficacy and feasibility of MR technology to enhance emergency care delivery in a simulated environment.

Design, Setting, and Participants

This pilot randomized crossover trial was conducted from September to November 2021 at a single center in a high-fidelity simulated environment with participants block randomized to standard care (SC) or MR-supported care (MR-SC) groups. Participants were 22 resident-grade physicians working in acute medical and surgical specialties prospectively recruited from a single UK Academic Health Sciences Centre. Data were analyzed from September to December 2022.

Intervention

Participants resuscitated a simulated patient who was acutely unwell, including undertaking invasive procedures. Participants completed 2 scenarios and were randomly assigned to SC or MR-SC for the first scenario prior to crossover. The HoloLens 2 MR device provided interactive holographic content and bidirectional audiovisual communication with senior physicians in the MR-SC group.

Main Outcomes and Measures

The primary outcome was error rate assessed via the Imperial College Error Capture (ICECAP) multidimensional error-capture tool. Secondary outcomes included teamwork (Observational Teamwork Assessment for Surgery [OTAS]; range, 0-6 and Teamwork Skills Assessment for Ward Care [T-SAW-C]; range, 1-5), scenario completion, stress and cognitive load (NASA Task Load Index [NASA-TLX; range 0-100]), and MR device user acceptability.

Results

A total of 22 physicians (15 males [68.2%]; median [range] age, 28 [25-34] years) were recruited. MR technology significantly reduced the mean (SD) number of errors per scenario compared with SC (5.16 [3.34] vs 8.30 [3.09] errors; P = .003), with substantial reductions in procedural (0.79 [0.75] vs 1.52 [1.20] errors; P = .02), technical (1.95 [1.40] vs 3.65 [2.03] errors; P = .01), and safety (0.37 [0.96] vs 0.96 [0.85] errors; P = .04) domains. MR resulted in significantly greater scenario completion rates vs SC (22 scenarios [100%] vs 14 scenarios [63.6%]; P = .003). It also led to significant improvements in the overall quality of teamwork and interactions vs SC as measured by mean (SD) OTAS (25.41 [6.30] vs 16.33 [5.49]; P < .001) and T-SAW-C (27.35 [6.89] vs 18.37 [6.09]; P < .001) scores. As reported via mean (range) NASA-TLX score, there were significant reductions for MR-SC vs SC in participant temporal demands (38 [20-50] vs 46 [30-70]; P = .03) and significant improvements in self-reported task performance (50 [30-60] vs 39 [10-70]; P = .01). Overall, 19 participants (86.4%) reported that they were more confident in making clinical decisions and undertaking clinical procedures with MR support.

Conclusions and Relevance

This study found that the use of MR technology reduced error, improved teamwork, and enhanced practitioner confidence when used to support the delivery of simulated emergency medical care.

Trial Registration

ClinicalTrials.gov Identifier: NCT05870137.

Seeing Yourself Through the Learner's Eyes: Incorporating Smart Glasses Into Objective Structured Teaching Exercises for Faculty Development

INTRODUCTION

Although physicians gain clinical knowledge in their specialty, it does not mean they receive adequate instruction to teach and provide feedback. Using smart glasses (SG) to provide educators with a first-person learner perspective has not been explored in faculty development such as Objective Structured Teaching Exercises (OSTEs).

METHODS

Integrated within a 6-session continuing medical education-bearing certificate course, this descriptive study involved one session where participants provided feedback to a standardized student in an OSTE. Participants were recorded by mounted wall cameras (MWCs) and SG. They received verbal feedback on their performance based on a self-designed assessment tool. Participants reviewed the recorded content and identified areas for improvement, completed a survey about their experience with SG, and wrote a narrative reflection.

RESULTS

Seventeen physicians at the assistant professor level participated in the session; data were analyzed on the 14 who had both MWC and SG recordings and who also completed the survey and reflection. All were comfortable with the standardized student wearing SG and indicated it did not affect communication. Eighty-five percent of the participants felt the SG provided additional feedback not available with the MWC, with majority noting additional feedback was related to eye contact, body language, voice inflection, and tone. Eighty-six percent see value in using SG for faculty development, and 79% felt that periodically using SG in their teaching would improve quality.

CONCLUSION

Use of SG during an OSTE on giving feedback was a nondistracting and positive experience. SG provided affective feedback otherwise not perceived from a standard MWC.

Smart glasses and telehealth services by professionals in isolated areas in Korea: Acceptability and concerns

BACKGROUND: Smart glass technology offers remote interaction between health professionals for telehealth, alleviating healthcare disparities in isolated areas. OBJECTIVE: To evaluate the professionals’ perceptions of smart glass technology as a tool for telehealth and distance learning. METHOD: This mixed-method study on health professionals in 10 different island areas in Korea involved participants experiencing a smart glass-based telehealth system using the scenario of clinical consultation with remote specialists. A group pre- and post-test design was used to examine the change in attitude and perceived importance among health professionals about using smart glasses in telehealth. RESULTS: Forty-seven participants completed both pre-and post-evaluation of smart glasses. A positive, statistically significant change in participants’ perceptions of smart glasses regarding their implications for telehealth and distance learning (p< 0.05) was found. Fifty-one health workers provided feedback on smart glasses, and a majority expressed their expectations of quality care with telehealth using advanced technology. The main concerns were patients’ privacy issues and inadequate technology for seamless application. CONCLUSION: The incorporation of smart glass technology offers great potential to enrich telehealth as well as distance learning for unskilled health professionals in isolated areas. Future studies are needed to increase efforts to secure a high level of acceptance for clinical consultation with remote specialists on this newly developed device.