N
Approximately 95% of students actively participated in the VR scenarios. Approximately 3–5% of students were not able to participate due to incompatible phones and therefore were transferred to the traditional simulation control group. Approximately 15% of students in the traditional simulation control group actively participated in the simulation scenarios with 85% observers, which is standard practice at the participating institute.
Pre-intervention there was nothing to suggest any systematic difference between the knowledge test results of the control group and of the intervention group. For the post-test (survey 2), 15 out of 17 t -tests returned positive results at the level of p < 0.001, suggesting that the intervention group performed better than the control group in the knowledge test (Table 3 ).
Knowledge Test, Questions Q1 – Q10 responses pooled to give Total Score/10. Descriptive statistics (columns 4–7; N, Mean, StdDev and 95% Confidence Interval) for Control and Intervention Groups
Selection Property | Group | Descriptive Statistics | t-test for Equality of Means | ||||||
---|---|---|---|---|---|---|---|---|---|
N | Mean | Std. Dev. | 95% C.I. | t | df | Sig. | |||
All Cases | Control (Sim) | 734 | 5.75 | 2.15 | 0.159 | -1.4 | 1598.4 | 0.169 | |
Intervention (VR) | 1115 | 5.89 | 2.21 | 0.132 | |||||
Module 1 | Control (Sim) | 157 | 7.85 | 1.49 | 0.238 | -1.8 | 279.8 | 0.080 | |
Intervention (VR) | 267 | 8.10 | 1.23 | 0.150 | |||||
Module 2 | Control (Sim) | 232 | 5.21 | 1.48 | 0.194 | -0.9 | 527.7 | 0.361 | |
Intervention (VR) | 327 | 5.33 | 1.65 | 0.182 | |||||
Module 3 | Control (Sim) | 245 | 4.36 | 1.87 | 0.240 | 0.9 | 484.9 | 0.382 | |
Intervention (VR) | 364 | 4.23 | 1.68 | 0.176 | |||||
Module 4 | Control (Sim) | 100 | 7.09 | 1.62 | 0.324 | -0.2 | 219.3 | 0.813 | |
Intervention (VR) | 157 | 7.14 | 1.71 | 0.273 | |||||
All Cases | Control (Sim) | 511 | 6.09 | 2.24 | 0.20 | -9.1 | 928.7 | < 0.001** | |
Intervention (VR) | 810 | 7.16 | 1.84 | 0.13 | |||||
Module 1 | Control (Sim) | 129 | 7.73 | 1.60 | 0.28 | -4.3 | 194.8 | < 0.001** | |
Intervention (VR) | 223 | 8.41 | 1.07 | 0.14 | |||||
Module 2 | Control (Sim) | 129 | 5.68 | 1.78 | 0.31 | -6.7 | 235.8 | < 0.001** | |
Intervention (VR) | 217 | 6.93 | 1.51 | 0.21 | |||||
Module 3 | Control (Sim) | 183 | 4.92 | 2.14 | 0.32 | -3.9 | 346.2 | < 0.001** | |
Intervention (VR) | 239 | 5.69 | 1.75 | 0.23 | |||||
Module 4 | Control (Sim) | 70 | 6.84 | 2.21 | 0.53 | -4.4 | 99.3 | < 0.001** | |
Intervention (VR) | 131 | 8.13 | 1.40 | 0.24 | |||||
All Cases | Control (Sim) | 270 | 5.88 | 2.68 | 0.33 | -0.6 | 570.9 | 0.541 | |
Intervention (VR) | 442 | 6.00 | 2.69 | 0.26 | |||||
Module 1 | Control (Sim) | 75 | 8.24 | 1.00 | 0.23 | -1.3 | 155.7 | 0.188 | |
Intervention (VR) | 120 | 8.43 | 0.99 | 0.18 | |||||
Module 2 | Control (Sim) | 72 | 5.94 | 1.91 | 0.45 | -1.1 | 136.0 | 0.257 | |
Intervention (VR) | 121 | 6.26 | 1.71 | 0.31 | |||||
Module 3 | Control (Sim) | 75 | 2.55 | 1.31 | 0.30 | 0.4 | 135.8 | 0.710 | |
Intervention (VR) | 121 | 2.48 | 1.09 | 0.20 | |||||
Module 4 | Control (Sim) | 48 | 7.29 | 1.61 | 0.46 | -0.1 | 104.2 | 0.945 | |
Intervention (VR) | 80 | 7.31 | 1.72 | 0.38 |
In survey 3, there was no significant difference between the knowledge test results of the control group and of the intervention group. The results indicate that any difference in knowledge was not maintained post clinical placement.
The results show immediately post intervention, the intervention group’s ratings for self-perceived knowledge, motivation and preparedness for clinical placement were more positive than the control group at the p < 0.01 level (Table 4 ). The differences between the control and interventions groups were not maintained post clinical placement.
Students’ self-perceived knowledge, motivation and preparedness for clinical placement or clinical practice. Descriptive statistics and Independent Samples t-test (All Cohorts. All Modules pooled. Surveys 2 and 3)
Survey 2 Question | Group | Descriptive Statistics | t-test for Equality of Means | |||||
---|---|---|---|---|---|---|---|---|
N | Mean | Std. Dev. | 95% C.I. | t | df | Sig. | ||
KNOWLEDGE | Control (Sim) | 493 | 4.57 | 1.495 | 0.134 | -9.99 | 903.3 | < 0.001** |
Intervention (VR) | 786 | 5.37 | 1.240 | 0.088 | ||||
MOTIVATION | Control (Sim) | 493 | 5.73 | 1.134 | 0.102 | -6.04 | 968.0 | < 0.001** |
Intervention (VR) | 786 | 6.11 | 1.027 | 0.074 | ||||
PREPAREDNESS (for clinical placement) | Control (Sim) | 493 | 5.03 | 1.163 | 0.104 | -6.57 | 1018.1 | < 0.001** |
Intervention (VR) | 786 | 5.46 | 1.124 | 0.080 | ||||
| ||||||||
KNOWLEDGE | Control (Sim) | 268 | 5.10 | 1.097 | 0.134 | -0.45 | 515.35 | 0.653 |
Intervention (VR) | 439 | 5.14 | 0.978 | 0.094 | ||||
MOTIVATION | Control (Sim) | 268 | 6.00 | 1.067 | 0.130 | 0.532 | 543.143 | 0.595 |
Intervention (VR) | 440 | 5.96 | 1.017 | 0.096 | ||||
PREPAREDNESS (for clinical practice) | Control (Sim) | 245 | 5.28 | 1.161 | 0.148 | 0.48 | 464.156 | 0.632 |
Intervention (VR) | 401 | 5.23 | 1.017 | 0.102 |
Immediately post intervention, the intervention group’s self-efficacy in learning was more positive than the control group’s for modules 3 and 4 and the p < 0.01 level. However, differences between the intervention and control groups were not maintained post clinical placement (Table 5 ).
Self-efficacy in learning, pooled responses to give Total Score/100, results resolved according to module number (1–4). Descriptive statistics (columns 4–7; N, Mean, StdDev and 95% Confidence Interval) for All Cohorts (i.e., both BN Cohorts and DN Cohorts), for Control and Intervention Groups. Independent Samples t-test comparing the mean values for the Control and Intervention groups. ** indicates significance at the p < 0.01 level
Selection Property | Group | Descriptive Statistics | t-test for Equality of Means | ||||||
---|---|---|---|---|---|---|---|---|---|
N | Mean | Std. Dev. | 95% C.I. | t | df | Sig. | |||
Module 1 | Control (Sim) | 121 | 81.00 | 10.05 | 1.83 | -1.3 | 260.2 | 0.183 | |
Intervention (VR) | 217 | 82.56 | 10.63 | 1.44 | |||||
Module 2 | Control (Sim) | 130 | 78.78 | 10.57 | 1.85 | -0.6 | 309.3 | 0.545 | |
Intervention (VR) | 217 | 79.55 | 12.65 | 1.72 | |||||
Module 3 | Control (Sim) | 182 | 70.04 | 14.96 | 2.22 | -6.4 | 352.3 | < 0.001** | |
Intervention (VR) | 238 | 78.91 | 12.63 | 1.64 | |||||
Module 4 | Control (Sim) | 71 | 76.08 | 14.00 | 3.32 | -4.1 | 117.1 | < 0.001** | |
Intervention (VR) | 131 | 83.97 | 10.94 | 1.91 | |||||
Module 1 | Control (Sim) | 75 | 81.29 | 9.77 | 2.26 | -0.2 | 166.3 | 0.821 | |
Intervention (VR) | 120 | 81.63 | 10.55 | 1.93 | |||||
Module 2 | Control (Sim) | 72 | 76.00 | 12.27 | 2.89 | 0.3 | 160.6 | 0.787 | |
Intervention (VR) | 121 | 75.48 | 13.48 | 2.45 | |||||
Module 3 | Control (Sim) | 73 | 72.05 | 14.89 | 3.49 | -1.1 | 137.3 | 0.256 | |
Intervention (VR) | 121 | 74.46 | 13.14 | 2.39 | |||||
Module 4 | Control (Sim) | 48 | 75.00 | 12.09 | 3.49 | -1.1 | 100.3 | 0.289 | |
Intervention (VR) | 78 | 77.37 | 12.20 | 2.76 |
OSCE data was obtained for 478 students (control n = 177, intervention n = 301). The Pearson Chi-Square test (c 2 = 0.267, df = 2, p = 0.875) indicated there was no statistically significant difference between the control and intervention groups.
For Modules 1 and 2 there was no significant difference between the Mean OSCE score (as a %) for the control and intervention groups. However, for Module 3 the Mean OSCE score for the intervention group was significantly greater than that for the control group, at the p < 0.01 level. When all three Modules were pooled together, while the OSCE score was greater for the intervention group than for the control group, the difference was not significant at the p < 0.05 level (Table 6 ).
Mean OSCE Score (as %, StdDev and 95% Confidence Interval) for all cases (n = 478), for Control and Intervention Groups
Module Number | Group | Descriptive Statistics | t-test for Equality of Means | |||||
---|---|---|---|---|---|---|---|---|
N | Mean Score % | Std. Dev. | 95% C.I. | t | df | Sig. | ||
Control (Sim) | 30 | 79.8 | 16.6 | 6.06 | 0.726 | 43.3 | 0.472 | |
Intervention (VR) | 51 | 77.3 | 10.7 | 2.98 | ||||
Control (Sim) | 99 | 70.0 | 11.1 | 2.23 | − 0.790 | 241.9 | 0.431 | |
Intervention (VR) | 162 | 71.3 | 14.0 | 2.19 | ||||
Control (Sim) | 48 | 49.1 | 17.7 | 5.10 | -3.606 | 94.3 | 0.000** | |
Intervention (VR) | 88 | 60.4 | 17.2 | 3.66 | ||||
Control (Sim) | 177 | 66.0 | 17.8 | 2.67 | -1.931 | 332.3 | 0.054 | |
Intervention (VR) | 301 | 69.1 | 15.7 | 1.80 |
All t -tests comparing mean values for the control and intervention groups for views on the modules returned positive results at the level of p < 0.01, with three of them at the level of p < 0.001 (Table 7 ).
Views about the module, responses pooled to give Total Score/50, (cohorts 1–6 -no data cohort 7)
Selection Property | Group | Descriptive Statistics | t-test for Equality of Means | ||||||
---|---|---|---|---|---|---|---|---|---|
N | Mean | Std. Dev. | 95% C.I. | t | df | Sig. | |||
All Cases | Control (Sim) | 382 | 40.37 | 6.59 | 0.67 | -8.9 | 665.4 | < 0.001** | |
Intervention (VR) | 791 | 43.88 | 5.71 | 0.41 | |||||
Module 1 | Control (Sim) | 77 | 41.34 | 6.41 | 1.46 | -2.8 | 125.6 | 0.005** | |
Intervention (VR) | 218 | 43.72 | 5.98 | 0.81 | |||||
Module 2 | Control (Sim) | 125 | 41.32 | 5.22 | 0.93 | -3.9 | 272.0 | < 0.001** | |
Intervention (VR) | 205 | 43.67 | 5.48 | 0.77 | |||||
Module 3 | Control (Sim) | 127 | 39.65 | 6.89 | 1.22 | -5.1 | 222.8 | < 0.001** | |
Intervention (VR) | 237 | 43.35 | 5.80 | 0.75 | |||||
Module 4 | Control (Sim) | 53 | 38.42 | 8.32 | 2.28 | -5.7 | 69.1 | < 0.001** | |
Intervention (VR) | 131 | 45.44 | 5.21 | 0.91 |
Several common themes were identified across the 4 modules for intervention students’ responses on views about the learning experience with Jasper VR (Table 8 ). Students reported that they found the VRS scenarios realistic. They valued the ability to be able to practise the various scenarios multiple times to embed their learning and highlighted the importance of being able to make mistakes without fear of impacting care. The VRS scenarios were perceived to be less stressful and intimidating than the usual simulation environment. The value of developing critical thinking from the VRS scenarios was highlighted and the development of the necessary knowledge and skills to be able to manage similar situations.
Qualitative data for intervention students’ views on Jasper VR .
Module | Theme | |
---|---|---|
Realism |
| |
Rehearsal, ability to make mistakes |
| |
Reduced stress and increased confidence compared to a normal SIM |
| |
Ability to practise the modules multiple times | ||
Development of critical thinking |
| |
Technical: VR headset |
| |
Scenario: Lack of interaction |
| |
Scenario: Development of clinical reasoning |
| |
Scenario: Revision of information presented | ||
Additional scenarios required in different settings |
|
While student responses were mostly positive and enthusiastic about the VR scenarios, they did express some reservations. Occasionally the VR headsets were reported to be uncomfortable to wear. Whilst some students found the VRS scenarios less intimidating than a normal simulation, a small number of students described their desire to be more physically involved, rather than watching and choosing options. A small number of students also reflected that their clinical reasoning skills would have benefitted from there being more than one correct choice of response, learning diverse ways to manage situations, or having multiple scenarios for each module. Further detail on students’ views on what they enjoyed the most and least for each module are detailed in appendix 1 .
The mean scores of the pooled usability scale are very complimentary of the usability of the system, particularly its ‘ease of use’ (Q3) and its property of being ‘easy to learn quickly’ (Q7) (Table 9 ).
System Usability Scale responses. Descriptive statistics (N, mean value, standard deviation and 95% confidence interval) for the pooled cohort (N = 306, Cohorts 1,2,3,4,5 and 6 combined) responses
Question # | Question Text | Cohort | N | Mean | Std. Dev. | 95% C.I. |
---|---|---|---|---|---|---|
Q1 | I think that I would like to use this system frequently | All | 305 | 4.06 | 0.97 | 0.11 |
Q2 | I found the system unnecessarily complex | All | 306 | 2.11 | 1.19 | 0.14 |
Q3 | I thought the system was easy to use | All | 306 | 4.22 | 0.92 | 0.10 |
Q4 | I think that I would need the support of a technical person to be able to use this system | All | 306 | 2.12 | 1.25 | 0.14 |
Q5 | I found the various functions in this system were well integrated | All | 305 | 3.95 | 0.93 | 0.11 |
Q6 | I thought there was too much inconsistency in this system | All | 306 | 2.02 | 1.06 | 0.12 |
Q7 | I would imagine that most people would learn to use this system very quickly | All | 305 | 4.19 | 0.87 | 0.10 |
Q8 | I found the system very cumbersome to use | All | 300 | 2.53 | 1.25 | 0.14 |
Q9 | I felt very confident using the system | All | 306 | 4.29 | 0.82 | 0.09 |
Q10 | I needed to learn a lot of things before I could get going with this system | All | 306 | 2.27 | 1.28 | 0.15 |
These findings were supported by the qualitative data in the surveys. Intervention students appreciated the ability to re-visit the VR scenarios as often as they liked and in their own time:
I really enjoyed being part of Jasper VR and I felt it was a really nice way to learn the situation… best thing was I can rewatch it as many times as I want. This was a great way to complete a simulation under the circumstances and a great way to continue this in the future as we have the luxury of completing it as many times as we will.
Intervention students also found the VRS scenarios less intimidating than traditional simulation and liked the ability to be able to make mistakes and see the consequences of those choices:
I really enjoy doing VR. I find it interesting and less stressful than doing a simulation with your whole class watching you and in front of actors/actresses. I also like how you can see what would happen if you chose the wrong choice in the situation and that you can do the VR as much as you want.
Occasionally students reported difficulties with the VR headsets:
I like the way that we could revisit the SIM whenever we wanted to, but I found controlling the SIM with the headwear hard to manage.
Table 10 depicts the cost of developing and delivering the VR and SBE for both the Bachelor and Diploma of Nursing groups. The total cost of delivering a single module of Jasper VR each year was $3,350. The cost of delivering a single SBE scenario (not necessarily the same) in nursing for both courses each year was $18,670.
The cost of delivering the VR and SBE for the Bachelor and Diploma of Nursing groups
Jasper (costs per individual scenario) | Bachelor of Nursing | Diploma of Nursing | |||||||
---|---|---|---|---|---|---|---|---|---|
One-off work | Item | Hrs | Cost | Item | Hrs | Cost | Item | Hrs | Cost |
Script development and review | 160 | $8,000 | Script development | 20 | $1,000 | Script development | 20 | $1,000 | |
Rehearsals | 40 | $2,000 | Document review | 12 | $600 | Document review | 8 | $400 | |
Filming (1 day) crew | $3,000 | ||||||||
Filming (1 day) actors | 64 | $2,560 | |||||||
Filming (1 day) teachers | 10 | $500 | |||||||
Document update | 10 | $500 | |||||||
Software development | 160 | $8,000 | |||||||
Testing and QA | 160 | $8,000 | |||||||
Project development overhead | 60 | $3,000 | |||||||
Software license | $2,000 | Preparations | 23 | $1,150 | Preparations | 16 | $800 | ||
Admin preparation | 15 | $750 | Sim day – teachers | 48 | $2,400 | Sim day – teachers | 32 | $1,600 | |
Pre-brief students | 4 | $200 | Sim day – actors | 21 | $840 | Sim day – actors | 32 | $1,280 | |
Debrief students | 4 | $200 | Sim day – others (sim techs) | 10 | $500 | Sim day – others (sim techs) | 10 | $500 | |
Technical support | 4 | $200 | Additional remedial sim day (depending on group size | 102 | $5,100 | Additional remedial sim day (depending on group size | 190 | $4,500 | |
Our study demonstrated that VRS provided authentic and positive learning experiences for nursing students. Participants indicated that they found the VR scenarios realistic, immersive, and aided in the development of their clinical reasoning. Authenticity in VR scenarios is important for preparation for the reality of clinical practice [ 25 ]. Our outcomes also support the view that VRS can be successfully employed to teach explicit behavioural skills such as teamwork, and decision-making [ 25 , 26 ]. The VR scenarios catered for greater student numbers when compared to traditional simulation. All VRS students were fully immersed in the scenarios and able to take an active learning role the decision-making process. Jasper VR was found to be a sustainable and cost-effective alternative to SBE.
Overall, this study found VRS to effective for improving student knowledge and performance, which is supported by other studies on the effects of VRS in nursing education [ 8 , 14 – 16 , 27 ]. Several factors can increase the cognitive load in VR scenarios compared to SBE. VR learners may initially need to process a large amount of sensory information due to a highly immersive experience, engagement of multiple senses simultaneously (for example, vision and hearing), mastery of controllers to interact with the virtual environment, and understanding and navigating 3D space. Our findings also reinforce the effectiveness of immersive VRS for improved cognitive load in nursing education, and that VRS is an effective teaching tool [ 9 , 26 ].
VRS students’ OSCE scores for module 3, the patient with cognitive impairment, were significantly greater than for traditional simulation at the end of semester, although this difference was not maintained post clinical placement. For this scenario, students were particularly complimentary about the communication and collaborative skills amongst the interprofessional team and being able to practise skills such as recording the handover and assessing the patient. Active learning methods have previously been found to facilitate the development of logical reasoning [ 28 ] and reflective thinking [ 29 ]. The opportunity to perform similar skills in future VR scenarios may contribute to their further success. The significant differences in knowledge test scores between the VRS and traditional simulation groups immediately post intervention were not maintained. VR scenarios have the advantage of being available for users to access at any time point with easy repetition of scenarios, [ 30 ], and therefore VR students in may need to be reminded to re-visit these to further consolidate their learning and achieve proficiency.
Students appreciated the opportunity the VR scenarios provided to develop clinical competencies in authentic clinical experiences and see new perspectives, whilst maintaining their own safety and that of their patients [ 9 ]. VR simulations can offer a high level of realism and immersion compared to traditional SBE, with the learning process accelerated as students can experience scenarios that closely mimic real-life situations. The use of VRS in nursing education has been found to influence positive learning outcomes, such as stimulating interactivity and motivation amongst participants [ 25 , 31 , 32 ]. Sim et al. (2022) found that VRS enhances delivery of content related to patient care management (Sim et al., 2022). VR students valued access to the mastery mode to learn strategies like de-escalation techniques for dealing with an aggressive patient. Enabling VR students to practise skills through repetition, may allow them to master the skills more efficiently and achieve proficiency, versus SBE which has limitations in terms of repetition. VRS has been found to be particularly useful in situations such as dealing with aggressive patients as it protects the health professional’s safety and allows them to take a ‘trial and error’ approach to learning how to respond in these situations [ 33 ].
Whilst a small number of students highlighted a lack of interaction in the scenarios and being unable to practise the clinical skills in person, others reported the value of a fully immersive environment, such as being able to assess the deteriorating patient and recording the handover. Simulating the management of an acutely deteriorating patient has previously been successfully implemented in a nursing curriculum, with participants finding the simulation to be realistic and prepared them for clinical practice [ 34 ]. VR students also appreciated the opportunity for easy repetition of scenarios, experiencing the consequences of making wrong decisions, and the value of this for their learning. Through the VRS, nursing students could develop greater self-awareness and modify their reactions to a situation [ 33 ]. The importance of VRS for learning non-clinical skills by being able to ‘get it wrong to get it right’ was also highlighted in a study of undergraduate nursing students [ 25 ]. VR students found participating in the scenarios less intimidating than a normal simulation and appreciated the psychological safety involved in the learning [ 32 ]. This feedback echoed the findings of other VR studies that reported students using VR were less anxious than control groups when performing in the real world [ 35 , 36 ]. Students also appreciated the ability to make mistakes in the virtual environment without fear of consequences [ 32 ].
Whilst the VR scenarios provided immediate feedback to the students and allowed them to correct their mistakes in real time, some students commented that there was only one correct option in the scenarios. They felt it would be more beneficial if the scenarios allowed a greater range of choices for patient management to more reflect the real world. Another study involving a VR scenario depicting unnecessary patient demand for antibiotics from a general practitioner, also found some scepticism amongst participants that VR technology could reflect the diversity and complexity of patient responses [ 33 ]. A system of learning for health professionals that involves menu-based actions, may mean that the student does not develop critical clinical reasoning skills [ 37 ]. VR simulations can be customised to meet the needs of learners and to meet specific learning objectives, which should be considered when developing further VR scenarios.
Participants in this study were generally positive about the usability of the VR technology, which echoes the findings of other immersive VRS nursing studies [ 11 , 38 ]. Usability in terms of ease of use and users’ level of satisfaction are important characteristics of learning using virtual reality [ 7 ].
When considering the economic viability of VRS, the cost effectiveness of VR versus SBE can vary depending on several factors, including initial investment, maintenance, scalability, and accessibility. A previous study found the cost-utility ratio of virtual simulation (US$1.08) to be lower compared to mannequin-based simulation (US$3.62) [ 39 ]. In this study, the VR required significant upfront costs for software, hardware and development and was therefore more costly to develop when compared to standard SBE. This concurs with the findings of Liaw et al. (2018) who found that funding was important for the development and evaluation of virtual worlds in nursing education, due to the high outlay costs during design and development phases [ 40 ]. The VR simulations may also require ongoing software updates and maintenance costs, whilst the SBE may require periodic equipment replacement. However, our economic evaluation found the long-term delivery costs of VR to be significantly reduced due to less on campus teaching time and more independent learning for students. As reported by Pottle (2019) the costs of simulation are difficult to define, vary widely between institutions and are frequently under-reported [ 41 ]. Therefore, further studies are required which evaluate the cost effectiveness of VR compared to SBE for nursing students [ 30 ]. Our study found VR simulations required more time initially for learners to become comfortable with the technology and to set up the VR equipment, when compared to SBE. However, the virtual simulations are more scalable, allowing a larger number of students to be served simultaneously and to be used in further studies. VR simulations can be accessed remotely, offering flexibility for students, and making them more convenient for students who may not have easy access to physical simulation labs. This can save time and eliminate the need for travel, compared to SBE which usually requires students to be physically present in a specific location. As a result of COVID-19 in 2020, all learning with Jasper VR moved to remote delivery. This resulted in an even further reduction in the hours associated with briefing and debriefing.
This study focused on undergraduate students and therefore further research is required to explore its application across the healthcare professional continuum. Some students felt their clinical judgement would benefit from having additional options rather than only one correct way of doing things. In future research, students could be given the opportunity to be included in the development of scenarios to gain their perspectives. There should be repeated exposure to similar situations to gain confidence in appropriately responding in real life. Future work could focus on students’ comments related to limited opportunities for hands on work in the VR scenarios, reduced patient interactions, and how these findings translate in the clinical setting. Due to the COVID-19 global pandemic in 2020, the implementation of control groups and cross over groups was not able to be achieved and all students were allocated into intervention groups to receive the Jasper VR learning experience. This was due to all simulations being cancelled in Semester 1, 2020. Furthermore, it was not possible to implement any Survey 3s and clinical assessments in 2020 due to the overwhelming number of cancellations of clinical placements and clinical assessments for students. This resulted in many more students in the intervention group than the control group.
Through a collaborative content and software development process, a sophisticated, scalable, highly usable, and authentic learning experience was created for pre-licensure nursing students. Jasper VR enabled increased numbers of students to actively participate in an immersive simulated learning environment at their own pace, in their own time and venue. Jasper VR fostered critical thinking and decision making and provided an efficient, cost effective and sustainable platform of learning for future nursing students. The VR simulations offered advantages in terms of immersive, repeatable, and feedback-rich experiences. Jasper VR provided an efficient, cost effective and sustainable platform for learning for future nursing students.
Below is the link to the electronic supplementary material.
The authors acknowledge: Swinburne University as a major collaborative partner, Karen Hall and Ronen Vansover for Project management, CurveTomorrow for software development, Ruth Callandar for VR implementation, teams of supporting clinicians that assisted in script writing of all scenarios, Michael Esler for statistical analysis, teaching staff of the Diploma and Bachelor of Nursing, and participating students.
LS drafted the manuscript. DK and LS were actively involved in the study. All authors read and approved the final manuscript.
This work was funded by a Victorian State Government Workforce Training Innovation Fund. The research was conducted independently from the funding body.
Declarations.
The study was conducted in accordance with the Declaration of Helsinki and ethical approval was obtained from Monash University Human Research Ethics Committee, Project ID: 19235.
Informed consent was obtained from all subjects involved in the study.
The authors declare no conflict of interest.
Not applicable.
The authors declare no competing interests.
Publisher’s Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Tuesday, 30 July, 2024
Having received funding from UCD College of Health and Agricultural Sciences (CHAS), the School of Nursing, Midwifery and Health Systems is delighted to announce that work is underway for development of a designated Simulation Suite and additional simulation facilities . This is a key project led by the School under our Simulation and Clinical Skills Strategy.
The fully equipped suite, with an integrated AV system, will allow for quality simulation activities, elevating our student's learning through realistic patient scenarios and real-time problem solving. Having this exposure in addition to placement learning will further bridge the gap between knowledge and practical skills. In addition to this, the School is installing a multipurpose simulation cave and briefing room. Using bespoke projection and lighting capabilities, students will be able to instantly change the surrounding environment - from a therapy room, to a care home, to an emergency department – allowing them to immerse themselves in a safe, realistic learning environment.
Simulation education involves a range of activities that improve the safety and effectiveness of healthcare delivery. Given the increased focus on improving quality care and patient safety, the sim suite will support the delivery of education and training to enhance curriculum and promote preparedness for clinical practice with a student centred simulation programme ensuring all undergraduate and postgraduate learners get the most out of their time with us.
Clinical Tutors Jennifer Sullivan and Michaela Schumann said of the project said of the project “We are very excited to see this project get off the ground. We feel confident that we speak for the entire nursing and midwifery team when we say the addition of a dedicated simulation suite will truly enhance the student journey .”
Building works and AV installation began in June and will be completed by 22nd August. Keep an eye on our Instagram ( (opens in a new window) @snmhs.official ) and X ( (opens in a new window) @ucdsnmhs ) channels for updates.
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3.6. The Future of Simulation in Nursing Education >Nursing science and art constitutes a highly significant and integral part of the health care system. Nurses and their training are fundamental elements of the effectiveness of the system; therefore, special attention is paid and must be paid.
Simulation. Simulation is frequently used teaching methodology in nursing education and staff development learning environments. Simulation is valued for its ability to provide realistic, context-rich experiential learning in a safe environment. From simulated patients, to low and high fidelity manikins, to virtual reality, each context ...
Nursing students may be familiar with types of simulation in nursing education, such as standardized patients, role playing, and low-fidelity mannequins. Yet, nursing education uses so many more types of simulation. ... Despite its low-fidelity, role-playing can benefit students, especially for changing attitudes or team training. 7 Virtual ...
To evaluate the effects of simulation-based training on nursing students' communication skill, self-efficacy and clinical competence in practice: Classroom: ... Choi et al. conducted a study on computer simulation education with nursing students (n = 131) using classroom-focused interactive communication. The education group was given the ...
Simulation education is needed to train a highly competent nursing workforce. In-person simulation requires many resources, such as faculty, space, and time, that can negatively affect its feasibility. These barriers have prompted educators to seek new technologies to provide experiential learning opportunities, such as virtual simulation (VS).
Research on SBL in nursing education is extensive; however, realist reviews have rarely been used in this research community. Accordingly, we consider a realist review to be a promising method to uncover the causal effects of SBL and address the call for more theory-driven research to promote the educational use of simulation in nursing education.
ABSTRACT Simulation has been used widely in the clinical training of health-care students and professionals. It is a valuable strategy for teaching, learning and evaluating clinical skills at different levels of nursing and midwifery education.
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When to Use Each Type of Simulation. When a nursing program wants to have an outcome-based more than a process-based curriculum, and wants to provide a more experiential learning environment, the simulation type will be chosen as noted above, guided by the particular SLOs for each course. For example, a low-fidelity simulation in a more ...
The integration of simulation-based learning in nursing education programs ensures that students are equipped with the necessary competencies to navigate the complexities of the healthcare environment and provide high-quality patient care upon entering the workforce. Discover the significance of simulation-based learning in nursing education.
The 2021 edition of the Annual Review of Nursing Research focused on simulation-based education. Watts, Hallmark, and Beroz (2021) contributed a chapter on professional development for simulation education and offer a framework for providing simulation content based on Benner's novice to expert theory as in the table below.
This article discusses the use of simulation in nurse education to improve patient safety. The current COVID-19 pandemic has had a significant effect on the delivery of nursing training in higher education and how workforce development programmes are delivered ( Health Education England (HEE), 2020 ). This has created a need to transform and ...
Scope and Purpose. Simulation Guidelines for Prelicensure Nursing Programs are meant to guide: Nursing Regulatory Bodies in evaluating the readiness of prelicensure nursing programs in using simulation as a substitute for traditional clinical experience. Nursing education programs in the establishment of evidence based simulation programs for ...
Helen Murphy , BS, RDMS, CHTS-TR. With a growing shortage of registered nurses, many are wary of accepting the added responsibility of training pre-licensure students in clinical sites. One way to prepare nursing students in a safe environment is with simulations. In this white paper, Elsevier Digital Product Educator, Helen Murphy, discusses ...
International Nursing Association for Clinical Simulation and Learning (INACSL) has released the Healthcare Simulation Standards of Best Practice. Society for Simulation in Healthcare (SSH) is an accreditation body for simulation programs. American College of Surgeons sets standards for simulation-based surgical education and training. They are ...
This is just another stepping stone to get to that real-person interaction.". Three Benefits of Clinical Simulation in Nursing School. Simulation labs are a critical component of your nursing education, allowing you to: Become confident dealing with high-pressure situations. Learn from your mistakes in a safe, supportive environment.
7 Tips for Nursing Students to Make the Most of Their Simulation Training Simulation in nursing education is one of the best ways to learn how to be a bedside nurse. Books and classes cannot teach you everything you need to know. Therefore, hands-on simulation experiences are vital, and taking simulations seriously will help you get the most ...
by Walsh University Online. May 22, 2023. Simulation in nursing education has become an increasingly valuable teaching tool. Not only do simulations allow students to problem-solve and apply clinical knowledge in a safe, low-stress environment, but simulated learning modules also allow students to practice what they've learned without needing ...
Simulation-based nursing education is an increasingly popular pedagogical approach. It provides students with opportunities to practice their clinical and decision-making skills through various real-life situational experiences. However, simulation approaches fall along a continuum ranging from low-fidelity to high-fidelity simulation.
These innovative technologies in nursing simulation labs enhance the learning experience by providing realistic patient scenarios, immersive virtual environments, and data-driven feedback. By incorporating innovative technologies, nursing education can better prepare students for real-world clinical practice.
www.abjournals.org. SIMULATION IN NURSING EDUCATION: IMPLICATIONS FOR NURSE. EDUCATORS AND NURSING PRACTICE. Mary Idowu Edward (Ph.D) and Lucy Chukwuka (P h.D) 1 Faculty of Nursing Science ...
5 Ways Simulation in Nursing Education Is Used To Prepare Tomorrow's Nurses. With emergence of the COVID-19 pandemic, simulation in nursing education has played a critical role in students' clinical education experiences since clinical placements in hospitals have been restricted or eliminated altogether.(1) However, even pre-pandemic, faculty and researchers recognized the value of ...
Kansas City Mayor Quinton Lucas recently inaugurated Western Governors University's (WGU) Clinical Learning and Simulation Center (commonly referred to as a nursing lab) in Kansas City, Missouri, by the Michael O. Leavitt School of Health (LSH), to provide high-quality, clinical nursing education to students from Missouri, Kansas, and Iowa. The facility is part of WGU's efforts to address ...
First Step: Establishing Effectiveness of Simulation in Teaching TeamSTEPPS. From August 2023 to January 2024, the project trained 220 Year 4 Nursing students and 299 Year 5 Medicine students in using the Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) framework through simulation. "We chose these 2 groups of ...
Background: The COVID-19 pandemic underscored the necessity for innovative educational methods in nursing. Our study takes a unique approach using a multidisciplinary simulation design, which offers a systematic and comprehensive strategy for developing virtual reality (VR) simulations in nursing education. Objective: The aim of this study is to develop VR simulation content for a pediatric ...
A representative sample of consenting students enrolled in the Bachelor and Diploma of Nursing courses at a Training and Further Education Institute between July 2019 and June 2020, participated in the study. Consenting students consisted of 7 cohorts (Table 1). Students were pre-allocated to tutorial groups (n = 5-6), which were randomly ...
Having received funding from UCD College of Health and Agricultural Sciences (CHAS), the School of Nursing, Midwifery and Health Systems is delighted to announce that work is underway for development of a designated Simulation Suite and additional simulation facilities.This is a key project led by the School under our Simulation and Clinical Skills Strategy.
Specifically, the funds will be used to double the number of pre-licensure nursing students in the program from 30 to 60 students per cohort (spring and fall); hire additional faculty and staff to support the increased student intake; upgrade simulation supplies and equipment to provide state-of-the-art training facilities; and enhance ...
Its nursing programs emphasize critical thinking, patient-centered care, and community health. Their high-tech simulation labs ensure the graduates are well-prepared for professional nursing practice.