“Design and evaluation of a 3D serious game for communication learning in nursing education”

Author: Cristina Yuri Nakata Hara and others ; 2021.


Background: Communication is essential for nursing practice; such competence is not intuitive and must be taught. Serious games in 3D virtual reality can support the nursing teaching-learning process; students connected to the virtual world can apply what they have learned in their professional practice.

Results: The participants considered Comunica-Enf suitable for nursing education because none of the heuristics reached more than 25% of high or urgent priority problems. The participants made suggestions that were analyzed and incorporated into the Comunica-Enf when possible.

Conclusions: Comunica-Enf is an educational technology that uses Oculus Rift® and a 3D virtual reality perspective as an innovative resource. It had its appearance and usability validated for nursing students, providing a safe and pleasant environment for communication competence.

“A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education”

Author: Rakshya Adhikari, Claire Kydonaki and others ; 2021.


Objective: A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses’ self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education.

Results: In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four over-arching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game.

Conclusions: IVR simulation show promise as an adjunct for nurse simulation and it appears to increase self-efficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.

“Collaborative virtual reality based advanced cardiac life support training simulator using virtual reality principles”

Author: Prabal Khanal , Akshay Vankipuram and others; 2014.


Objective: The major objective of the study is to describe, including the design, implementation, and evaluation of a novel approach of delivering ACLS training to care providers using the proposed virtual reality simulator that can overcome the challenges and drawbacks imposed by the traditional face-to-face training method.

Results: The difference in performance between control and persuasive groups was not statistically significant (P=.37 for PEA and P=.1 for VFib/VTach). However, the difference in performance between control and minimally persuasive groups was significant (P=.05 for PEA and P=.02 for VFib/VTach). The pre-post comparison of performances of the groups showed that control (P=.017 for PEA, P=.01 for VFib/VTach) and persuasive (P=.02 for PEA, P=.048 for VFib/VTach) groups improved their performances significantly, whereas minimally persuasive group did not (P=.45 for PEA, P=.46 for VFib/VTach). Results also suggest that the benefit of persuasiveness is constrained by the potentially interruptive nature of these features.

Conclusions: Our results indicate that the VR-based ACLS training with proper feedback components can provide a learning experience similar to face-to-face training, and therefore could serve as a more easily accessed supplementary training tool to the traditional ACLS training. Our findings also suggest that the degree of persuasive features in VR environments have to be designed considering the interruptive nature of the feedback elements.

“Exploring User Needs in the Development of a Virtual Reality-Based Advanced Life Support Training Platform: Exploratory Usability Study”

Author: Nathan Moore, Soojeong Yoo and others ; 2020.


Objective: This exploratory study aimed to determine the specific user needs of clinicians engaging with a new interactive VR ALS simulation (ALS-SimVR) application to inform the ongoing development of such training platforms.

Results: The ALS-SimVR training app was well received. Thematic analysis of the interviews revealed five main areas of user needs that can inform future design efforts for creating engaging VR training apps: affordances, agency, diverse input modalities, mental models, and advanced roles.

Conclusions: This study was conducted to identify the needs of clinicians engaging with ALS-SimVR. However, our findings revealed broader design considerations that will be crucial in guiding future work in this area. Although aligning the training scenarios with accepted teaching algorithms is important, our findings reveal that improving user experience and engagement requires careful attention to technology-specific issues such as input modalities.

“Comparing the Effects on Learning Outcomes of Tablet-Based and Virtual Reality-Based Serious Gaming Modules for Basic Life Support Training: Randomized Trial”

Author: Emin Aksoy ; 2019.


Objective: The aim of this study is to compare the effects on the knowledge level of participants after using a tablet-based serious game and a virtual reality (VR)-based serious game for Basic Life Support using a pretest/posttest method.

Results: Mean posttest results were significantly higher in both groups. The posttest results were significantly higher in the VR group in terms of pre- and posttest changes (P=.021; Student t test).

Conclusions: Past research studies have shown that serious gaming presents a favorable additional tool for medical education. The results indicate that both serious gaming modules are effective and that VR-based serious gaming is more efficient in terms of learning outcome than tablet-based gaming.

“An Immersive Multi-User Virtual Reality for Emergency Simulation Training: Usability Study”

Author: Dieter Lerner , Stefan Mohr and others ; 2020.


Objective: In the EPICSAVE (Enhanced Paramedic Vocational Training with Serious Games and Virtual Environments) project, a highly immersive room-scaled multi-user 3-dimensional VR simulation environment was developed. In this feasibility study, we wanted to gain initial insights into the training effectiveness and media use factors influencing learning and training in VR.

Results: The 18 participants rated the VR simulation training positive in terms of training effectiveness and quality of the training execution. A strong, significant correlation (r=.53, P=.01) between experiencing presence and assessing training effectiveness was observed. Perceived limitations in usability and a relatively high extraneous cognitive load reduced this positive effect.

Conclusions: The training within the virtual simulation environment was rated as an effective educational approach. Specific media use factors appear to modulate training effectiveness (ie, improvement through “experience of presence” or reduction through perceived limitations in usability). These factors should be specific targets in the further development of this VR simulation training.

“Serious games, a game changer in teaching neonatal resuscitation? A review”

Author: Simran K Ghoman, Siddhi D Patel and others ; 2020.


Objective: To review the current literature about serious games, and how these games might improve knowledge retention and skills in neonatal healthcare professionals.

Results: Twelve serious games were included in this review (four board games, five video games and three virtual reality games). Overall, knowledge improvement was reported for the RETAIN (Resuscitation training for healthcare professionals) board game (10% increase in knowledge retention) and The Neonatology Game (4.15 points higher test score compared with control). Serious games are increasingly incorporated into Nursing and Medical School Curriculums to reinforce theoretical and practical learning.

Conclusions: Serious games have the potential to improve healthcare professionals’ knowledge, skills and adherence to the resuscitation algorithm and could enhance access to SBE in resource-intensive and resource-limited areas. Future research should examine important clinical outcomes in newborn infants.

“Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation”

Author: Sean W Hauze and others. 2019


Nurses serve a valuable role in the healthcare industry. Nurses are trained with the skills and knowledge to thrive in a fast-paced, evolving environment. In order to meet the complex and diverse needs of patients, nurses must be able to assess and prioritize care to produce safe and high-quality outcomes. Simulation is an established method of educating nursing students and preparing nurses to respond appropriately to situations they are likely to encounter in practice. Traditional nursing simulation devices are prohibitively expensive for many nursing education institutions. The development of augmented, mixed, and virtual reality simulation delivery offers a new platform for simulation, known as immersive simulation

“Virtual Reality Simulation in Nontechnical Skills Training for Healthcare Professionals: A Systematic Review”

Author: Marie-Stéphanie Bracq, Estelle Michinov, Pierre Jannin ; Jun 2019.


This systematic review, conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, is aimed to review current research in virtual reality (VR) for healthcare training, specifically pertaining to nontechnical skills.

„Virtual reality as a teaching method for resuscitation training in undergraduate first year medical students: a randomized controlled trial”

Author: Malte Issleib and others. 2021


Objective: Compare conventional CPR training with virtual reality (VR) training.

Results: CPR training using VR is a feasible and effective training method. However, for teaching technical skills, a classic training is still superior to a VR training. On the other hand, considering the overall learning gain, VR training is superior to the classic training in most items in a comparative self-assessment.

Future BLS course formats, consider incorporating VR into classic CPR training or vice versa to take advantage of both teaching techniques. Virtual reality and classical teaching methods can and should complement each other to achieve the best results.

„Nurse-Physician Communication Team Training in Virtual Reality Versus Live Simulations: Randomized Controlled Trial on Team Communication and Teamwork Attitudes”

Author: Liaw SY and others ; April 2020.


Objective: This study aimed to evaluate a team training program using virtual reality vs conventional live simulations on medical and nursing students’ communication skill performances and teamwork attitudes.

Results:The team-based simulation assessment revealed no significant differences in the communication performance posttest scores (P=.29) between the virtual and simulation groups.

Conclusions: The research results did not show the inferiority of team training using virtual reality compared to live simulations (…) VR should replace costly human moderators in the future to achieve better scalability and durability of team training in interprofessional education.

The research results do not impose inferiority in training using virtual reality compared to live simulations. Virtual reality can improve scalability and durability of team training.

„The effectiveness of virtual reality in nursing education:
a meta-analysis”

Author: Feng-Qin Chen and others; September 2020.


Objective: The purpose of this study was to evaluate the effectiveness of VR in nursing education in the areas of knowledge, skills, satisfaction, confidence, and performance time. The analysis was conducted to identify studies that showed the effectiveness of VR in terms of knowledge, skills, satisfaction, self-confidence and uptime. The study selection and data extraction were made by two independent reviewers.

Conclusions: A total of 12 studies with 821 participants were selected for the final analysis. VR was more effective than the control conditions in improving knowledge, and there was no difference between VR and control conditions in terms of skill, satisfaction, confidence and execution time.

VR is more effective in improving the knowledge of training participants than classic simulation conditions and allows for similar effectiveness of teaching in terms of skills, satisfaction, self-confidence and time needed for training.

„Virtual Patient Simulations in Health Professions Education: Systematic Review and Meta-Analysis by the Digital Health Education Collaboration”

Author: A. Kononowicz and others. 2017


Objective: The goal of this study was to evaluate the effectiveness of virtual patients compared with traditional education, blended with traditional education, compared with other types of digital education, and design variants of virtual patients in health professions education. The outcomes of interest were knowledge, skills, attitudes, and satisfaction.

Conclusions: The evidence suggests that when compared with traditional education, virtual patients can more effectively improve skills, and at least as effectively improve knowledge. The skills that improved were clinical reasoning, procedural skills, and a mix of procedural and team skills.

Compared to traditional education, virtual patients can be more effective in raising skills and at least as effective in raising knowledge. Skills improved included clinical reasoning, procedural skills, and a combination of procedural and team skills.

“Using Game-Based Virtual Reality with Haptics for Skill Acquisition”

Author: Ann L. Butt and others.


Objective: The purpose of the study was to validate the usability and user response of a game-based VR system designed to train bladder catheterization skills.

Results: Subjects rated usability of the VR system favorably; they also rated practicing catheter insertion this way as highly engaging and enjoyable. Subjects using the VR system spent more time practicing and completed more procedures in 1 hour than students who practiced traditionally. Follow-up skill demonstration pass rates between groups were identical at 2 weeks.

Practicing nursing skills using game-based VR may be an effective way to promote mastery learning and retention.

“Classical approach to ALS algorithm teaching versus custom-designed ALS- serious game (SG) for first year nursing students”

Author: B. Wudarska and others: 2017 r. – page 111


Objective: To analyze the effectiveness of serious games in teaching first-year nursing students of the ALS algorithm.

Results: The 3-hour workshop turned out to be an effective tool for learning the algorithm. The SG teams were doing better, incl. in the diagnosis of cardiac arrest.

Serious games can be an effective tool for learning the ALS algorithm, positively influencing the diagnosis of cardiac arrest and defibrillation decisions.

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