Adoption of Augmented Reality into Nursing Education Programs in Intensive Care in Tertiary Academic Hospitals

doi:10.21203/rs.3.rs-3090839/v1

Background

The introduction of new technologies is transforming traditional educational approaches into ones that incorporate new technologies. The use of technology enhances learning by making it enjoyable and engaging, and this applies to all fields, including nursing education. While the potential of augmented reality (AR) and virtual reality (VR) technologies for remote clinical skills training has been recognized, research integrating AR into nursing education programs is limited. Therefore, the aim of this study was to develop and implement an educational program using AR and evaluate the satisfaction, usability, and acceptance of future nurses as actual users.

Objective

This study aims to utilize AR-based learning platforms to educate ICU nurses on device usage. The objective is to evaluate the effectiveness of this innovative approach and document the outcomes.

Methods

The AR learning platform utilized in this study was based on Kern's six-step approach, widely used in educational research when introducing new teaching methods. To identify existing issues, interviews were conducted with four nursing education experts, and their insights were incorporated into the development of the AR-based program. Two AR educational programs were developed and applied to actual users, followed by evaluations. The evaluation process consisted of interviews and surveys conducted with four developers and operators to ascertain the necessity of the AR learning program, as well as interviews and surveys conducted with program users.

Results

Overall, the evaluation of AR-based education was positive with participants indicating that AR could improve their actual clinical performance. AR is a technology suitable for self-directed or hands-on learning theory those who interested in experience and self-learning rated the program particularly well. Nurses were found to be receptive to education using new technology.

Conclusions

This study highlights the potential of using AR in nursing education as a successful alternative to traditional education in terms of self-directed learning and practical training. By strategically integrating AR into educational programs, trainees were able to gain valuable practical experience in a safe and controlled environment while maintaining control over their learning journey. The utilization of AR technology fostered active participation, learner-centered self-directed learning, and technological advancement, thereby enhancing the overall efficiency of medical education programs.

Augmented reality (AR)

Healthcare training

Nurse education

Technology-based education

Clinical skills training

Recently, conventional education has evolved into a new form with the introduction of new technologies[1]. The use of technology makes learning fun and interesting and applies to all areas, including nursing education[2]. During the COVID-19 pandemic and social distancing protocols, non-face-to-face education programs, such as online lectures or mobile apps, have increased in number and have been newly developed[3]. Using Metaverse is one of the trends in future education with great potential, especially in the medical area[4]. Metaverse includes concepts of augmented reality(AR) and virtual reality(VR), which is a 3D digital space mixed with the real and virtual worlds[5].

Clinical skills training requires hands-on practice and bedside training, but training numerous nurses requires physical and time constraints[6]. Metaverse is a computer-generated environment that allows users to interact with each other in real-time[7]. It has recently been explored as a new way of clinical skill training because it allows training remotely, and the trainee can self-learn through virtual guides without requiring supervision[8],[9].

One previous study evaluated the success of VR-based learning in tracheostomy care in an Intensive Care Units (ICUs) setting[10]. VR increased self-efficacy, including familiarity and confidence, and reduced anxiety about tracheostomy-related knowledge and skills compared to the control group[11]. However, previous research on VR was usually limited to a one-time study that evaluated the effectiveness of metaverse in clinical trial settings[12], and none of the studies was connected to subsequent steps, such as incorporating augmented reality into the route nursing curriculum[13]. Trainees need hands on practice or bedside training to become proficient in medical procedures[14]; however, this type of education requires human resources and is time intensive, which limits its ability to educate many trainees. Studies have shown that metaverse training can help healthcare providers develop critical skills and knowledge in a safe and controlled environment, leading to better patient outcomes[15].

In this study, our objective is to educate ICUs nurses on the proper use of important devices through the utilization of new technologies. To achieve this, we have established a task force team tasked with the replacement of certain conventional curricula with AR technology. Furthermore, we aim to develop and implement an AR-based learning platform and subsequently document the outcomes of our efforts.

Method – Overview

Figure 1 provides a schematic overview of the entire study process. The AR learning platform was launched step-by-step based on Kern’s six steps[16], which are widely used when introducing a new educational method in pedagogy. Kern’s six steps in curriculum development are widely used and well-validated. The steps are as follows:

Problem identification
Needs assessment
Goals and objectives
Educational strategies
Implementation
Evaluation

Previous research has demonstrated that AR-based learning is superior to the conventional method[17] Following Kern’s six steps approach, we translated nursing education to an AR-based learning platform.

We conducted interviews with four nursing education chiefs to identify the existing issue and selected a procedure for conversion into an augmented reality (AR) education format[18]. Subsequently, we developed an AR educational program consisting of two primary procedures and implemented and assessed its effectiveness. The evaluation process encompassed interviews and surveys administered to trainees, as well as feedback gathered from the four nursing education chiefs and two operators, each providing insights from their respective perspectives. We delineated the comprehensive steps undertaken in problem identification, program operation, and evaluation of a sustainable AR learning platform. The Institutional Review Board of Samsung Medical Center approves the study design (2021-12-112) and all Participants were provided written informed consent before their inclusion in the study.

Method - Stage 1. Problem Identification

In this stage, we aimed to identify the problem, and general needs assessment is conducted to understand the scope and nature of the problem. To identify the problem—including physical, time, and resource limitations—we have adopted two approaches. We derived perspectives by conducting interviews relevant nursing education chiefs and reviewing previous studies[19].

In order to gather relevant insights, we conducted interviews with four chiefs of nursing education. These interviews followed a semi-structured approach and were carried out with the informed consent of the participants. Voice recordings were obtained to ensure accuracy and capture the valuable information shared by the chiefs. Through these interviews, we were able to affirm the identification of the problem or issue at hand. Additionally, a general needs assessment was conducted to gain a comprehensive understanding of the scope and nature of the identified problem.

To further enhance our understanding, we also conducted a review of previous studies. This involved an examination of medical records and the administration of surveys to patients, healthcare providers, and other stakeholders who are relevant to the issue at hand. By conducting this assessment, we aimed to identify common issues and gather valuable insights from existing research and literature. This review of previous studies enabled us to broaden our perspective and ensure that our findings were well-informed and grounded in existing knowledge[20].

Method - Stage 2. Needs Assessment

To develop AR nurse education, we attempted to identify the need for related people, such as educators, operators, and program developers. We interviewed nurses in various jobs, such as content production nurses, educational program-operating nurses, and program development nurses in the nursing education team. The interview for this study was conducted in a semi-structured format, with one researcher and one participant. The mode of the interview, whether online or offline, was depended on the preference of the participant.

Method - Stage 3. Goals And Objectives

We set the Goals and objectives referencing with operators and education officials, including researchers. The priority was equipment with low accessibility (high-risk equipment), expensive equipment, and equipment that required repeated learning several times due to high difficulty levels. The number of people who needed actual training and the difficulty of education were comprehensively evaluated.

Method - Stage 4. Educational Strategies

Step 1. Choosing the Right Technology

The contents of nursing education are hands on practice and that self-directed learning is highly important. Therefore, in education using technology, it is necessary to be able to hands on the same medical device as the actual clinical environment, and nurses themselves should be able to receive education without restrictions on educators, time, and resources.

Step2. Educational Material Development

Based on self-directed learning and hands-on practice, we attempted to select the most appropriate Software and device among AR devices. To facilitate hands-on practice, the AR-based education program included 3D objects that could be manipulated in real-time by trainees. The development of the training materials was a complex process that required careful consideration of the specific needs of nurses. In addition, the program needed to support self-directed learning by providing video materials that could be used to supplement the AR content.

Step3. Preparation of Educational Environment

We attempted to prepare the educational tools necessary to conduct education using AR and implement a safe and appropriate environment.

Method - Stage 5. Implementation

.Intensive care nurses, facing a high demand for complicated medical devices, were invited to apply for voluntary participation in education. For each AR education session, advertisements were posted on the hospital’s internal internet network and interested parties were encouraged to register online for the programs on a voluntary basis.

Method - Stage 6. Evaluation

This study is conducted at an academic tertiary hospital in Seoul with more than 3,100 nurses and 2,000 inpatient beds. The annual number of ED admissions averaged 78,000. This study planed as mixed-methods study.

Training provided to nurses in intensive care. AR education was conducted in a space prepared for training outside the hospital. A survey was conducted targeting the trainees who participated in the education program to assess internal and external factors. Internal factors included preferences of the educators and their professional goals, while external factors encompassed the educators' need for assistance and the strengths and weaknesses of the AR program. We obtained approval from IRB for using retrospective study data and collecting prospective study data. Consent was obtained from all subjects who participated in the interview.

Outcome measure of Survey

We evaluated the user experience of the AR platform based on Self Directed Learning and hands-on practice theory. The acceptability and usability of the AR platform were evaluated using the System Usability Scale(SUS)[21] and Technology Acceptance Model(TAM)[22] survey questionnaires. The use of AR for medical device education among nurses was evaluated, with a focus on the appropriateness of educational content, usability of devices, and acceptance of technology. The training provided included instruction on how to use ventilators and address ECMO alarm. After completing the AR training, nurses were asked to complete an evaluation questionnaire. The anonymous questionnaire included participants’ personal information, work satisfaction, suitability, HMD experience of AR technology, occupation and position, internal/surgical classification, number of years of work, preferred learning device, head-mounted display device experience, augmented/virtual reality experience, and 50 questions. According to the questions, there were short answers, 5-point, 7-point, and optional types.

Outcome measure of Interview

The willingness of the questionnaire-responding nurses to be interviewed was also confirmed. Online and offline interviews were conducted with willing nurses. The interviews were semi-structured based on a previous study’s nursing education theory. Researchers and nurses conducted online and offline interviews, depending on the situation. Up to two additional questions were asked based on the interviewees’ answers.

Statistical analysis

All continuous variables were expressed as median [IQR] or mean ± SD, and all nominal variables were expressed as n (%).

After checking the normal distribution between the two groups, the average value of the success fraction was compared using a t-test.

Results-Stage 1. Problem Identification

We derived these perspectives by interviewing four chiefs of nursing education.

Requirement of Education in Difficult-to-use Devices

Using difficult-to-use medical devices in healthcare can pose a significant challenge for medical staff due to the increased risk of errors, negatively impacting patient outcomes. Proper education and training on these devices are essential to ensure that medical staff can use them safely and effectively.

Lack of Resources; Space, Instructor, Time, and Cost

The lack of training resources in healthcare can be a significant challenge for healthcare organizations and medical staff. Training is essential to ensure that healthcare professionals possess the necessary knowledge, skills, and abilities to provide safe and effective care to patients. However, many healthcare organizations face barriers in providing adequate training resources to their staff, which can negatively impact patient outcomes.

One of the main challenges is a shortage of funding for training and education. Training budgets may be reduced or eliminated, making it difficult for healthcare organizations to provide the necessary resources to their staff.

Another challenge is the lack of adequate training time. Healthcare professionals are often required to work long hours, and finding time to attend training sessions and complete the necessary coursework can be difficult. This lack of time can make it difficult for healthcare organizations to provide training tailored to the specific needs of their staff.

Results-Stage 2. Needs Assessment

A series of interviews was conducted with two educators and two operators, with each interviewee holding a distinct role. The interviews were initially planned as semi-structured, allowing for flexibility in question selection based on the specific circumstances encountered.

Following the interviews, we identified crucial factors to consider when selecting educational topics. Educators highlighted the lack of training devices and instructors as significant challenges. Additionally, they emphasized the need for training in technically demanding skills. Trainers expressed a preference for educational topics that required hands-on practice. Their rationale stemmed from the recognition that devices with higher complexity are frequently utilized in the care of critically ill patients. The nurses' proficiency in operating such devices directly impacts the patients' prognoses.

Table 1

Trainer’s and operator 's Interview Responses (Table 1)
The details of the work	Identify training needs as well Thinking about the training contents that fit the characteristics of AR devices The production of educational proposals Establishing a class operation plan Buying Equipment Rental of educational medical devices Purchasing and subscribing to the operation of a class
Reasons for choosing a topic	Conventional training was difficult due to the lack of ECMO devices Educators who can train ECMO have limitations Not many devices or opportunities to practice I believe that training on how to use the device will be appropriate for self-learning methods
Considerations when creating a program	Consideration is given to reducing the burden of education, even if you have less experience Meet the level of nurses with the right experience for the program Standardize the training phase Apply it to the training subjects in the development stage and check their understanding Try to refine the confusing order and educate them in detail
Issues encountered at the production	Not enough objects are available for creation Insufficient features in the software Slower work due to heat generation and developer fatigue The recognition rate of AR devices is not high, so the working time is increased
Issues encountered at the training	Internet experience and connection are not smooth The program has limitations in controlling difficulty Trainees wearing glasses or difficulties in wearing masks exist Difficult to see or focus clearly Difficulty in recruiting educational devices and places HoloLens 2 has different continuous use time and actual use time It is not considered appropriate for nurse education in high age groups High fatigue during training

Results-Stage 3. Goals And Objectives

Selected objectives

Following the results of interview objectives selected of ECMO and ventilator as difficult-to-use devices. Ventilators were chosen as important but difficult-to-use devices. The device’s complexity and many connections make it difficult for new nurses. ECMO is a high-risk medical device that COVID-19 patients must have. In case of ECMO problems, nurses must immediately find a solution. Owing to its rarity, even experienced nurses have not encountered this problem. Rare but appropriate training was needed as it could be a risk to the patient, so it was chosen as the ECMO problem situation.

Selected goals

We aimed to develop a sustainable AR learning platform. AR learning platforms can provide many benefits for education, such as increasing engagement and motivation for learners, providing interactive and immersive experiences, and allowing more personalized learning. Key considerations for developing a sustainable AR learning platform include designing for scalability and accessibility, incorporating user feedback to improve the platform, and ensuring that the platform is cost-effective to maintain and operate over time. We focused on self-directed learning and hands-on practice.

Results-Stage 4. Educational Strategies

Step 1. Development AR-based instructions

The ECMO training program consists of 45 slides with 4 parts, each explaining how to operate ECMO devices, handle device disruptions, respond to “Low Bat” alarms, and address “SIG” alarms. Each part consists of about 8–10 steps to train how to handle each situation.

The ventilator education program comprised 3 parts and 46 slides. Each part consisted of 26 steps of ventilator setting and pre-use inspection, 7 steps of application, alarm setting, and training content evaluation. The training was conducted by checking supplies, power and Wall O2, medical gas connection, exhalation cassette connection, power on, pre-use check, test tube connection, target and application method selection, humidifier power on, mode setting, parameter setting, patient connection, monitoring after patient application, and alarm setting.

Step 2. Adoption of new technology

A nurse from the nursing education team developing a nursing education program. The training will utilize a servo-I mechanical ventilator from Maquet and the PLS ECMO device was Rotaflow II System from getinge. An attempt was made to incorporate a 3D guide for hands-on practice and to utilize video for enhanced understanding. The AR education program is being developed using the Microsoft Dynamic 365 Guide program. The program’s content will be delivered to users through a Microsoft HoloLens 2 device.

Step 3. Operating plan

N ventilator devices and N ECMO devices were located in the simulation laboratory in the hospital, and a place was prepared to provide the minimum required space for AR training, at least 3 x 3 meters of space to provide enough physical room for the trainee to move and perform the necessary tasks[23]

Results-Stage 5. Implementation

The AR education platform was operational for a period of two months. Training sessions were scheduled from 9 a.m. to 5 p.m., allowing nurses to choose their preferred date and time within this timeframe. For the implementation of the program, five Hololens2 devices were utilized, along with two laptops for supervisor screen connection and two large screens for the research environment.

Furthermore, it is important to note that a total of 24 individuals enrolled in our survey and interview study. However, during the actual duration of the program, there were 28 participants who actively engaged in the education sessions.

Results-Stage 6. Evaluation

Participants

From January 1 to February 3, two educators and two education directors trained 24 intensive care unit nurses.

Demographics

During the study, a total of 24 trainees were instructed, and surveys and interviews were conducted. The participating trainees had varying levels of experience with a maximum of 13 years and a minimum of less than 1 year. The average level of experience was found to be 3.75(SD3.9) years. Of the participants, twelve were trained in ventilator usage, while the remaining twelve educated on extracorporeal membrane oxygenation. In terms of gender distribution, 17 participants (70.83%) were women, and 7 participants (29.17%) were men.All participants belonged to the general nursing field. Among them, 15 nurses (62.5%) were employed in the Medical Intensive Care Unit, while 9 nurses (37.5%) worked in the Surgical Intensive Care Unit. Additionally, the majority of the participants (24, 100%) possessed smartphones, tablet PCs, and laptops (23, 95.83%). Prior to the instruction, 13 nurses (54.17%) already experienced a head-mounted display.

Table 2

Demographics of the study participants (N = 24) (Table 2)
Variable			N	Percent
Method
ECMO			12	50%
Ventilator			12	50%
Sex
Male			7	29.17%
Female			17	70.83%
Classification of Internal/surgical Medicine
Internal Medicine			15	62.5%
Surgical Department			9	37.5%
Family group
Nurse			24	100%
Department
Internal Medicine Intensive Care Unit			5	20.83%
Neurology Intensive Care Unit			2	8.33%
Cardiology Intensive Care Unit			2	8.33%
Oncology Center Internal Medicine Intensive Care Unit			6	25%
Pediatric Cardiovascular Surgery Intensive Care Unit			1	4.17%
Neurosurgery Intensive Care Unit			1	4.17%
Cardiac Surgery			1	4.17%
Cardiac Surgery Intensive Care Unit			3	12.50%
Oncology Center Thoracic Surgery Intensive Care Unit			1	4.17%
Oncology Center Surgery Intensive Care Unit			1	4.17%
Pediatric Intensive Care Unit			1	4.17%
Variable	mean (sd)	median (Q1, Q3)		min, max
Work experience (Years)	3.75 (3.9)	3 (0, 6.25)		0, 13

Result of System Usability Scale(SUS) and Technology Acceptance Model(TAM)

In the usability test, the item "I think that I would like to use this system frequently" and "I don't think the system unnecessarily complex" received the highest rating of 4.38 out of a possible 5, while the lowest rated item "I thought there was too much inconsistency in this system" received an average score of 1.83. The responses regarding technology acceptance were classified into four categories: perceived usefulness, perceived ease of use, perceived enjoyment, and intention to use. The survey consisted of 15 questions on a 7-point scale. The item with the highest score was "It is fun to use" with a score of 6.71, while the lowest rated item was "It is easy to use" with a score of 5.17. In other survey results, age, sex, department of work, and years of work did not affect satisfaction with education or usability. All response results for the survey have been attached as Supplementary 1.

The evaluation of the AR learning

A total of 24 nurses utilized the AR platform, out of which 15 voluntarily agreed to participate in the study. These participants completed surveys and took part in interviews related to their experiences with the AR education platform.

The platform was located outside the hospitals. During the operation period, 24 nurses used the platform, 11 trainee and 4 trainers agreed to participate in this study by conducting surveys and interviews. The responses of the 11 trainees who participated in the interviews have been summarized in Table 3.

Table 3

Trainee's Interview Responses, an internal factor
Factor	Phase	Contents
1–1. Intrinsic Motivation	1) Goals for this education	I wanted to experience education through Augmented Reality technology (3) I want to get an education that will help me with the job of a nurse (4) Expect better results than traditional education (4) Need to learn about devices that have no practical experience (3)
	2) Reasons for participation	Recommendation from other nurses (4) I have relevant educational experience (1) Curiosity about new methods of education (4) Solving questions about the contents of the training (1)
1–2. Self-management	3) thoughts on existing nursing skills education	Conventional training alone can confuse nursing techniques (1) Takes a long time to understand concepts (1) The content of training varies depending on the educator’s propensity and level (1)
1–3. Desire for learning	4) Preference among conventional education/self-directed learning	Conventional learning methods 6/11 (55.5%) Self-directed learning 5/11 (45.5%)
	5) Reasons for your preference	Conventional learning methods (6/11) Feedback and questions can be solved (3/6) Test or tutor-integrated verification (1/6) Self-directed learning is difficult in the educational system (1/6) Nursing techniques are always applied to the patient and require confirmation from the tutor (1/6) Self-directed learning (5/11) It’s good that I can learn as much as I need (1/5) Existing education may not match the speed at which the instructor delivers information (2/5) I feel many things while doing it (1/5) Self-directed learning is necessary for self-development (1/5) The conventional method has little left after the evaluation is over (1/5)
1–4. Awareness	6) Face-to-face/non-face education preferences	Face-to-face (6/11,54.5%) Books are more comfortable than videos (1) Unaccustomed to non-face-to-face training (2) I think the educational effect is better (1) Feedback is available (2) Non-face-to-face (5/11 45.5%) Focus on lecture content without worrying about surroundings (1) Can study at speed (1) Features such as pauses are available (1) No space-time constraints (2) Repeatable (1)
	7) Whether the preference for learning methods has changed before and after the outbreak of COVID-19	Changed 4/10 (40%) - Getting used to non-face-to-face after COVID-19 - Recognizing that non-face-to-face contact can also be concentrated No change 6/10 (60%)

Table 4

Trainee's Interview Responses, an External factor
2 − 1.Extrinsic Motivation	8) whether this education will improve technical skills and help you evaluate your job	Will improve (9/11) It’s a lot more helpful than just a theory (1) It will be helpful to improve your technical skills by watching videos (1) I can definitely learn the confusing parts (1) It helps me think about how to deal with it in the clinic (1) It’s easy to understand (1) I will be able to perform with confidence, which will help my job (1) Will not improve (2/11) It is helpful to acquire concepts but not to improve technical skills (1) It will not be a direct help (1)
2–2. Concrete experiences	9) Experience wearing an HMD	Yes (8/10) No (2/10)
	10) Experienced AR/VR	VR game (6/8) Skill training (2/8)
2–3. Reflective observation	11) Advantages of education through AR/VR	More realistic than virtual reality Education at one’s own pace Provide specific information To be able to see the video and the description at the same time
	12) Disadvantages of education through AR/VR	The AR machine itself is unfamiliar Curiosity and attention tend to focus on the device’s operation rather than the training contents Difficulty in asking questions Difficulty moving content freely Unaccustomed to using the instrument The handwriting is small Difficult to focus on content
	13) Whether the contents of the training were appropriate	Suitable (9/11) This is a high-risk device, and it is difficult to use daily. So it's less burdensome because I can practice it without using it in real patients. Usually 2/11 AR education is good, but there is no big difference from education using existing videos
	14) Supervisor help required while education	None (2/11) Technical Assistance Required (9/11)
	15) Advantages over conventional education methods	It was nice to repeat learning according to my own educational pace Easily find my errors through comparison between real and video Repeatable multiple times
	16) Disadvantages over conventional education methods	Difficult to operate the instrument (8) Limited time due to lack of practical equipment (1) Lack of content for in-depth learning (1) Since it is self-learning, it is difficult to solve once there is a blockage (1)
2–4. Abstract Conceptualization	17) Evaluation of Hands-on Education	Effective by touching and learning the actual device (8/11) Effective by allowing you to learn situations that you won’t actually experience (1/11) Effective only when learning new concepts (1/11) Conducting hands-on education for many nurses will require significant resources, including manpower. (1/11)
	18) whether the existing training replaceable	Conventional training can be replaced (4/11) Only some of the training content can be replaced (7/11)
	19) Will AR education be able to improve nursing skills	It is thought that it will be difficult to solve the limitations of existing education only with AR devices (1) I can practice what you want to practice repeatedly(1) Similar to self-practice watching a video (1) I think it’s an educational method that helps you understand (1) I think it would be more helpful to learn on your own than the conventional learning method (1) Help to implement situations that are unpredictable or difficult to experience (2) Iterative learning is possible (1)
2–5. Active experimentation	20) Most appropriate target for this training method	New nurse (4) Nurse with experience but no specific device experience (2) Department transfer, reinstatement, other department helper (4) Nurse with machine experience (3) Nurse student (1) Target Restrictions (1)
	21) Most helpful thing about self-learning using AR	Less pressure (2) Self-learnable (1) Save time (2) Review as much as you want (3) Ability to learn about unusual situations (1) Repeatable Learning(1) Selectable for learning time(1) Educator time saved(1) less burden on human relationships(1)
	22) Most worried thing about self-learning using AR	Limitations of clinical application(1) No sharing of personal experiences or tips(1) It will take a long time(1) Even if you don’t like this approach, you may have to participate in it(1) Worries about system errors(1) Limitations due to device quantity limitations(1)

Overall, the evaluation of AR-based education was positive with participants indicating that AR could improve their actual clinical performance. AR is a technology suitable for self-directed or hands-on learning theory those who interested in experience and self-learning rated the program particularly well. Nurses were found to be receptive to education using new technology.

When asked if they needed assistance with the curriculum, no participant answered negatively regarding the content. However, some participants did express a need for help in adapting to new devices and technologies.

Principal Results

The principal findings of this study provide valuable insights into the strategic organization and effectiveness of AR-based education platforms for healthcare training. Through interviews conducted with trainers and trainees prior to program development, the study successfully identified the specific needs and requirements of educators in the healthcare field. The primary objective of the AR education program was to address limitations associated with spatial constraints, time restrictions, and resource availability that are often encountered in traditional educational programs. The study strategically organized the program to achieve each aspect, leveraging the capabilities of AR technology to enhance self-directed learning (SDL) and hands-on practice.

In the educational strategies employed, the study capitalized on the unique features of AR to facilitate SDL. By providing interactive and immersive learning experiences, AR empowered trainees to take ownership of their learning process. The program incorporated instructional materials and modules that allowed learners to explore and acquire knowledge at their own pace, fostering a sense of autonomy and self-guided learning. The use of AR also facilitated real-time feedback and assessment, enabling learners to track their progress and identify areas for improvement.

Moreover, AR technology played a crucial role in enhancing hands-on practice. By overlaying digital information and virtual models onto real-world settings, trainees were able to engage in simulated scenarios that closely resembled authentic healthcare environments. This hands-on component of the program allowed learners to apply their knowledge and skills in realistic contexts, promoting a deeper understanding of the subject matter and the development of critical thinking and problem-solving abilities.

The discussion surrounding the use of AR in this study highlights how the technology contributed to the success of SDL and hands-on practice. By strategically integrating AR into the educational program, trainees were empowered to take control of their learning journey, while also gaining valuable practical experience in a safe and controlled environment. The utilization of AR technology facilitated active engagement, learner-centeredness, and skill development, thereby enhancing the overall effectiveness of the healthcare training program.

Limitations

While the study gathered and analyzed various opinions through surveys and in-depth interviews, it was limited to a small sample size of 15 nurses who volunteered to participate. Additionally, the study acknowledges that AR education programs cannot fully replace traditional nursing education due to technological limitations.

Comparison with Prior Work

AR technology has been extensively explored in healthcare education and training, encompassing areas such as surgical simulation, anatomy education, and patient safety training. However, it is worth noting that this study represents the first investigation into the use of AR for ECMO training specifically within the nursing field. By incorporating this new technology, namely AR, the study pioneers the integration of innovative approaches in nursing education.

The development of an AR training program for nurses focusing on ventilator and ECMO usage contributes significantly to the growing body of research on AR implementation in healthcare education and training. Through the targeted focus on a specific procedure in nursing care and active involvement of experienced nursing educators in the development process, the program holds the potential to address specific gaps that exist within current nursing education programs.

This study provides insights on the development, launch, and operation of AR-based education platforms in healthcare training. While it acknowledges the limitations of AR education programs and the need for further technological development, the study suggests that AR education programs can be a good alternative to compensate for insufficient resources for nurse education. Further research can be conducted to compare the effectiveness and feasibility of this program with other AR-based education programs and traditional nursing education programs.

AR: Augmented reality

ECMO: Extracorporeal membrane oxygenation

ED: Emergency department

HMD: Head-mounted display

ICU: Intensive care unit

IQR: Interquartile range

IRB: Institutional Review Board

MV: Mechanical ventilation

RCT: Randomized controlled trial

SAIHST: Samsung Advanced Institute for Health Sciences and Technology

SW: Software

VR: Virtual reality

Acknowledgements

We would like to express our sincere gratitude to all the individuals who contributed to the successful completion of this study. First and foremost, we would like to thank the nursing education chiefs for their valuable insights and participation in the interviews. We are also grateful to the nurses who willingly participated in the study, sharing their experiences and providing valuable feedback. Additionally, we extend our appreciation to the operators who assisted in the implementation of the AR educational program.

Conflicts of Interest

none declared.

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No competing interests reported.

Adoption of Augmented Reality into Nursing Education Programs in Intensive Care in Tertiary Academic Hospitals

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Abstract

Background

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Methods

Results

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Introduction

Methods

Results

Discussion

Conclusions

Abbreviations

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Acknowledgements

Conflicts of Interest

References

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Supplementary Files

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Version 1