1Associate Professor, Department of Nursing, Gangneung-Wonju National University, Wonju, Korea
2Professor, Department of Nursing, Inha University, Incheon, Korea
3Professor, Department of Nursing, Gangneung-Wonju National University, Wonju, Korea
Copyright © 2023 Korean Academy of Child Health Nursing.
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial and No Derivatives License (https://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted non-commercial use, distribution of the material without any modifications, and reproduction in any medium, provided the original works properly cited.
Authors' contribution
Conceptualization: all authors; Data collection, Formal analysis: all authors; Writing-original draft, Writing-review and editing: all authors; Final approval of published version: all authors.
Conflict of interest
No existing or potential conflict of interest relevant to this article was reported.
Firth author (published year) | Nationality of sample | Study design | Type of simulation | Scenario contents | Process of simulation | Participant characteristics | Outcomes | Results | |
---|---|---|---|---|---|---|---|---|---|
1 | Kim et al. (2019) [11] | South Korea | Non-equivalent control group experimental design | E: blended VR vSim for Nursing (Laerdal Medical) + simulation scenario was developed by NLN using SimJunior (SimJunior, Laerdal Medical) | The scenario included the assessment of respiratory problems, medication, and education for pediatric patients with asthma | VR: suggested reading → Pre-quiz → vSim → Post-quiz → Documentation assignment → Guide for reflection | Nursing students (4th year) E (22) /C (26) | Critical thinking, problem-solving processes, critical competency | The pretest-posttest results of each group showed statistically significant improvements in 3 variables. In a comparison of the 2 groups, critical thinking differed significantly. |
HFS: Pre-orientation → Simulation operation → Debriefing on pediatric nursing asthma modules developed by NLN | |||||||||
C: only VR | |||||||||
2 | Díaz et al. (2021) [16] | USA | Quasi-experiment al design | E1: mannequin-based (HFPS) | Scenario: pediatric respiration, pediatric dehydration, pediatric sickle cell | HFPS: 4 groups, 2 participants, 2 observers total 45 min, scenario 15 min, debriefing 30 min | BSN students E1 (HFS): 119, E2 (VR): 134, C: 120 | Knowledge acquisition | Immediately after the simulation, a significant difference was seen in the knowledge of two modules out of seven categories, but only one module showed a significant difference. |
E2: VR (self-development) | VR: 7 hrs until the computer reaches 90% of the set competency score, all simulations are carried out on the same day | ||||||||
C: SBE | |||||||||
3 | Farre and Cummins (2016) [17] | USA | Program development | The simulation was developed to present users with a high-fidelity, immersive training environment to maximize learning (Unity Technologies, San Francisco, CA, USA) | Content from the National Pediatric Readiness Project (2014). VRS scenario: NICU. Standards of Best Practice. The scenarios were built so that there were realistic renderings of the unit, stairwells, halls, equipment, and supplies. | Room doors are activated with an activation key. Sliding doors like those in the J-pod must be manually opened or closed with the action key. Those leaving the neonate room must close the door on the exit. Redirect to close neonate's door if not closed. Redirection: move through a virtual environment using a head-mounted display and controllers. | 26 reviewers | Realism and usability during the VRS, ability to complete the VRS | Realism and usability during the VRS; Likert format question responses ranged from 0 to 5 with 5 signifying that participants were highly satisfied. |
4 | Goldsworthy et al. (2019) [18] | Canada | Quasi-experimental pre/post study | E: HFS + vSim (self-development) | Deteriorating patient: pediatric asthma, sepsis, neonatal seizure | 16-hour simulation intervention over 2 days. Adult and pediatric deteriorating patients–HFS: pre-brief 15 min, simulation 20 min, debrief 25 min | Nursing students: E (24) C (39) random assignment | Clinical self-efficacy, knowledge | CSE (9/10) significantly increased in the E group, and the pre-post difference in knowledge was significant in 3 out of 5 modules. |
5 | Kang et al. (2020) [19] | South Korea | Pretest and posttest quasi-experimental study | VR (vSim for Nursing; Laerdal Medical), HFS (SimJunior, Laerdal Medical) based on vSim | Pediatric patient with asthma | vSim: pre-simulation quiz, simulation, post-quiz HFS, post-simulation debriefing | Nursing students E1 (vSim) 54, E2 (HFS) 69, E3 (vSim+HFS) 69 | Knowledge, confidence, performance | Knowledge and confidence were significantly higher in E1 and E3, with the highest performance in E2. |
6 | Kotcherlakota et al. (2020) [25] | USA | Mixed-methods single-condition study | AR and Interactive Storytelling (ARIS) mobile app. | ARISE clinical scenario: pediatric patient with asthma | ARIS app on iPads | Pediatric nurse practitioner students (21) | Instructional materials motivation survey, SDS, student satisfaction and self-confidence in learning scale | The correlations between IMMS and SSSC were positive. The pediatric asthma test score significantly improved. |
7 | Ng et al. (2020) [21] | Hong Kong | One group posttest design | Virtual ward environment (Unity3D platform + software). The virtual ward: Autodesk Maya, Blender, Motion Builder, and Adobe Photoshop. The virtual ward can be run with a VR system(e.g., HTCVive) on a PC. | Virtual ward environment (VWE) and AR for skill-based learning-injection methods, wound dressing | Nursing education: ward orientation, fundamental nursing skills training | Junior nursing students | Virtual ward orientation, nursing skills | 80% of students agreed that the VWE could help them become familiar with the material. Most students were satisfied with the AR app's development in learning fundamental nursing skills. |
Virtual ward environment | Males (10) | ||||||||
AR for skill-based learning: injection methods, wound dressing | Females (20) | ||||||||
8 | Peterson et al. (2020) [20] | USA | One-group pretest- posttest design | Mixed-reality simulation using SPs portraying family members and high-fidelity manikins | Medical resuscitation of an unstable infant (aged 2 months with bronchiolitis simulated via high-fidelity manikin) and SP, GABHS sepsis and respiratory failure and shock | Short introduction/briefing → running → in-depth debriefing that included team members, faculty, and SPs. Each session lasted 2 hours. | 27 clinicians on the transport team: RN (10), RRT (9), EMT (8) | Pre-post self-perceptions of skills and program quality | There was a significant change in preand post-program self-perceptions of skills in communication. |
9 | Putnam et al. (2021) [26] | USA | One-group pretest- posttest design | VR with Hololens | 1. Interactive instructional pediatric airway videos | Interactive instructional videos → VR trainer and a brief orientation to the Hololens. Each participant was allowed up to three attempts to manage the patient. At the conclusion of each module, an interactive quiz tested real-time understanding of the information. Feedback was given after each quiz. | 41 (medical students, residents, faculty, and advanced practice nurses) | Knowledge of pediatric airway management, detecting a difference of airway size | Questions on pediatric anatomy, anaphylaxis, Heimlich maneuver, and foreign body removal showed the highest improvement in scores (p<.05) |
2. VR trainer (Hololens technology), simulating a pediatric critical airway event | |||||||||
10 | Reed et al. (2017) [27] | USA | Retrospective report | Realistic mock code + TBST | An in-house pager system was implemented and tested for the NICU resuscitation team based on the NICU Code Blue Communication Pathway. | 18 cases: home birth (esophageal intubation, hypothermia, hypoglycemia), acute pulmonary hemorrhage, respiratory failure (sepsis/pneumonia), tension pneumothorax/ cardiogenic shock pneumothorax post-surfactant, ECPR—cardiac, myelomeningocele self-extubation, ECPR—general surgery, premature infant self-extubation | The participants comprised more than 500 NICU staff | Attendance rate Number of attendees | The intervention resulted in 65 completed TBST events and 87% adherence to our schedule. Procedural skills included intubation, needle thoracotomy, intra-osseous needle placement, IV placement, shock management, defibrillation, cardioversion, chest compressions, and medication administration. |
11 | Yu and Yang (2022) [22] | South Korea | Development of a VR program | VR simulation program addressing neonatal infection control for nursing students | Scenario 1: basic care upon initial admission | Production of VR program → VR program equipment and software | Nursing students (4th year) | PPE knowledge, infection control performance, self-efficacy | The E group showed significantly greater improvement in PPE knowledge, infection control performance, and self-efficacy. |
Scenario 2: feeding management | E (25) / C (25) | ||||||||
Scenario 3: skin care and environmental management | |||||||||
12 | Yu et al. (2021) [28] | South Korea | Nonequivalent control group design | VR: The program employed a Vive ProFull-Kit Head- Mounted Display and sensor (HTC VIVETM, USA), a Leap Motion Controller™ (Ultraleap, USA) hand-tracking device with a VR developer mount, and a VR kit containing an EliteDesk800 G4 laptop computer | Neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management, and skincare and environmental management for the prevention of neonatal infection. | Virtual reality infection control simulation (VRICS): pre-briefing (20 min) → VR simulation (40 min, 3 scenarios) → Debriefing (20 min) | Nursing students (3rd and 4th years) | Knowledge, performance, satisfaction | There was no significant difference between the E and C groups regarding knowledge. Based on pretest and posttest results, high-risk neonatal infection control performance self-efficacy significantly increased in both the E and C groups. The E group showed significantly higher learner satisfaction. |
E (25) / C (25) | |||||||||
13 | Kim and Kim (2022) [23] | South Korea | One group pretest- posttest test design | VR (vSim for Nursing; Laerdal Medical) | Pediatric vSim for Nursing | Orientation → Briefing → Pre-quiz → vSim operation → Post quiz | Nursing students (4th year): 44 | Critical thinking disposition, critical competency, practice satisfaction | The E group showed significantly higher learner critical thinking disposition, critical competency, and practice satisfaction. |
- Gastroenteritis scenario | |||||||||
- Asthma (mild intermittent asthma, asthma and pneumonia) | |||||||||
14 | Rim and Shin (2021) [24] | South Korea | Methodological study | VRS | Hypoglycemia, neonatal apnea, transfusion | Each scenario session comprised an orientation, pre-briefing, simulation, and debriefing, and lasted 130-150 min. | Expert-FGI | CVI and narrative contents | The CVI value was lower than 0.8. For virtual elements, "representation and interaction" and "feedback system" both scored 0.67. |
Nursing students |
AR, augmented reality; C, control group; CVI, content validity index; E, experimental group; ECPR, extracorporeal cardiopulmonary resuscitation; EMT, emergency medical technician; FGI, focus group interview; GABHS, group A beta-hemolytic streptococcus aureus; HFS, high-fidelity simulation; HFPS, high-fidelity patient simulation; IMMS, Instructional Materials Motivation Survey; NICU, neonatal intensive care unit; NLN, National League for Nursing; PPE, personal protective equipment; RN, registered nurse; RRT, respiratory therapist; SDS, Simulation Design Scale; SP, standardized patient; SSSC, Student Satisfaction and Self-Confidence in Learning Scale; TBST, team-based simulation training; VR, virtual reality; VRS, virtual reality simulation; vSim, virtual simulation; VWE, virtual ward environment.
Firth author (published year) | Nationality of sample | Study design | Type of simulation | Scenario contents | Process of simulation | Participant characteristics | Outcomes | Results | |
---|---|---|---|---|---|---|---|---|---|
1 | Kim et al. (2019) [11] | South Korea | Non-equivalent control group experimental design | E: blended VR vSim for Nursing (Laerdal Medical) + simulation scenario was developed by NLN using SimJunior (SimJunior, Laerdal Medical) | The scenario included the assessment of respiratory problems, medication, and education for pediatric patients with asthma | VR: suggested reading → Pre-quiz → vSim → Post-quiz → Documentation assignment → Guide for reflection | Nursing students (4th year) E (22) /C (26) | Critical thinking, problem-solving processes, critical competency | The pretest-posttest results of each group showed statistically significant improvements in 3 variables. In a comparison of the 2 groups, critical thinking differed significantly. |
HFS: Pre-orientation → Simulation operation → Debriefing on pediatric nursing asthma modules developed by NLN | |||||||||
C: only VR | |||||||||
2 | Díaz et al. (2021) [16] | USA | Quasi-experiment al design | E1: mannequin-based (HFPS) | Scenario: pediatric respiration, pediatric dehydration, pediatric sickle cell | HFPS: 4 groups, 2 participants, 2 observers total 45 min, scenario 15 min, debriefing 30 min | BSN students E1 (HFS): 119, E2 (VR): 134, C: 120 | Knowledge acquisition | Immediately after the simulation, a significant difference was seen in the knowledge of two modules out of seven categories, but only one module showed a significant difference. |
E2: VR (self-development) | VR: 7 hrs until the computer reaches 90% of the set competency score, all simulations are carried out on the same day | ||||||||
C: SBE | |||||||||
3 | Farre and Cummins (2016) [17] | USA | Program development | The simulation was developed to present users with a high-fidelity, immersive training environment to maximize learning (Unity Technologies, San Francisco, CA, USA) | Content from the National Pediatric Readiness Project (2014). VRS scenario: NICU. Standards of Best Practice. The scenarios were built so that there were realistic renderings of the unit, stairwells, halls, equipment, and supplies. | Room doors are activated with an activation key. Sliding doors like those in the J-pod must be manually opened or closed with the action key. Those leaving the neonate room must close the door on the exit. Redirect to close neonate's door if not closed. Redirection: move through a virtual environment using a head-mounted display and controllers. | 26 reviewers | Realism and usability during the VRS, ability to complete the VRS | Realism and usability during the VRS; Likert format question responses ranged from 0 to 5 with 5 signifying that participants were highly satisfied. |
4 | Goldsworthy et al. (2019) [18] | Canada | Quasi-experimental pre/post study | E: HFS + vSim (self-development) | Deteriorating patient: pediatric asthma, sepsis, neonatal seizure | 16-hour simulation intervention over 2 days. Adult and pediatric deteriorating patients–HFS: pre-brief 15 min, simulation 20 min, debrief 25 min | Nursing students: E (24) C (39) random assignment | Clinical self-efficacy, knowledge | CSE (9/10) significantly increased in the E group, and the pre-post difference in knowledge was significant in 3 out of 5 modules. |
5 | Kang et al. (2020) [19] | South Korea | Pretest and posttest quasi-experimental study | VR (vSim for Nursing; Laerdal Medical), HFS (SimJunior, Laerdal Medical) based on vSim | Pediatric patient with asthma | vSim: pre-simulation quiz, simulation, post-quiz HFS, post-simulation debriefing | Nursing students E1 (vSim) 54, E2 (HFS) 69, E3 (vSim+HFS) 69 | Knowledge, confidence, performance | Knowledge and confidence were significantly higher in E1 and E3, with the highest performance in E2. |
6 | Kotcherlakota et al. (2020) [25] | USA | Mixed-methods single-condition study | AR and Interactive Storytelling (ARIS) mobile app. | ARISE clinical scenario: pediatric patient with asthma | ARIS app on iPads | Pediatric nurse practitioner students (21) | Instructional materials motivation survey, SDS, student satisfaction and self-confidence in learning scale | The correlations between IMMS and SSSC were positive. The pediatric asthma test score significantly improved. |
7 | Ng et al. (2020) [21] | Hong Kong | One group posttest design | Virtual ward environment (Unity3D platform + software). The virtual ward: Autodesk Maya, Blender, Motion Builder, and Adobe Photoshop. The virtual ward can be run with a VR system(e.g., HTCVive) on a PC. | Virtual ward environment (VWE) and AR for skill-based learning-injection methods, wound dressing | Nursing education: ward orientation, fundamental nursing skills training | Junior nursing students | Virtual ward orientation, nursing skills | 80% of students agreed that the VWE could help them become familiar with the material. Most students were satisfied with the AR app's development in learning fundamental nursing skills. |
Virtual ward environment | Males (10) | ||||||||
AR for skill-based learning: injection methods, wound dressing | Females (20) | ||||||||
8 | Peterson et al. (2020) [20] | USA | One-group pretest- posttest design | Mixed-reality simulation using SPs portraying family members and high-fidelity manikins | Medical resuscitation of an unstable infant (aged 2 months with bronchiolitis simulated via high-fidelity manikin) and SP, GABHS sepsis and respiratory failure and shock | Short introduction/briefing → running → in-depth debriefing that included team members, faculty, and SPs. Each session lasted 2 hours. | 27 clinicians on the transport team: RN (10), RRT (9), EMT (8) | Pre-post self-perceptions of skills and program quality | There was a significant change in preand post-program self-perceptions of skills in communication. |
9 | Putnam et al. (2021) [26] | USA | One-group pretest- posttest design | VR with Hololens | 1. Interactive instructional pediatric airway videos | Interactive instructional videos → VR trainer and a brief orientation to the Hololens. Each participant was allowed up to three attempts to manage the patient. At the conclusion of each module, an interactive quiz tested real-time understanding of the information. Feedback was given after each quiz. | 41 (medical students, residents, faculty, and advanced practice nurses) | Knowledge of pediatric airway management, detecting a difference of airway size | Questions on pediatric anatomy, anaphylaxis, Heimlich maneuver, and foreign body removal showed the highest improvement in scores (p<.05) |
2. VR trainer (Hololens technology), simulating a pediatric critical airway event | |||||||||
10 | Reed et al. (2017) [27] | USA | Retrospective report | Realistic mock code + TBST | An in-house pager system was implemented and tested for the NICU resuscitation team based on the NICU Code Blue Communication Pathway. | 18 cases: home birth (esophageal intubation, hypothermia, hypoglycemia), acute pulmonary hemorrhage, respiratory failure (sepsis/pneumonia), tension pneumothorax/ cardiogenic shock pneumothorax post-surfactant, ECPR—cardiac, myelomeningocele self-extubation, ECPR—general surgery, premature infant self-extubation | The participants comprised more than 500 NICU staff | Attendance rate Number of attendees | The intervention resulted in 65 completed TBST events and 87% adherence to our schedule. Procedural skills included intubation, needle thoracotomy, intra-osseous needle placement, IV placement, shock management, defibrillation, cardioversion, chest compressions, and medication administration. |
11 | Yu and Yang (2022) [22] | South Korea | Development of a VR program | VR simulation program addressing neonatal infection control for nursing students | Scenario 1: basic care upon initial admission | Production of VR program → VR program equipment and software | Nursing students (4th year) | PPE knowledge, infection control performance, self-efficacy | The E group showed significantly greater improvement in PPE knowledge, infection control performance, and self-efficacy. |
Scenario 2: feeding management | E (25) / C (25) | ||||||||
Scenario 3: skin care and environmental management | |||||||||
12 | Yu et al. (2021) [28] | South Korea | Nonequivalent control group design | VR: The program employed a Vive ProFull-Kit Head- Mounted Display and sensor (HTC VIVETM, USA), a Leap Motion Controller™ (Ultraleap, USA) hand-tracking device with a VR developer mount, and a VR kit containing an EliteDesk800 G4 laptop computer | Neonatal intensive care unit practice. The program consisted of three scenarios: basic care, feeding management, and skincare and environmental management for the prevention of neonatal infection. | Virtual reality infection control simulation (VRICS): pre-briefing (20 min) → VR simulation (40 min, 3 scenarios) → Debriefing (20 min) | Nursing students (3rd and 4th years) | Knowledge, performance, satisfaction | There was no significant difference between the E and C groups regarding knowledge. Based on pretest and posttest results, high-risk neonatal infection control performance self-efficacy significantly increased in both the E and C groups. The E group showed significantly higher learner satisfaction. |
E (25) / C (25) | |||||||||
13 | Kim and Kim (2022) [23] | South Korea | One group pretest- posttest test design | VR (vSim for Nursing; Laerdal Medical) | Pediatric vSim for Nursing | Orientation → Briefing → Pre-quiz → vSim operation → Post quiz | Nursing students (4th year): 44 | Critical thinking disposition, critical competency, practice satisfaction | The E group showed significantly higher learner critical thinking disposition, critical competency, and practice satisfaction. |
- Gastroenteritis scenario | |||||||||
- Asthma (mild intermittent asthma, asthma and pneumonia) | |||||||||
14 | Rim and Shin (2021) [24] | South Korea | Methodological study | VRS | Hypoglycemia, neonatal apnea, transfusion | Each scenario session comprised an orientation, pre-briefing, simulation, and debriefing, and lasted 130-150 min. | Expert-FGI | CVI and narrative contents | The CVI value was lower than 0.8. For virtual elements, "representation and interaction" and "feedback system" both scored 0.67. |
Nursing students |
AR, augmented reality; C, control group; CVI, content validity index; E, experimental group; ECPR, extracorporeal cardiopulmonary resuscitation; EMT, emergency medical technician; FGI, focus group interview; GABHS, group A beta-hemolytic streptococcus aureus; HFS, high-fidelity simulation; HFPS, high-fidelity patient simulation; IMMS, Instructional Materials Motivation Survey; NICU, neonatal intensive care unit; NLN, National League for Nursing; PPE, personal protective equipment; RN, registered nurse; RRT, respiratory therapist; SDS, Simulation Design Scale; SP, standardized patient; SSSC, Student Satisfaction and Self-Confidence in Learning Scale; TBST, team-based simulation training; VR, virtual reality; VRS, virtual reality simulation; vSim, virtual simulation; VWE, virtual ward environment.