ReviewThe integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review
Introduction
Information technology (IT) is rapidly changing and challenging traditional pedagogy. The large scale, and availability, of digital technology most notably mobile phone and tablet devices and associated applications, enables students to have extensive access to vast amounts of information anywhere, anytime (Chang et al., 2018). The Lancet Independent Global Commission for the Education of Health Professionals for the 21st Century urges health education institutions to rethink the current approaches to education and curriculum design to strengthen theoretical and clinical education through the adoption of IT empowered learning (Frenk et al., 2010). In the disciplines of nursing and midwifery, educators are constantly challenged to find accessible and innovative methods of teaching and learning that transition the student from novice practitioner to work ready clinician (Butt et al., 2018; Irwin and Coutts, 2015). Virtual Reality (VR) is one technology that has increasingly received attention within the literature as an IT medium with potential application into nursing and midwifery education (Butt et al., 2018; Chang et al., 2018; Vottero, 2014).
Like most technology advancements VR has progressed overtime and has emerged from the research lab into a commercially available and viable product (Sherman and Craig, 2018). As VR technology advances and becomes increasingly affordable there has been a shift in focus from technology advancement to content development, integration, and application into real world industry (Sherman and Craig, 2018).
The application of VR into undergraduate nursing and midwifery education has the potential to transform theoretical and clinical learning. Virtual Reality has been proposed as a novel solution for overcoming situational and organisational barriers associated with experiential clinical skills development (Cobbett and Snelgrove-Clarke, 2016; Kilmon et al., 2010; Vidal et al., 2013). Virtual Reality affords the ability to provide a failsafe and accessible learning environment that may increase patient safety, through repeated exposure to educational content such as clinical skills and critical events as novice practitioners (Butt et al., 2018; Chang et al., 2018; Kilmon et al., 2010).
Virtual Reality has been used to describe a range of computer simulated programs and simulation devices including virtual worlds (Mandal, 2013; Sherman and Craig, 2018). Non-immersive VR (NVR) or desktop VR such as the popular Second Life® program provides a window into a virtual world that is displayed on a computer monitor (Irwin and Coutts, 2015; Kilmon et al., 2010). Users might create a representation of themselves called an AVATAR to interact with other users and the virtual environment itself, by using computer hardware such as a mouse and keyboard (Choi et al., 2015; Irwin and Coutts, 2015; Mandal, 2013).
This paper is focused on the use of Immersive Virtual Reality (IVR) defined as ‘medium composed of interactive computer simulations that sense the participant's position and actions and replace or augment the feedback to one or more senses, giving the feeling of being mentally immersed or present in the simulation’ (Sherman and Craig, 2018). Authentic IVR is comprised of the following 4 key components. 1) A virtual world – the space manifested by a medium such as that created by computer simulation software, programed to resemble a real-world environment. 2) Immersion – the physical and mental sensation of being in the virtual environment. This is generally achieved through the use of individual head mounted displays (HMDs) or CAVE systems (room like spaces surrounded by computer generated imagery). 3) Sensory feedback – An IVR system provides direct sensory feedback to the participant based on their physical position. This is often referred to as tracking. 4) Interactivity - where the system responds and reacts to the actions of the user (Choi et al., 2015; Dubovi et al., 2017; Sherman and Craig, 2018).
The extent and application of IVR within undergraduate nursing and midwifery education is largely unknown (Cant and Cooper, 2017; Williams et al., 2018). Previous systematic reviews have focused on the integration and use of virtual worlds and effectiveness of high and low fidelity simulation programs (Cant and Cooper, 2017; Irwin and Coutts, 2015). Therefore, the purpose of this study is to broaden the evidence base and undertake a scoping review of the published literature to identify the application and integration of IVR within undergraduate nursing and midwifery tertiary education programs. This review will provide a discipline specific baseline of IVR and identify areas for further research.
Section snippets
Methods
This study is guided by the Joanna Briggs Institute (JBI) methodology for scoping reviews (Peters et al., 2015). This review additionally considered the work of Levac and Colquhoun (2010) and Daudt et al. (2013) to strengthening the scoping review methodology, increase rigor and ensure transparency and replicability of the study design.
Scoping review frameworks assist in mapping out particular research areas of interest and allow reviewers to examine the extent and nature of the evidence
Results
The flowchart in Fig. 1 details the identification, screening and inclusion of articles for this review. The primary search strategy identified n = 706 non-duplicate records. Following level one screening n = 36 articles were retrieved in full text and subjected to level two screening. A total of n = 2 articles were subjected to quality appraisal and included for review.
Discussion
To our knowledge this is the first scoping review undertaken to look at the application and integration of IVR technology within tertiary nursing and midwifery education programs. A thorough search of the published literature revealed only two papers of varying quality. Using a quality appraisal instrument the paper by Butt et al. (2018) was assessed as being of good quality, while the paper by Kilmon et al. (2010) was assessed as being poor. It should be noted, however, that the latter paper
Strengths
We have conducted a methodologically rigorous and contemporary search of the published literature of the current state of the application and integration of IVR technology into nursing and midwifery tertiary education programs. The review identified two papers of good to poor quality in terms of research design.
Limitations
The use of IVR technology into nursing and midwifery education is only just emerging. There is considerable scope for research to be conducted into the development, application and integration of IVR into undergraduate nursing and midwifery education.
Conclusion
There is a paucity of quality published literature on the application and/or integration of IVR into nursing and midwifery tertiary education. Immersive Virtual Reality has the potential to increase competence and confidence for students providing accessible and repeatable learning opportunities in a fail-safe environment. Immersive Virtual Reality additionally has the potential to assist in meeting the identified challenges associated with clinical practice experiences such as increased
Declarations and funding
We the authors declare that there are no competing or conflicting interests with any of the authors for this manuscript. As this is a review article Ethical approval was not sought for this publication. No funding has been sought for this study. I declare on behalf of all authors that this manuscript has not been published or submitted for publication in any other journal. As this is a review article ethics was not required for this study.
Acknowledgements
We would like to acknowledge Debbie Booth research librarian for her assistance with the search strategy.
Author contribution
I declare that all named authors have contributed to the manuscript development and have approved the manuscript for publication. Shanna Fealy is the lead reviewer who devised the research protocol undertook database searches, participated in article screening and overall writing and editing of the review. Donovan Jones undertook article screening and data extraction and contributed to the overall writing of the review. Alison Hutton undertook article screening, participated in quality checking
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