Ignite Creation Date:
2024-10-26 @ 3:36 PM
Last Modification Date:
2024-10-26 @ 3:36 PM
Study NCT ID:
NCT06536361
Status:
COMPLETED
Last Update Posted:
None
First Post:
2024-07-23
Brief Title:
Impact of a VR-Based Learning Tool on Nursing Students Skills in Thorax and Lung Examination
Sponsor:
None
Organization:
None
Study Overview
Official Title:
The Effect of a Virtual Reality-Based Learning Tool on Nursing Students Knowledge and Skills in Thorax and Lung Physical Examination
Status:
COMPLETED
Status Verified Date:
2024-07
Last Known Status:
None
Delayed Posting:
No
If Stopped, Why?:
Not Stopped
Has Expanded Access:
No
If Expanded Access, NCT#:
N/A
Has Expanded Access, NCT# Status:
N/A
Acronym:
None
Brief Summary:
Short Title Impact of VR-Based Learning Tools on Nursing Students Thoracic and Lung Examination Skills
Short Summary This study evaluates the impact of a virtual reality VR based learning tool on nursing students knowledge and skills in thoracic and lung physical examinations Designed as a single-blind pre-test-post-test control group parallel-group randomized controlled trial in accordance with SPIRIT 2013 guidelines the study was conducted with 82 second-year nursing students from Gazi University comprising 41 students in the experimental group and 41 in the control group Initially participants were informed about the study and received theoretical training during the first week The second week included a review through demonstration videos while the third week involved hands-on practice using high-fidelity simulators in a skills lab for auscultation and physical examination The final exam was administered in the fifth week Participants meeting eligibility criteria were stratified by gender and academic performance then randomly assigned to groups by an independent statistician Pre-reading materials were distributed one week before the intervention followed by an evaluation of knowledge and skill levels The experimental group underwent VR-based training whereas the control group received traditional instruction Final assessments of knowledge and skills were conducted one week post-training Data collection included demographic forms knowledge tests skill assessments and student feedback Blinding was applied to evaluators participants and statisticians to minimize bias Data analysis will employ statistical software utilizing parametric tests for normally distributed data and non-parametric tests for non-normally distributed data
Study Type Interventional Study Design Single-blind pre-test-post-test control group parallel-group randomized controlled trial
Primary Outcomes
Knowledge and skill levels Measured by knowledge tests and skill assessment forms
Secondary Outcomes
Participant feedback on the VR-based learning tool Assessed through student feedback forms
Eligibility Criteria
Second-year nursing students at Gazi University enrolled in the Health Assessment course who have passed with at least a CC grade have an academic success score between 200 and 400 are willing to participate and do not have visual impairments affecting depth perception eg amblyopia anisometropia strabismus
Short Summary This study evaluates the impact of a virtual reality VR based learning tool on nursing students knowledge and skills in thoracic and lung physical examinations Designed as a single-blind pre-test-post-test control group parallel-group randomized controlled trial in accordance with SPIRIT 2013 guidelines the study was conducted with 82 second-year nursing students from Gazi University comprising 41 students in the experimental group and 41 in the control group Initially participants were informed about the study and received theoretical training during the first week The second week included a review through demonstration videos while the third week involved hands-on practice using high-fidelity simulators in a skills lab for auscultation and physical examination The final exam was administered in the fifth week Participants meeting eligibility criteria were stratified by gender and academic performance then randomly assigned to groups by an independent statistician Pre-reading materials were distributed one week before the intervention followed by an evaluation of knowledge and skill levels The experimental group underwent VR-based training whereas the control group received traditional instruction Final assessments of knowledge and skills were conducted one week post-training Data collection included demographic forms knowledge tests skill assessments and student feedback Blinding was applied to evaluators participants and statisticians to minimize bias Data analysis will employ statistical software utilizing parametric tests for normally distributed data and non-parametric tests for non-normally distributed data
Study Type Interventional Study Design Single-blind pre-test-post-test control group parallel-group randomized controlled trial
Primary Outcomes
Knowledge and skill levels Measured by knowledge tests and skill assessment forms
Secondary Outcomes
Participant feedback on the VR-based learning tool Assessed through student feedback forms
Eligibility Criteria
Second-year nursing students at Gazi University enrolled in the Health Assessment course who have passed with at least a CC grade have an academic success score between 200 and 400 are willing to participate and do not have visual impairments affecting depth perception eg amblyopia anisometropia strabismus
Detailed Description:
Purpose of the Research The study was designed to determine the effect of a virtual reality VR-based learning tool for thorax and lung physical examination on nursing students knowledge and skills related to thorax and lung physical examination
Hypotheses of the Study
Hypothesis 0-1 There is no significant difference in the knowledge of thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 1-1 There is a significant difference in the knowledge of thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 0-2 There is no significant difference in the skills related to thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 1-2 There is a significant difference in the skills related to thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Research Question What are the opinions of students in the experimental group regarding the use of the VR-based thorax and lung physical examination learning tool Variables of the Study
Independent Variables
Training Method Small group instruction for the control group VR-based thorax and lung physical examination learning tool for the experimental group
Dependent Variables
Knowledge Level Knowledge as measured by pre-test and post-test results Skill Level Skill level assessed by pre-skill and post-skill measurements
Control Variables
Participants gender Participants course achievement scores Materials and Method Type of Research This study was designed as a single-blind pretest-posttest control group parallel-group randomized controlled trial The study was conducted in accordance with the SPIRIT 2013 guidelines To minimize bias the study protocol will be registered in the Clinical Trials registration system
Location Characteristics and Time of the Research The study was conducted with students enrolled in the elective course Health Assessment HEM 205 at Gazi University Faculty of Nursing during the 2023-2024 academic year This two-credit elective course covers physical examination methods and techniques both theoretically and practically Theoretical instruction occurs in classrooms while practical training is provided in skills and simulation laboratories by field experts
Population and Sample of the Study The study population comprised second-year nursing students who had successfully completed their first year and were enrolled in the second year during the 2023-2024 academic year and who selected the Health Assessment elective course HEM 205 for the first time The sample size for the study was calculated using GPower version 3197 software The sample size calculation in GPower utilized a t-test to assess the mean difference between two independent groups with a priori values of α 005 power 090 and a large effect size f 080 Cohens d Based on the statistical analysis a total sample of 68 participants was determined with 34 assigned to the control group and 34 to the experimental group In experimental research it is critical to keep participant loss below 20 to minimize bias and increasing the sample size helps control for potential bias due to attrition To address potential losses the study aimed to include 41 participants in each group resulting in a total sample size of 82 participants
Randomization The randomization process was conducted in accordance with the CONSORT 2017 guidelines An independent statistician stratified participants based on their achievement scores in the Health Assessment course and their gender Female students with achievement scores between 200-300 CC CB BB were placed in the first stratum while those with scores between 301-400 BA AA were placed in the second stratum Male students with achievement scores between 200-300 CC CB BB were assigned to the third stratum and those with scores between 301-400 BA AA were assigned to the fourth stratum The statistician then performed simple randomization within each stratum using Excel software resulting in random assignment of 41 students to the experimental group and 41 students to the control group
Data Collection Tools Descriptive Characteristics Form Developed by the researcher based on the literature this form consists of fourteen questions It includes eight questions regarding the demographic characteristics of the participants one question concerning their eye health one question about their willingness to choose the nursing profession and four questions related to their technological attitudes
Thorax and Lung Physical Examination Knowledge Test Created by the researcher in alignment with the subject scope and learning objectives of the theoretical course on thorax and lung physical examination This test comprises 20 questions with five options each assessing knowledge necessary for performing thorax and lung physical examinations Each question is scored out of 5 points with higher scores indicating greater knowledge levels
Thorax and Lung Physical Examination Skill Control Form Designed to assess the initial and final skill levels of the students This form developed in accordance with the literature includes a total of 48 procedural steps Scores range from 0 to 96 with higher scores reflecting higher skill levels
Student Opinion Form Prepared by the researcher following relevant literature to gauge student opinions on the VR-based learning tool This form has two sections The first section based on the technology acceptance model and literature review consists of 29 items evaluating the ease of use 14 items and perceived usefulness 15 items of the VR tool The second section contains six open-ended questions about the VR-based thorax and lung physical examination learning tool
Content Validity Analysis Content validity was assessed by consulting 13 experts in physical examination methods and innovative digital education They rated the forms on a 4-point Likert scale 4 Very appropriate 3 Appropriate with minor adjustments 2 Appropriate with major adjustments 1 Not appropriate regarding purpose objectives language and expression Expert opinions were analyzed using Daviss technique to calculate the content validity index and agreement was tested with Kendalls W
Designing a VR-Based Learning Tool
In designing the VR-based thorax and lung physical examination learning tool the Healthcare Implementation Standards of Best Practice Simulation Design guide provided by the International Nursing Association for Clinical Simulation and Learning INACSL was used as the foundation The design process was structured as follows
Analysis Phase The researcher completed training necessary for effective simulation design Existing training methods of the target group were evaluated through SWOT analysis The objectives of the learning tool were defined using SMART analysis
Design Phase The relevant literature was reviewed to determine the simulation method and scenario to be employed The interaction methods within the VR learning tool and the scenario outline were developed
Development Phase High-quality graphics models and interaction methods were utilized to enhance the realism of the learning tool Facilitative approaches were planned to support the participants learning process
Implementation Phase Materials to guide the learning tool were prepared The PEARLS method was employed to evaluate the learning tool following the simulation implementation The tools applicability and usability were assessed by participants and necessary adjustments were made based on the feedback received from the pre-application
Pre-Application To evaluate the VR-based learning tool and data collection instruments a pre-application was conducted with third-year students at Gazi University Faculty of Nursing who had previously completed the elective course Health Assessment coded HEM 205 This pre-application assessed the clarity of the data collection tools in terms of language and expression as well as the usability of the VR-based learning tool
Application
In the first week of the study all participants underwent theoretical training The second week included a review of the topic through demonstration videos and skills training in the simulation laboratory was conducted in the third week By the fifth week all participants completed the final exam Participants were then stratified and assigned to research groups based on their gender and course achievement scores
The VR-based thorax and lung physical examination learning tool for the experimental group was designed and developed over a period of five months During this time all necessary preparations were completed Pre-reading materials and demonstration videos were distributed to the participants Seven days following the distribution of these materials initial knowledge and skill assessments were conducted
Practical training took place seven days after the initial assessments The control group received 55 minutes of training in groups of 8 which included 7 minutes for an overview of the training purpose and content 40 minutes for hands-on practice 5 minutes per student and 8 minutes for feedback The experimental group used the VR-based tool for 35 minutes which comprised 7 minutes for an introduction to the Oculus Meta Quest 3 20 minutes for skill practice on a virtual patient and 8 minutes for a debriefing session
Final knowledge and skill assessments were carried out seven days post-intervention The experimental group participants completed the Student Opinion Form to provide feedback on the usability and applicability of the VR-based tool Additionally they received further training with the VR-based tool after the completion of all measurements and evaluations
Analysis Data will be analyzed using a computer program The normal distribution of variables will be assessed through histograms coefficient of variation skewness kurtosis Kolmogorov-Smirnov and Shapiro-Wilk tests p005 Descriptive statistics number percentage mean standard deviation and Chi-square tests will be used Parametric tests will be applied to normally distributed data while non-parametric tests will be applied to non-normally distributed data An independent sample t-test will be used for comparisons between two independent groups ANOVA with Bonferroni correction for comparisons among more than two groups and analysis of variance for repeated measures For non-normally distributed data Mann-Whitney U and Kruskal-Wallis H tests with Bonferroni correction will be applied Randomization balance will be maintained using Intention-to-Treat ITT analysis
Limitations of the Study This study was conducted exclusively with second-year students enrolled at the Faculty of Nursing of a university in Turkey This limitation affects the generalizability of the research findings as the results may not be directly applicable to other student populations or educational settings
Hypotheses of the Study
Hypothesis 0-1 There is no significant difference in the knowledge of thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 1-1 There is a significant difference in the knowledge of thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 0-2 There is no significant difference in the skills related to thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Hypothesis 1-2 There is a significant difference in the skills related to thorax and lung physical examination between students in the experimental group using the VR-based learning tool and students in the control group receiving small group instruction
Research Question What are the opinions of students in the experimental group regarding the use of the VR-based thorax and lung physical examination learning tool Variables of the Study
Independent Variables
Training Method Small group instruction for the control group VR-based thorax and lung physical examination learning tool for the experimental group
Dependent Variables
Knowledge Level Knowledge as measured by pre-test and post-test results Skill Level Skill level assessed by pre-skill and post-skill measurements
Control Variables
Participants gender Participants course achievement scores Materials and Method Type of Research This study was designed as a single-blind pretest-posttest control group parallel-group randomized controlled trial The study was conducted in accordance with the SPIRIT 2013 guidelines To minimize bias the study protocol will be registered in the Clinical Trials registration system
Location Characteristics and Time of the Research The study was conducted with students enrolled in the elective course Health Assessment HEM 205 at Gazi University Faculty of Nursing during the 2023-2024 academic year This two-credit elective course covers physical examination methods and techniques both theoretically and practically Theoretical instruction occurs in classrooms while practical training is provided in skills and simulation laboratories by field experts
Population and Sample of the Study The study population comprised second-year nursing students who had successfully completed their first year and were enrolled in the second year during the 2023-2024 academic year and who selected the Health Assessment elective course HEM 205 for the first time The sample size for the study was calculated using GPower version 3197 software The sample size calculation in GPower utilized a t-test to assess the mean difference between two independent groups with a priori values of α 005 power 090 and a large effect size f 080 Cohens d Based on the statistical analysis a total sample of 68 participants was determined with 34 assigned to the control group and 34 to the experimental group In experimental research it is critical to keep participant loss below 20 to minimize bias and increasing the sample size helps control for potential bias due to attrition To address potential losses the study aimed to include 41 participants in each group resulting in a total sample size of 82 participants
Randomization The randomization process was conducted in accordance with the CONSORT 2017 guidelines An independent statistician stratified participants based on their achievement scores in the Health Assessment course and their gender Female students with achievement scores between 200-300 CC CB BB were placed in the first stratum while those with scores between 301-400 BA AA were placed in the second stratum Male students with achievement scores between 200-300 CC CB BB were assigned to the third stratum and those with scores between 301-400 BA AA were assigned to the fourth stratum The statistician then performed simple randomization within each stratum using Excel software resulting in random assignment of 41 students to the experimental group and 41 students to the control group
Data Collection Tools Descriptive Characteristics Form Developed by the researcher based on the literature this form consists of fourteen questions It includes eight questions regarding the demographic characteristics of the participants one question concerning their eye health one question about their willingness to choose the nursing profession and four questions related to their technological attitudes
Thorax and Lung Physical Examination Knowledge Test Created by the researcher in alignment with the subject scope and learning objectives of the theoretical course on thorax and lung physical examination This test comprises 20 questions with five options each assessing knowledge necessary for performing thorax and lung physical examinations Each question is scored out of 5 points with higher scores indicating greater knowledge levels
Thorax and Lung Physical Examination Skill Control Form Designed to assess the initial and final skill levels of the students This form developed in accordance with the literature includes a total of 48 procedural steps Scores range from 0 to 96 with higher scores reflecting higher skill levels
Student Opinion Form Prepared by the researcher following relevant literature to gauge student opinions on the VR-based learning tool This form has two sections The first section based on the technology acceptance model and literature review consists of 29 items evaluating the ease of use 14 items and perceived usefulness 15 items of the VR tool The second section contains six open-ended questions about the VR-based thorax and lung physical examination learning tool
Content Validity Analysis Content validity was assessed by consulting 13 experts in physical examination methods and innovative digital education They rated the forms on a 4-point Likert scale 4 Very appropriate 3 Appropriate with minor adjustments 2 Appropriate with major adjustments 1 Not appropriate regarding purpose objectives language and expression Expert opinions were analyzed using Daviss technique to calculate the content validity index and agreement was tested with Kendalls W
Designing a VR-Based Learning Tool
In designing the VR-based thorax and lung physical examination learning tool the Healthcare Implementation Standards of Best Practice Simulation Design guide provided by the International Nursing Association for Clinical Simulation and Learning INACSL was used as the foundation The design process was structured as follows
Analysis Phase The researcher completed training necessary for effective simulation design Existing training methods of the target group were evaluated through SWOT analysis The objectives of the learning tool were defined using SMART analysis
Design Phase The relevant literature was reviewed to determine the simulation method and scenario to be employed The interaction methods within the VR learning tool and the scenario outline were developed
Development Phase High-quality graphics models and interaction methods were utilized to enhance the realism of the learning tool Facilitative approaches were planned to support the participants learning process
Implementation Phase Materials to guide the learning tool were prepared The PEARLS method was employed to evaluate the learning tool following the simulation implementation The tools applicability and usability were assessed by participants and necessary adjustments were made based on the feedback received from the pre-application
Pre-Application To evaluate the VR-based learning tool and data collection instruments a pre-application was conducted with third-year students at Gazi University Faculty of Nursing who had previously completed the elective course Health Assessment coded HEM 205 This pre-application assessed the clarity of the data collection tools in terms of language and expression as well as the usability of the VR-based learning tool
Application
In the first week of the study all participants underwent theoretical training The second week included a review of the topic through demonstration videos and skills training in the simulation laboratory was conducted in the third week By the fifth week all participants completed the final exam Participants were then stratified and assigned to research groups based on their gender and course achievement scores
The VR-based thorax and lung physical examination learning tool for the experimental group was designed and developed over a period of five months During this time all necessary preparations were completed Pre-reading materials and demonstration videos were distributed to the participants Seven days following the distribution of these materials initial knowledge and skill assessments were conducted
Practical training took place seven days after the initial assessments The control group received 55 minutes of training in groups of 8 which included 7 minutes for an overview of the training purpose and content 40 minutes for hands-on practice 5 minutes per student and 8 minutes for feedback The experimental group used the VR-based tool for 35 minutes which comprised 7 minutes for an introduction to the Oculus Meta Quest 3 20 minutes for skill practice on a virtual patient and 8 minutes for a debriefing session
Final knowledge and skill assessments were carried out seven days post-intervention The experimental group participants completed the Student Opinion Form to provide feedback on the usability and applicability of the VR-based tool Additionally they received further training with the VR-based tool after the completion of all measurements and evaluations
Analysis Data will be analyzed using a computer program The normal distribution of variables will be assessed through histograms coefficient of variation skewness kurtosis Kolmogorov-Smirnov and Shapiro-Wilk tests p005 Descriptive statistics number percentage mean standard deviation and Chi-square tests will be used Parametric tests will be applied to normally distributed data while non-parametric tests will be applied to non-normally distributed data An independent sample t-test will be used for comparisons between two independent groups ANOVA with Bonferroni correction for comparisons among more than two groups and analysis of variance for repeated measures For non-normally distributed data Mann-Whitney U and Kruskal-Wallis H tests with Bonferroni correction will be applied Randomization balance will be maintained using Intention-to-Treat ITT analysis
Limitations of the Study This study was conducted exclusively with second-year students enrolled at the Faculty of Nursing of a university in Turkey This limitation affects the generalizability of the research findings as the results may not be directly applicable to other student populations or educational settings
Study Oversight
Has Oversight DMC:
None
Is a FDA Regulated Drug?:
None
Is a FDA Regulated Device?:
None
Is an Unapproved Device?:
None
Is a PPSD?:
None
Is a US Export?:
None
Is an FDA AA801 Violation?:
None