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There are limitations to conducting face-to-face classes following the recent COVID-19 pandemic. Web-based education is no longer a temporary form of teaching and learning during unusual events, such as pandemics, but has proven to be necessary to uphold in parallel with offline education in the future. Therefore, it is necessary to scientifically organize the priorities of a learner needs analysis by systematically and rationally investigating and analyzing the needs of learners for the development of virtual reality (VR) programs for core nursing skills (CNS).
This study aimed to identify the priorities of learners’ needs for the development of VR programs for CNS using the Locus for Focus Model and Borich need assessment model.
The participants included nursing students in South Korea who were in their second year or higher and had taken courses in fundamental nursing or CNS-related classes. The survey took place from May 20 to June 25, 2021. A total of 337 completed questionnaires were collected. Of these, 222 were used to conduct the final analysis. The self-report questionnaire consisted of 3 parts: perception of VR programs, demand for developing VR programs, and general characteristics. The general characteristics of the participants were analyzed using descriptive statistics. To determine the priority of the demand for developing VR programs for CNS, the Locus for Focus Model and the Borich priority formula were used.
In all, 7 skills were identified as being of the top priority for development, including intramuscular injection, intradermal injection, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction.
The analysis showed that nursing students generally needed and prioritized the development of VR programs for the nursing skills involving invasive procedures. The results of this study are intended to help in various practical education classes using VR programs in nursing departments, which are currently facing difficulties in teaching CNS on the web owing to COVID-19.
Nursing education is aimed at ensuring the provision of high-quality nursing services by identifying and responding appropriately to various needs of nursing recipients through theoretical and practical education. Regarding practical training, the Korean Accreditation Board of Nursing Education (KABONE) selected 20 basic and frequently implemented nursing skills in nursing practice as core nursing skills (CNS). CNS are the essential nursing skills that nurses must possess. Moreover, it is recommended to instill these skills in nurses by training them using the theoretical background related and in addition to the skills [
Traditional core nursing practice training in nursing schools is conducted in a way that enables students to directly practice the relevant skills face to face in the practice room using models and others after receiving theoretical and demonstrative education from an educator, such as a professor or practical instructor, who is proficient in technical skills. However, there have been limitations to conducting face-to-face classes following the COVID-19 pandemic. Consequently, web-based classes using webcams have been activated. Web-based education, which is currently being implemented at many universities, is no longer a temporary form of teaching and learning during unusual events, such as pandemics, but has been proven to be necessary to uphold in parallel with offline education in the future [
To overcome the limitations of core nursing practice training conducted through web-based education, a system similar to the actual clinical field in virtual reality (VR) could be built. VR provides a more optimized and immersive learning experience as well as a self-directed and practical learner-centered learning environment for individual learners, allowing them to learn without temporal and spatial limitations in a virtual environment [
In health care and medical fields, it was difficult to find studies on 3D VR–related educational content before 2005. However, active research has been conducted since 2006, with 10 studies published in 2008 and 2010. A total of sixty-two 3D VR–related studies were published in the health care and medical field from 1990 to 2013 [
The development of educational programs begins with conducting a learning needs analysis (LNA) of learners who are end users. Diagnosing and analyzing the exact needs of learners determines participation in adult education and is an essential procedure for verifying the need for education beforehand [
This cross-sectional descriptive study aimed to identify development priorities by analyzing the development needs for CNS-related VR programs for nursing students.
The participants of this study included nursing students in South Korea who were in their second year or higher and had taken courses in fundamental nursing or CNS. The survey took place from May 20 to June 25, 2021. A total of 337 copies of the relevant questionnaire were collected. Of these, 222 (66%) copies were used to conduct the final analysis; participants who did not have experience of a VR program and those who gave blank answers were excluded.
The self-report questionnaire comprised items on the perception of VR programs, VR program development requirements, and the general characteristics of the participants. The author first composed a draft questionnaire based on the literature review and further formed an expert group based on the criteria of Lynn [
The questionnaire on the perception of VR programs comprised 10 items, including items inquiring how much the individuals knew about the concept of a VR program, the necessity of introducing a VR program in the nursing department, and the need for developing VR programs. The answers ranged from 1 point (“strongly disagree”) to 5 points (“strongly agree”) and were scored on a 5-point Likert scale. In this study, Cronbach α was .78.
In this research, the “needs” means the discrepancy between participants’ current status and future importance required to develop the VR program for CNS. Performance competence level (PCL), reflecting the current importance level, and required competence level (RCL), reflecting the priority for developing VR programs, were surveyed for 20 CNS suggested by the KABONE. Answers were given on a 5-point Likert scale, ranging from 1 (“strongly disagree”) to 5 (“strongly agree”). In this study, Cronbach α was .82.
The questionnaire on the general characteristics of the participants comprised 9 items, including the total credits for the CNS, age, sex, etc.
The collected data were coded and analyzed using SPSS statistics software (version 25.0; IBM Corp). The general characteristics of the participants were analyzed using descriptive statistics, such as frequencies and percentages, as well as means and SDs. To determine the priority of the demand for developing VR programs for CNS, the analysis method of Cho [
First, the significance of the average difference between the PCL and RCL was analyzed using a 2-tailed
Second, Borich priority was calculated to determine the priority of the development of VR programs of CNS [
RCL is each individual’s current importance level of CNS score, PCL is each individual’s importance level for developing VR programs of CNS score,
Third, priorities were visualized using the LFM. The items belonging to the first quadrant, higher than the average value of the RCL and PCL, were determined as priorities. The LFM is shown in
Finally, both Borich priority and the LFM were combined to determine the highest priority. The LFM is a simple quadrant plot, but when used with the Borich formula, it has the advantage of comprehensively considering the current status and future importance of training needs and the discrepancy between the 2. Specifically, if 10 needs fall into the HH quadrant in the LFM, we checked whether those 10 needs are also ranked as the top 10 priorities by the Borich formula. If so, those needs were considered to have the highest priority.
The Locus for Focus Model.
A recruitment notice introducing the study, including the research purpose, ethics protocol, and survey URL, was posted on a social networking site frequently visited by nursing students. Students who wished to participate completed a web-based survey in Google Forms. The first question required participants to confirm their informed consent to take part in the study. The form advised participants that they could withdraw at any time and that their data would be used only for security maintenance and research purposes. No personal information, such as names and email addresses, was collected to ensure participants’ anonymity.
This study was approved by the Institutional Review Board of Wonkwang University (approval WKIRB-202011-SB-078).
A total of 222 nursing students participated in the survey, among whom women were the majority (n=201, 90.5% vs men, n=21, 9.5%), with an average age of 23.3 (SD 3.33) years. Most participants (n=95, 42.8%) were third-year students. Regarding the contents of VR programs experienced in real life, games were the most common (42/308, 13.6%), followed by movies or dramas (39/308, 12.7%). Unlike experience in real life, only 27 (N=222, 12.2%) students experienced VR in university subjects, with nursing-related subjects being the most frequent (20/44, 45.5%;
General characteristics of participants (n=222).
Characteristic | Value | |
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Male | 21 (9.5) |
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Female | 201 (90.5) |
Age (years), mean (SD) | 23.3 (3.33) | |
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Second year | 36 (16.2) |
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Third year | 95 (42.8) |
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Fourth year | 91 (41) |
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Seoul capitol | 50 (22.5) |
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Metropolitan city | 60 (27) |
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Province | 112 (50.5) |
Nursing practice credits, mean (SD) | 3.65 (1.5) | |
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Game | 42 (13.6) |
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Movie or drama | 39 (12.7) |
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Education | 34 (11) |
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Travel or sightseeing | 34 (11) |
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Shopping | 31 (10.1) |
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Sports | 17 (5.5) |
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Concert | 10 (3.2) |
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Others | 1 (0.3) |
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Yes | 27 (12.2) |
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No | 195 (87.8) |
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Nursing | 20 (45.5) |
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Engineering | 8 (18.2) |
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Media, architecture, or costume | 5 (11.4) |
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Art or music | 5 (11.4) |
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Pure science | 3 (6.8) |
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History | 3 (6.8) |
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English | 0 (0) |
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Others | 0 (0) |
aVR: virtual reality.
The overall perception of the VR program (calculated as the mean score for the 10 survey items) was 3.57 (SD 0.57), which was above average. Regarding the questionnaire items, the subjects showed the most positive response to the items indicating that the core nursing VR program would enhance clinical performance (mean 3.90, SD 0.98) and the quality of CNS (mean 3.90, SD 0.95). In contrast, the items “How much do you think you know about the concept of VR?”(mean 3.22, SD 0.90) and “Do you think VR products have become popular?” (mean 3.22, SD 0.92) had the lowest score but moderate-to-high levels of awareness (
Perception of virtual reality (VR) programs (N=222).
No | Items | Score, mean (SD) |
1 | Do you think that VR products have become popular? | 3.22 (0.92) |
2 | How much do you think you know about the concept of VR? | 3.22 (0.90) |
3 | Do you think that the nursing department needs to introduce VR programs? | 3.60 (0.90) |
4 | Do you think that it is necessary to develop a VR program for teaching CNSa? | 3.75 (0.90) |
5 | Do you think that the CNS VR program will enhance clinical performance such as imparting technical skills? | 3.90 (0.98) |
6 | Do you think that the CNS VR program will help improve critical thinking? | 3.40 (1.06) |
7 | Do you think that the CNS VR program will help improve communication? | 3.35 (1.06) |
8 | Do you think that the CNS VR program will help in decision-making? | 3.58 (1.09) |
9 | Do you think that the CNS VR program will enhance the quality of CNS lectures? | 3.90 (0.95) |
10 | Do you think that the CNS VR program can replace face-to-face CNS lecture? | 3.25 (1.21) |
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Total | 3.57 (0.57) |
aCNS: core nursing skills.
To find out the needs of nursing students for the development of the CNS VR program, the 2-tailed
Results of paired 2-tailed t test and the Borich needs assessment model for the demand of the development of virtual reality (VR) programs (N=222).
No | Core nursing skills | PCLa, mean (SD) | RCLb, mean (SD) | Mean difference, mean (SD) | Borich | |||
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Needs | Rank |
1 | Vital sign | 3.69 (1.08) | 4.19 (0.97) | 0.50 (1.42) | 5.20 | <.001 | 2.08 | 12 |
2 | Administration of oral medication | 3.64 (0.93) | 3.97 (1.12) | 0.33 (1.29) | 3.79 | <.001 | 1.30 | 19 |
3 | Administration of IMc injection | 3.73 (1.18) | 4.45 (0.79) | 0.73 (1.25) | 8.69 | <.001 | 3.25 | 2 |
4 | Administration of SQd injection | 3.99 (0.97) | 4.33 (0.98) | 0.34 (1.31) | 3.89 | <.001 | 1.48 | 18 |
5 | Administration of IDe injection | 3.82 (1.09) | 4.42 (0.87) | 0.61 (1.27) | 7.15 | <.001 | 2.69 | 5 |
6 | IVf infusion | 4.00 (1.08) | 4.27 (1.19) | 0.26 (1.51) | 2.58 | .011 | 1.11 | 20 |
7 | Blood transfusion | 3.90 (10.6) | 4.42 (0.84) | 0.53 (1.15) | 6.84 | <.001 | 2.33 | 9 |
8 | Tube feeding | 3.73 (1.09) | 4.39 (0.95) | 0.66 (1.25) | 7.91 | <.001 | 2.91 | 3 |
9 | Urinary catheterization | 3.93 (0.97) | 4.35 (0.93) | 0.42 (1.11) | 5.63 | <.001 | 1.82 | 16 |
10 | Foley catheterization | 3.93 (1.08) | 4.34 (1.06) | 0.41 (1.32) | 4.62 | <.001 | 1.78 | 17 |
11 | Enema | 3.65 (1.05) | 4.40 (0.88) | 0.75 (1.10) | 10.16 | <.001 | 3.29 | 1 |
12 | Preoperative care | 3.68 (1.03) | 4.19 (0.92) | 0.51 (1.20) | 6.38 | <.001 | 2.15 | 11 |
13 | Postoperative care | 3.77 (1.07) | 4.37 (0.86) | 0.60 (1.16) | 7.67 | <.001 | 2.62 | 6 |
14 | Admission care | 3.50 (1.03) | 3.97 (1.21) | 0.47 (1.40) | 5.04 | <.001 | 1.88 | 14 |
15 | Gowning and gloving technique | 3.72 (1.01) | 4.18 (1.01) | 0.46 (1.25) | 5.46 | <.001 | 1.92 | 13 |
16 | Pulse oximeter and EKGg monitoring | 3.68 (1.06) | 4.24 (0.98) | 0.56 (1.27) | 6.60 | <.001 | 2.39 | 7 |
17 | Supplying oxygen via nasal cannula | 3.73 (1.06) | 4.36 (0.93) | 0.63 (1.16) | 8.10 | <.001 | 2.75 | 4 |
18 | Endotracheal suction | 3.80 (1.11) | 4.34 (1.05) | 0.54 (1.28) | 6.30 | <.001 | 2.34 | 8 |
19 | Tracheostomy tube care | 3.86 (1.04) | 4.29 (1.06) | 0.43 (1.23) | 5.25 | <.001 | 1.85 | 15 |
20 | CPRh and using defibrillator | 3.96 (1.10) | 4.45 (0.80) | 0.50 (1.17) | 6.30 | <.001 | 2.21 | 10 |
aPCL: performance competence level.
bRCL: required competence level.
cIM: Intramuscular.
dSQ: subcutaneous.
eID: intradermal.
fIV: Intravenous.
gEKG: electrocardiogram.
hCPR: cardiopulmonary resuscitation.
In the analysis of the priority for the development of a VR program using the LFM, the average RCL for the development of a VR program for CNS was 4.30, and the average level of the difference between the RCL and PCL was 0.51. As a result of dividing the coordinate planes using these averages as an axis, 8 items such as IM injection, ID injection, blood transfusion, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction were included in the HH quadrant (
Finally, both Borich priority and the LFM were combined to determine the highest priority. In other words, any number of the 8 items of the first quadrant (HH) using the LFM and the 8 items of the Borich ranking priority could be selected. As a result, 7 items were included in the top priority for development, including IM injection, ID injection, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction (
Visualization of priority of the development needs of a virtual reality program using the Locus for Focus Model. C: core nursing skill; HH: high-discrepancy, high-importance; PCL: present competency level; RCL: required competency level.
Top-priority developmental needs for core nursing skills according to Borich needs assessment model and the Locus for Focus Model (LFM).
No | Core nursing skill | Borich rank | LFM quadrant | Top priority |
1 | Vital sign | 12 | LLa |
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2 | Administration of oral medication | 19 | LL |
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3 | Administration of IMb injection | 2 | HHc | ✓d |
4 | Administration of SQe injection | 18 | LHf |
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5 | Administration of IDg injection | 5 | HH | ✓ |
6 | IVh infusion | 20 | LL |
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7 | Blood transfusion | 9 | HH |
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8 | Tube feeding | 3 | HH | ✓ |
9 | Urinary catheterization | 16 | LH |
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10 | Foley catheterization | 17 | LH |
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11 | Enema | 1 | HH | ✓ |
12 | Preoperative care | 11 | LL |
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13 | Postoperative care | 6 | HH | ✓ |
14 | Admission care | 14 | LL |
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15 | Gowning and gloving technique | 13 | LL |
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16 | Pulse oximeter and EKGi monitoring | 7 | HLj |
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17 | Supplying oxygen via nasal cannula | 4 | HH | ✓ |
18 | Endotracheal suction | 8 | HH | ✓ |
19 | Tracheostomy tube care | 15 | LL |
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20 | CPRk and using defibrillator | 10 | LH |
|
aLL: low discrepancy, low importance.
bIM: intramuscular.
cHH: high discrepancy, high importance.
d✓: indicates the highest priority for developing into virtual reality programs.
eSQ: subcutaneous.
fLH: low discrepancy, high importance.
gID: intradermal.
hIV: intravenous.
iEKG: electrocardiogram.
jHL: high discrepancy, low importance.
kCPR: cardiopulmonary resuscitation.
The purpose of this study was to use the Borich priority formula and LFM to understand which CNS most require the development of VR programs to meet the needs of nursing students.
The study participants comprised 222 students in their second year or higher, who had taken courses on fundamental nursing or CNS and had experienced VR programs. Although 72.8% of the participants experienced VR programs in their daily lives, only 12.2% used them in the university curriculum. The participants showed the lowest score (mean 3.22, SD 0.90) for the questionnaire item regarding the concept of VR. This appeared to be consistent with the previous research results, which indicated that only 61.6% of students who had heard of VR or augmented reality (AR) before (99.7%) said they could accurately distinguish between VR and AR [
Based on the results of this study, the participants identified the differences between the PCL and RCL in developing VR programs for CNS. In other words, the PCL was statistically significantly lower than the RCL for all the items. This result means participants showed awareness of the need to develop VR programs when there is a difference between the PCL and RCL [
In the last step, the items and number of items in the HH quadrant of the LFM, as well as the same number of priority items according to the Borich needs assessment, were identified to determine the overlapping items in the 2 methods. As a result of the analysis, a total of 7 items, including IM injection, ID injection, tube feeding, enema, postoperative care, supplying oxygen via nasal cannula, and endotracheal suction, were found to be the top-priority items for the development of a VR program.
This result was similar with the items identified in previous studies, indicating that new graduate nurses and nursing students had the lowest confidence in the necessary skills for enemas, tracheostomy tube care, tube feeding, postoperative care, etc [
Previous related studies indicated that students who undergo CNS training through a VR program were able to minimize possible harm to patients when exposed to the actual clinical environment [
Education comprises 3 elements: the educator, student, and educational content. The “student” variable is considered the most important factor in determining the quality of educational performance. Students are the end consumers of all the content provided in the curriculum and are substantially influenced in terms of their career paths through the enhancement of their abilities and competencies. Therefore, it is essential to first analyze the needs of learners and configure the curriculum accordingly in the new, normal post–COVID-19 era. Particularly, in the field of nursing, where practical education occupies a large part of the curriculum, it is necessary to identify the needs of students for practical education and develop a curriculum that reflects them [
This study has the following limitations. First, in terms of study participants and sampling, the survey was conducted on a website visited by many nursing students. Therefore, it was not possible to perform more precise sampling by region and year of university. This limits generalization in the interpretation and application of the research results. Therefore, there is need for future research to increase the possibility of generalization through sampling by region and year of university. Second, there is a need for further research according to demographic characteristics, such as how participants take relevant classes (face to face or remotely) or their exposure to clinical or VR training. Previous studies on confidence in CNS showed differences in difficulty and confidence depending on the general characteristics of the subjects. In other words, conducting research by considering the variables more comprehensively according to the demographic characteristics of participants, such as how they take CNS-related courses, will enable the development of more practical and systematic VR programs for teaching CNS, providing appropriate content for students in each year of university. Third, this study was conducted among nursing students. Therefore, there is a need to conduct studies with participants with various experiences, such as new nurses or preceptors. In other words, it will be possible to establish a continuous and virtuous cycle of learning that connects schools to hospitals and back to schools by examining the training methods and confidence in CNS for new nurses and reflecting these results back into the curriculum of the university.
There are many studies on CNS, but there are no studies examining the needs of students following the development of CNS VR programs. As there are no studies similar to this study, it is difficult to compare its results with those of previous studies.
Nursing education is aimed at acquiring and integrating knowledge, attitudes, and skills to solve health problems through lectures and practice. CNS are practical skills that each individual nursing student must acquire through repeated practice before clinical practice, requiring self-directed learning capabilities. The analysis of the development demands and priorities for developing VR programs for CNS showed that nursing students generally asked for the development of VR programs for nursing skills that involved invasive procedures. The results of this study are intended to help various aspects of in-school practical education using VR programs in nursing departments, which are currently facing difficulties in teaching CNS on the web owing to COVID-19.
augmented reality
core nursing skills
content validity index
high discrepancy, high importance
Item–content validity index
intradermal
intramuscular
intravenous
Korean Accreditation Board of Nursing Education
Locus for Focus Model
low discrepancy, low importance
learning needs analysis
present competency level
required competency level
subcutaneous
virtual reality
This research was supported by the research fund of Wonkwang University in 2022.
Both authors listed in this publication conducted the research. EJ and JL were responsible for study conception and design. JL collected the data. EJ and JL analyzed and interpreted the results. EJ and JL wrote the article. Both authors reviewed the results and approved the final version of the manuscript.
None declared.