Application of head-mounted display-based augmented and mixed reality in nursing education: a scoping review

With Generation Z becoming the primary group of nursing learners and the increasing shortage of nursing education resources, augmented reality and mixed reality based on head-mounted displays are being used more and more in nursing education. However, the current application landscape and the proper usage of these concepts remain unclear. Therefore, this study aims to conduct a scoping review to explore the current applications of head-mounted display-based augmented reality and mixed reality in nursing education and to clarify the definitions and usage of the concepts of augmented reality and mixed reality, ultimately providing directions for future applications and research.

Based on the five-stage framework and PRISMA-ScR guidelines, a comprehensive collection and summarization of evidence regarding the application of head-mounted display-based augmented reality and mixed reality in nursing education were conducted. The databases retrieved include CNKI, Wanfang Database, VIP, CBM, PubMed, Cochrane Library, Embase, CINAHL, Web of Science, Scopus, IEEE Xplore, ACM Digital Library, and Ei. The languages of the included literature are Chinese and English. The retrieval was up to October 2024.

A total of 44 studies were included in this review, covering three types of head-mounted displays: immersive head-mounted displays, smart glasses, and smartphone-based head-mounted displays. The main application areas were skills training and knowledge acquisition. Most of the studies were feasibility studies, though they also included some efficacy studies and research on personal experiences. In addition, these studies often employed vague or inconsistent definitions of augmented reality and mixed reality.

Despite various explorations in the application of head-mounted display-based augmented reality and mixed reality in nursing education, there is still room for improvement in the relevant theory and utilization of this technology. In the future, interventions should use the three dimensions (observation of reality, real - virtual interaction, and fidelity of virtuality) described in detail, rather than simply employing the concepts of augmented reality or mixed reality. Efforts should be concentrated on developing and implementing head-mounted displays combined with other technologies that boast enhanced performance and cost - effectiveness, and further validating their effectiveness.