Use of a Nonimmersive Virtual Reality System for Clinical Thinking in Obstetric Nursing Education: Mixed Methods...

Traditional obstetric nursing training faces limitations in inadequate interactivity and nonrepeatable demonstrations, limiting students' development of clinical thinking. Virtual reality (VR) offers a solution for complex health care education, enhancing nursing students' clinical thinking.

This study applied the Nonimmersive Virtual Reality System for Clinical Thinking in Obstetric Nursing (NIVRSCTON), grounded in salutogenesis theory, to examine its effects on nursing students.

The NIVRSCTON was applied under the auspices of the Nursing Virtual Teaching Hub in the Coastal Area (NVTHCA). In September 2023, a convenience sample of 88 undergraduate nursing students from 4 partner institutions participated in the study. A single-group pre-post design and an explanatory sequential mixed methods design were used to measure changes in clinical thinking ability following the training and to assess the system's performance. The quantitative assessment tools included the general information questionnaire, the Clinical Thinking Ability Evaluation Scale (CTAES), and the Evaluation Instrument for Virtual Reality System (EIVRS). Each student was required to submit one reflective journal developed in accordance with the Bass model. Quantitative data were analyzed using IBM SPSS (version 22.0), and qualitative data were thematically coded using NVivo (version 12; QSR International Pty Ltd).

After the NIVRSCTON training was completed, the students' overall clinical thinking score increased from 49.08 (SD 11.30) to 80.50 (SD 11.01), indicating a significant improvement (t₈₇=-18.76; Cohen d=-2.82, 95% CI -34.74 to -28.08). All clinical thinking dimension scores improved, and the improvements were all statistically significant (P<.001). Critical thinking scores increased from 13.98 (SD 3.76) to 24.77 (SD 3.11; t₈₇=-20.37; Cohen d=-3.13, 95% CI -11.85 to -9.74), system thinking scores increased from 26.82 (SD 6.40) to 44.51 (SD 6.24; t₈₇=-19.18; Cohen d=-2.80, 95% CI -19.53 to -15.86), and evidence-based thinking scores improved from 18.10 (SD 4.40) to 27.31 (SD 4.61; t₈₇=-13.42; Cohen d=-2.04, 95% CI -10.57 to -7.84). The variable df is all 87. In terms of application effectiveness, the students provided the following ratings: 0.82 (SD 0.15; rated as good) for interface design, 0.82 (SD 0.15; rated as good) for technical performance, 0.83 (SD 0.14; rated as good) for learning content, and 0.85 (SD 0.15; rated as excellent) for learning function. The overall evaluation was 0.82 (SD 0.15; rated as good). Qualitative data revealed that the training not only improved the clinical thinking and decision-making skills of the nursing students but also fostered their professional attitudes, values, and emotions.

NIVRSCTON training enhances students' clinical thinking and professionalism. It was well received, confirming its effectiveness. As an obstetric nursing teaching tool, it enhances clinical thinking and professional competence. It may also promote equity and access in nursing education, offering an innovative model for digital nursing education.