Nursing Student Perceptions of Presence in a Virtual Learning Environment: A Qualitative Description Study

Abstract

Multifaceted approaches to learning are used for educating student nurses. One common teaching modality in nursing education, simulation, provides hands-on experiences in a safe environment to prepare student nurses for professional roles. High quality simulation standards recommend an engaging immersive experience, with physical, emotional, and conceptual fidelity to clinical practice. Presence is the perception of being there in a simulation as if it were real. Studies have reported improved learning outcomes with increased sense of presence. A simulation modality seldom used in nursing education is virtual reality simulation (VR-Sim) a three dimensional, immersive experience. VR-Sim with head mounted visual and haptic enhancements has the potential to increase presence and improve learning. Student perceptions of presence in VR-Sim is unknown. The purpose of this study was to explore student nurses’ perceptions of presence during simulation. A qualitative description design included a VR-Sim of a patient needing cardiopulmonary resuscitation (CPR). Each participant (N=11) performed two repetitions in the VR-Sim followed by debriefing and a guided interview. The conceptual framework for the study was informed by extant literature including theoretical frameworks. Two research questions guided the study to 1) explore student perceptions of presence in VR-Sim and 2) align findings with current theories of simulation and presence. Braun and Clarke’s (2006) steps for theme development and Saldaña’s (2016) coding informed the data analysis. For Research Question 1, three themes and eight subthemes described participants perceptions of being there in the VR-Sim environment. Findings showed all participants reported experiencing presence during the simulation (Theme: What Brought Me In, What Brought Me Out), but glitches, feel of compressions, and sensing the real physical environment outside the simulation interrupted the experience of presence (Theme: Issues in VR-Sim). Additionally, participants described the experience of learning CPR with the VR-Sim (Theme: Higher Level of Learning). For Research Question 2, the main constructs from the extant theories aligned with the perceptions of participants including ideas about presence, fidelity, individual factors, learning outcomes, and collaboration. The study conceptual model provided a sound framework for continued research of the efficacy of VR-Sim in nursing education.