Exploring Usability: Mixed Reality for Nursing Skills Training Delivery

<p dir="ltr">INTRODUCTION Mixed Reality (MR) is transforming nursing education by integrating 3D holographic elements with the physical world, enhancing hands-on learning, self-directed practice, and efficiency. While MR has shown promise in healthcare training, its application in nursing education remains underexplored. Studies by Wolf et al. (2021) and Ingrassia et al. (2021) demonstrated MR's usability for procedures like extracorporeal membrane oxygenation cannulation and basic cardiac life support, whereas Schoeb et al. (2020) found no significant improvements in urinary catheter placement, highlighting the need for usability refinements. At Ngee Ann Polytechnic's School of Health Sciences, we conducted a study to assess the usability of Microsoft's Mixed Reality headset, HoloLens 2, and Dynamics 365 Guides in delivering instructions for tasks such as suction apparatus assembly, naso- and oropharyngeal (NP/OP) suctioning, and nebulizer administration. To enhance usability, we refined our implementation by developing step-by-step guides and instructional videos, as well as training student champions to assist their peers. </p><p dir="ltr">METHODS STUDY SETTING AND SAMPLE A total of 922 first- and second-year nursing students in a three-year diploma program participated. </p><p dir="ltr">MR GUIDE DEVELOPMENT Expert nursing instructors authored the MR guide using Microsoft's Dynamics 365 Guides.</p><p dir="ltr"> PROCEDURE Before the scheduled nursing skills lab lesson, participants received an information sheet detailing the study objectives, MR technology, and potential risks. On the study day, students attended their usual nursing skills lab lesson, which included theory, demonstrations, and small-group practice. Following this, they received an introduction to the MR system, covering headset use, spatial anchoring, eye calibration, and navigation. Students then engaged in self-directed learning using the MR guide, with technical support available as needed. </p><p dir="ltr">DATA COLLECTION Post-training, students completed an anonymous online questionnaire assessing usability and attitudes using validated scales (Brooke, 1995; Kennedy et al., 1993; NASA, 2020). The NP Institutional Review Board approved a waiver of consent. </p><p dir="ltr">RESULTS With an 88% response rate, key findings included: 1. Usability: The System Usability Scale indicated acceptable usability. 2. Mental Workload: The NASA Task Load Index showed an acceptable cognitive workload. 3. Comfort: Students reported minimal nausea, oculomotor discomfort, and disorientation. 4. Attitudes: 75% recommended MR training to peers and felt confident performing tasks post-training. </p><p dir="ltr">CONCLUSION MR training for NP/OP suctioning and nebulizer administration demonstrated positive user experiences, supporting its role in nursing education. The immersive nature of MR enhanced engagement and hands-on learning. Encouraged by these results, we are expanding its application to higher-level clinical skills. Further research is needed to assess long-term impacts on skill retention, clinical proficiency, and scalability. Future refinements, such as UI enhancements and integration with other training methods, could optimize its effectiveness in healthcare education.</p>