Immersive Virtual Reality for Respiratory System Physical Examination Training Compared With Peer-Assisted Small-Group Practice: A Randomized Controlled Trial

NCT06536361 | Completed

• 3 other identifiers: 2023-9152024-9040TDK-2024-9040
• Study Type: interventional
• Target: 76
• Locations: 1 country
• Sites: 1

Brief Summary

Aim To compare the effects of immersive virtual reality (I-VR) and peer-assisted small-group practice on nursing students' knowledge, skill performance, and performance time in respiratory system physical examination. Background Respiratory system physical examination is a fundamental yet difficult-to-teach clinical skill in nursing education. Although I-VR has increasingly been used in physical examination teaching, existing studies have largely focused on limited examination components, most commonly inspection or auscultation. Evidence remains limited on how respiratory system physical examination can be taught as a holistic and structured clinical process within an I-VR environment. Design A single-blind, parallel-group, randomized controlled trial with a pre-test/post-test design. Methods Second-year nursing students from a university participated in the study. Participants were randomized to either the I-VR group or the peer-assisted small-group practice group. Data were collected using a knowledge test, a skill checklist, performance time measurement, and a technology acceptance questionnaire. Analyses included t-tests, chi-square tests, Pearson correlation analyses, and frequency analyses. Results Knowledge and skill scores improved in both groups, but the increase was significantly greater in the I-VR group (p \<0.001). Performance time was longer in the I-VR group (p =0.01). Students also rated the I-VR simulation highly in terms of feasibility and usability. Conclusions A systematically designed I-VR approach may be a useful instructional option for teaching respiratory system physical examination as a holistic, multi-step clinical skill in undergraduate nursing education.

Conditions

Nurse's Role; Nurse-Patient Relations; Exanimation

Keywords

Clinical Skills; Educational Technology; Immersive Virtual Reality; Respiratory System; Physical Examination; Nursing Education

Outcome Measures

Primary Outcomes (2)

• Knowledge Test

  The knowledge test was created by the researchers to evaluate participants' theoretical understanding of the physical examination of the respiratory system, aligned with the course content and learning objectives (Choi et al., 2021; Des Jardins \& Burton, 2023; Fennessey \& Wittmann-Price, 2011; Jarvis, 2023; Narula et al., 2018; Reyes et al., 2024; Tybjerg, 2023). According to expert assessments, the I-CVI scores for each item ranged from 0.92 to 1.00, with an inter-rater agreement of Kendall's W =0.72 and p =0.00 (Davis, 1989). To assess the suitability of the knowledge test items, a pilot study was conducted with a group of 80 third-year undergraduate nursing students who had previously completed the Health Assessment course. After the pilot, the Item Difficulty Index (IDI) and Item Discrimination Index (IDIsc) were calculated for each question. One question with an IDI of 0.11 and an IDIsc of 0.15 was removed from the test. The final version of the knowledge test was designed to ens

  Skill levels will be assessed seven days before the intervention (pre-test) and seven days after the intervention (post-test).

• Skill Checklist

  The skill checklist was created by the researchers, based on relevant literature, to assess participants' respiratory system physical examination skills (Choi et al., 2021; Des Jardins \& Burton, 2023; Fennessey \& Wittmann-Price, 2011; Jarvis, 2023; Narula et al., 2018; Reyes et al., 2024; Tybjerg, 2023). The form was organized around a scenario where the student performs a respiratory system physical exam on a conscious patient who can meet basic needs independently in a single-patient examination room. According to expert evaluations, the I-CVI scores for individual items ranged from 0.92 to 1.00, with inter-rater agreement of Kendall's W =0.72 and p =0.00 (Davis, 1989). The pilot version of the form was tested with a group of ten third-year nursing students who had previously completed the Health Assessment course. Based on their feedback, the final version of the checklist included 48 procedural steps, with a total possible score ranging from 0 to 96.

  Knowledge levels will be evaluated seven days prior to the intervention (pre-test) and seven days following the intervention (post-test)

Secondary Outcomes (1)

• Technology Acceptance Questionnaire

  Seven days after the intervention

Study Arms (2)

Immersive Virtual Reality Group

EXPERIMENTAL

Following the orientation, each participant was allocated a fixed one-hour period to complete the I-VR simulation. During this session, participants progressed through the application at their own pace, could repeat steps as needed, and performed the respiratory system physical examination holistically in the virtual environment. Within the simulation, participants prepared the necessary materials, communicated with the virtual patient, performed inspection, carried out superficial palpation, chest expansion, and thoracic vibration assessments, conducted indirect percussion, and performed auscultation. They also evaluated normal and abnormal respiratory and percussion sounds, informed the patient about the examination findings, and recorded the assessment data in the system. In addition, they completed self-checklist forms after each examination step. Participants were allowed to remove the headset and take breaks whenever needed throughout the training session.

Other: Virtual Reality-Based Learning Tool

Peer-Assisted Small-Group Practice Group

ACTIVE COMPARATOR

After the pre-briefing, participants were divided into groups of eight, with four peer pairs formed within each group. The implementation was conducted according to peer-assisted learning principles and aligned with the peer practice approach (Lam et al., 2024). During the session, each participant assumed two roles: (i) a patient admitted to the surgical ward for an operation and capable of independent self-care, and (ii) a clinical nurse responsible for performing a preoperative respiratory system examination and managing postoperative follow-up. These roles were alternated within standardized scenarios. Each pair was given a total of one hour for the activity, allowing students to proceed at their own pace and repeat the examination as needed. Throughout the sessions, participants reinforced their learning through mutual observation, structured peer feedback, and role switching. Researchers remained in an observational role without direct intervention in order to ensure safety, pri

Other: Traditional Small Group Training

Interventions

Virtual Reality-Based Learning Tool OTHER

The intervention involves the use of a virtual reality-based learning tool to teach thorax and lung physical examination skills. The tool uses Oculus Meta Quest 3 VR headset to provide immersive simulation experiences. The VR tool includes high-quality graphics and interactive scenarios to facilitate skill development.

Immersive Virtual Reality Group

Traditional Small Group Training OTHER

The intervention involves traditional small group training conducted in the Nursing Principles Skills Laboratory. This training includes hands-on practice with physical examination techniques using simulation mannequins and feedback from instructors. The approach is designed to provide practical experience without the use of virtual reality technology.

Peer-Assisted Small-Group Practice Group

Eligibility Criteria

• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64), Older Adult (65+)

You may qualify if:

• The student must:
• Voluntarily participate in the study,
• Not have difficulty understanding and speaking Turkish,
• Not have refractive errors that can affect depth perception, such as amblyopia (lazy eye), anisometropia (different refractive errors of the two eyes), and strabismus (crossed eyes) (Chan et al., 2023). (The individual's self-declaration was used to determine refractive errors. Individuals with these refractive errors were not included in the study because focal eye adjustment was required, but this adjustment was not supported on the Oculus 2 device. Individuals with other refractive errors were able to use the application with their glasses).
• Have a general academic achievement score between 2.00 and 4.00,
• Have taken the Health Assessment course for the first time in the 2023-2024 academic year and passed this course with at least a CC grade (CC indicates minimum success; grades below indicate conditional passing).

You may not qualify if:

• The student must:
• Have a high school, associate's degree, or bachelor's degree in a health-related field,
• Be retaking the Health Assessment course (code HEM 205).
• Criteria for removal from the study:
• The student must:
• Want to withdraw from the study,
• Not attend the theoretical thoracic and pulmonary physical examination course,
• Not watch the thoracic and pulmonary physical examination demonstration videos,
• Not attend the practical lessons,
• Not fill out and/or incompletely fill out the data collection forms,
• Not use the virtual reality-based learning tool,
• Not participate in any stage of the skills assessment.

Sponsors & Collaborators

• Gazi University: lead

Study Sites (1)

Gazi University Nursing Faculty

Ankara, Ankara, 06500, Turkey (Türkiye)

Location

Related Publications (18)

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MeSH Terms

Conditions

Coma

Condition Hierarchy (Ancestors)

Unconsciousness; Consciousness Disorders; Neurobehavioral Manifestations; Neurologic Manifestations; Nervous System Diseases; Signs and Symptoms; Pathological Conditions, Signs and Symptoms

Study Officials

• Dr. Aslı A YILMAZ, PhD

  Gazi University Nursing Faculty

  STUDY DIRECTOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Masking Details: Randomization was conducted independently by computer. Participant blinding was maintained throughout the study. In addition, skill performance was evaluated by an independent blinded assessor, and statistical analyses were performed using coded group data. To reduce contamination, the two groups were trained separately and at different times, and participants were asked not to discuss the interventions until the study was completed.
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Professor of Nursing

Model Details: An assessor-blinded, parallel-group, pre-test/post-test randomized controlled trial.

Study Record Dates

• First Submitted: July 23, 2024
• First Posted: August 2, 2024
• Study Start: May 20, 2024
• Primary Completion: June 14, 2024
• Study Completion: July 14, 2024
• Last Updated: March 19, 2026

Record last verified: 2026-03

Data Sharing

• IPD Sharing: Will not share

Locations

TU (1)