# NursingXR: Advancing Nursing Education Through Virtual Reality-Based Training
## 3 Materials and Methods  
### Conceptual Design  
The design of NursingXR is centered around creating an immersive virtual environment that replicates real-world clinical settings. The goal is to provide nursing students with a realistic platform to practice fundamental nursing procedures in a controlled, repeatable manner. Recent research has demonstrated the effectiveness of VR in medical training, highlighting its ability to create immersive, interactive, and realistic learning environments that improve skill acquisition and retention [46]. Previous work [16] indicated a number functional requirements, shown below, that guide the implementation and development of the platform. * FR1: provides easy to use interface to access the different available functionalities. * FR2: user logs in to NursingXR using unique credentials. * FR3: each procedure provides clear training objectives and step-by-step instructions with interactive elements, medical equipment, etc. * FR4: integrate virtual patients with different symptoms and responses depending on defined scenario-based training for each procedure. * FR5: provides feedback mechanisms and performance evaluation based on predefined criteria to guide user. * FR6: technical support and onboarding available to assist new users. Designed to run on mainstream untethered VR devices, the platform was developed to house a library of immersive learning experiences organized as modules and submodules (lessons). For example, the module \"Vital Signs\" will have submodules such as \"_Assessing Body Temperature_\" and \"_Assessing Peripheral Pulse_\". As detailed in Section 3.2.2, each lesson will have two modes of interaction: _training_ and _evaluation_. While the Training Mode provides users with hints and supporting cues to perform specific procedures, the Evaluation Mode allows users to perform a procedure without hints or feedback and obtain an assessment upon completion. The conceptual design and system architecture of NursingXR (Figure 1) integrate three primary components: the _User_, the _Game Engine_ (Unity), and the _Virtual Reality Head-Mounted Display_ (VR HMD). The User interfaces with the system by selecting either Training Mode or Evaluation Mode through the Game Engine. In Evaluation Mode, the system utilizes the user's unique _userID_ to collect and store performance data. The _Game Engine_ serves as the central hub, delivering the interactive experience by transmitting visuals, audio, and haptic feedback to the _VR HMD_. This feedback includes immersive visuals of the virtual nursing training environment (_Virtual Environment_), spatial audio with sound effects (SFX), and controller vibrations that simulate tactile interactions. Performance data collected in Evaluation Mode is stored on the HMD's onboard memory for later analysis. Within the Game Engine, several interconnected components work together to provide an immersive and functional experience. These include _OpenXR_ for cross-platform compatibility, the _XR Interaction Toolkit_ for enabling user input and interactions, and a _Physics_ engine for collision detection, haptics, and object manipulation. The engine also houses the _Nursing Curriculum_, which drives the sequence of steps and visual cues in Training Mode, as well as the scoring mechanisms in Evaluation Mode. The _Virtual Environment_ is further enhanced by 3D models, including a simulated clinical examination room, tools, instruments, and a patient avatar, alongside user interface (UI) elements. _Spatial sound_ design adds realism, incorporating background noise, event-driven audio, and sound effects that align with user actions. The _VR HMD_ acts as the primary output device, equipped with a display, speakers, controllers, and storage memory. The HMD and its controllers are tracked in six degrees of freedom (6 DOF), enabling the system to respond to the user's movements and input in real time.