# NursingXR: Advancing Nursing Education Through Virtual Reality-Based Training
## 4 Validation and User Study
### Experiment Design and Protocol  
The goal of this experiment is to investigate overall usability, satisfaction, and initial reactions to NursingXR's interface, feedback mechanisms, and ability to support accurate clinical task execution. While this study did not include a direct comparison to traditional field-based training, participants' responses were used to evaluate the system's perceived realism and effectiveness in replicating clinical procedures. Participants engaged with the platform in both the Training Mode, which provides guided instructions, and the Evaluation Mode, where tasks are completed independently. A mixed-methods approach was employed, combining quantitative and qualitative data collection. Quantitatively, questions that evaluate usability, visual and haptic feedback, and overall satisfaction were used with a 5-point Likert scale. These measures assessed the platform's effectiveness for participants with varying levels of experience. Qualitatively, on the other hand, open-ended responses captured participants' perceptions of the platform's realism, its potential impact on nursing education, and suggestions for improvement. Thematic analysis of these responses identified recurring patterns and provided actionable insights for refining the platform. Data collection for the experiment followed a structured protocol to ensure consistency and reliability across sessions:  
* Reading and signing the Informed Consent form (5 min): Participants were required to sign a consent form before starting the experiment to acknowledge that their data would remain confidential and inform them of potential VR side effects, such as dizziness, vertigo, or loss of balance. The experiments were conducted with assistance by trained VR lab technicians.
* Introduction to VR equipment (5 min): VR lab technicians guided participants on equipping and adjusting the VR headset and using the VR controllers. Participants were introduced to the VR tutorial, which demonstrated basic controls such as nav  
Figure 7: Nursing students participating in the study and using NursingXR to supplement their classroom experience on various devices such as the Meta Quest 2 (**a**) and the HP Reverb (**b**).  
igation, interaction, and object manipulation. Each participant was assigned a randomized four-digit ID to ensure anonymity while tracking progress.
* Engagement with NursingXR (10 min): Participants were encouraged to explore NursingXR at their own pace. They selected a submodule of their choice and worked through the steps of the procedure. VR lab technicians remained available to provide guidance and assistance. Figure 8 depicts some moments from the Intramuscular Injection submodule.
* Questionnaire Completion (5 min): After completing the session, participants were assisted in removing the VR headset and directed to an online questionnaire. Small talk initiated by the researcher helped participants reflect on their experience before filling out the survey. The questionnaire could be accessed via a barcode scanner on mobile devices or on lab PCs.  
Two questionnaires were designed for the two participant groups, reflecting their unique perspectives and objectives. Both surveys included questions focused on usability, knowledge retention, visual and haptic feedback, ease of understanding, and overall satisfaction. However, the survey for experts included additional questions related to the utility of NursingXR in replicating clinical procedures and its pedagogical potential. Closed-ended questions were designed to evaluate these metrics on a 5-point Likert scale, while open-ended questions allowed students to provide qualitative insights into their experience to uncover nuanced perspectives on the platform's usability, realism, and educational value, as well as suggestions for improvement.