# NursingXR: Advancing Nursing Education Through Virtual Reality-Based Training
## 3 Materials and Methods
### Foundational Building Blocks
#### 3.2.3 Multi-Modal Functionality  
For each nursing submodule (lesson), NursingXR offers two distinct modes: Training Mode and Evaluation Mode, each serving complementary purposes in the learning process (Table 2).  
\begin{table}
\begin{tabular}{p{113.8 pt} p{113.8 pt} p{113.8 pt}} \hline \hline  & **Training Mode** & **Evaluation Mode** \\ \hline Purpose & Educate via guidance and feedback. & Assess proficiency and readiness. \\ Instructions provided & Step-by-step instructions. & Only main goal (procedure). \\ Feedback & Real-time during procedure. & Based on generated performance report. \\  & Blinking visual cues highlight objects to interact with. & Absent. User must independently \\ Environment & Predefined steps in structured phases. & Candbox-style environment, up to user. \\ Object Functionality & Objects require enabling before interaction (sequential). & Objects are immediately usable (non-sequential). \\ Data Collection & No data collection for actions or performance. & Tracks step order, duration, and scores; stores progress. \\ Grading/scoring & Non-graded; focus on learning and mastery. & Graded; generates performance and task completion report. \\ User ID Tracking & Not applicable. & Unique ID tracks user performance. \\ Ability to make mistakes & Absent. & User can make mistakes or perform steps out of order. \\ Wall clock time provision & Timer provided. & Wall clock provided. \\ Error proofing and prevention & Present. & Absent. \\ \hline \hline \end{tabular}
\end{table}
Table 2: Side-by-side comparison between Training and Evaluation modes for NursingXR.  
Training Mode focuses on teaching users how to perform selected procedures by providing step-by-step instructions and visual guidance. This mode helps mitigate performance anxiety by allowing users to practice at their own pace in a low-pressure environment, ensuring they understand each step correctly before moving forward. Users are restricted to one action at a time, reinforcing the correct sequence of steps. Training Mode consists of three interconnected sections: pre-procedure, procedure, and post-procedure, each guiding the user through key tasks. Instructional mechanisms include highlighting relevant 3D objects, playing sound effects, and displaying instructional boards to enhance comprehension and engagement. Training Mode does not assess or grade user performance; instead, its primary purpose is to foster confidence and competence through unlimited, guided practice.  
Evaluation Mode, on the other hand, is designed to test users' comprehension and readiness to apply what they have learned in Training Mode. This mode removes instructional guidance and visual indicators, requiring users to rely on memory and prior training to complete the selected procedure independently. Unlike Training Mode, Evaluation Mode consists of a single \"manager\" section instead of the three-step structure. This manager tracks the sequence of user actions, their duration, and procedural accuracy. The environment adopts a sandbox-style approach, granting users full control over object interaction and task execution order. The system generates a detailed performance report, comparing user actions against the correct procedural flow and assigning a proficiency score. Additionally, each user is assigned a unique ID, ensuring that their performance data can be securely stored, accessed later for review, and used for further evaluation or tailored instruction. Evaluation Mode provides an essential tool for assessing readiness and identifying areas where additional training may be required.