# NursingXR: Advancing Nursing Education Through Virtual Reality-Based Training
## 3 Materials and Methods
### Implementation and Development  
#### 3.3.1 Nomenclature Analysis and Translation  
The accurate translation of nursing procedures into virtual interactions was a critical step in the design process. To achieve this, a detailed nomenclature analysis was conducted to break down each task into its essential steps. These steps were then mapped onto corresponding virtual interactions, ensuring that the tasks performed in VR mirrored real-world procedures as closely as possible. The nomenclature analysis involved the collaboration of nursing professionals and VR developers to create a common language that accurately reflects clinical practice.  
Furthermore, and to ensure fidelity and validity of the developed system, a planning and data collection phase took place at the outset of the development cycle to obtain relevant information about each nursing lesson including listing and analyzing each step of the procedure and the objects/interactions that step involves. Subsequently, categories of nomenclature were classified for the nursing procedures to identify specific terminology, which can then be translated (converted) to one compatible with game engine design and development. This mapping is created by asking questions such as: _What is the user seeing? What object does the user touch? What does the user do with this object? What happens when the user takes that action? How should the environment react to the user's action?_ The resulting translation mapping included (among many) the following:  
* Nursing chapter = module.
* Lesson in a chapter = submodule = Game engine scene.
* Leave the lesson = interact with door handle.
* User uses hands to handle objects = interactors.
* Instruments and tools = 3D models and grabbable interactables.
* UI elements or instructions = 2D graphics and selectable interactables.  
* Locations of interactions in the room = locomotion spots and anchors.
* Two objects touching each other = collision detection.
* Object moves = animation.
* Sterile field = collision radius.
* Wait for event to occur (e.g., mercury movement in thermometer) = start simulation clock and animate object.
* Object placed in approximate location = socket interaction.
* Item placed in trash or hazmat bin = dispose and destroy (garbage collection).  
This mapping serves as the foundation of the developed program and created the infrastructure for studying the real-world process and then building a faithful representation of its simulated equivalent. The result of this effort is a template or rubric that depicts that mapping specifically for each sub-module (lesson) and brings each step of the procedure down to its lowest common denominator. This layout document shows the elements that are involved in performing an entire procedure including interactions, UI displays, controls and settings, and user events (Figure 2).  
This material was the outcome of multiple meetings, consultations, and discussions between nursing staff and software developers across institutions, as well as the analysis of curriculum material like the textbook lab manual, and syllabus. The devised template document was divided into sections to include general information, pre-procedure, procedure, and post-procedure. A color-coding scheme was used to identify various elements for translation. Although time consuming, this document served as a meeting ground for software developers and nursing professionals, and a documented mapping of all elements involved in the simulation to equate the action that a nurse would take into an equivalent action inside the NursingXR application.