## 3 The Ambiguity of Virtual Reality Terminology in Healthcare and Beyond
### Rethinking the Meaning of Virtual Reality: A Proposed Framework  
The terminology surrounding VR in healthcare is characterized by inconsistency and ambiguity, particularly regarding levels of immersion. While [PERSON] et al., (2023) [43] provided a comprehensive attempt to define VR terminology for healthcare applications, their approach primarily aimed to accommodate the existing confusion in the field, rather than resolve it by addressing the ambiguity surrounding terms like non-immersive, semi-immersive, and immersive VR. We believe there is significant confusion regarding what constitutes different levels of immersion in VR environments, particularly in defining non-immersive and semi-immersive VR. Meanwhile, current definitions of immersive VR are often limited solely to the use of HMD headsets, overlooking other modern technologies that stimulate additional exteroceptive senses (as presented in Section 3.2). Additionally, there also appears to be confusion about whether VR is understood as an immersive environment or as an environment that can encompass various levels of immersion. This lack of clarity underscores the need to develop a more refined framework specifically addressing the concept of immersion. To the best of our knowledge, our proposed framework is the first in the healthcare field to tackle this issue comprehensively. Our article serves as a starting point for establishing uniform terminology in this field, which appears to urgently require a standardized approach. We believe it will contribute to reducing ambiguity and facilitating clearer communication within the field. Our framework is not intended to prioritize immersive VR over non-immersive VR or to suggest that one is inherently more beneficial than the other. Instead, it seeks to address existing terminological inconsistencies and provide a standardized basis for understanding VR environments based on their technical characteristics. VR begins when visual field is entirely occupied with virtual information. In line with certain authors [40], we argue that VR experiences should be limited to so-called immersive VR experiences, where the individual cannot see the real world and is thus visually completely detached from it. According to this understanding, VR cave technologies would not fall under VR, as individuals using this technology can still see their own body and the physical surface they are standing on. The only technology currently capable of achieving such visual detachment from the real world are HMDs. What is currently referred to as \"non-immersive VR\" should be distinguished from VR and excluded from the umbrella term encompassing VR and related technologies. Non-immersive VR experiences, commonly categorized as virtual environments that individuals observe or interact with via computer screens, should not be considered part of VR or related technologies and should not fall under the XR umbrella (or mixed reality, which some propose as an umbrella term). For VR in healthcare currently labeled as \"non-immersive\", which typically involves the projection of artificial environments on a computer or television screen (e.g., Wii _games_) and does not allow for complete visual detachment from the real world, regardless of whether these environments are interactive or non-interactive, we propose the term \"_non-immersive fully artificial environments_\". The term \"non-immersive\" distinctly separates these environments from VR, which, according to our proposal, begins only when an individual's entire visual field is occupied by virtual information. Thus, VR can never truly be \"non-immersive\" (as it always involves at least visual immersion), making \"non-immersive\" a suitable term to differentiate these environments. The term \"fully artificial\" further clarifies the distinction from environments where virtual objects are integrated into the real world, a feature commonly included in definitions of AR or MR. Non-immersive fully artificial environments can still provide a certain degree of presence [78].