A mixed-methods feasibility study to assess the acceptability and applicability of immersive virtual reality sepsis game as an adjunct to nursing education

Background: Virtual Reality (VR) simulation has been a topic of interest in recent years as an innovative strategy for healthcare education. Although there are a handful of studies evaluating VR simulation on knowledge, motivation, and satisfaction; there is a paucity of evidence to evaluate the effectiveness, acceptability and usability of 'Immersive' VR (IVR) simulation in nursing students. Objectives: A two-stage sequential mixed-methods feasibility study underpinned by gaming theory investigated; (1) the impact of IVR sepsis game on pre-registration nurses' self-efficacy and, (2) their perceptions of the acceptability and applicability of IVR sepsis game as an adjunct to nursing simulation education. Methods: The IVR simulation intervention was designed in collaboration with serious game specialists. Stage one collated pre and post-intervention self-efficacy scores with 19 pre-registration nurses using the validated instrument, Nursing Anxiety and Self-Confidence with Clinical Decision Making (NASC-CDM (c)) scale. Stage two used a descriptive qualitative approach to explore student nurses' perceptions of the game. Results: In stage one, pre and post-test scores revealed significant increase in self-confidence (26.1%, P < 0.001) and a significant decrease in anxiety (23.4%, P < 0.001). Stage two qualitative responses revealed four overarching themes: acceptability, applicability, areas of improvement of IVR sepsis game and limitations of IVR game. Conclusion: IVR simulation show promise as an adjunct for nurse simulation and it appears to increase selfefficacy in pre-registration nursing students. Further testing with a sufficiently powered sample size will ratify findings and provide effective solutions to distance and online learning.