INTRODUCTION:

The fast growth of the chasing generation of computerized innovations has impacted the field of training significantly, and clinical training is without a doubt one of the most affect ones. One of the technological advances is Mixed Reality (MR)—a fusion of Virtual Reality (VR) and Augmented Reality (AR)—which has revolutionized nursing education¹. MR facilitates the merging of physical and digital settings that creates immersive experiences and allows nursing students to practice clinical scenarios in a safe and structured environment².

Traditional way of teaching was already being exchanged with technology-based teaching and the COVID-19 pandemic just pushed this transition forward, where every institution shifted to digital learning platforms. The recent global health crisis revealed significant shortcomings of traditional classroom-centered pedagogy and exposed the urgent need for innovative, flexible yet interactive distance learning solutions³. During this time, MR became an important tool, providing an innovative means of delivering clinical education while protecting the safety and health of nursing students and adhering to social distance guidelines.

In the conventional nursing education process, most of the learning depends on theoretical explanation and minimal practical exposure. Still, MR provides a more dynamic and interactive environment conducive to the development of critical thinking, clinical decision making, and procedural skills. With the use of specialized libraries on this foundation, different scenarios can be created, such as VR-based simulations that immerse learners in realistic clinical environments to practice relevant patient care procedures without the risk of harming actual patients⁴. In contrast, AR superimposes digital information onto physical environments, particularly useful for visualizing anatomy and providing real-time guidance for clinical procedures⁵.

Moreover, MR supports collaborative learning, as remote simulations enable students to interact with fellow students and educators beyond geographical barriers⁶. Recent studies have shown that adding MR to nursing curricula can lead to much higher engagement, retention, and demonstration of clinical competence. MR is a powerful tool for educated future generations of nurses⁷.

This article discusses the practical applications of MR in nursing education, highlights the benefits, and explains the challenges involved. This paper also highlights future reflections on the potential for the continual influence of MR within nursing education to enhance patient care outcomes.

What is Mixed Reality?

Mixed Reality (MR) is the blending of real and virtual worlds to produce new environments where physical and digital objects co-exist and interact in real-time. While both VR, which immerses its users in a fully computer-generated reality, and AR, which superimposes images in the real world, provides a framed experience, MR enables a flow of information between realities. In nursing education, students can use MR applications to interact with real and simulated patients, practice hands-on clinical skills, and make patient outcome-affecting decisions.

MR technology utilises specialised equipment, including headsets (like the Microsoft HoloLens), and software that can project hologram or interactive digital simulations into the real-world environment. These technologies facilitate much richer, more interactive ways to tailor learning experiences to students' activities in the moment, promoting engagement and active learning (Doughty et al., 2020).

Applications of Mixed Reality in Nursing Education:

1. Skill-Based Training: MR allows nursing students to practice procedures (IV insertions, catheterizations, and wound care) in simulated environments. VR scenarios enable learners to experience immersive training in high-risk, low-frequency clinical scenarios — allowing them to hone their practical skills in an environment that is both safe and controlled².

2. Critical Thinking and Clinical Decision-Making: This involves the use of simulated clinical scenarios with MR which engage and challenge students to assess, diagnose and intervene in patient care situations. Evidence of this type of interactive learning shows an improvement in decision-making abilities and enhanced confidence among students in practical clinical experiences³.

3. Anatomy and Physiology Visualization: Augmented Reality (AUX) applications can provide models of human anatomy in three dimensions, independent to other device's views and allow students to navigate through body structures. This technology allows for improved understanding of complex anatomic relationships and physiologic processes⁴.

4. Remote Learning and Collaboration: MR is used to support remote education through the virtual collaboration between the students and instructors. It enables real-time guidance and feedback to clinical simulations, which improves access for students based in different geographic locations⁵.

Pedagogical Theories Supporting Mixed Reality in Nursing Education:

MR aligns with several educational theories that underpin effective learning:

· Experiential Learning Theory: Focuses on experiential learning, as MR simulations are perfect for practicing clinical skills in a lifelike environment.

· Constructivist Theory: Promotes active learning and knowledge construction – an aspect that MR supports through immersive, hands-on experiences.

· Social Learning Theory: MR also promotes collaborative working with other peers and social interaction, leading to observational learning in realistic group utilities.

Case Studies and Success Stories:

Several institutions have successfully integrated MR into their nursing curricula:

· University of South Australia: Used VR simulations for acute care situations, resulting in notable enhancements in students' clinical decision-making abilities and response times⁷.

· Johns Hopkins University: Launched AR-enhanced anatomy sessions, enabling nursing students to visualize and interact with 3D anatomical models, which boosted their understanding and exam results⁸.

· King’s College London: Incorporated VR-based mental health simulations into their training, which greatly improved students' empathy and insight into psychiatric conditions⁹.

Ethical Considerations in Using MR:

While Mixed Reality (MR) offers many learning benefits, we must think about ethical issues to use it right:

· Data Privacy: MR systems often gather user info, so we need strong privacy steps to keep student details safe.

· Accessibility: Schools need to make sure MR tools are easy for all students to get, even those with disabilities or not much tech access.

· Psychological Effects: Long use of immersive tech might cause confusion, tiredness, or feeling sick from simulations, so schools should set good rules for how to use it¹⁰.

Benefits of Mixed Reality in Nursing Education:

· Enhanced Engagement: Immersive environments draw in the students that are better at active learning⁶.

· Safe Learning Environment: Students can practice clinical skills in safe environments, where it is perfectly acceptable to make mistakes and learn from them⁷.

· Enhanced Clinical Competence: MR simulations have been shown to enhance clinical judgement, procedural skills, and overall readiness for practice in the real-world⁸.

Challenges and Limitations:

Despite its advantages, MR integration in nursing education faces several barriers:

· Financial Constraints: Duration and cost of MR hardwires, software, and training are significantly limiting and prohibitive to educational institutions⁹.

· Technical Constraints: Hardware discomfiture, restricted view and technical failures can limit a user experience¹⁰.

· Instructor Training: MR requires specialized training for educators, creating more hurdles for institutions¹¹.

Future Perspectives:

Such technologies, together with artificial intelligence, haptic feedback, and wearable technologies, will come to streamline MR applications for richer reality and interactivity. Further studies are needed to determine the long-term effects of MR on outcomes related to learning and to explore best practices regarding its implementation in nursing programs.

CONCLUSION:

Mixed Reality has an edge over other mediums where training needs to be interactive or immersive, as learning does in nursing. While the challenges already mentioned are present, further technological evolution and new research will likely encourage broader implementation and eventually enhance nursing competencies and patient care outcomes.

REFERENCES:

1. Cook DA, Brydges R, Hamstra SJ, Zendejas B, Hatala R. Comparative effectiveness of technology-enhanced simulation versus other instructional methods in health professions education. JAMA. 2012; 307(23):2457-65.

2. Padilha JM, Machado PP, Ribeiro A, Ramos J, Costa P. Clinical virtual simulation in nursing education: Randomized controlled trial. J Med Internet Res. 2019; 21(3): e11529.

3. Liaw SY, Wong LF, Chan SW, Ho JT, Mordiffi SZ, Ang SB, et al. Designing and evaluating an interactive multimedia web-based simulation for developing nurses’ competencies in acute nursing care: Randomized controlled trial. J Med Internet Res. 2015; 17(1): e5.

4. Wong J, Khoshhal K, Bhandari M. Augmented reality in medical education: A systematic review. Can Med Educ J. 2021; 12(1): e21-30.

5. Al-Ghaili A, Wong H, Sing SN. The impact of mixed reality in telemedicine: A systematic review. Telemed J E Health. 2020; 26(9): 1123-30.

6. Foronda C, Alfes CM, Dev P, Kleinheksel AJ, Nelson DA, O’Donnell JM, et al. Virtually nursing: Emerging technologies in nursing education. Nurse Educ. 2017; 42(1): 14-7.

7. Yoo S, Kim S. Effectiveness of immersive virtual reality-based simulation in nursing education: A meta-analysis. Nurse Educ Today. 2020; 90: 104438.

8. Frisch N, Atherton P, Fallon J. Exploring the use of augmented reality in nursing education. Comput Inform Nurs. 2021; 39(2): 98-105.

9. Bridges SM, Dyson MD, Corbett JL. Evaluating cost-effectiveness of VR and AR in nursing training. Med Educ Online. 2022; 27(1): 1993921.

10. Hamilton DK, Watkins DH. The future of augmented reality in healthcare. Health Tech. 2023; 13(4): 467-79.

11. Strickland P, Smith J. Integrating virtual reality into nursing education: Challenges and strategies. J Nurs Educ. 2021; 60(6): 327-34.

Received on 04.01.2025 Revised on 08.03.2025

Accepted on 18.04.2025 Published on 17.05.2025

Available online from May 20, 2025

Int. J. Nursing Education and Research. 2025;13(2):120-122.

DOI: 10.52711/2454-2660.2025.00025

This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. Creative Commons License.