Seeing Visual Technology Through a Nursing “Lens”

By: Tonya Schneidereith and Sue Forneris

As nurses, we view care through a lens of patient outcomes. But, as today’s nurse educators, how do we help our students learn to see through that lens? Part of the answer to this question lies in the technology available to help our students visualize reality (see Skiba, 2017 a, b; Forneris & Tiffany a, b; Feronda & Alfes, 2017). These technologies include Augmented Reality (AR) and Virtual Reality (VR). Nurse educators are beginning to advance the active learning conversation with this new visual “lens,” bringing AR and VR into nursing education.

Let’s differentiate the realities. Augmented reality uses computerized systems to enhance the learning experience. It provides a means of inserting digital information into a real environment in real time, digital information that includes visual objects, sounds, and other sensory information that interacts with the real environment. The hardware includes any commonly used smart device (phone/tablet) or specialized headgear.

22046600_10155815485509533_2940890196812155561_nVirtual reality creates a simulated world that replaces the real world, like video games played on Xbox and PlayStation. VR is a fully digital interactive environment presented via various forms of displays, from flat screen, computer-based systems to immersive, multisensory haptic technology systems. The three characteristic elements that define VR are: 1) a digitally simulated world that 2) immerses the user in that simulated world, 3) with the ability to interact with(in) that world  (Feronda et al., 2017).

Google Glass (GG), through the Google Glass Explorer Program, is one of the oldest AR technologies to change our lens. With a heads-up display for hands-free access to technology, GG was one of the first wearable technologies (Tsukayama, 2014). Think of it as a handsfree smartphone, used to take pictures, search the internet with a few simple verbal commands, listen to music, talk on the phone, or record a video. The apparatus provides a view unlike other video-recorders that allow one to see what the wearer is seeing in real time.

With these unique characteristics, GG has been used by educators in simulation to identify undergraduate students’ behaviors during medication administration  (Schneidereith, 2015) and allow access to information at the point of care (Byrne & Senk, 2017). Chaballout, Molloy, Vaughn, Brisson, and Shaw (2016) used the AR capabilities of GG to augment the care of a simulated manikin, with videos of an actor portraying respiratory distress shown on the heads-up display of GG as students participated in a high-fidelity simulation. The video was created to match in real time expected student actions performed on the manikin. Talk about hybrid simulations!

GG, one of the first head-mounted displays, is no longer available to the general public. But technology has again moved ahead with Microsoft’s next-generation reality device, the world’s first self-contained holographic computer known as HoloLens.

HoloLens can be categorized as a VR device as well as an AR product like Google Glass. GG was designed to perform the functions of a smartphone while HoloLens is designed to project images in midair and on surrounding objects. HoloLens moves beyond the gaming platform.

22048046_10155815483099533_6683034585194517900_oVia email on January 12, the NLN TEQ Blog visited with Dr. Michael Gates, associate professor and director of the School of Nursing, San Diego State University, who reported that Pearson Publishing is utilizing the HoloLens to pilot mixed reality nursing content at San Diego State and Texas Tech University Health Sciences Center in Lubbock (  Pearson’s collaboration with Microsoft is aimed at creating patient scenarios that allow nursing students the opportunity to experience patient situations that they may never be able to see in an actual patient care environment. Nurse faculty at the two nursing programs are exploring whether this new mixed reality technology has the potential to complement the current family of patient simulation technologies that schools of nursing are currently using to prepare the next generation of nurses.

To develop the content for this pilot, Pearson, in consultation with San Diego State and Texas Tech, utilized Microsoft’s holographic video-capture capability, filming actors to simulate patients with various health concerns and then transferring that video into holograms that look and sound just as if they were part of the real world.  When nursing students participate in the simulations using the HoloLens, they will have a standardized and repeatable real-world experience where they have the opportunity to assess and evaluate patients in real time. This will allow the students to build the confidence and competence they will need throughout their nursing careers. The pilot runs through 2018.

While advanced technology can enrich the learning experience, specific technologies, as with all teaching strategies, should be selected based on learning outcomes and student levels to ensure the best experience. Skiba (2017a) reminds us that “technology is not going away, and as faculty, we need to harness the power of technology to facilitate higher level student outcomes” (p. 52). What do you do to bring technology to your students? We’d love to know how you are helping students see the future.


Byrne, P.J. and Senk, P.A. (2017). Google glass in nursing education. CIN: Computers, Informatics, Nursing, 35(3), 117-120.

Chaballout, B., Molloy, M., Vaughn, J., Brisson, R., and Shaw, R. (2016). Feasibility of augmented reality in clinical simulations: Using Google glass with manikins. JMIR Medical Education, 2(1), e2, 1-4.

Forneris, S., & Tiffany, J. (2017, September 5). Future of technology in nursing education part 1: The what and why of technology use in today’s nursing student. NLN TEQ Blog.

Forneris, S., & Tiffany, J. (2017, October 24). Future of technology in nursing education part 2: How nursing education programs are currently using educational technology. NLN TEQ Blog.

Foronda, C., & Alfes, C.M. (2017, June 1). Virtual nursing: Emerging technologies in nursing education. NLN TEQ Blog.

Foronda, C.L., Alfes, C.M., Dev, P., Kleinheksel, A.J., Nelson, D.A., O’Donnell, J.M., Samosky, J.T. (2017). Virtually nursing:  Emerging technologies in nursing education. Nurse Educator, 42(1), 14-17.

Schneidereith, T.A. (2015). Seeing through Google glass: Using an innovative technology to improve medication safety behaviors in undergraduate nursing students. Nursing Education Perspectives, 36(5), 337-339.

Skiba, D.J. (2017a). Students, technology, and teaching: Findings from the 2016 ECAR Report. Nursing Education Perspectives, 38(1), 51-52.

Skiba, D.J. (2017b). Horizon report: Knowledge obsolescence, artificial intelligence, and rethinking the educator role. Nursing Education Perspectives, 38(3), 165-167.

Tsukayama, H. (2014, February 27). Everything you need to know about Google glass.  The Washington Post.

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