Extended Reality: The Future of Nursing Education

By: Michelle Aebersold, PhD, RN, CHSE, FAAN and Tonya Schneidereith , PhD, CRNP, PPCNP-BC, CPNP-AC, CNE, CHSE-A, ANEF

What is new in XR, you ask? Extended Reality (XR) is an umbrella term that describes all the immersive technology that we currently use and may use in the future, including augmented reality, mixed reality, and virtual reality. This exploding area of innovative and exciting options is mostly used in settings outside of education. However, the use of XR in educational settings has grown exponentially with the need for virtual formats brought about by the COVID-19 pandemic. Forbes predicts the XR industry will grow to $209 billion by 2022 (Marr, 2019).

In nursing education, we have witnessed a trend toward the increasing use of virtual simulation, much of which is screen-based on laptops and tablets. Although virtual simulations programs are good and helpful, they lack the immersive quality that our students experience when they are in the simulation center. Two important concepts are needed to build immersive virtual reality (VR) environments – presence and immersion. Presence is the sensation of being in the environment. Immersion happens when one is fully inside and surrounded by the virtual environment (Bailenson, 2018). 

In immersive VR, students are able to experience the feeling of being inside the experience through use of a headset that blocks out the actual environment and immerses the individual in a new environment. They are able to see all around them, move in the space, and interact with objects using their hands or, more commonly, controllers. Several companies offer immersive VR programs for nursing that focus on decision-making and assessment. These products show promise toward delivering better outcomes when compared to nonimmersive VR (Kyaw et al., 2019).

Augmented reality (AR) is the display of objects into the real world. The advantage of AR is that the individual can see everything in the physical environment, with the digital image projected into space. We can use our hands to interact with these images. Examples of how AR is used in nursing include wound care, IV injections, hand hygiene, and the display of instructions or algorithms. In some situations, AR is combined with a manikin, for example, a wound is projected onto a manikin instead of using moulage (Wuller et al., 2019).

Mixed reality (MR) is similar to AR because it mixes the real world and digital imagery. The difference is that with MR, digital objects are anchored into the virtual world and you can easily interact with them. For this reason, MR requires a headset and cannot be tablet-based at this time (Kaminsky, 2019).

While all of these teaching techniques require somewhat complicated technologies, another way to extend reality is through online, live simulations, using a web-based conferencing platform. Try taking a face-to-face simulation and converting it to a virtual simulation. Depending on the level of the learner or the program of study, you can share images of disease states, changes on a cardio-respiratory monitor, or interview a standardized participant in real time. Recently, one of the author’s ran a neonatal resuscitation with neonatal nurse practitioner students with only an online monitor and their imaginations. The students responded to changes on the monitor, communicated clearly, and administered compressions without a manikin. The feedback was extremely positive. One student found the absence of a manikin beneficial to her learning as she was no longer distracted by the plastic simulator. She could “see” the premature neonate in her mind, allowing her to better suspend disbelief and engage.

With so much to think about, especially at this time, consider new ways to bring the future into your program. Let us know your thoughts. What are you doing to continue experiential learning outside of traditional spaces?


Virtual Reality for Education

This website and research group is dedicated to examining the relationship between virtual reality and the classroom. The primary focus is grades K-12. However, many resources are applicable for nursing students.

Educators in VR

Educators in VR is an open, global, cross-platform community of educators, researchers, and trainers exploring and collaborating with and in virtual and augmented reality. https://educatorsinvr.com/


Bailenson, J. (2018). Experience on demand: What virtual reality is, how it works, and what it can do. WW Norton & Company.

Marr, B. (August, 2019) What is extended reality technology? A simple explanation for anyone. https://www.forbes.com/sites/bernardmarr/2019/08/12/what-is-extended-reality-technology-a-simple-explanation-for-anyone/#9ea55eb72498

Kaminsky, G. (Aug 26, 2019) The differences between augmented, mixed and virtual reality explained. https://www.ptc.com/en/thingworx-blog/differences-between-augmented-mixed-and-virtual-reality?gclid=EAIaIQobChMIhenm5an16QIVkcDACh2liwi4EAAYASAAEgIIp_D_BwE

Kyaw, B. M., Saxena, N., Posadzki, P., Vseteckova, J., Nikolaou, C. K., George, P. P., … & Car, L. T. (2019). Virtual reality for health professions education: systematic review and meta-analysis by the Digital Health Education collaboration. Journal of medical Internet research21(1), e12959.

Wüller, H., Behrens, J., Garthaus, M., Marquard, S., & Remmers, H. (2019). A scoping review of augmented reality in nursing. BMC nursing18(1), 19.

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