Abstract
Virtual reality technology has been adopted to overcome barriers of conventional simulation. This study was conducted to determine the impact of mixed simulation (a 360[degrees] virtual reality and a high-fidelity simulator) on learning how to provide nursing care for patients with arrhythmia. A total of 49 students were randomly assigned to intervention (n = 25) and control (n = 23) groups. They were given four arrhythmia cases with a 360[degrees] virtual reality system first followed by a manikin-based simulation. The mixed simulation group showed greater improvement in knowledge, higher decision-making competency in "knowing and acting" (P = .025) and "seeking information from instructors" (P = .049), and lower anxiety in "using resources to gather information" (P = .031). Study participants achieved a good level of empathy (3.28 +/- 0.72) and liked the program (4.56 +/- 0.60). They were satisfied with the program (4.48 +/- 0.65). These findings provide new insight into learning through blending of new technology. When the 360[degrees] virtual reality was used with existing manikin-based simulation, they effectively reinforced one another. The 360[degrees] virtual reality can be an effective strategy to ensure active participation to gain a comprehensive understanding of and empathy for patients.