Comparing Mixed Reality, Video-Based, and Instructor-Led Training for Nasogastric Tube Insertion in Nursing Students

Overview

This study explores how nursing students learn to insert a nasogastric tube (NGT), a common but potentially risky clinical procedure. The goal is to compare three different teaching methods: Mixed Reality (MR) glasses with virtual instructions Video-based learning Traditional instructor-led training The study investigates which method leads to better learning outcomes, how usable the technologies are, and how students experience MR in their learning. Participants will be first-year nursing students with no prior experience in NGT insertion. They will be randomly assigned to one of the three training methods, complete the procedure, and answer questionnaires about their performance and experience. Six months later, they will repeat the procedure to assess long-term learning.

This randomized controlled trial investigates the effectiveness of three teaching methods Mixed Reality (MR), Video-Based Learning (VBL), and Instructor-Led Training in teaching nasogastric tube (NGT) insertion to first-year nursing students. The study aims to compare learning outcomes, usability, and user experience across these methods, and to assess long-term retention of clinical skills. NGT insertion is a routine but high-risk procedure in nursing. Incorrect placement can lead to serious complications such as aspiration, nasal trauma, or increased mortality. Effective training is essential to ensure safe and competent practice. Participants will be randomized into three parallel groups with identical instructional content based on a standardized NGT insertion protocol: Mixed Reality (MR) Group (N=60) Students use Meta Quest 3 mixed reality glasses running a stepwise instructional application developed with CTRL Studio. The MR application provides interactive, virtual guidance for each step of the NGT insertion procedure. Prior to practice, students receive technical familiarization, including hands-on use of the MR device and navigation of the virtual interface. The virtual content is identical to the other groups and can be replayed during practice. Video-Assisted Group (N=60) Students watch a video of the NGT insertion procedure recorded from the operator's point of view using a head-mounted, voice-controlled smart camera. The video content is identical to the MR and instructor-led sessions and can be replayed during practice. No additional verbal guidance is provided during practice. Instructor-Led Group (Control) (N=60) Students receive classroom-based instruction including theoretical slides and a live demonstration of the NGT insertion procedure. Students practice individually on a manikin under teacher supervision. The teacher answers questions but does not provide step-by-step coaching. All students complete a pre-test on NGT theory and a demographic questionnaire. Each student performs the NGT insertion individually on a manikin during the practice phase. After practice, students complete: NASA-TLX workload assessment and NGT theory post-test (all groups) System Usability Scale (SUS) and User Experience Questionnaire (UEQ) (MR and video groups only) MR group also submits a written reflection on device usability. Finally, students repeat the NGT insertion in a separate room without guidance. Performance is assessed by a blinded research assistant using a standardized NGT checklist. The study follows the Medical Research Council (MRC) Framework for developing and evaluating complex interventions. The intervention materials are evidence-based and piloted with teachers and students before implementation. The sample size is calculated to ensure statistical power, and data will be analyzed using SPSS software. ANOVA and t-tests will be used to compare group outcomes, and qualitative data from student reflections will be analyzed using content analysis. This study contributes to the development of evidence-based teaching strategies in nursing education. It explores how immersive technologies like MR can enhance skill acquisition, motivation, and satisfaction. The findings will inform future curriculum design and support the integration of digital tools in clinical training. Ethical approval has been obtained, and all participants will provide informed consent. Data will be anonymized and securely stored. The study is conducted in collaboration with the University of Turku and Turku University of Applied Sciences.