Graduation Year

2026

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Educational and Psychological Studies

Major Professor

Sanghoon Park, Ph.D.

Committee Member

Shannon Bailey, Ph.D.

Committee Member

Yiping Lou, Ph.D.

Committee Member

John Maye, Ph.D.

Keywords

cognitive load theory, instructional design, learner perceptions, nurse anesthesia education, simulation-based education

Abstract

Simulation-based education (SBE) is a widely used learning method in nursing education to develop clinical skills, while in recent years, immersive virtual reality (IVR) has become a sought-after SBE method. There is a significant need to understand how to support IVR integration. Previous research suggests exploring students’ perceptions and experiences toward IVR holistically and comprehensively to understand how to integrate IVR into nursing educational practices. This explanatory sequential mixed methods research study aimed to explore the learning experiences, perceived cognitive loads, and attitudes toward IVR of 11 graduate nursing students in an IVR clinical training environment. To explore perceptions, students participated in an IVR interaction with an anesthesia machine checkout procedure to share their perspectives and to describe phenomena experienced. Students were equipped with IVR pre-training and training prior to their IVR interaction. The study was conducted in two phases following the interaction. The first quantitative phase consisted of data collection via surveys and a psychometric instrument, Simulation Task Load Index (SIM-TLX). The second phase utilized semi-structured interviews, which allowed the students to elaborate further on their experiences.

The first-phase findings identified how students responded to the IVR interaction, yielding results consistent with their described experiences in the machine checkout simulation. Students reported overall low workload demands during the IVR interaction, with moderate levels of frustration and temporal demands. With some students reporting having a background with IVR, those without experiencing higher levels of demand within the interaction. In the phase-two findings, students expressed their interest in using IVR in their educational practices, citing they would like to see it incorporated as a supplementary tool. In the integration findings, students reported experiencing higher-than-typical frustration and temporal demands; these findings were explained by simulation-specific factors, such as the time limit and unfamiliarity with the mechanical and environmental layout. The findings indicated that while students experienced higher cognitive load in some areas, they remained willing to use IVR and view it as a tool for future practices.

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