Virtual technologies in nurse education: the pairing of critical realism with partial least squares structural equation modelling as an evaluation methodology.

Abstract

Background: Virtual technologies have been, and continue to be, of significant interest to Higher Education (HE) educators. There have been many research studies carried out into the efficacy and acceptability of these technologies. But, this research (via a systematic literature review) found that there are significant methodological shortcomings in many of those studies, particularly with respect to understanding the mechanisms of the effect of virtual technologies on learning. Most papers were superficial and concentrated on the Technology Acceptance Model (TAM) of usability and ease of use. Some carried out perfunctory assessments of learning effect, but predominantly by measuring student enjoyment via subjective self-reporting. This thesis responded to this gap in the literature by implementing a non-immersive virtual reality (VR) (accessed via a laptop), educational simulation of a deteriorating diabetic patient and creating a novel and powerful method to evaluate the effect of that simulation on nurse education. Method: The systematic review of the literature led to the creation of a diabetes VR simulator. A novel approach was designed to evaluate this simulator which consisted of the pairing of a randomised controlled trial (RCT) (n=171), analysed via Partial Least Squares-Structural Equation Modelling (PLS-SEM). The conceptual pathway model for this PLS-SEM approach was drawn from a Critical Realist (CR) review. Hence the main aim was to assess the effectiveness of CR paired with PLS-SEM as a method to evaluate the impact of VR simulations on undergraduate nurse education. The RCT enabled comparison of the VR simulation with normative teaching methods which addressed the two objectives: to determine the effect of pairing CR with PLS-SEM as an evaluative method, and to determine how using this novel evaluative method can inform our understanding of the impact and future use of VR simulations for undergraduate nurse education. Findings: The effect of pairing CR with PLS-SEM was that deep insight was gained into how VR simulations can benefit student nurses. VR was found to be significantly (P=<.001) better in terms of hypoglycaemia knowledge than normative methods. Moreover, the novel method also enabled identification of the key point of action of the simulation, via analysis of the conceptual model which evidenced that the “engagement to immersion” pathway was responsible for leading to higher knowledge scores in the VR group. This thesis is claiming addition to knowledge about how the novel methodological approach taken has the potential to deepen understanding of how virtual technologies can affect learning. Recommendations for policy, practice, and further research have been made on this basis. Future studies could use PLS-SEM combined with CR in order to ascertain both measurable and rich data about how new technologies can improve nurse education.