Clinical Competence, Education, Nursing Students, Nasogasrtic Tube Insertion, Teaching Innovation, Teaching Method, User Experience
Conditions
Keywords
Nasogastric Tube Insertion, Nursing Education, Mixed Reality, Video-Based Learning, Instructor-Led Training, Meta Quest 3, Nursing Clinical Skills, Randomized Controlled Trial, Nursing Students, Extended Reality in Healthcare
Brief summary
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.
Detailed description
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.
Interventions
DEVICEMixed Reality NGT Training
Participants use Meta Quest 3 mixed reality glasses with a stepwise instructional application developed in CTRL Studio. The application provides interactive virtual guidance for nasogastric tube (NGT) insertion. Students receive technical familiarization before practice. Content is standardized and identical to other groups.
DEVICEVideo-Based NGT Training
Participants 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 is identical to the MR and instructor-led groups and can be replayed during practice. No verbal guidance is provided during the procedure.
BEHAVIORALInstructor-Led NGT Training
Participants 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.
Sponsors
Turku University of Applied Sciences
University of Turku
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
SINGLE (Outcomes Assessor)
Masking description
Only the outcomes assessor is blinded to group allocation. Students, instructors, and researchers are aware of the assigned intervention. The assessor evaluates NGT insertion performance without knowledge of which instructional method the student received.
Intervention model description
Participants are randomized into three parallel groups, each receiving a different instructional method for nasogastric tube (NGT) insertion training. All groups follow the same standardized protocol and instructional content. The MR group uses Meta Quest 3 mixed reality glasses with a stepwise virtual application developed in CTRL Studio. The video group watches a head-mounted smart camera recording of the procedure. The instructor-led group receives classroom-based instruction and a live demonstration. Each student performs the procedure individually on a manikin, and outcomes are assessed post-intervention and at six-month follow-up.
Eligibility
Sex/Gender
ALL
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
* First-year nursing student * Performing nasogastric tube (NGT) insertion for the first time * No prior theoretical education or pre-material on NGT insertion procedure
Exclusion criteria
* Previous nursing education (e.g., practical nurse qualification) * Diagnosis of epilepsy * Presence of a pacemaker
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| NGT Checklist Performance Score | Immediately after training; 6 months after training | Student performance in nasogastric tube (NGT) insertion is assessed using a structured NGT checklist. Total score on the NGT checklist is 38 point. Higher scores indicate better procedural performance. The checklist evaluates both technical and non-technical procedural steps to determine clinical competence. Assessment is conducted immediately after the intervention (M1) and again six months later (M2) without instructional support. Checklist completed by a research assistant or staff member observing the student performing the NGT procedure on a manikin. The NGT checklist is based on validated tools (e.g., Kebede et al., 2024) and is designed to objectively measure students' ability to perform NGT insertion safely and correctly. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| User Experience Questionnaire (UEQ) | Immediately after intervention | Students complete the User Experience Questionnaire (UEQ) after performing the NGT insertion procedure. The UEQ measures six dimensions of user experience: attractiveness, perspicuity, efficiency, dependability, stimulation, and novelty. Each dimension is scored from -3 to +3, with higher scores indicating a more positive experience. The questionnaire is used to evaluate the perceived quality and usability of the Mixed Reality and Video-Based Learning environments. |
| System Usability Scale (SUS) | Immediately after intervention | Students complete the SUS questionnaire after performing the NGT procedure. The SUS is a standardized 10-item Likert-scale tool that measures perceived usability of the Mixed Reality and Video-Based Learning environments. Scores range from 0 to 100, with higher scores indicating better perceived usability. |
| NASA Task Load Index (NASA TLX) | Immediately after intervention | NASA Task Load Index (NASA TLX), a multidimensional workload assessment tool. Scores range from 0 to 100, with higher scores indicating greater cognitive workload Students complete the NASA TLX questionnaire to assess cognitive workload during the NGT procedure. The tool includes six dimensions: mental demand, physical demand, temporal demand, performance, effort, and frustration. |
| Student Reflection Texts | Immediately after intervention | Students who used MR glasses submit written reflections describing their learning experience, including factors that facilitated or hindered skill acquisition. |
| Nasogastric Tube (NGT) theory pre- and post-test | Baseline; Immediately after intervention | Students complete a Nasogastric Tube (NGT) theory pre-test before the intervention and a post-test immediately after performing the NGT insertion procedure. Both tests use the same set of 15 questions to assess theoretical knowledge of nasogastric tube insertion. The pre-test is used to establish baseline knowledge and group homogeneity, while the post-test measures knowledge acquisition following the assigned learning method. Scores range from 0 to 15, with higher scores indicating better theoretical knowledge of NGT insertion. |
Countries
Finland
Contacts
Primary ContactMarika Leppänen, Doctoral Researcher
Outcome results
None listed