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Skill training in nursing education has been highly dependent on self-training because of Korea’s high student-faculty ratio. Students tend to have a passive attitude in self-practice, and it is hard to expect effective learning outcomes with traditional checklist-dependent self-practice. Smart glasses have a high potential to assist nursing students with timely information, and a hands-free device does not interrupt performance.
This study aimed to develop a smart glass–based nursing skill training program and evaluate its usability and feasibility for the implementation of self-practice.
We conducted a usability and feasibility study with 30 undergraduate nursing students during a 2-hour open lab for self-practice of core nursing skills, wearing smart glasses for visualized guidance. The usability test was conducted using a 16-item self-reporting questionnaire and 7 open-ended questions. Learning satisfaction was assessed using a 7-item questionnaire. The number of practice sessions was recorded, and perceived competency in core nursing skills was measured before and after the intervention. At the final evaluation, performance accuracy and time consumed for completion were recorded.
Smart glass–assisted self-practice of nursing skills was perceived as helpful, convenient, and interesting. Participants reported improved recollection of sequences of skills, and perceived competency was significantly improved. Several issues were raised by participants regarding smart glasses, including small screen size, touch sensors, fogged lenses with masks, heaviness, and heat after a period of time.
Smart glasses have the potential to assist self-practice, providing timely information at students’ own paces. Having both hands free from holding a device, participants reported the convenience of learning as they could practice and view the information simultaneously. Further revision correcting reported issues would improve the applicability of smart glasses in other areas of nursing education.
Advancements in life science and biotechnology have transformed the hospital environment, and the need for qualified health professionals has never been higher [
Acquisition of mastery in clinical nursing skills not only improves the overall quality of patient care, but also leads to a successful and confident nursing career [
Regardless of the importance of skill training, challenges exist for running educational training programs in Korea. Schools lack the ability to accommodate necessary training because of high student-teacher ratios, so self-practice has been introduced as an alternative method for nursing skill training [
At present, students use a written checklist for self-practice, which provides text-based descriptions for each step. However, using these checklists without proper instruction from lecturers means that there is a high risk that students will misconduct their self-practice and repeat wrong performances. Prior studies have indicated that text alone is limited in delivering messages clearly when it contains complex issues [
Visualization can be an effective solution, and its value for better learning engagement and active learning has been used recognized in education [
Previous studies found passive attitudes among students participating in self-training programs, leading to a lack of competency in future nursing practice [
Along with visualization, timely information facilitates skill acquisition and completion. It is necessary to provide the experience of performing a true-to-life working process [
Smart glasses using augmented reality (AR) have previously been applied to support nursing care activities (eg, wound care management, mass casualty triage classification, and central line placement) [
We developed an XR image guide training program for 2 core nursing skills, specifically, blood transfusion and intradermal injection administration. Of the 20 core nursing skills listed, these 2 skills were randomly chosen from those ranked high in difficulty level, classified by KABONE according to the procedures’ complexity. The numerous steps of these skills were split into several graphical images to be displayed on smart glasses. Each graphical image transposed to the smart glasses paralleled the text information in the original checklists. The contents of the XR image guide training program are shown in
Description of core nursing skills for smart glass–based self-practice.
Item | Steps, n | Core task | Necessary equipment and supplies |
Blood transfusion | 23 | 1. Preparing equipment and supplies. |
Number of items: 18 |
Administration of intradermal injection | 27 | 1. Preparing equipment and supplies. |
Number of items: 12 |
aIV: intravenous.
bAST: antibiotic skin test.
A group of 5 students was given 2 hours of self-training and shared 2 Vuzix smart glasses. Students were encouraged to use the smart glasses at least once, with scheduled turns for the first use. According to KABONE, the estimated time to complete each skill was 10 minutes [
Each image slide consists of 2 or 3 zones (
Composition and contents of smart glass displays.
The graphical images appeared in the order of actions following the sequence of the original text-based checklists. The 2 core skills of blood transfusion and intradermal injection administration were adapted to 23 and 27 screens, respectively (Figures S1 and S2 in
The Vuzix Blade has a display only in the right eye, the display size is 480 × 853, and the shape of the display is a square. Vuzix’s appearance is similar to that of ordinary glasses, and it supports voice recognition and touchpads. It supports Bluetooth and Wi-Fi networks and has a camera attached to take photos and videos or engage in remote collaboration. It is a stand-alone device that weighs 93.6 g and does not require additional equipment. It has a screen saver, so users can use it like a transparent glass in normal times and turn on the display when they need information. The Vuzix Blade currently runs Android 5.1, which supports application programming interface (API) 22 for the target API. Developers can develop the software using Java or Kotlin using Android Studio. Differences from general Android programming include the voice recognition API, touch interface API, and heads-up display API for graphical user interface [
We set up our device as an always-on display. In general, smart glass displays are on-demand displays that turn off the screen after a certain period to save power. When information is only available for a short time upon request, job performance declines because of psychological pressure [
The Vuzix Blade allows user interface elements to be navigated with simple left/right/up/down navigation. The menu is expressed in a square shape at the bottom of the screen. Students can select a submenu by swiping and tapping the touchpad. When a student chooses a submenu, the corresponding image is displayed. We implemented a simple input method to reduce malfunctioning when students use the touchpad. When selecting a task in the list, they are only allowed to use the left/right swipe and one-finger tap. When flipping the slide, only left/right swipes were permitted. It was originally set up to swipe when moving to the upper menu, but we assigned a two-finger tap for moving to the upper menu.
Seventeen items were used for the quantitative usability test. Items were developed based on previous studies in which relevant items were selected and revised to be aligned with the purpose and methodology of this study. The study participants reported perceived usefulness items and ease of use items on 5-point scales, from strongly disagree (1 point) to strongly agree (5 points).
Level of satisfaction was assessed using 7 questions rated on a scale of 1 (strongly disagree) to 10 (strongly agree). Developed by Ji and Chung [
Levels of perceived competency on 2 core nursing skills (administration of intradermal injection and transfusion) were assessed using a 10-point Likert scale. Developed by Han, Cho, and Won [
During the 2-hour self-practice program, the overall number of practice attempts and number of practice attempts wearing smart glasses were observed and recorded by a research assistant. Developed by KABONE, a standardized checklist was used to measure the performance of 2 nursing skills (administration of intradermal injection and transfusion). The checklist consists of procedures of each skill, from preparing materials to writing nursing records after completion of skills. Scoring ranged from 0 to 100; a higher score indicates more accurate and precise performance without mistakes or omitted steps. At the nursing skill performance examination, individuals’ time spent on performance completion was measured and recorded by a research assistant.
Seven qualitative questionnaires were used to obtain comprehensive and detailed information about students’ experiences using smart glasses for core skill nursing training. The questionnaire included the following: (1) How did you find the smart glass–based training in general? (2) Was this program easy to use? Did you need additional instructions? (3) Was there any content causing confusion or difficulties? (4) Did you experience any difficulties while operating smart glasses? (5) Do you think it will be helpful for your future clinical practice? If so, how? (6) Would you make any recommendations that are needed to improve this training program? (7) If you have any other comments regarding this smart glass–based training program, feel free to add them.
The application of smart glass–based core nursing training for undergraduate nursing students was approved by the institutional review board (IRB no. MNUIRB-200326-BM-004-02) at a national university in Korea. Informed consent was obtained prior to obtaining the pretest data, and participants were told that they could stop participating anytime they wanted.
Quantitative statistical data analysis was conducted using SPSS (version 25.0; IBM Corp). Mean, SD, frequency, and percentage were calculated for the demographic data, observation data, usability, and learning satisfaction survey. Paired 2-tailed
The mean age of the study participants was 22.70 years, and 63% (19/30) were female. Approximately two-thirds of participants (22/30, 73%) reported possessing a moderate level of competency in core nursing skills, and approximately 1 in 10 (3/28, 11%) had previous experience with AR (
Demographic characteristics of study participants (N=30).
Characteristics | Value | ||
Age (years), mean (SD) | 22.70 (1.39) | ||
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Male | 11 (37) | |
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Female | 19 (63) | |
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Good | 4 (13) | |
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Fair | 18 (60) | |
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Poor | 8 (27) | |
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High | 21 (70) | |
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Moderate | 9 (30) | |
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Low | 0 (0) | |
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Good | 8 (27) | |
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Fair | 22 (73) | |
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Poor | 0 (0) | |
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Yes | 3 (11) | |
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No | 25 (89) |
Participants were given 2 hours of open lab for self-practice of 2 core nursing skills. The number of practice attempts varied between 5 and 9. Full usage of the smart glasses during the self-practice open lab was observed and recorded. Participants used smart glasses in their practice as little as 2 and as many as 6 times (
Number of practice attempts and smart glass use.
Categories | Range | Mean (SD) | |||
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Blood transfusion | 2-6 | 3.30 (0.952) | ||
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Administration of intradermal injection | 2-5 | 3.73 (0.944) | ||
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Total | 5-9 | 7.03 (1.25) | ||
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Blood transfusion | 0-3 | 1.83 (0.747) | ||
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Administration of intradermal injection | 0-3 | 1.70 (0.651) | ||
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Total | 2-6 | 3.53 (0.973) |
Regarding self-reported usability of the smart glass–based self-practice program, the highest score was obtained for question 11 (perceived interest) with a mean of 9.50 (SD 0.86). Question 5 (screen resolution) scored the lowest with a mean of 7.20 (SD 2.02). The degree of difficulties experienced with devices was rated with a mean of 3.83 (SD 2.73) (
Results of 16-item usability test (N=30).
Item | Range | Usability, mean (SD) | |
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1. How convenient do you think the smart glass–based core nursing education program is? | 3-10 | 8.10 (1.58) |
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2. Was the initial education regarding the device and usage appropriate? | 5-10 | 8.77 (1.46) |
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3. Was the text information presented on the screen easy to read? | 3-10 | 7.27 (2.26) |
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4. Was the picture information presented on the screen clearly understood? | 4-10 | 8.17 (1.90) |
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5. Was the resolution of the screen good? | 4-10 | 7.20 (2.02) |
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6. Did you have any difficulties because of errors that occurred during the performance? | 1-10 | 3.83 (2.73) |
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7. Was the progression speed adequate? | 5-10 | 8.63 (1.22) |
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8. Was the location of the information on the smart glass appropriate? Consistent? Easy to see? | 3-10 | 8.53 (1.85) |
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9. Was it convenient to operate the smart glass? | 6-10 | 8.40 (1.48) |
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10. Did the pictures and text information shown help you perform core basic nursing skills? | 6-10 | 9.07 (1.05) |
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11. Was this type of educational program interesting? | 7-10 | 9.50 (0.86) |
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12. Did you expect better scores using the smart glass training program? | 6-10 | 8.90 (1.21) |
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13. Did you have a better understanding of core basic nursing techniques using augmented reality? | 5-10 | 8.77 (1.48) |
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14. Would you recommend the smart glass–based core nursing education program to other friends? | 3-10 | 8.70 (2.00) |
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15. Do you think smart glass core nursing education will be useful in clinical practice in the future? | 4-10 | 8.77 (1.61) |
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16. Are you willing to use a smart glass for other core nursing skills in the future? | 5-10 | 8.87 (1.57) |
The overall score for learning satisfaction was 9.00 (SD 0.72). The participants gave the highest rating to “It was an interesting learning experience” (mean 9.60, SD 0.68) and the lowest rating to “It was more effective than lecturer-based education” (mean 7.43, SD 1.81) (
Results of 7-item learning satisfaction score (N=30).
Item | Range | Mean (SD) |
1. It was an interesting learning experience. | 8-10 | 9.60 (0.68) |
2. Educational goals of this program were well-achieved. | 7-10 | 9.30 (0.88) |
3. It was a meaningful learning experience. | 8-10 | 9.47 (0.73) |
4. It was more effective than lecturer-based education. | 3-10 | 7.43 (1.81) |
5. I actively engaged in learning. | 7-10 | 9.27 (0.91) |
6. I felt satisfied with the educational program overall. | 7-10 | 9.23 (0.90) |
7. I hope to use this educational program for other subjects. | 3-10 | 8.73 (1.46) |
Learning satisfaction score (total) | N/Aa | 9.00 (0.72) |
aN/A: not applicable.
Paired 2-tailed
Perceived competency in nursing skills before and after smart glass–based self-practice (N=30).
Item, time | Mean (SD) | |||
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−6.53 (29) | <.001 | ||
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Pre | 7.23 (1.17) |
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Post | 8.90 (0.85) |
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−7.00 (29) | <.001 | ||
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Pre | 6.17 (1.64) |
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Post | 8.50 (0.97) |
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The Pearson correlation test was conducted and identified statistically significant negative correlations between the number of practice attempts wearing smart glasses and performance time (
In general, the majority of students found smart glass–based skill training interesting (13/30, 43%) and convenient (8/30, 27%). About one in three participants (8/30, 27%) did not find significant benefits of using smart glasses for self-practice, and one participant reported, “It was interesting at first, but previous text based learning fits better for me.” Resistance to learning new technology was revealed, with participants saying, “I think I had to make more effort to learn about the devices.”
With regard to smart glasses, a large number of participants reported some degree of discomfort. There were touch sensor–related issues (9/30, 30%), specifically, “The touch sensor was too sensitive.” Others complained about the smart glass screen, and participants said, “Small sized text and low resolution caused eyestrain.”
Generally, participants responded that this smart glass–based self-training has educational benefits. Some participants found increased engagement in learning with new technology, saying “I was fascinated by the smart glasses and practice became more interesting using it.” Participants responded to the effectiveness of visualized information, improving their memory of educational content (n=7). Moreover, timely provision of information was found to have significant positive benefits (n=8): “Assisted by timely provided information, accurate and seamless practice was ensured using smart glasses.”
Overall, the participants considered smart glass–based training to be very intuitive. Two out of three (20/30, 67%) reported immediate adaptation to smart glasses, with one participant saying “It was quite straightforward, I figured out how it works right away.” One-third of participants expressed the need for additional instructions, with one saying “I got confused with device, especially the touch pad on the glasses did not make sense for me.”
Several participants provided feedback regarding areas that needed further improvement. In terms of the smart glasses, participants raised the following issues: (1) touch sensor not working properly while wearing latex gloves, (2) glasses easily fogging while wearing a mask, (3) pain of double-layering glasses for people with poor eyesight, and (4) discomfort due to heavy weight and heat after a period of time (about 15 minutes). Regarding the training program content, participants reported tediousness of the simple text and image, saying “I expected something more entertaining like games.”
We explored the perceived usability and feasibility of smart glass–based self-practice among undergraduate nursing students. In general, the findings indicate that the participants had a greater degree of interest in this new device. Although some participants showed resistance to learning about the device, most students were pleased with having new educational methods to assist in their self-practice. This is closely linked to the characteristics of the study population. Recent advances in computing technology have transformed education, and the current generation is accustomed to this continuous change [
The findings of this study revealed the positive effects of smart glasses on engaging students in self-practice. Like self-practice, where an active learning attitude is essential, smart glasses could certainly provide a learner-centered education platform, allowing learning at an individual’s own pace without restrictions of time and supervisors [
The findings of this study indicate greater improvement in perceived competency of performing blood transfusions. One possible explanation is variability in individual skills. Blood transfusion requires not only skillful performance but also complex procedures that involve multiple confirmation process (eg, physicians’ orders, blood continuants, lab examination results, monitoring patients for side effects) [
In terms of number of uses, there was a positive correlation with learning satisfaction and a negative correlation with time consumed on performance completion. In addition, participants responded to educational benefits, as a timely graphical image assisted in improving their memory of the correct sequences. This suggests that the use of smart glasses has great potential to boost students’ abilities for task completion. This is in line with previous studies on AR smart glasses, which assist health professionals in enabling simultaneous performance of multiple tasks [
Several responses involved feedback that needs further consideration for the use of smart glasses to practice skills in nursing education, including low resolution, lack of visibility due to small-sized text, light smudging, perceived heaviness, severe condensation when wearing masks, and pain and discomfort for users wearing eyeglasses. Smart glasses have been considered for clinical implementation such as medical remote collaboration; thus, this is crucial information for future studies. Tasks are (1) determining the optimal size of text for users with poor eyesight, (2) identifying colors that cause light smudging, and (3) comparing and selecting smart glasses that are less likely to cause these issues. For example, the recently developed Google Glass may overcome some of these drawbacks with its advanced display, customizable hard case (lighter version without lenses or version with a thicker and solid frame), and lightweight form factor [
Findings of learning satisfaction outcomes revealed relatively lower scores on the item: “It was more effective than lecturer-based education.” This indicates a limitation of the smart glass–based self-practice program. Although students’ practice was assisted by the smart glasses, it could not sufficiently replace lecturer-based education. This implies the need for additional strategies to meet the educational needs of nursing skill training. Integration of prior educational strategies could effectively reinforce the current version of smart glass–based education.
The diverse features of smart glasses would more effectively replace previous strategies used for self-practice in nursing education. First, self-practice with video recording with self-feedback or peer feedback, the effectiveness of which was well established in a previous review study [
We conducted further statistical analysis (Tables S1 and S2 in
This study was not without limitations. First, although this was a pilot study focusing on usability and feasibility, the small sample size restricted the interpretation of some of the results. In addition, it is not possible to fully elucidate the effectiveness of the smart glass–based training program. Examining usability and feasibility, we did not thoroughly compare the effectiveness of the smart glass–based training program to other existing training programs that are prevalent in nursing education (eg, smartphone video recording of self-practice). Given the finding from this study that smart glasses can be a useful education strategy, more thoroughly demonstrating the effectiveness with future research would encourage faculties to actively incorporate such devices into their education plans. Lastly, it is questionable whether the Vuzix Blade is the best device for nursing skills training, as new smart glasses are continuously released in this growing market. Thus, future research using a variety of smart glasses with differing specifications that reflect factors that caused discomfort and inconvenience in this study would offer valuable information for educators considering the use of smart glasses. Employing and comparing various AR presentation types (eg, 3D content, data visualization, virtual characters) and AR augmentation techniques (eg, multimodal, physical feedback, sound augmentation) are worthy of further investigation to elucidate optimal smart glasses–based practices.
The findings of this study suggest the use of smart glasses was a useful educational strategy for assisting self-practice of skills in nursing education. Given the benefits of timely information and hands-free operation (hands free from holding a device), participants reported positive experiences in general, including a high level of interest and appreciation for the convenience of this training program. Participants who had favorable views of this technology-enhanced education were more likely to report greater learning satisfaction, which shows great potential in transforming a previously passive attitude to an active one. Future revision reflecting the feedback from this study would effectively foster a high level of skill competency among undergraduate nursing students, engaging students in active learning and reducing the burden on faculty members.
Snapshots of the image guide for intradermal injection, snapshots of the image guide for blood transfusion, Pearson correlation analysis among study variables, and difference of usability score (ease of use and usefulness) by gender and previous experience of augmented reality.
application programming interface
augmented reality
Korean Accreditation Board of Nursing Education
National Research Foundation of Korea
extended reality
This research was supported by a grant (20012234) of Regional Customized Disaster-Safety R&D Program funded by the Ministry of the Interior and Safety (Korea). This work was supported by a National Research Foundation of Korea (NRF) grant funded by the Korean government (No. NRF-2019R1G1A1006737 and No. NRF-2018R1D1A1B07048247).
None declared.