Development and usability of the mixed reality–based intubation nursing simulation: A mixed methods study

Abstract

Background: Integrating mixed reality (MR) into nursing simulation education, particularly for procedural training such as endotracheal intubation, offers a promising avenue to the repetitive training of practical execution and collaboration. This study aimed to develop an MR-based intubation nursing (MRIN) simulation tailored for nursing professionals and focused on usability. Methods: This study used a mixed methods design. The MRIN scenario with eight steps was developed using HoloLens 2 and evaluated by 12 nursing master's students experienced in intubation. After two simulation sessions, quantitative data for the simulation task load index (SIM-TLX) and task completion time were evaluated, while qualitative data were gathered through think aloud (TA) interviews. Results: The subtotal task load of the SIM-TLX decreased from 4.25/10 ± 2.21 in the first simulation to 3.08/10 ± 1.37 in the second simulation, with reduced task completion time. TA interviews highlighted the need for modifications to enhance realism, procedural accuracy, and the program's strengths. Conclusion: The MRIN simulation represents an advancement in MR technology for nursing education, offering an immersive and effective platform for procedural training. © 2025