虛擬實境對護理人員學習成效之探討-以照護高風險傳染性疾病個人防護為例

Abstract

研究背景與目的：多媒體教學訓練為臨床護理教育中不可或缺的教學方式，其中360虛擬實境因提供沉浸式情境教學，近年來逐漸受到醫護教育領域的重視，尤其用於具高風險情境的訓練，如面對患有高風險傳染性疾病病人之照護。然而過去並沒有相關的研究探討360虛擬實境與傳統二維影片教學成效的差異。因此，本研究目的在探討虛擬實境(Virtual Reality, VR)與二維影片(Two Dimensions，2D)多媒體教材對於護理人員穿戴防護裝備與處理隔離室中之危機情境的學習成效，及對VR與2D多媒體教學工具之使用感受差異。 研究方法：本研究採真實驗研究設計（true-experimental research design），以簡單隨機分派方式分兩組，使用VR學習組為實驗組（VR組）、2D影片學習組為對照組（2D組）。研究工具在自變項方面採自行發展之高風險傳染性疾病照護教學案例，包含兩部劇本：第一部為「個人防護連身裝備篇」，內容涵蓋連身型個人防護裝備之正確穿戴與脫除流程；第二部為「危機處理篇」，聚焦於護理人員於隔離室中照護高風險傳染性疾病病患時，面對病人有情緒反應、攻擊或不當行為時之危機處理。教學案例以VR與2D兩種多媒體形式呈現，教案之內容效度（Content Validity Index, CVI）在相關性、正確性、適切性之面向均達0.99以上。依變項之研究工具則包含1.自填式之認知問卷及壓力量表，於教學前後進行施測，以評估VR與2D多媒體教材對護理人員對高風險傳染性疾病照護之認知與情意態度構面之影響；2.採用「技能檢核表」及「螢光檢測表」評估教學後受試者之個人防護設備穿戴動作技能與污染情形，以比較VR與2D多媒體教學在技能學習成效之差異；3.以「多媒體教育之使用者感受」量表，以評估護理人員對兩種多媒體教學工具之評價。最後以SPSS統計套裝軟體進行資料建檔與分析。 研究結果：自2025年5月31日至2025年9月30日止，共納入238位護理人員參與本研究。在高風險傳染性疾病照護之認知表現方面，VR組與2D組於後測之認知分數均較前測顯著提升（p < .001），且VR組於前後測之認知得分差距顯著高於2D組（p < .001）。個人防護設備穿戴動作技能方面，兩組的技能檢核得分均幾乎可達到滿分（VR：Mean = 99.6, SD = 1.4；2D：Mean = 98.9, SD = 2.0；p = .003）；汙染部位方面，VR手部污染率顯著低於2D組，VR：7人（5.9%）；2D：17人（14.2%）(p= .035）。照護高風險傳染性疾病病人壓力方面，兩組於後測之壓力分數皆較前測顯著下降（p < .001），雖兩組之壓力降低程度之總分未達統計上的顯著差異（p = .536），但在「感染控制的困難與焦慮」次量表中，VR組的壓力降低程度顯著較2D組為多（VR：Mean = -2.2, SD = 3.6；2D：Mean = -1.1, SD = 3.0；p = .017）。在多媒體教材使用感受、學習滿意度與學習自信心構面中，VR組之整體評價均高於2D組，VR組認為「非常滿意」的比例均達90-92%、2D組86-88%。整體結果，顯示護理人員對VR與2D多媒體教學工具之使用感受皆呈現正向態度，對教材內容與教學流程具有高度滿意，並能有效提升其學習自信心。 結論：本研究顯示VR與2D多媒體教材皆能有效提升護理人員在高風險傳染性疾病照護的知識、動作技能與壓力調適，且整體學習體驗良好。其中，VR在程序性技能訓練、降低手部污染風險及改善感染控制焦慮的成效比2D組更為顯著。

Objective: Simulation-based education is a core component of clinical nursing education, and 360-degree virtual reality (VR) has been increasingly adopted to facilitate immersive learning in high-risk clinical scenarios, including the care of patients with highly infectious diseases. This study aimed to compare nurses’ learning outcomes and user perceptions of VR and conventional two-dimensional (2D) video-based simulation in relation to personal protective equipment donning and doffing and crisis management in isolation-room settings. Methods: A true-experimental design with simple random assignment was used. Participants were randomly allocated to either a virtual reality (VR) group or a two-dimensional (2D) video group. The intervention consisted of researcher-developed, simulation-based instructional scenarios for high-risk infectious disease care, comprising two modules: a personal protective equipment (PPE) module addressing correct donning and doffing procedures, and a crisis management module focusing on nurses’ responses to a patient with emotional distress, aggressive behaviors, and inappropriate actions in isolation-room settings. The instructional materials were delivered in both VR and 2D formats and demonstrated excellent content validity, with a Content Validity Index exceeding 0.99. Learning outcomes were evaluated using pre- and post-intervention assessments of cognitive knowledge and stress, post-intervention measures of PPE procedural skill performance and contamination risk using a skills checklist and fluorescent assessment, and a user experience questionnaire to examine learners’ perceptions of the two simulation modalities. Data were analyzed using SPSS statistical software. Results: Between May 31 and September 30, 2025, a total of 238 clinical nurses participated in the study. In terms of cognitive performance in high-risk infectious disease care, both the VR and 2D groups showed significant improvements in post-intervention scores compared with baseline (p < .001). The magnitude of cognitive learning gains was significantly greater in the VR group than in the 2D group (p < .001). Procedural skill performance related to PPE donning and doffing improved in both groups, with skill checklist scores approaching the maximum possible score. Nevertheless, the VR group achieved significantly higher scores than the 2D group (VR: M = 99.6, SD = 1.4; 2D: M = 98.9, SD = 2.0; p = .003). In addition, contamination outcomes differed significantly between groups, with a lower hand contamination rate observed in the VR group (7 participants, 5.9%) compared with the 2D group (17 participants, 14.2%; p = .035). Stress associated with caring for patients with high-risk infectious diseases decreased significantly after the intervention in both groups (p < .001). Although no significant between-group difference was found in overall stress reduction (p = .536), participants in the VR group exhibited a significantly greater reduction in the “infection control difficulty and anxiety” subscale compared with those in the 2D group (VR: M = -2.2, SD = 3.6; 2D: M = -1.1, SD = 3.0; p = .017). Regarding learner perceptions, participants in the VR group consistently reported higher ratings across multimedia usability, learning satisfaction, and learning self-confidence, with 90-92% indicating they were “very satisfied,” compared with 86-88% in the 2D group. Overall, both VR and 2D multimedia instruction were perceived positively, with high satisfaction regarding the instructional content and learning process, and enhanced learning confidence. Conclusions: This study demonstrates that both virtual reality (VR) and two-dimensional (2D) multimedia instruction effectively enhance nurses’ knowledge, procedural skills, and stress management in the care of patients with high-risk infectious diseases, while providing an overall positive learning experience. Notably, VR-based simulation offers greater advantages over 2D instruction in procedural skill training, reducing hand contamination risk, and alleviating infection control–related anxiety.