Background: 

The ability to engage in critical thinking is essential for making clinical decisions in nursing. Deficits in critical thinking and clinical decision-making have been noted in nursing students, who tend to fixate on rules and task completion, neglecting important patient cues. This is a critical issue for patient safety, as nurses in inpatient settings make decisions about every ten minutes, and intensive care nurses make decisions every 30 seconds. Furthermore, up to 70% of errors in healthcare are related to communication, teamwork, and clinical decision-making ("Human Factors").

The Innovation: 

To address deficits and uncertainities in clinical decision making, the DHBW Stuttgart has implemented and evaluated an innovative, technology-supported teaching-learning concept using Augmented Reality (AR) with Microsoft HoloLens hardware and the GigXR HoloPatient software. This creates a high-fidelity, mixed-reality simulation where a holographic patient exhibiting various clinical pathologies (e.g., anaphylactic shock, diabetic coma) is projected into the real classroom environment, offering a 360-degree perspective, and including realistic visual and acoustic stimuli like pathological breathing sounds. The use of AR has been shown to support the development of clinical decision-making skills in nursing studies.

The AR simulation is integrated into an academically founded didactic design within an  Seminar for DHBW nursing students in their 3^rd year. The pedagogical framework combines:

• Situated Learning Theory (focusing on authentic, complex problem-solving situations that build on prior knowledge).

• Hermeneutic Case Work by Schrems, guiding students through a structured, four-step process of pre-understanding, understanding based on case work/evidence, and the development of interventions.
• A Hybrid Clinical Decision-Making Model (O’Neill’s model) that merges information processing with intuitive/humanistic approaches.
• An essential Debriefing/Reflection phase that follows established simulation concepts, ensuring self-reflection and error analysis.
• Students document their work using the structure of a guideline for case reportsthat has been specially adapted for nursing case work.

This presentation founded on a pilot project (Winter Semester 2022/23 and subsequent iterations) is conducted as part of the federally funded EdCoN (Education Competence Network) initiative. The goal of the evaluation is to determine the extent to which AR supports the learning goals related to satisfaction, learning promotion, learning success, and learning gain.

• Initial Quantitative Findings (Self-Assessment, N=27): Students reported a high perceived learning gain, particularly in clinical knowledge (Score 5.0 on a 6-point Likert scale), and improved self-assessed skills in critical thinking (Score 4.56) and clinical decision-making (Score 4.15).
• Qualitative Findings (Focus Group Interviews): A core identified value is the creation of an error-tolerant, pressure-free learning environment that supports competence acquisition in a non-hazardous way, especially beneficial for novice students. The experience is also described as highly authentic and emotionally engaging.
• Operational Challenges and Solutions: Challenges identified include the high technical effort for registration and managing updates, but a major advantage is the ability for multiple group members to participate remotely via a smartphone or tablet by projecting the hologram into their space.

Conclusion of Pilot Phase: The combination of AR technology with case-based learning provides an innovative, error-tolerant approach for nursing students to acquire complex competencies, thus contributing to improved patient safety.

Relevance 

This presentation is highly current as it details a newly implemented didactic concept using AR technology (HoloPatient) as validated by a pilot implementation. It is relevant as it addresses documented international and national deficits in critical competencies for future healthcare professionals, contributing directly to the global focus on patient safety. The content is non-commercial, focusing purely on the innovative pedagogical approach, didactic design, and evaluation results, regardless of the commercial technology used to facilitate it.