Development of neonatal Apgar scoring training program utilizing contactless hand tracking in immersive virtual reality

Background: The rapid and accurate assessment of neonatal asphyxia is critical to preventing potentially fatal outcomes. Therefore, nursing students must acquire the skills to assess newborn conditions immediately after birth and implement appropriate interventions. Virtual reality (VR) simulation education has emerged as a promising tool for nursing education, offering repetitive and customizable clinical training while ensuring patient safety and overcoming spatiotemporal limitations. Aim: This study investigated the effects of a contactless hand-tracking-based immersive VR neonatal Apgar scoring program, adapted from experiential learning theory. Design: A non-randomized controlled trial with a pre-post-test, quasi-experimental design was conducted. Settings: The study was conducted at two nursing schools from July to October 2023. Participants: Participants comprised nursing students holding bachelor's degrees in nursing, with three or four years of experience and successful completion of a neonatal nursing theory course. Additionally, individuals with at least six months of experience working in a neonatal ward or delivery room before enrolling in nursing school were eligible. Methods: The participants were divided into three groups: the VR group (n = 27) received contactless handtracking-based immersive VR neonatal Apgar scoring training; the simulation group (n = 28) received face-toface Apgar scoring simulation training; and the control group (n = 26) received instruction on the Apgar scoring criteria. Changes in scores among the VR, simulation, and control groups were statistically compared using ANOVA with SPSS-WIN 27.0. Results: The VR group exhibited significant improvements in knowledge, learning satisfaction, self-confidence, immersion, and motivation compared to the simulation and control groups. Moreover, satisfaction was significantly higher in the VR group than in the simulation group. Conclusions: The hand-tracking-based immersive VR neonatal Apgar scoring program represents an innovative and effective educational tool, prioritizing the privacy and rights of mothers and infants. It can potentially replace traditional delivery-room clinical training, which is observation-based and limited.