JMIR Publications

ABSTRACT

Background:

Continuous Kidney Replacement Therapy (CKRT) is a complex ICU treatment requiring significant expertise, but training is often time-limited, lacks hands-on practice, and long gaps between training and device use can lead to skill degradation. ICU challenges such as staff shortages and high turnover further hinder proficiency. Augmented reality (AR) offers a promising solution by providing realistic, flexible, and standardized training within clinical settings.

Objective:

This study evaluated the impact of AR-based re-training for a commercial CKRT device on nurse performance, confidence, stress levels, and acceptance in the ICU.

Methods:

The study included 34 ICU nurses who attended classroom training on CKRT devices, followed by a 2–14-day delay to simulate real-world conditions. Participants were then allocated to AR and non-AR groups; the AR group completed self-guided AR re-training and had a 30-minute delay before testing, while the non-AR group did the testing without such re-training. Task performance for device setup and troubleshooting (completion rates, errors, and time on task) was measured during testing, while perceived confidence, stress, and AR learning experience were assessed through structured questionnaires.

Results:

The AR group outperformed the non-AR group in task completion for device setup (94% vs. 88%) and troubleshooting (69% vs. 6%), with fewer errors on average (setup: 1.6 vs. 3.9, troubleshooting: 0.6 vs. 4.5) and faster median setup time. Confidence in device setup declined post-decay in both groups (AR: 59%, non-AR: 41%) but fully recovered in the AR group after re-training (76% "rather confident," 24% "confident"). Troubleshooting confidence was initially low in both groups, declined further post-decay, but improved in the AR group after re-training (65% "rather confident"). Stress levels were lower in the AR group at baseline but followed a similar trend to confidence and troubleshooting, with a decline post-decay and recovery after AR re-training. AR re-training was rated easy to use by 71% of participants, with 86% expressing interest in future use. Most participants valued flexibility (77% preferred self-scheduling, 59% self-paced learning) and emphasized the importance of standardized training content (73%).

Conclusions:

AR re-training showed potential to improve nurse performance, particularly for complex tasks like troubleshooting. Its ability to support procedure rehearsal may also enhance confidence and reduce stress levels.