Pediatric Orotracheal Suctioning Training Using a Benner Model-Based Augmented Reality Application

**Background**

Pediatric endotracheal suctioning is a clinical procedure requiring appropriate knowledge, technical skills, and patient assessment. Nursing students need opportunities to develop these competencies in a controlled educational environment before performing the procedure in clinical practice. Augmented reality (AR) offers an additional approach to procedural training through interactive visualization and simulated practice.

Patricia Benner's Novice to Expert Model provides a conceptual basis for supporting the development of nursing competencies. This study applied the model to an AR-based training module for pediatric endotracheal suctioning in orally intubated patients.

**Objective**

The study aimed to evaluate the effect of Benner model-based AR training on nursing students' knowledge and procedural skills compared with conventional mannequin-based training. It also explored students' experiences with the AR-based educational intervention.

**Study Design and Participants**

A two-arm randomized controlled study was conducted within a convergent mixed-methods framework at Istanbul Medipol University, Türkiye, during 2023.

Eligible participants were undergraduate nursing students enrolled in the Pediatric Nursing Practice course who voluntarily agreed to participate and met the study eligibility criteria.

Sixty-six students were randomized into two groups, with 33 participants allocated to each group. Sixty-one students completed the assessments and were included in the quantitative analysis.

**Educational Interventions**

The intervention group received AR-based pediatric endotracheal suctioning training guided by Patricia Benner's Novice to Expert Model. The training focused on knowledge acquisition and procedural skill development in the care of orally intubated pediatric patients.

The control group received conventional mannequin-based training covering the same clinical procedure.

**Outcome Assessment**

Knowledge was assessed before and after training using a researcher-developed 20-item multiple-choice test. Scores ranged from 0 to 100, with higher scores indicating greater knowledge.

Procedural skills were evaluated before and after training using a researcher-developed 25-step assessment form. Each correctly performed step received one point, producing a total score ranging from 0 to 25.

Two independent faculty members assessed procedural performance. Although the assessors were not informed of group allocation, complete blinding could not be guaranteed because the training methods were visibly different.

**Qualitative Component**

Individual semi-structured interviews were conducted with 10 volunteers from the intervention group after the educational intervention. The interviews explored participants' experiences, perceived educational benefits, opportunities for practice, feedback, and challenges associated with AR-based training.

Quantitative and qualitative data were analyzed separately and integrated during interpretation to provide a broader understanding of the educational intervention.

• Benner Model-Based Augmented Reality Training (Behavioral): Nursing students in the intervention group received augmented reality-based pediatric orotracheal suctioning training guided by Patricia Benner's Novice to Expert Model. The educational module was designed to support students' knowledge acquisition and procedural skill development in endotracheal suctioning of orally intubated pediatric patients.
• Conventional Mannequin-Based Training (Behavioral): Nursing students in the control group received conventional mannequin-based training in pediatric orotracheal suctioning. The training focused on the procedural steps required to perform endotracheal suctioning in orally intubated pediatric patients.

Primary outcomes

• Pediatric Endotracheal Suctioning Knowledge Score [Immediately before and after the educational intervention (pretest and posttest)]: Knowledge was assessed using a researcher-developed 20-item multiple-choice test covering pediatric open-system endotracheal suctioning and related clinical care in orally intubated pediatric patients. Each correct answer received 5 points, and each incorrect answer received 0 points. Total scores ranged from 0 to 100, with higher scores indicating greater knowledge.
• Pediatric Endotracheal Suctioning Procedural Skill Score [Immediately before and after the educational intervention (pretest and posttest)]: Psychomotor skills were assessed using a researcher-developed 25-step procedural skill assessment form. Each step was scored as 0 (incorrect) or 1 (correct). Total scores ranged from 0 to 25, with higher scores indicating better procedural performance. Skills were assessed before and after the educational intervention.

Secondary outcomes

• Nursing Students' Experiences With Augmented Reality-Based Training [After completion of the educational intervention]: Students' experiences and perceptions of augmented reality-based training were explored through individual semi-structured interviews with 10 volunteers from the intervention group. Interviews lasted approximately 25-30 minutes and addressed practice opportunities, feedback, perceived educational benefits, and implementation challenges. Data were analyzed using a hybrid deductive-inductive qualitative content analysis approach to identify categories and themes.

Sex: All, accepts healthy volunteers

Inclusion Criteria:

* Undergraduate nursing students enrolled in the Pediatric Nursing Practice course.
* Voluntary agreement to participate in the study.
* Sufficient Turkish language proficiency to understand the instructional materials and complete the assessments.
* No hearing, visual, or fine motor impairments.

Exclusion Criteria:

\- Students who had previously completed or repeated the Pediatric Nursing Practice course.

• Sema Kuguoğlu, Prof.Dr., Study chair, Medipol Unıversty