# Experimental Development of XR Enteral Feeding Function for an Endotracheal Suctioning Training Environment Simulator

## TL;DR

This study developed an XR simulator for enteral feeding training that uses sensors and real-time patient reactions to improve nursing education and assessment.

## Contribution

The integration of dosing-rate sensing devices with XR to enable real-time patient reactions and quantitative skill assessment in nursing training.

## Key findings

- Sensor data revealed greater dosing-rate variability and longer procedure times among students compared to nurses.
- Projection mapping was perceived as more embodied, while tablet displays offered better visibility.
- Students showed small-to-large perceived learning gains across both experiments.

## Abstract

What are the main findings?
The simulator uniquely integrates dosing-rate sensing devices with XR to present real-time patient reactions, including facial expression changes and cyanosis.Sensor-derived data enabled the quantitative measurement of procedural behaviors in both students and nurses.Projection mapping and tablet-based interfaces produced different perceptions of embodiment, visibility, and usability among learners.

The simulator uniquely integrates dosing-rate sensing devices with XR to present real-time patient reactions, including facial expression changes and cyanosis.

Sensor-derived data enabled the quantitative measurement of procedural behaviors in both students and nurses.

Projection mapping and tablet-based interfaces produced different perceptions of embodiment, visibility, and usability among learners.

What are the implications of the main findings?
The system provides a foundation for assessing aspects of nursing skills that have traditionally been considered tacit or difficult to quantify.Objective, sensor-based performance metrics may support more standardized and data-driven approaches to enteral-feeding education.Insights from interface comparisons can guide future XR design choices to optimize learner engagement and instructional effectiveness.

The system provides a foundation for assessing aspects of nursing skills that have traditionally been considered tacit or difficult to quantify.

Objective, sensor-based performance metrics may support more standardized and data-driven approaches to enteral-feeding education.

Insights from interface comparisons can guide future XR design choices to optimize learner engagement and instructional effectiveness.

Background: Existing XR simulators for enteral feeding rely mainly on self-reported learning outcomes and procedural checklists. As a result, they offer limited opportunities to capture objective behavioral data or to present dynamic patient reactions. This two-stage pilot study evaluated an XR-based gastrostomy tube-feeding simulator (ESTE-TF) that integrates sensor-derived performance metrics and two biological-reaction presentation modalities (projection mapping and tablet display). Methods: In Experiment 1, nursing students completed pre- and post-experience questionnaires assessing perceived learning across seven domains, alongside sensor-based measurements of feeding-start timing, dosing-rate characteristics, and total procedure time. Experiment 2 employed a tablet-based version with four learning items assessed for students and post-experience evaluations collected from registered nurses. Participants also compared the two XR presentation methods. Results: Students demonstrated perceived learning gains of small-to-large magnitude across both experiments (Experiment 1: d = 0.455–0.974; Experiment 2: d = 0.014–0.886), with wide 95% confidence intervals reflecting the exploratory nature of this pilot work. Sensor-derived data showed greater dosing-rate variability and longer procedure times among students than nurses. Participants reported that projection mapping offered a more embodied experience, whereas tablet displays provided clearer visibility. Conclusions: These findings indicate the feasibility and preliminary educational potential of integrating sensing technologies with XR-based biological-reaction presentation for gastrostomy-feeding training. Given the small samples and non-validated measures, results should be interpreted as exploratory. Future research will refine sensor accuracy, establish standardized performance metrics, and evaluate learning outcomes using validated instruments and controlled study designs.