Advanced Cardiac Life Support EducationNCT07862322
Effects of Two-Tier Test-Based Virtual Reality Instruction on ACLS Outcomes Among Clinical Nurses
A study testing Two-Tier Test-Based Virtual Reality Instruction and Traditional Interactive Virtual Reality Instruction in people with Advanced Cardiac Life Support Education, run by Taoyuan General Hospital at 1 site in Taiwan.
Trial summary
This study aims to evaluate the effects of two-tier test-based virtual reality (VR) instruction on Advanced Cardiac Life Support (ACLS) learning outcomes among clinical nurses. Participants will be randomly assigned to either a two-tier test-based VR instruction group or a traditional interactive VR instruction group. Read more about this study
- Who is it for?
- Any ageHealthy volunteers can take part
- Conditions the study is for
- Advanced Cardiac Life Support Education
- What is being tested?
- Two-Tier Test-Based Virtual Reality Instruction and Traditional Interactive Virtual Reality Instruction
- Type of treatment
- Pill or oral medicine, Lifestyle or therapy programme
- Could I receive a placebo?
- No, everyone receives an active treatment
- How many people
- 100 participants
- Where
- 1 siteTaiwan
- Study dates
- Oct 2026to May 2027
- Phase
- Interventional
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages Any age
- All sexes
- Healthy volunteers accepted
- Child, Adult, Older adult
Who may be able to join
- Clinical nurses holding a valid nurse or registered nurse license.
- Clinical nurses who have completed the hospital's emergency and resuscitation training courses.
Who cannot join
- Newly employed nurses within the first 3 months of employment.
- Instructors for the hospital's resuscitation training courses.
Trial locations and contacts
1 site in 1 country. Contact the study team or a site near you to ask about taking part.
Taiwan1 site
Taoyuan General Hospital, Ministry of Health and Welfare
Taoyuan, 33004
Cheng-Wei Chen, BSN, +886-972-608-263, g462113003@tmu.edu.tw
CHENG-WEI CHEN, BSN
About this study
Official title: The Effects of Two-tier Test-based Virtual Reality Teaching on ACLS Knowledge and Resuscitation Self-efficacy Among Clinical Nurses
This study aims to evaluate the effects of two-tier test-based virtual reality (VR) instruction on Advanced Cardiac Life Support (ACLS) learning outcomes among clinical nurses. Participants will be randomly assigned to either a two-tier test-based VR instruction group or a traditional interactive VR instruction group. Both groups will use tablet-based, non-immersive VR to learn and practice ACLS-related clinical scenarios.
The study will assess ACLS knowledge, ACLS skills, resuscitation self-efficacy, critical reflection ability, and cognitive load. Assessments will be conducted before and after the intervention, with follow-up assessments conducted one month later to evaluate the retention of learning outcomes.
Read the detailed description
This study is a two-group randomized controlled trial designed to evaluate the effectiveness of two-tier test-based virtual reality (VR) instruction for Advanced Cardiac Life Support (ACLS) education among clinical nurses. A total of 100 clinical nurses will be randomly assigned in a 1:1 ratio to either the experimental group or the control group using computer-generated block randomization.
Both groups will receive tablet-based, non-immersive VR instruction using the same ACLS clinical scenario, learning content, equipment, and intervention duration. The VR scenario simulates the emergency management of a hospitalized patient and incorporates ACLS-related knowledge, clinical decision-making, and interactive questions with immediate feedback.
In the experimental group, participants will receive two-tier test-based VR instruction. Each embedded question consists of two levels: the first tier assesses ACLS knowledge or clinical decisions, and the second tier assesses the reasoning underlying the first-tier response. Both tiers use single-choice questions, and the system provides immediate feedback based on participants' responses. In the control group, participants will receive traditional interactive VR instruction using the same first-tier ACLS questions and immediate feedback but without the second-tier reasoning questions.
The study includes three assessment periods. Before the intervention, participants will complete assessments of ACLS knowledge, resuscitation self-efficacy, and critical reflection ability, along with demographic information. Immediately after the VR intervention, participants will complete assessments of ACLS knowledge, resuscitation self-efficacy, critical reflection ability, and cognitive load. Cognitive load will be assessed only after the intervention.
ACLS skills will be evaluated using a one-to-one, integrated simulation scenario rather than a multi-station assessment. Participants will be required to perform patient assessment, emergency response activation, cardiopulmonary resuscitation, ventilation, rhythm recognition, defibrillation, medication administration, and advanced airway management. A trained assessor will evaluate performance using a standardized scenario script and structured skills checklist without providing additional prompts or correctness feedback. To maintain consistency in assessment conditions, participants will undergo the post-intervention ACLS skills assessment on a scheduled assessment day after completion of the intervention phase, and the follow-up ACLS skills assessment will be conducted approximately one month later under the same standardized conditions.
At the one-month follow-up, ACLS knowledge, ACLS skills, resuscitation self-efficacy, and critical reflection ability will be reassessed to evaluate changes and retention of learning outcomes over time.
- Conditions
- Advanced Cardiac Life Support Education
- Being tested
- Two-Tier Test-Based Virtual Reality Instruction, Traditional Interactive Virtual Reality Instruction
- Keywords
- Advanced Cardiac Life Support, Virtual Reality, Two-Tier Test, Nursing Education, Clinical Nurses
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
Two-Tier Test-Based Virtual Reality InstructionBehavioural
Participants will receive a single session of tablet-based, non-immersive virtual reality (VR) instruction lasting approximately 20-25 minutes. The VR program presents a simulated Advanced Cardiac Life Support (ACLS) scenario involving the emergency management of a hospitalized patient.
Interactive two-tier test questions are embedded within the VR scenario. The first tier consists of single-choice questions assessing ACLS knowledge and clinical decision-making, and the second tier consists of single-choice questions assessing the reasoning underlying the first-tier responses. After participants respond, the system provides immediate feedback to support learning and reflection.
The experimental and comparator interventions use the same tablet equipment, VR scenario, first-tier questions, core ACLS learning content, and intervention duration. The distinguishing feature of this intervention is the addition of second-tier reasoning questions.
Traditional Interactive Virtual Reality InstructionBehavioural
Participants will receive a single session of tablet-based, non-immersive virtual reality (VR) instruction lasting approximately 20-25 minutes. The VR program presents a simulated Advanced Cardiac Life Support (ACLS) scenario involving the emergency management of a hospitalized patient.
Single-tier, single-choice questions assessing ACLS knowledge and clinical decision-making are embedded within the VR scenario. After participants respond to each question, the system provides immediate feedback.
The comparator and experimental interventions use the same tablet equipment, VR scenario, first-tier questions, core ACLS learning content, and intervention duration. The distinguishing feature of this intervention is that it does not include the second-tier reasoning questions used in the experimental intervention.
| Study group | Role | What they receive |
|---|---|---|
| Two-Tier Test-Based Virtual Reality Instruction | Experimental | Participants in this arm will receive tablet-based, non-immersive virtual reality (VR) instruction using a simulated Advanced Cardiac Life Support (ACLS) clinical scenario. The VR instruction incorporates two-tier test questions. The first tier consists of single-choice questions assessing ACLS knowledge and clinical decision-making, while the second tier consists of single-choice questions assessing the reasoning underlying the first-tier responses. The system provides immediate feedback based on participants' responses. The VR instruction will last approximately 20-25 minutes. Receives: Behavioral: Two-Tier Test-Based Virtual Reality Instruction |
| Traditional Interactive Virtual Reality Instruction | Active comparator | Participants in this arm will receive tablet-based, non-immersive virtual reality (VR) instruction using the same simulated Advanced Cardiac Life Support (ACLS) clinical scenario, learning content, equipment, and intervention duration as the experimental group. The VR instruction incorporates single-tier, single-choice questions assessing ACLS knowledge and clinical decision-making. The system provides immediate feedback after participants respond. Unlike the experimental group, this arm does not include second-tier questions assessing the reasoning underlying the first-tier responses. The VR instruction will last approximately 20-25 minutes. Receives: Behavioral: Traditional Interactive Virtual Reality Instruction |
What is being measured
The primary outcome is the main question the study is designed to answer.
Advanced Cardiac Life Support Knowledge
Advanced Cardiac Life Support (ACLS) knowledge will be assessed using researcher-developed 20-item single-choice tests. The baseline knowledge test assesses fundamental ACLS knowledge, including cardiopulmonary resuscitation procedures, electrocardiogram rhythm recognition, defibrillation, and emergency medications. The post-intervention knowledge test includes ACLS knowledge as well as clinical scenario-based questions assessing rhythm recognition, emergency response procedures, medication selection and use, team communication, and clinical decision-making. Each correct response receives 1 point, while an incorrect or unanswered item receives 0 points, resulting in a total score ranging from 0 to 20. Higher scores indicate greater ACLS knowledge. The same post-intervention knowledge test will be used at the one-month follow-up.
Measured: Baseline, immediately after the intervention, and 1 month after the intervention
Advanced Cardiac Life Support Skills
Advanced Cardiac Life Support (ACLS) skills will be assessed using a researcher-developed 20-item structured skills performance checklist. The checklist evaluates the correct performance of ACLS procedures, including endotracheal intubation assistance, electrocardiogram rhythm recognition, defibrillation, cardiopulmonary resuscitation, and emergency medication-related assessment, decision-making, and technical performance. Each correctly performed item receives 1 point, while each incorrectly performed or omitted item receives 0 points, resulting in a total score ranging from 0 to 20. Higher scores indicate better ACLS skills performance.
Measured: Post-intervention skills assessment and 1 month after the post-intervention skills assessment
Secondary outcomes (5)
Resuscitation Self-Efficacy
Resuscitation self-efficacy will be assessed using the 17-item Resuscitation Self-Efficacy Scale developed by Roh et al. (2012). The scale includes four domains: recognition, debriefing and recording, responding and rescuing, and reporting. Each item is rated on a 5-point Likert scale from 1 to 5, resulting in a total score ranging from 17 to 85. Higher total scores indicate greater resuscitation self-efficacy.
Measured: Baseline, immediately after the intervention, and 1 month after the intervention
Critical Reflection Competency
Critical reflection competency will be assessed using the 19-item Critical Reflection Competency Scale developed by Shin et al. (2022). Each item is rated on a 5-point Likert scale from 1 to 5, resulting in a total score ranging from 19 to 95. Higher total scores indicate greater critical reflection competency.
Measured: Baseline, immediately after the intervention, and 1 month after the intervention
Intrinsic Cognitive Load
3 items from the 10-item Cognitive Load Scale
Measured: Immediately after the intervention
Extraneous Cognitive Load
3 items from the same 10-item Cognitive Load Scale
Measured: Immediately after the intervention
Germane Cognitive Load
4 items from the same 10-item Cognitive Load Scale
Measured: Immediately after the intervention
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted7 Oct 2026
- Study startOct 2026 (estimated)
- Primary completionMay 2027 (estimated)
- Study completionMay 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Advanced Cardiac Life Support EducationStudies of the same condition, open and under way.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Interventional
- Phase
- Phase N/A
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Model description
- Participants will be randomly assigned in a 1:1 ratio to either the two-tier test-based virtual reality instruction group or the traditional interactive virtual reality instruction group using computer-generated block randomization.
- Masking
- Single blind
- Who is masked
- Outcomes assessor
- Enrolment
- 100 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Taoyuan General Hospital
- Sponsor type
- Other government
- Responsible party
- Sponsor
- Investigators
- CHENG-WEI CHEN, BSN, Principal investigator, Taoyuan General Hospital
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07862322
- Sponsor's protocol ID
- TYGH115056
- Status last verified
- Sep 2026
- First submitted
- 1 Oct 2026
- Last updated
- 7 Oct 2026
- Results posted
- No
- Data monitoring committee
- No
- FDA-regulated drug
- No
- FDA-regulated device
- No
- Individual data sharing
- No: Individual participant data will not be shared with other researchers because data sharing is not included in the current IRB-approved study protocol or informed consent. Study results will be reported only in aggregate form to protect participant confidentiality.
Study at a glance
From the registry record, last updated by the sponsor on 7 Oct 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- The Effects of Two-tier Test-based Virtual Reality Teaching on ACLS Knowledge and Resuscitation Self-efficacy Among Clinical Nurses
- ClinicalTrials.gov ID
- NCT07862322
- Acronym / sponsor ID
- TYGH115056
- Conditions
- Advanced Cardiac Life Support Education
- Keywords
- Advanced Cardiac Life Support, Virtual Reality, Two-Tier Test, Nursing Education, Clinical Nurses
- Study type
- Interventional
- Recruitment status
- Not yet recruiting
- Enrolment
- 100 participants (estimated)
- Lead sponsor
- Taoyuan General HospitalOther government
- Study start
- Oct 2026 (estimated)
- Primary completion
- May 2027 (estimated)
- Study completion
- May 2027 (estimated)
- First posted
- 7 Oct 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
This study aims to evaluate the effects of two-tier test-based virtual reality (VR) instruction on Advanced Cardiac Life Support (ACLS) learning outcomes among clinical nurses. Participants will be randomly assigned to either a two-tier test-based VR instruction group or a traditional interactive VR instruction group. Both groups will use tablet-based, non-immersive VR to learn and practice ACLS-related clinical scenarios.
The study will assess ACLS knowledge, ACLS skills, resuscitation self-efficacy, critical reflection ability, and cognitive load. Assessments will be conducted before and after the intervention, with follow-up assessments conducted one month later to evaluate the retention of learning outcomes.
Detailed description
This study is a two-group randomized controlled trial designed to evaluate the effectiveness of two-tier test-based virtual reality (VR) instruction for Advanced Cardiac Life Support (ACLS) education among clinical nurses. A total of 100 clinical nurses will be randomly assigned in a 1:1 ratio to either the experimental group or the control group using computer-generated block randomization.
Both groups will receive tablet-based, non-immersive VR instruction using the same ACLS clinical scenario, learning content, equipment, and intervention duration. The VR scenario simulates the emergency management of a hospitalized patient and incorporates ACLS-related knowledge, clinical decision-making, and interactive questions with immediate feedback.
In the experimental group, participants will receive two-tier test-based VR instruction. Each embedded question consists of two levels: the first tier assesses ACLS knowledge or clinical decisions, and the second tier assesses the reasoning underlying the first-tier response. Both tiers use single-choice questions, and the system provides immediate feedback based on participants' responses. In the control group, participants will receive traditional interactive VR instruction using the same first-tier ACLS questions and immediate feedback but without the second-tier reasoning questions.
The study includes three assessment periods. Before the intervention, participants will complete assessments of ACLS knowledge, resuscitation self-efficacy, and critical reflection ability, along with demographic information. Immediately after the VR intervention, participants will complete assessments of ACLS knowledge, resuscitation self-efficacy, critical reflection ability, and cognitive load. Cognitive load will be assessed only after the intervention.
ACLS skills will be evaluated using a one-to-one, integrated simulation scenario rather than a multi-station assessment. Participants will be required to perform patient assessment, emergency response activation, cardiopulmonary resuscitation, ventilation, rhythm recognition, defibrillation, medication administration, and advanced airway management. A trained assessor will evaluate performance using a standardized scenario script and structured skills checklist without providing additional prompts or correctness feedback. To maintain consistency in assessment conditions, participants will undergo the post-intervention ACLS skills assessment on a scheduled assessment day after completion of the intervention phase, and the follow-up ACLS skills assessment will be conducted approximately one month later under the same standardized conditions.
At the one-month follow-up, ACLS knowledge, ACLS skills, resuscitation self-efficacy, and critical reflection ability will be reassessed to evaluate changes and retention of learning outcomes over time.
Study design
- Primary purpose
- Other
- Allocation
- Randomised
- Intervention model
- Parallel groups
- Masking
- Single blind (outcomes assessor)
- Number of arms
- 2
- Model description
- Participants will be randomly assigned in a 1:1 ratio to either the two-tier test-based virtual reality instruction group or the traditional interactive virtual reality instruction group using computer-generated block randomization.
| Arm | Type | Receives |
|---|---|---|
| Two-Tier Test-Based Virtual Reality Instruction | Experimental | Behavioral: Two-Tier Test-Based Virtual Reality InstructionParticipants in this arm will receive tablet-based, non-immersive virtual reality (VR) instruction using a simulated Advanced Cardiac Life Support (ACLS) clinical scenario. The VR instruction incorporates two-tier test questions. The first tier consists of single-choice questions assessing ACLS knowledge and clinical decision-making, while the second tier consists of single-choice questions assessing the reasoning underlying the first-tier responses. The system provides immediate feedback based on participants' responses. The VR instruction will last approximately 20-25 minutes. |
| Traditional Interactive Virtual Reality Instruction | Active comparator | Behavioral: Traditional Interactive Virtual Reality InstructionParticipants in this arm will receive tablet-based, non-immersive virtual reality (VR) instruction using the same simulated Advanced Cardiac Life Support (ACLS) clinical scenario, learning content, equipment, and intervention duration as the experimental group. The VR instruction incorporates single-tier, single-choice questions assessing ACLS knowledge and clinical decision-making. The system provides immediate feedback after participants respond. Unlike the experimental group, this arm does not include second-tier questions assessing the reasoning underlying the first-tier responses. The VR instruction will last approximately 20-25 minutes. |
Who may qualify
- Sex
- All
- Healthy volunteers
- Accepted
- Age groups
- Child, Adult, Older adult
Key inclusion criteria (2 listed)
- Clinical nurses holding a valid nurse or registered nurse license.
- Clinical nurses who have completed the hospital's emergency and resuscitation training courses.
Key exclusion criteria (2 listed)
- Newly employed nurses within the first 3 months of employment.
- Instructors for the hospital's resuscitation training courses.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Interventions
| Intervention | Type | Arms |
|---|---|---|
| Two-Tier Test-Based Virtual Reality InstructionParticipants will receive a single session of tablet-based, non-immersive virtual reality (VR) instruction lasting approximately 20-25 minutes. The VR program presents a simulated Advanced Cardiac Life Support (ACLS) scenario involving the emergency management of a hospitalized patient. Interactive two-tier test questions are embedded within the VR scenario. The first tier consists of single-choice questions assessing ACLS knowledge and clinical decision-making, and the second tier consists of single-choice questions assessing the reasoning underlying the first-tier responses. After participants respond, the system provides immediate feedback to support learning and reflection. The experimental and comparator interventions use the same tablet equipment, VR scenario, first-tier questions, core ACLS learning content, and intervention duration. The distinguishing feature of this intervention is the addition of second-tier reasoning questions. | Behavioural | Two-Tier Test-Based Virtual Reality Instruction |
| Traditional Interactive Virtual Reality InstructionParticipants will receive a single session of tablet-based, non-immersive virtual reality (VR) instruction lasting approximately 20-25 minutes. The VR program presents a simulated Advanced Cardiac Life Support (ACLS) scenario involving the emergency management of a hospitalized patient. Single-tier, single-choice questions assessing ACLS knowledge and clinical decision-making are embedded within the VR scenario. After participants respond to each question, the system provides immediate feedback. The comparator and experimental interventions use the same tablet equipment, VR scenario, first-tier questions, core ACLS learning content, and intervention duration. The distinguishing feature of this intervention is that it does not include the second-tier reasoning questions used in the experimental intervention. | Behavioural | Traditional Interactive Virtual Reality Instruction |
Primary outcome
Advanced Cardiac Life Support Knowledge
Time frame: Baseline, immediately after the intervention, and 1 month after the intervention
Advanced Cardiac Life Support (ACLS) knowledge will be assessed using researcher-developed 20-item single-choice tests. The baseline knowledge test assesses fundamental ACLS knowledge, including cardiopulmonary resuscitation procedures, electrocardiogram rhythm recognition, defibrillation, and emergency medications. The post-intervention knowledge test includes ACLS knowledge as well as clinical scenario-based questions assessing rhythm recognition, emergency response procedures, medication selection and use, team communication, and clinical decision-making. Each correct response receives 1 point, while an incorrect or unanswered item receives 0 points, resulting in a total score ranging from 0 to 20. Higher scores indicate greater ACLS knowledge. The same post-intervention knowledge test will be used at the one-month follow-up.
Advanced Cardiac Life Support Skills
Time frame: Post-intervention skills assessment and 1 month after the post-intervention skills assessment
Advanced Cardiac Life Support (ACLS) skills will be assessed using a researcher-developed 20-item structured skills performance checklist. The checklist evaluates the correct performance of ACLS procedures, including endotracheal intubation assistance, electrocardiogram rhythm recognition, defibrillation, cardiopulmonary resuscitation, and emergency medication-related assessment, decision-making, and technical performance. Each correctly performed item receives 1 point, while each incorrectly performed or omitted item receives 0 points, resulting in a total score ranging from 0 to 20. Higher scores indicate better ACLS skills performance.
5 secondary outcomes
Resuscitation Self-Efficacy
Time frame: Baseline, immediately after the intervention, and 1 month after the intervention
Critical Reflection Competency
Time frame: Baseline, immediately after the intervention, and 1 month after the intervention
Intrinsic Cognitive Load
Time frame: Immediately after the intervention
Extraneous Cognitive Load
Time frame: Immediately after the intervention
Germane Cognitive Load
Time frame: Immediately after the intervention
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 7 Oct 2026.
- Individual participant dataSharing planned: No. Individual participant data will not be shared with other researchers because data sharing is not included in the current IRB-approved study protocol or informed consent. Study results will be reported only in aggregate form to protect participant confidentiality.
Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
CHENG-WEI CHEN, BSN principal investigator
Taoyuan General Hospital
1 site in 1 country: see every site and its status.
Questions about this trial
What is this clinical trial studying?
A study testing Two-Tier Test-Based Virtual Reality Instruction and Traditional Interactive Virtual Reality Instruction in people with Advanced Cardiac Life Support Education, run by Taoyuan General Hospital at 1 site in Taiwan.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 2 inclusion and 2 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 7 Oct 2026. Status can change between updates, so confirm with the study contact before making plans.
Where is the study taking place?
The record lists 1 site in Taiwan. Whether a site is taking part right now should be confirmed with that site. See every site.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
Contact Cheng-Wei Chen, BSN (+886-972-608-263, g462113003@tmu.edu.tw), or a site near the patient. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
Advanced Cardiac Life Support Knowledge (time frame: Baseline, immediately after the intervention, and 1 month after the intervention). The study lists 2 primary outcomes in all. It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 7 Oct 2026.