Assessing Physiological Stress Responses in Student Nurses Using Mixed Reality Training

Abstract

This study explores nursing students' stress responses while they are being trained in a mixed reality (MR) setting that replicates highly stressful clinical scenarios. Using measurements of physiological indices such as heart rate, electrodermal activity, and skin temperature, the study assesses the level of stress when the students interact with digital patients whose vital signs and symptoms interact dynamically to respond to student inputs. The simulation consists of six segments, during which critical events like hypotension and hypoxia occur, and the patient's condition changes based on the nurse's clinical decisions. Machine learning algorithms were then used to analyze the nurse's physiological data and to classify different levels of stress. Among the models tested, the Stacking Classifier demonstrated the highest classification accuracy of 96.4%, outperforming both Random Forest (96.18%) and Gradient Boosting (95.35%). The results showed clear patterns of stress during the simulation segments. Statistical analysis also found significant differences in stress responses and identified key physiological markers linked to each stress level. This pioneering study demonstrates the effectiveness of MR as a training tool for healthcare professionals in high-pressured scenarios and lays the groundwork for further studies on stress management, adaptive training procedures, and real-time detection and intervention in MR-based nursing training.

Keywords: mixed reality; nursing; physiological measures analysis; wearable sensors.

Figure 1

Learner engaged in the experiment, interacting with the digital patient and equipment within a physical environment.

Figure 2

View inside of the HoloLens Headset.

Figure 3

Steps of the data preprocessing.

Figure 4

Normalized feature importance from Random Forest and Gradient Boosting models.

Figure 5

Correlation matrix of the features.

Figure 6

Distribution of time spent by each learner across different stress levels: 0 (low), 1 (medium), and 2 (high).

Figure 7

Average heart rate across stress levels for each learner.

Figure 8

Average skin temperature across stress levels for each learner.

Figure 9

Average electrodermal activity across stress levels for each learner.