The ROI of XR: The Clinical Reasoning Cycle

Modern nursing education has a plethora of technology with which to help students prepare for entry into the healthcare field and caring for patients. Manikins and task trainers are excellent for practicing manual skills required in nursing. But there is one critical aspect of training that goes beyond textbook knowledge and practical physical ability: decision making.

“Providing students with opportunities to develop clinical reasoning skills before entering clinical practice is foundational to safe nursing practice. However, with factors such as increased competition for clinical placements, advances in digital health technology, pressure on teaching timetables etc., alternative methods of delivery are necessary to ensure students gain confidence in the development of their clinical skills,” wrote Emma Collins and Liz Ditzel of Otago Polytechnic, in a study published in the Journal of Nursing Education and Practice.



Extended or mixed reality (XR or MR, both terms cover technology that melds digital and real environments) offers a way to do just that. Hologram patients are excellent tools for helping students learn the key process of determining, providing and evaluating care. This is the clinical reasoning model that was developed by Tracy Levett-Jones as an educational model (other clinical reasoning systems are also in use around the world) to help nurses better understand and respond to signs that a patient is deteriorating and provide timely and correct intervention, as outlined in this seminal study.


The Clinical Reasoning Cycle

  1. Consider the patient situation. Describe or list facts, context, objects and people.
  2. Look and collect cues and information; recall relevant theoretical and practical knowledge.
  3. Process information by interpreting, discriminating, relating, and inferring to predict an outcome.
  4. Identify problems/issues by synthesizing facts to make a definitive diagnosis of the patient’s problems.
  5. Select a course of action from among different alternatives.
  6. Take action (treat the patient).
  7. Evaluate the outcome.
  8. Reflect and process new learning from the case.

How does MR help teach those concepts?

Applied learning is a vital method for training students to not only retain information but gain an understanding of how to think critically and utilize that knowledge. In nursing and other medical professions, they will also be called upon to do so in sometimes urgent and stressful situations. Using MR to view a holographic patient provides a safe-to-fail environment in which to apply the clinical reasoning model to a real patient.

Among the 17 advantages Collins and Ditzel found in using hologram patients, realism and the ability to contact a visual assessment rankly highly among students, as did the feeling that it provided good preparation for clinical practice. Going forward, it also helps train students for continuing education.

To learn more about how you can apply GIGXR’s mixed reality applications to prepare your students for clinical practice, schedule a demo here.


1. University of Newcastle. Clinical Reasoning Instructor Resources,
School of Nursing and Midwifery, Faculty of Health, Australia. 2009.