{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T23:38:12Z","timestamp":1787701092550,"version":"build-2784847793"},"reference-count":25,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T00:00:00Z","timestamp":1747699200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Center for University Education Scholarship (CUES) at University of Arizona"},{"name":"Sensor Lab Seed Grants to Advance Innovative Research at University of Arizona"},{"name":"Edwardson School of Industrial Engineering at Purdue University"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>This study explores nursing students\u2019 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\u2019s condition changes based on the nurse\u2019s clinical decisions. Machine learning algorithms were then used to analyze the nurse\u2019s 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.<\/jats:p>","DOI":"10.3390\/s25103222","type":"journal-article","created":{"date-parts":[[2025,5,20]],"date-time":"2025-05-20T11:50:31Z","timestamp":1747741831000},"page":"3222","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Assessing Physiological Stress Responses in Student Nurses Using Mixed Reality Training"],"prefix":"10.3390","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-0984-4268","authenticated-orcid":false,"given":"Kamelia","family":"Sepanloo","sequence":"first","affiliation":[{"name":"Edwardson School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Shevelev","sequence":"additional","affiliation":[{"name":"School of Information Science, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4004-2155","authenticated-orcid":false,"given":"Young-Jun","family":"Son","sequence":"additional","affiliation":[{"name":"Edwardson School of Industrial Engineering, Purdue University, West Lafayette, IN 47907, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0150-7172","authenticated-orcid":false,"given":"Shravan","family":"Aras","sequence":"additional","affiliation":[{"name":"Center for Biomedical Informatics and Biostatistics, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Janine E.","family":"Hinton","sequence":"additional","affiliation":[{"name":"College of Nursing, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,5,20]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e924171-1","DOI":"10.12659\/MSM.924171","article-title":"Psychological impacts and coping strategies of front-line medical staff during COVID-19 outbreak in Hunan, China","volume":"26","author":"Cai","year":"2020","journal-title":"Med. 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