Digitalization has drastically changed the daily practice of health care professionals. Health information technologies such as the electronic medical record (EMR) system are designed to support nurses and other healthcare professionals to work more effectively and provide better quality care (e.g. Huter et al., 2020; Krick et al., 2020). Empirical findings suggest that digital technologies must be well adapted to the needs of nursing staff and integrated into existing work processes and daily routines to be perceived as beneficial and effectively adopted (Ammenwerth et al., 2011, Seibert et al., 2020). However, little is known about the specific challenges associated with the successful implementation and use of EMR systems in nursing practice in hospitals.

Theoretical framework and objective

The objective of the presented study was to explore the challenges inherent to the effective use of EMR systems in nursing practice in hospitals from the perspective of head nursing and ward managers, and to give specific examples of challenges that are valid across hospitals and that can be used for nursing education. Researchers followed a socio-technical approach to digital health technologies, which emphasizes that effective technology implementation and use is not limited to technical factors predominantly, but has also to address human, social and organizational factors and their interrelations. They used Sittig and Singh’s (2010) socio-technical model for studying health information technologies in healthcare systems, which considers eight dimensions of the complex healthcare system.

Research design and Methods

The presented study was part of a larger study that combined job shadowing with a video ethnographic approach to investigate the impact of digitalization on the transmission of patient care information in nursing practice in hospitals. A partnership was established with six Swiss hospitals in two language regions to carry out the onsite data collection. One ward per hospital voluntarily participated in the study.

Before the job shadowing, semi structured interviews were conducted with the head nursing managers of the participating hospitals (n=6) and the ward managers (n=6) to gather contextual information and understand the current roles of health information technologies and digitalization at both the hospital and ward levels. The EMR system was an essential technology for the nursing staff in all participating hospitals, as all patient care information was documented electronically in the EMR system. The interviews were conducted in person and in the respective national language at the hospitals during working hours. They were audio recorded and transcribed verbatim.

The interview transcripts were thematically coded and analyzed. First, thematic descriptions in relation to challenges regarding the use of EMR systems in nursing practice were identified and inductively coded (Braun & Clarke, 2006). This resulted in a list of key topics. Second, the key topics were classified into the eight dimensions of Sittig and Singh’s (2010) socio-technical model. Third, interactions between the eight dimensions of the model were explored.

Results and their meaning

The interviewees addressed socio-technical challenges regarding the use of EMR systems in nursing practice that can be classified into seven out of eight dimensions of Sittig and Singh’s (2010) socio-technical model. One example is the lack of integration or interoperability between the systems of the various clinical departments within a hospital, which was due to their different needs but led to media discontinuities for the nursing staff. That is, nurses had to manually enter information into the EMR system, which was time-consuming and prone to error. For nursing training, the documented challenges together with the specific examples from nursing practice offer the opportunity to discuss and reflect on realistic action scenarios.

Professional Education and Training (PET) programs often struggle with the effective transfer of knowledge from the training environment to on-the-job performance. Recent advances in artificial intelligence, particularly Large Language Models (LLMs) like GPT-4, promise new approaches to address this longstanding “knowledge transfer” problem. This paper explores an AI-augmented learning paradigm in PET, where LLMs serve as interactive, intelligent assistants to both trainers and learners. We provide a comprehensive literature review of AI in education, comparing LLM-based approaches to traditional intelligent tutoring systems (ITS) and drawing on cognitive science theories of learning and transfer. Using an analytical methodology that synthesizes empirical findings and theoretical insights, we examine how LLMs can personalize learning, provide real-time feedback, and bridge the gap between training and practical application. Results from existing studies are integrated to demonstrate that LLM interventions have improved learning outcomes across domains – from programming and language learning to workplace safety training – indicating strong potential for enhancing knowledge transfer. We also delve into the ethical considerations of AI-driven education, including biases, privacy, misinformation, and overreliance risks, and discuss frameworks for responsible implementation. The discussion situates LLMs within established educational theories, arguing that these models can function as on-demand tutors or cognitive scaffolds that operate in a trainee’s zone of proximal development. We conclude with recommendations for integrating LLMs into PET, calling for further empirical research and robust ethical guidelines to realize an effective and equitable AI-augmented learning paradigm.

School principals in Switzerland described the COVID-19 pandemic as a strong driver for digitalization efforts at their schools. This external shock reinforced the ongoing public debates to promote educational platforms such as moodle and teams in order to deepen the digital integration. In addition, international policy papers, as well as national education policies urged the education world to enforce the digital infrastructure. The result was a massive investment in digital infrastructure and research for digital education. A bring-your-own-device (BYOD)-friendly approach for schools was also welcomed by the public, but also in schools.

This presentation is based on research from a Secondary-2-level survey and qualitative data, exploring how school leaders have implemented this new digital strategy in their own schools (Schmitz et al. 2023). In this paper we adhere to a neo-pragmatic perspective which refers to the convention-theory (see Imdorf and Leemann 2023).

In this study, different arguments for school-specific digitalization strategies by school leaders were analysed from such a convention theory perspective, which discerns several orders of worth: civic, industry, market, domestic, project, creativity, and fame. Content analysis based on semi-structured interviews with 13 headmasters of 2 secondary school types (most vocational education schools, but also mixed and baccalaureate schools) revealed that similar legitimation patterns were unfolded by each school. The domestic convention was present in all the schools, as school leaders stressed the added value of digital technologies for individualized learning and teaching. Industrial justification was also prominent, with school leaders emphasizing students’ acquisition of digital competencies and the potential of digital technologies to facilitate administrative work and teaching. Moreover, most school principals described the COVID-19 pandemic as a strong booster for enhanced digitalization efforts at their schools and referred to new school-based digital projects (based in a project convention). The fame- and creativity-based conventions were less frequently referred to by the school principals. Fame-based legitimation was only used by headmasters from vocational schools, which might be attributed to the high prestige of vocational education in Switzerland.

Digital integration often requires new teaching–learning arrangements, involving collaboration between teachers, a change in communication with learners, and different access to learning materials, including new performance assessments. These changes have also created conflicts, as not all teachers have been willing to adapt. Meanwhile a move toward a new school culture that integrates digital tools has become the new standard, at least in innovative schools.

Schools with bolder digital integration policies tend to adhere to an exploratory regime, drawing on a wide range of legitimations.

Technological advancements are rapidly transforming education, particularly immersive technologies such as virtual reality (VR). Research has demonstrated the effectiveness of VR technology in facilitating the learning process (Hwang et al., 2022; Makransky, 2022). Immersive, realistic simulations have been shown to promote a strong sense of presence, thereby enabling learners to contextualize theoretical knowledge. These findings are of particular importance within the domain of vocational education and training (VET). Furthermore, virtual reality has been demonstrated to enhance learner engagement, motivation, and information retention (Csikszentmihalyi, 1991; Ryan et al., 2022; Urhahne, 2008). This phenomenon can be attributed to the facilitation of a state of flow, which, in turn, has been shown to enhance learners' performance and their positive attitude towards learning (Hwang et al., 2022; Makransky, 2022).

Despite extensive research on VR's potential to enhance learning process, the interrelationships between presence, motivation, and flow experience, their manifestation in immersive and non-immersive environments, and their impact on performance – particularly in VET – remain underexplored. This study aims to fill this gap by comparing the performance of VET students using VR with those using desktop computer-based methods.

In 2023, a quasi-experimental study with a randomized controlled trial design was conducted with 81 participants (three women and 78 men) from a Swiss vocational school, aged 17 to 24 (M = 18.56, SD = 1.60). The study spanned two consecutive weeks, with each participant engaging over two days. In the first week, students received theoretical instruction on apartment handovers, focusing on identifying housing damages through a structured three-step didactic approach, including a teacher-led presentation, self-study materials, and an interactive digital quiz. In the second week, the experimental group explored a virtual apartment using a Meta Quest 2, while the control group completed the same task on a desktop computer. Both groups had to verbally identify defects within a 15-minute timeframe; afterwards, they had to fill in an online questionnaire assessing their perceived presence, motivation, and flow experience.

Various statistical tests, including t-tests, ANCOVAs, Pearson correlation, SEM, linear regression, and mediation analysis, were conducted to examine group differences, assess the influence of sense of presence, motivation, and flow experience, and explore whether these factors mediate the relationship between sense of presence and the student performance. The findings demonstrated a notable enhancement in performance when VR with head-mounted displays was utilized in comparison to the desktop approach. Participants using VR found significantly more housing defects and damage (M = 6.57, SD = 2.49, n = 42) than the participants in the control group using a desktop computer (M = 4.95, SD = 1.91, n = 37) [t(77) = 3.219, p = .002]. The effect size is d = .76, which corresponds to a medium effect (Cohen, 1992). The study also identified motivation and sense of presence as critical factors for improving performance. Linear regression analyses demonstrated that the sense of presence and motivation explained together explained for 20% of the variance [F(1,77) = 9.37, p < .001]. Additionally, the study revealed a complex relationship between sense of presence and performance, with neither motivation nor flow experience acting as direct mediators (Keller et al., 2025).

The present results contribute to the understanding of the impact of VR on learning outcomes in VET and provide insights for future research and practice. For example, the experience that learners' performance in the immersive environment was better than in the non-immersive environment suggests the effectiveness of VR as an alternative for examination situations. However, further research is needed to explore the benefits and subtleties of integrating immersive technologies into educational environments.