The Technology Acceptance Model (TAM) has been used extensively to understand technology adoption in the context of virtual reality (VR). The model includes external variables that are important drivers of attitudes towards adopting technology. In this mixed-methods study, we assessed the effects of cognitive engagement and individual dimensions of cognitive load (CL) on the attitudes driving the intention to use an AI-supported VR system for nursing students' patient management training: perceived usefulness (PU) and perceived ease of use (PEOU). The participants were a group of nursing students from a university in the Midwestern United States. We also explored interview data to understand the participants' perceptions about the resulting factors. The quantitative results showed that engagement and PEOU are significant predictors of PU, and so are frustration (one of the dimensions of CL) and engagement with PEOU. Interview data revealed that participants' frustrations did not always have a negative effect. They generally enhanced their engagement by making the scenarios feel realistic and valuable for skill development.

Engagement has been traditionally linked to presence in desktop-based virtual reality learning environments. Although several studies have been performed to determine other factors affecting cognitive engagement, the role of cognitive load as a factor of student's engagement in desktop-based virtual reality (VR) has received little attention in the literature. The main purpose of this study was to explain if individual dimensions of cognitive load (mental demand, effort, and frustration level) can be used in addition to factors like presence and self-efficacy to predict student's cognitive engagement. The results of the study confirmed presence and self-efficacy as significant predictors of student's engagement. Also, a three-step hierarchical regression analysis revealed that two of the three individual dimensions of cognitive load (effort and frustration level) were also significant predictors of student's engagement.