HealthApril 10, 2023

Virtual Reality builds on over a century of nursing simulation innovations

In the mid-to-late 1800s, when nurses at the London Hospital Nurse Training Program began using leg models in a bandaging class, little did they know they were on the cusp of an evolving era of simulation innovations for nursing education, eventually leading to the advances we see today in virtual reality (VR).

Nursing preparation over the decades

History shows us just how far nursing education has come in its quest to leverage simulation and evolve the overall nursing landscape, helping to graduate practice-ready nurses that improve quality of care while protecting patient safety. By 1911, nursing education graduated from model “limbs” with the introduction of the first life-size mannequin, designed by doll maker Martha Jenkins Chase for the Hartford Hospital Nurse Training Program, which was used to help student nurses learn how to dress, turn, and transfer patients.

Of course, “Mrs. Chase,” as the mannequin came to be known, was only the beginning, with the ‘20s and ‘30s seeing ongoing advances leading to classroom environments with all manner of practice equipment and demonstration rooms. This was further accelerated in the late ‘40s, fueled largely by President Harry S. Truman’s 1946 Hill-Burton Act, which poured funding into the healthcare industry for the construction and modernization of the health system infrastructure. Hill-Burton created a demand for more nurses trained in the latest practices resulting from increasing healthcare complexity.

In 1978, with the introduction of “Harvey,” a cardiology patient mannequin that made heart and lung sounds, it was clear that the more lifelike the simulator training, the better. Laerdal Medical took this to the next level in 2001 with its first fully automated “SimMan,” which brought enhanced realism into the clinical simulation setting by using an external air compressor capable of demonstrating real-time palpations. SimMan and other simulators would grow in use and sophistication over the next decade, enabling students to engage in real-world scenarios from the safety of a learning lab. The landmark 2014 national study by the National Council of State Boards of Nursing (NCSBN) verified the effectiveness of simulator training, noting that up to 50% of the traditional clinical time could be replaced by simulation.

Evolving nursing simulation with virtual reality

While mannequins were commanding the lion’s share of attention in the 20th century, another form of technology was also percolating in the entertainment, education, and science sectors. In 1962, Morton Heilig, whose roots were in the film industry, introduced a Sensorama machine to help people feel they were inside a movie. In 1968, Ivan Sutherland, at the University of Utah, and then-student Bob Sproull, built the first head-mounted virtual reality (VR) device to immerse people inside a movie, an early prototype for VR headsets that would later become popular in educational settings.

Then, in the ‘80s, NASA developed a Virtual Interface Environment Workstation (VIEW), allowing astronomers to move through a virtual version of space using head-mounted devices and gloves for tactile immersion, laying the groundwork for technology that is commonly used in VR simulations today.

John R. Phillips, RN, PhD, is noted as one of the first to use VR in nursing. In his 1993 paper “Virtual reality: a new vista for nurse researchers?” he wrote that “virtual reality is one way nurse researchers will shape their own reality and the reality of others,” adding, “it will offer nurses an almost real alternate reality in which anything can happen,” albeit in a safe environment.

How VR is transforming nursing education

It has been more than a century since nursing students in London began practicing bandaging on artificial limb models, with VR emerging as the next wave of innovation for both learners and educators. Many virtual applications for nursing students have already proven their viability to provide patient interaction and the hands-on clinical time students need to meet graduation requirements.

What does the latest in VR training look like today? Donned with VR headsets and hand controllers, students may enter a hospital room to take a patient’s blood pressure or start an IV. They can move around the patient’s bed, interact with the patient, and decide on the best angle to approach them. Importantly, the student can be presented with multiple patient scenarios, requiring that they make judgments, shift priorities as care needs change, and perform interventions on virtual patients to gain experience without jeopardizing safety.

Research on use of VR in nursing education shows that students who have developed fundamental skills in virtual environments are more likely to feel comfortable and confident, minimizing the harm that may result from interventions in real clinical settings.

From a practical standpoint, use of VR and other forms of simulation holds the promise of replacing up to 50% of the traditional clinical time without negative impact, solving many of the resource and logistical challenges currently plaguing nursing education. In 2020, U.S. nursing schools turned 80,521 qualified students away due to a shortage of clinical sites, faculty, and other resource constraints. As an alternative, VR allows nursing educators to scale their programs to meet demand, boosting their market reputation through use of the latest technology to increase knowledge and NCLEX® scores.

vrClinicals for Nursing builds on learning experience

Developed through a long-term partnership between Wolters Kluwer, Laerdal Medical, and the National League for Nursing (NLN), vrClinicals for Nursing, which is currently in beta format, utilizes immersive VR technology to continuously challenge nursing students. Simulations, which are being tested in collaboration with nurse educators and students, help prioritize actions and hone skills across diverse patient and clinical scenarios.

For schools with simulation labs, vrClinicals for Nursing builds on the student learning experience, which is designed to introduce students to basic practice and advanced experiential, multi-patient, complex care scenarios. The progression from simulation to virtual reality helps nursing students strengthen clinical judgment and critical thinking skills as they progress through the curriculum.

The benefits of this virtual reality solution are made even stronger through the power of the Lippincott® Nursing Education product suite. The Lippincott® CoursePoint digital learning platform, which includes CoursePoint+ with vSim® for Nursing and Lippincott® Advisor, is designed for solutions to work together, reinforcing the same principles and learning techniques students are exposed to throughout the curriculum.

Nursing educators supporting students at all levels

How are educators reacting to vrClinicals for Nursing? Jaimee Gerrie, MSN, BSN, RN, LNC, CPPS, NCPMT, an assistant nursing professor at Lake Superior State University, said, "This is a very functional tool for student learning. I can use it to teach students at all levels. When trialing the product, I felt real feelings of needing to prioritize. I experienced nervousness, thinking to myself, ‘I have not seen the patient complaining of leg pain yet.’ I found myself worried because he may have developed a deep vein thrombosis (DVT) that I needed to assess. What if he gets himself out of bed while I am caring for another patient and the DVT moves?

“As an experienced nurse, these feelings felt real. As an educator, we want our students to be immersed in real environments. We want them to have the full experience that includes feelings, emotion, the ability to develop intuition and critical thinking," she added.

Leila Casteel, DNP, APPRN, NP-C, associate vice president Curriculum & Innovation at Herzing University, described the feelings experienced with VR as “just enough urgency. I did feel the stress, and that was perfect. It was exactly the right amount and very similar to what you would see in a clinical setting.”

Learn more about vrClinicals for Nursing to experience this transformational solution in action.

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