XR Technologies in Nursing Education
XR technologies and digitalization are changing the world. Different kinds of devices of XR technologies are beginning to be in consumer prices. Nowadays you can buy simple VR glasses by less than twenty euros. Of course, the best ones are more expensive and may cost thousands of euros. In the simplest way, those technologies are already in our mobile phones applications and features.
XR technologies are changing the health care and health care education too. Nursing shortage, which is a worldwide problem, can benefits a lot from the possibilities brought by XR technologies. This problem, together with the financial demands and decreasing practical training placement forces educators to find adequate teaching methods, that are more effective, attractive and present new ways of doing things.
In health care education, simulation pedagogy, learning practical, technical skills sessions are widely used before starting the on-the-job learning and clinical practice. Students gradually get more into practice, applying the knowledge to each situation and gathering more experience and new competencies and skills. When we think about the VR – content and application, what should we emphasize for an appropriate VR simulator? Of course, the usability, the right and authentic content are essential features. “The feeling of being there” is important. That means that the virtual environment becomes the dominant reality and the user has the feeling of having visited a place rather than just seeing images of it (Bracq et all 2019).
Other aspects to take into account are the technical and pedagogical features. Technical features include technological requirements, for example, possible bugs and gestures needed when using the scenario. Pedagogical features include the overall feedback from the scenario, the effective way the user can progress in the scenario and the guidance given to user during the scenario.
Virtual reality and other XR technologies can play an important role in the transition toward an authentic working environment in a cost-effective way. VR can be used to create different nursing simulations and scenarios, from wards to operating rooms and to practice wide selection of skills and tasks. These VR simulations and scenarios can be a part of a lesson, but also more and more self-learning tools. VR content is usable at any time and at any place, as long as the user has the required hardware and software. Of course, the guidance for the use is also needed.
Virtual and augmented reality in health care is being used, for example in therapies, in pain treatment, nursing and surgery. In our project, we are going to create a virtual environment for operating room, where VR technologies will be used. Here, I will have a look to three VR applications for nursing education currently found on the market.
Let us first start with the PeriopSim, which seem to be one of the most appropriate solution for our operating virtual environment. PeriopSim focus on surgical training and assessment for the operating team. It has been developed in close collaboration with surgeons, nurses, educators and neuroscientists. There are modules for surgery and for the instrumentation. Both modules are interactive and have several surgical procedures. There is also assessment and scoring in both modules. Briefly, users can practice and be assess on a procedure, on the anticipation of surgeon and sterile spheres, sharpness of safety, sterilization of technique, instrumentation and passing technique.
Our second option, the Oxford Medical Simulation, which does not provide scenarios for intraoperative nursing care at the moment, do have a very good feedback system in their application. What you do as a user, affects the scenario. User can have feedback about what went well and what to improve. The completion time of the scenario is also showed. The user can have analytics of the progress and skills performance. Teacher can see when students have been practicing and can see analytics for the group or individual student. One disadvantage is that user do not have to use hand devices, so the experience is not fully immersive VR.
UbiSim, our third option, claims to be the world’s first immersive VR training platform for nursing. Even though they are continually adding scenarios and environments, unfortunately, I did not found any new intraoperative nursing (that does not mean they do not have one). What is very good in UbiSim is that they have also debriefing after the session. You can visualize the whole recording session and reflect with self-guided questions. You can also review the personalized performance feedback and go through a quiz to assess your understanding.
Like mentioned in the beginning, XR technologies can be one remedy for nursing shortage. Virtual simulators are suitable for almost everybody. Based on a study done about training scrub nurses in the preparation of the instrumentation table, issues such as age, gender and experience had no effect on the evaluation of acceptability of the simulator (Bracq et all 2019).
Besides all the good in VR, there are also disadvantages in virtual reality. Several studies have pointed out, that user can suffer oculomotor fatigue, nausea and global simulator sickness. (Bracq et all 2019) I hope that this will be overcome as technology further develops. At the same time, we cannot go on only by technology ahead. Technology is not an answer for everything. Traditional learning methods are good too. This is particularly good to keep in mind, when considering that we have different learners and learning styles. We must also discuss and further study the effectiveness of the education with these technologies.
Bracq, M-S., Michinov, E., Arnaldi, B., Caillaud, B., Gibaud B., Gouranton, V., Jannin, P. (2019). Learning procedural skills with a virtual reality simulator: An acceptability study, Nurse Education Today 79 (2019, 153-160.
Oxford Medical Simulation http://oxfordmedicalsimulation.com/ (read 19.5.2020)
PeriopSim https://periopsim.com/ (read 19.5.2020)
UbiSim https://www.ubisimvr.com/ (read 19.5.2020)
Written by Jaana Heiskanen