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Using virtual reality to bridge gaps in nursing

Through cutting-edge technology, Texas A&M nursing students gain clinical experience before working directly with patients

Before nursing students at Texas A&M University ever enter a clinic, even before they engage in face-to-face clinical scenarios with people acting as patients, they already have hours of experience interacting with patients. They’re accomplishing this through new, innovative virtual reality (VR) simulations developed by their professors.

Since early 2020 (in the pre-pandemic days), a team at the Texas A&M College of Nursing has been working on integrating VR simulations into their curriculum to help bridge the gap between classroom and clinic. They have launched two simulations so far that provide immersive experiences for students to hone their skills before working with real patients.

“VR simulation is in that area that we call a ‘safe container,’” said Elizabeth Wells-Beede, PhD, RN, C-EFM, CHSE-A, CNE , clinical assistant professor at the College of Nursing. “We’re all human and mistakes are going to be made. This is a place that we hope to create that psychologically safe environment for mistakes to be made, where we as the experts can help walk the students through the processes, and then they take that experience into practice and not make the mistake with a real-life patient.”

Clinical simulation is not new. It has been used in nursing education for many years and allows students to apply the theory they’ve learned from books and skills they’ve learned in labs (such as checking vital signs, inserting IVs and conducting evaluations) to patient scenarios that they could encounter in a clinical setting. In a traditional simulation, a student is presented with a standardized patient (or trained actor), a mannequin or a computer-based program, to name a few. The student must work through the case presented to them by reading the patient’s chart, interviewing the patient and conducting an examination to decide what action to take.

Virtual reality is a new, emerging form of clinical simulation that provides more accessible and immersive experiences that don’t require learners to travel to clinical settings, helping with the increasing burden on clinical practice partners to place learners.

two nursing students wear virtual reality goggles and take part in a simulation run by a nursing professor who sits in front a laptop computer
Texas A&M nursing students take part in a virtual SBIRT simulation in Round Rock, Texas, on April 13, 2022, while Elizabeth Wells-Beede facilitates the simulation from a computer.

The technology used at Texas A&M is being developed in close collaboration with Jinsil Hwaryoung Seo, PhD, associate professor and director of the Institute for Applied Creativity at the Texas A&M College of Architecture. Nursing faculty write the clinical scenarios and then work with Seo and her students to turn those scenarios into immersive, virtual reality experiences.

To access the simulated world, nursing students put on VR headsets that transport them into a virtual setting that can be a clinic, home or school. There, they meet with a virtual patient and work through their case to make a decision while their instructor observes and provides feedback.

“I am convinced VR is the future of simulation,” said Cindy Weston, DNP, APRN, FNP-BC, CHSE, associate dean for clinical and outreach affairs at the College of Nursing. “This is an immersive platform that’s deeper than what we’ve been able to do in the past with simulation in the other variety of forms it takes. Student learners feel like they’re in the environment, and it’s a safe space for them to hone and develop skills with faculty guidance and feedback.”

Better care for vulnerable patients

Currently, the College of Nursing has applied VR simulation in two areas: Screening, Brief Intervention and Referral to Treatment (SBIRT), and forensic nursing. SBIRT is an approach that health care providers use to quickly recognize when a patient uses drugs and/or alcohol in risky ways so that they can provide brief intervention and refer them to specialty care if more extensive treatment is needed. Forensic nurses are professionally trained to treat victims of violence through patient-centered, trauma-informed care. Both SBIRT and forensic nursing involve patients in vulnerable situations that require highly competent, compassionate and experienced care providers.

“We know that when confidence is high, nurses’ performance, retention, and their ability to perform the skill is high,” Weston said. “VR simulation builds their confidence and then we’re able to assess their competence before they head into the clinical setting.”

The SBIRT VR simulation has been in use for about a year. It is currently instructor-guided, meaning that when students are interacting with the patient inside the virtual world, an instructor monitoring the simulation from the outside answers on behalf of the patient. The team is working on taking this to the next level and is currently developing an artificial intelligence capability for the platform.

The first forensic nursing VR simulation, which launched last month, is self-contained. In it, nurses complete a number of tasks to learn how to conduct a  sexual assault examination. The goal is to help them become comfortable performing the exam before working with a live standardized patient.

“We have had an overwhelming excitement with all of it,” said Stacey Mitchell, DNP, MBA, MEd, RN, SANE- FAAN, clinical professor and director of the Texas A&M Health Center of Excellence in Forensic Nursing. “Most of the students, every time they put on the VR headset, they say, ‘Oh my gosh, this is so amazing!’ They are thrilled and excited that we’re bringing this to them.”

Bridging gaps in rural areas 

The VR simulations are not only designed to bridge gaps inside nursing school. As part of three Health Resources and Services Administration (HRSA) grants, they are helping to bridge gaps in rural and medically underserved areas as well. Specific areas of focus include mental health, chronic disease management, medication management, postpartum care, and forensic nursing.

“We’re trying to meet the need for those areas, and that’s really not where the big VR companies are. They’re looking at the acute care setting, not the ambulatory care setting where we are,” Wells-Beede said. “Although this whole VR world is building up around us, we are doing something in between that’s going to meet the need for rurally underserved areas. This is where I feel our niche is; we are a land-grant institution and we’re giving back to our community by doing these simulations that can actually be brought into the community setting.”

The VR simulation team at the College of Nursing has been selected to receive a team Innovation Award from Texas A&M Technology Commercialization. This award recognizes individuals whose research exemplifies the spirit of innovation within The Texas A&M University System. Wells-Beede, Weston and Mitchell, along with Angela Mulcahy, PhD, RN, CMSRN, CHSE, will be presented with the award at the Patent and Innovation 2022 Awards luncheon on April 22.

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