See It, Hear It, Feel It: Virtual Reality Immersive Learning

Author Information
Author(s): 
Jaime Hannans
Author(s): 
Colleen Nevins
Author(s): 
Ben Hytrek
Institution(s) or Organization(s) Where EP Occurred: 
California State University Channel Islands
Effective Practice Abstract/Summary
Abstract/Summary of Effective Practice: 

Undergraduate nurse preparation is inclusive of a holistic, caring framework with patients of varied ages across a health-illness continuum (AACN, 2008). The need for students to understand the impact of chronic disease, including vision and hearing loss, and aspects of dementia, are important in current society where there is an increasing age of patients requiring healthcare. Class readings and discussion offer background information for student; clinical experiences are often by chance. Foronda et al. (2017) notes three characteristics unique to VR: a digitally simulated world, immersion in that simulated world, and the ability of the learner to interact with/within the simulation. The significance of the virtual learning experience can be highly impacting in a relatively short sequence of time. Embodied Labs is a VR audio-visual immersion experience using Oculus goggles, where the learner becomes someone with chronic disease, i.e., Alfred (vision and hearing loss) or Beatriz (advancing dementia).

To explore the use of VR simulation in clinical courses using Embodied Labs, data was collected from students groups to evaluate learning experiences by obtaining pre- and post-surveys. There were two active VR experiences integrated into nursing courses: Alfred, a 74-year old male with hearing and vision impairment; and, Beatriz, a 66-year old woman with advancing dementia. Student response to the integrated VR experience was overwhelmingly positive from students supporting VR as an innovative approach.

Nursing education continues to need to find innovative and diverse ways to improve students’ understanding of patient perspectives, to provide safe, holistic patient-centered care. Building empathy in the curriculum would broaden the horizons for how we can continue to improve teaching, impacting knowledge, skills, and attitudes in higher education. Both quantitative and qualitative results of this innovative strategy reflect the positive impact to student learning. The data from this project integrating VR into nursing curriculum appears to have potential as a high-impact emerging technology in higher education.

Description of the Effective Practice
Description of the Effective Practice: 

Background
In 2008 the NLN released Preparing the Next Generation of Nurses to Practice in a Technology-Rich Environment: An Informatics Agenda. Acknowledging that health care technology had expanded and that access to information had grown at a phenomenal rate, the position statement called for nurses to acquire the necessary “21st-century knowledge and skills for practice in a complex, emerging technologically sophisticated, consumer-centric, global environment” (Warren & Connors, 2007, p. 58).

The Robert Wood Johnson Foundation-funded Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health (2011), noted that while the US redesigns the health care landscape, nursing education has not kept pace with consumer engagement, the changing patient demographic, health system expectations, evolving practice requirements, and the focus on innovative technologies”

Integration of Virtual Reality
Embodied Labs is a VR immersion experience using Oculus goggles, where the learner becomes someone with chronic disease, Alfred (vision and hearing loss) or Beatriz (advancing dementia); a third scenario is to be released next month with a focus on end-of-life. CSUCI Teaching and Learning Innovations (TLI) and Nursing Program obtained a one year license, which led the the opportunity to explore the use of Embodied Labs in nursing clinical courses through March 2019. Through intentional coordination the immersive virtual reality experiences were integrated into medical-surgical nursing courses to align with course learning outcomes. In collaboration with institutional research, qualitative and quantitative data was collected from students during spring and fall 2018 to evaluate student learning experiences using the VR simulation in the form of a pre- and post-surveys. There were two active VR experiences: Alfred, 74 year old male with hearing and vision impairment has two scenarios; Beatriz, 78 year old woman with advancing dementia has three scenarios. Each scenario runs approximately seven minutes.

The Future of VR Learning Experiences
VR learning experiences are growing rapidly in nursing education and across disciplines. Specific to teaching, nursing education continues to need to develop innovative and diverse ways to improve students’ understanding of patient perspectives, to provide safe, holistic patient-centered care. Building empathy and understanding in the curriculum would broaden the horizons for how we can continue to improve teaching, impacting knowledge, skills, and attitudes in practice. To engage nursing students in this type of learning in tandem with other simulated experiences, offers a unique, immersive approach for preparation, aligning to the future direction of nursing educational practices, while being an example of early adopters of immersive VR experiences as a teaching-learning strategy. In addition, other disciplines may find unique opportunities and grow innovative ideas for the integration of virtual learning experiences as an effective practice.

Supporting Information for this Effective Practice
Evidence of Effectiveness: 

Quantitative and qualitative data was collected from pre and post surveys specific to the experience (Alfred or Beatriz Labs). A total of 89 students completed the pre and post surveys for the Alfred experience; 71 students completed the pre and post surveys for the Beatriz experience. There is evidence of increased knowledge in the mean differences from pre to post survey responses related to understanding the patient perspective and the disease process. There is evidence of increased student confidence in caring for someone in early, middle, and late stages of Alzheimer's disease. Qualitative feedback was very positive related to the student overall experience, with 99% of students indicating virtual reality experiences, such as Alfred and Beatriz, support the development of empathy.

How does this practice relate to pillars?: 

Immersive virtual learning provides an innovative experience aligning to OLC’s Five Pillars of Quality Online Education.

The Learning Effectiveness Pillar: Virtual reality is an effective practice with increased student interaction, student engagement, meeting diverse learner needs, and structured using pedagogical foundations and intentional course alignment. Student satisfaction is evident, and needed development of "soft skills" is provided.

The Scale Pillar: Although current student use is with traditional face-to-face students, there are no limitations to the number of students who can participate in the virtual reality experience. This offers scalability across other disciplines beyond nursing such as other health professions, psychology, sociology, or even communication programs. As technology continues to develop, online options and/or expansion of the immersive experiences are anticipated

The Faculty Satisfaction Pillar: Virtual reality learning experiences offer a method for faculty to support students in the development of knowledge, confidence, and empathy beyond the classroom or textbook. The potential for faculty development in the area of virtual reality, publications, and recognition has been very rewarding. There is encouragement to develop opportunities for the expansion of virtual learning with working nurses in the community with the goal of impacting continuing education for health care providers with a focus on patient-centered care.

The Student Satisfaction Pillar: Preliminary data collected demonstrates clear evidence of student satisfaction with the immersive virtual learning experiences. Student find the technologies used to support individualized and engaged learning aligned to the development of skills healthcare providers require. Students have inquired to verify if the nursing program will permanently implement virtual reality experiences, as they believe there is significant value in a unique and different approach in the experience.

Equipment necessary to implement Effective Practice: 

Oculus Virtual Reality Headset + Controllers
Leap Motion Controller
Alienware Laptop
Embodied Labs Product License

Estimate the probable costs associated with this practice: 

Annual License $6000
One time equipment purchase $8000 (one virtual reality station)
Staff/Student support for running labs/equipment may be needed

References, supporting documents: 

Agency for Healthcare Research and Quality (AHRQ). (2016). Healthcare Simulation Dictionary. Retrieved January 13, 2019, from https://www.ahrq.gov/sites/default/files/publications/files/sim-dictiona...

Albright, G., Bryan, C., Adam, C., McMillan, J., & Shockley, K. (2018). Using virtual patient simulations to prepare primary health care professionals to conduct substance use and mental health screening and brief intervention. Journal of the American Psychiatric Nurses Association, 24(3), 247–259. https://doi.org/10.1177/1078390317719321

Cant, R., Cooper, S., Sussex, R., & Bogossian. F. (2019). What is in a name? Clarifying the nomenclature of virtual simulation. Clinical Simulation in Nursing, 27, 26-30. https://doi.org/10.1016/j.ecns.2018.11.003

Dang, B. K., Palicte, J. S., Valdez, A., & O’Leary-Kelley, C. (2018). Assessing simulation, virtual reality, and television modalities in clinical training. Clinical Simulation in Nursing, 19, 30–37.

Foronda, C., & Bauman, E. B. (2014). Strategies to incorporate virtual simulation in nurse education. Clinical Simulation in Nursing, 10(8), 412–418. https://doi.org/10.1016/j.ecns.2014.03.005

Foronda, C. L., Hudson, K. W., & Budhathoki, C. (2017). Use of virtual simulation to impact nursing students’ cognitive and affective knowledge of evidence-based practice. Worldviews on Evidence-Based Nursing, 14(2), 168–170. https://doi.org/10.1111/wvn.12207

INACSL Standards Committee. (2016, December). INACSL standards of best practice: Simulation glossary. Clinical Simulation in Nursing, 12(S): S39-47. https://doi.org/10.1016.j.ecns.2016.09.012

Kilmon, C. A., Brown, L., Ghosh, S., & Mikitiuk, A. (2010). Immersive virtual reality simulations in nursing education. Nursing Education Perspectives (National League for Nursing), 31(5), 314–317.

Levett-Jones, T., Bowen, L., & Morris, A. (2015). Enhancing nursing students’ understanding of threshold concepts through the use of digital stories and a virtual community called ‘Wiimali’’.’ Nurse Education in Practice, 15(2), 91–96. https://doi.org/10.1016/j.nepr.2014.11.014

National League for Nursing Technology Edge. (2018, February). The forecast for tech usage and
growth in nursing education: Part 4 of the series the future of technology in nursing. Retrieved January 13, 2019, from https://nlnteq.org/2018/02/07/the-forecast-for-tech-usage-and-growth-in-...

Smith, S. J., Farra, S. L., Ulrich, D. L., Hodgson, E., Nicely, S., & Mickle, A. (2018). Effectiveness of two varying levels of virtual reality simulation. Nursing Education Perspectives (Wolters Kluwer Health), 39(6), E10–E15. https://doi.org/10.1097/01

Strekalova, Y. A., Krieger, J. L., Kleinheksel, A. J., & Kotranza, A. (2017). Empathic communication in virtual education for nursing students. Nurse Educator, 42(1): 18–22. https://doi.org/10.1097/NNE.0000000000000308

Other Comments: 

This topic is accepted for Educate and Reflect Session.

This effective practice is submitted with a focus on innovation and use of technology in instructional practice.

Contact(s) for this Effective Practice
Effective Practice Contact: 
Jaime Hannans
Email this contact: 
jaime.hannans@csuci.edu
Effective Practice Contact 2: 
Colleen Nevins
Email contact 2: 
colleen.nevins@csuci.edu
Effective Practice Contact 3: 
Ben Hytrek
Email contact 3: 
benjamin.hytrek134@csuci.edu