Dr. Dan Weberg Webinar Follow-Up: Answering Your Questions on VR in Nursing Education

Thank you to everyone who attended my session on "Closing the Transition to Practice Gap: VR Technology-Enabled Education" and asked such thoughtful questions! This is our blockbuster moment, the time to build a future we want in a time of massive change. We had so many questions during the sessions that we could not answer all of them. So … we created this blog post to provide insights to the themes that we could not get to during the webinar.  

I'd like to address a few of them here:

How can you increase buy-in for new technology with older nursing educator staff?

• This is a great question, as resistance to new technology is a common challenge. One approach is to emphasize the benefits of VR in terms of student learning outcomes and patient safety. You can also provide faculty with opportunities to experience VR firsthand and see how it can be integrated into their teaching. Additionally, offering training and support can help faculty feel more comfortable using new technology. 
• Innovation literature suggests that allowing a faculty to have a no-pressure environment to try out the technology, test it with a small group of students, and have some basic technology support to use the tools will lead to more adoption.  Additionally, finding excited peers in the faculty group who want to adopt VR usually builds trust for others to try it as well.

It seems it is helpful for VR adoption in nursing schools if you have a tech expert assigned to help faculty. That way, faculty can serve as the facilitator/expert and a tech sim person can help with the technology.

• Absolutely, having a dedicated tech expert can be invaluable in supporting faculty and ensuring that the technology runs smoothly. This allows faculty to focus on their role as facilitators and educators, while the tech sim person can troubleshoot any technical issues. We saw this as a great resource as manikin-based simulation became popular. We got more simulation adoption when we allowed faculty to write scenarios and be the subject matter expert instead of the tech wiz. Having a lab technology person support the set up and initial technology use can lower the barrier to adoption as well. With VR, it's possible to have remote support as well. The headsets are easy to turn on, and once in the settings you can have remote support join a class, teach a class, and even support the technology.  

Where do faculty find the time to get their own learning/feel up to speed in order to teach their learners....there is comfort in following tradition that is hard to overcome if they don't feel like they have time to learn.

• I understand this concern completely. Faculty are already stretched thin, and finding time for additional learning can be difficult. One strategy is to integrate professional development on VR into existing faculty meetings or workshops. Another is to provide faculty with access to online resources and tutorials that they can complete at their own pace.
• All of the nursing education conferences have VR vendors now, it's a great place to try it out without the pressure of peers or students. Setting up faculty days and inviting a vendor to showcase the technology can also be a great way to expose faculty to the technology. Lastly, it may be possible that one of your staff or faculty already has a headset that they could bring in to share in a short open VR day at the school. Just playing games in VR can really change the perception of the technology and improve adoption.

How do we implement clinical judgment when a large group is watching the scenario using casting?

• This is an important consideration when using VR for simulation. One way to implement clinical judgment is to have students work in small groups to discuss the scenario and make decisions together. The faculty member can then facilitate a debriefing session where students can share their thought processes and rationale for their decisions. There is evidence to support that watching simulations and debriefing them can equate to equal learning compared to those in the actual simulation. 
• The nice thing about VR is that you can be in the simulation and watching at the same time. Students not participating in the actual simulation can also use headsets to watch through the eyes of the participants, being in the scenario much more immersive than with manikin-based simulation watching. You can also have students from multiple locations in the same scenario, unlike manikin-based simulation. 

Would love your thoughts on how we support transition towards new ways of supporting nursing practice. We haven't changed the old "policy and procedure" model in 75 years, except to remove it from a paper-based binder to an online (and often harder to find) one.

• We need to follow the evidence. If there is evidence of new learning and teaching techniques, it's the obligation of the faculty to adopt and the program to hold its faculty accountable to use the latest evidence in their education practice. We should be using the right technique for the right outcome, not burying ourselves into the traditions of the past. This takes both bold administrative leadership and nimble faculty support to test, measure, and adopt new ways of teaching.  
• The transition to new ways of supporting nursing practice requires a shift in mindset and culture. It's important to involve nurses in the process of developing and implementing new policies and procedures. Additionally, providing education and training on new technologies and evidence-based practices can help nurses feel more confident and competent in their roles.  

How can Associate Degree in Nursing (ADN) programs foster a culture that effectively prepares students for specialized areas of care? Would establishing partnerships with local hospitals for student internships in specific units be a viable approach?

• ADN, BSN, and Master's Entry programs all can do better in this area.  The first step is to work with practice partners to understand the hiring needs and hard to fill jobs for nursing.  Then work to support curriculum enhancements that bolster the skills and experience in those settings.  Internships are great but fickle because of budget, etc.  Building curricular experiences in simulation, VR, and clinical rotations is essential.  It's worth looking at Arizona State University's program that works with Phoenix Children's Hospital to provide a pediatric-centric program.  All clinicals are based in Phoenix Children's and graduate with a significant acceleration of skills in the pediatric space.

Making an assumption that VR does not replace clinical experience but rather augments or enhances the learner’s readiness for practice. 2 questions:  Is there a program/ school doing this and having success, and how do you layer VR into a curriculum? 

• There are several schools that have incorporated VR into their curriculum: 
  
  • The Ohio State University has a program of research in the use of VR in nursing curriculum and has set up a lab to test different approaches. They have a conference coming up soon in April called DisruptRNx about their findings.  
  • The Kaiser Permanente School of Medicine has a cadaver-less anatomy and skills lab that uses VR extensively.  They have published some articles on this.
  • Check out UbiSim’s case studies for programs and schools that use UbiSim VR.
  • Ultimately VR, Sim, and Clinicals need to be thoughtfully interwoven.  They are different techniques for teaching content.  For example, VR can be used to orient and show process and decision making in a safe and fail-free environment.  It can also create a consistent assessment of process and decision making at scale. Manikin sim provides that translation of skill to real world application. Again, practice with hands on to prep for real patient care. Clinicals is where it all comes together.  But if they are not woven, each approach becomes more confusing or disjointed, creating a learning experience that is frustrating.

How do we make a Reduced Time to Onboard metric? And how do we get buy-in for it?

• Hospitals are ready for it.  We spend significant money on transition to practice programs.  Reducing onboarding by weeks would save millions of dollars a year.  Find a willing partner and be ready to change your curriculum with them.  In my experience, the curricular change side is the biggest barrier.  

I see great value for rural sites in ED nurses currently practicing who have low volume and take longer for experiential learning. Are there connectivity challenges?

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• From the UbiSim Team: Connectivity requirements in a rural (or any) location are an important consideration. The short answer is: you'll be able to run UbiSim as long as your internet connection is stable and can handle the equivalent of an audio-only Zoom call.

More detail: Only text data and voice data are transferred on your network. All 3D rendering is done on the device itself and does not impact network traffic. For example, during a typical 15 minute UbiSim session, only 50-100 MB of data go through the network.

About the Author 

Dan Weberg, PhD, MHI, RN, FAAN, is a fellow of the American Academy of Nursing and expert in nursing, healthcare innovation, and complex systems leadership. He has extensive clinical experience in emergency departments, acute in-patient hospital settings, and academia. Dan supports Kaiser Permanente as the Executive Director of Nursing Workforce Development and Innovation, building nursing workforce planning, a system-level new grad residency program, and other system-level nursing workforce initiatives. He has also held leadership roles at KP in nursing innovation, research, and technology strategy across eight regions, 38 hospitals, and 70,000 nurses. Dan was part of the founding faculty for the new Kaiser Permanente School of Medicine. Dan is on the faculty at the Ohio State University College of Nursing and multiple innovation fellowship programs. He previously taught on nursing innovation and leadership at Arizona State University. He is on the editorial board for Nursing Administration Quarterly and has authored two dozen peer-reviewed articles and two textbooks, including Leadership for Evidence Based Innovation for Health Professions and Leadership in Nursing Practice. Dan earned his Bachelor's in Nursing, was in the first cohort of the Master's in Healthcare Innovation program. and was the first-ever graduate of the PhD in Healthcare Innovation Leadership program at Arizona State University. Dan serves as Vice President of the American Nurses Association California.

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