Nursing VR: Understanding Virtual Simulation and Virtual Reality

As we increasingly use novel technologies in simulation education it is important to differentiate between the types of virtual modalities. Virtual simulation is sometimes used as an umbrella term to describe a variety of simulation-based experiences, from screen-based platforms to immersive virtual reality. However, there are significant differences in the level of fidelity, immersion, and presence among virtual platforms. There is room for many virtual solutions in education and there is no “one size fits all” modality for nursing programs. Choosing the right virtual solution depends on your program needs and the purposes of your simulation-based experiences. Are you ready to explore exciting virtual simulation modalities at your program? Read on to learn about the difference between virtual simulation and immersive virtual reality!

‍Virtual Simulation

According to the Healthcare Simulation Dictionary, virtual simulation is “the recreation of reality depicted on a computer screen.” When participating in virtual simulations, learners experience simulated clinical scenarios from a computer screen while often using a mouse or keyboard to interact with the environment and maneuver their avatars. Learners often select actions and communications from a menu as they provide nursing care to the virtual patient. Upon completion of the simulation, an automated report provides standardized feedback on whether the student met the scenario learning objectives.

Benefits of Virtual Simulation

‍Virtual simulation has demonstrated to be an effective pedagogy that supports student learning outcomes. Research has shown that virtual simulations can improve knowledge retention, clinical reasoning, and student satisfaction with learning. Other benefits of virtual simulation include the ability for educators to provide experiential learning in a manner that easily complies with social distancing and infection control guidelines. Virtual simulations are often web-based and accessible with standard computers or laptops, thus seamlessly translating to a remote simulation-based experience.

‍Limitations of Virtual Simulation

‍As with any simulation modality, there are limitations to virtual simulation. Interacting from a computer-screen with menu-based actions and communications can decrease the immersion, fidelity, and realism of the simulation experience. Although appropriate cueing is an important facilitation strategy, a menu-based system may prompt the learner to complete an action or communication they may not have otherwise considered. Some educators report a lack of student engagement with certain screen-based options, as students may click through the scenario without using critical thinking skills. Since learners often interact with the environment through the use of a mouse or keyboard, this can limit the assessment of certain psychomotor skills that require exacting, fine motor movements. In addition, educators should consider emerging technologies that offer a higher degree of immersion and presence. According to a recent study, the use of virtual simulation in nursing education is expected to decrease over the next 2 to 5 years. During the same timeframe, the use of emerging technologies like virtual reality are expected to rise.

‍Immersive Virtual Reality

The Healthcare Simulation Dictionary defines virtual reality as “the use of computer technology to create an interactive three-dimensional world in which the objects have a sense of spatial presence.” The various types of virtual reality can be distinguished by the levels of immersion and presence.The most immersive virtual reality platforms often use head mounted displays that immerse participants in a realistic virtual world. This multi-sensory, immersive experience translates to a high degree of presence where participants perceive themselves as being in the simulated clinical environment rather than the physical world around them. Immersive virtual reality simulations are hands-on, allowing participants to care for realistic patients, collaborate in teams, and operate virtual equipment. Participants also have a sense of proprioception where they can feel their position and movement within the virtual environment as they provide nursing care.

‍Benefits of Immersive Virtual Reality Simulation

‍Immersive virtual reality is a promising simulation modality for healthcare education. When looking at the impact of immersive virtual reality on student learning outcomes, it has demonstrated non-inferior learning outcomes when compared with traditional methods and improvements in cognitive, psychomotor, and affective skills. A recent study found that learners using immersive virtual reality were 2.3 times more engaged and emotionally connected to the content than those learning from a computer screen. It has also been demonstrated that learners in immersive virtual reality are up to 4 times more focused during their training when compared with those using a computer.  A study conducted prior to the COVID-19 pandemic that examined the future of technology in nursing education found the use of immersive virtual reality is projected to increase from 10% to 45% over the next 5 years. Given the COVID-19 pandemic served as a catalyst for many nursing programs to adopt emerging technologies like immersive virtual reality, it is reasonable to postulate that the projected increase in adoption may be even greater if the same survey were conducted today. Although some platforms may incorporate menu-based actions or communications, certain highly immersive virtual reality solutions allow the learner to organically implement actions and therapeutic communication without the use of menus. This allows learners to develop clinical judgment and transferable skills as they autonomously act and communicate in their own words as they would in a real-life clinical setting. Like virtual simulations, immersive virtual reality platforms often include an automated feedback report and self-guiding questions after the simulation. This provides standardized feedback that is specific to the learner’s performance and fosters reflection on the simulation-based experience.

Watch a nurse learner communicate with the patient in her own words during a VR simulation

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The recent democratization of immersive virtual reality  has increased the accessibility and affordability of this modality. Educators can now use immersive virtual reality simulation with minimal equipment, using commercially available headsets connected to standard gaming laptops. Recent developments include standalone headsets that do not require the purchase of a gaming laptop, thus further increasing accessibility. Immersive virtual reality simulation can be implemented almost anywhere that learners have access to the technology. This gives educators a feasible solution for providing meaningful simulation experiences beyond the simulation lab, while complying with any social distancing and infection control guidelines. Interprofessional education and team-based learning are critical to healthcare education and certain immersive virtual simulation platforms have a multiplayer feature that allows groups of learners to collaborate in a scenario even when not physically present in the same room. This minimizes barriers to interprofessional education, including scheduling conflicts and space constraints. Certain immersive virtual reality platforms also empower educators to design and develop scenarios curated for their students’ unique learning objectives and outcomes.

Watch learners collaborate in an immersive VR simulation

Limitations of Immersive Virtual Reality Simulation

‍As mentioned previously, all simulation modalities have limitations. Participating in immersive virtual reality requires orientation to the equipment so learners are prepared for the simulation-based experience. Like virtual simulation, not all skills can be adequately assessed in immersive virtual reality. Learners often use hand controllers that can minimize the ability to perform exacting movements like intravenous catheter insertion. This can limit the assessment of certain psychomotor skills but provides an excellent opportunity to use your manikins or task trainers in a hybrid approach that leverages the best of emerging and traditional modalities.

‍Further Considerations

‍The healthcare industry is a leader in adopting emerging technologies that optimize workflows and improve patient outcomes. Learning solutions that keep pace with our digital world help future nurses to thrive in a technology-rich environment. Nurses use computers throughout their shifts and will likely interface with immersive virtual reality platforms for continuing education and the treatment of certain patient conditions. Both virtual simulation and immersive virtual reality are evidence-based modalities that use technology to provide meaningful learning experiences. Before you decide which modality is best for your program, take a moment to consider the benefits, limitations, and what will ultimately meet your student learning objectives and expected outcomes.

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