What the Data Tell Us About the UbiSim VR Platform for Nursing Simulation [Fall 2024]

This research brief explores the profound impact of virtual reality (VR) in nursing education and focuses on the UbiSim immersive VR platform for nursing simulation. By analyzing peer-reviewed research as well as a survey conducted by UbiSim, we provide a comprehensive evaluation of VR's efficacy and highlight how UbiSim supports nurses in developing the competence and confidence they need to provide patient-centric care.

I. Peer-Reviewed Article: Learnings After Adopting UbiSim

The paper “Virtual Reality Simulation Integration in a Prelicensure Nursing Program: Lessons Learned” describes lessons learned for nurse educators considering adopting UbiSim immersive VR simulation technology to reduce the costs of live role-play with standardized patients and relieve the screen fatigue that can accompany 2D computer-based virtual simulation. 

1. VR is Affordable, Subscription Must Be Sustainable: At the authors’ institution, UbiSim VR simulation was found to allow greater student-to-faculty ratios, less need for medical equipment, and less use of paid standardized participants than live simulations, making the cost of UbiSim roughly half the cost of live simulation. They cautioned that educators should carefully consider how to sustain subscription access (eg, beyond any grant funding) before integrating VR simulation into their curriculum, as well as how ongoing VR equipment, faculty training, and support needs will be funded.

2. Plan for Cleaning and Maintainance: The authors cited the need for nursing programs to plan for the cleaning of VR headsets and controllers between users, with care taken to avoid damaging components. They recommended the purchase of ultraviolet cabinets, a significant up-front cost, or a less costly process of using antimicrobial wipes, air drying the components, and then wiping with fragrance-free baby wipes. However, they noted that this process is not eco-friendly and creates a list of supplies that must be maintained over time.

3. Consider Hands-On Learning: Following VR simulation, some nurse learners provided feedback that they also felt the need to get their hands on the physical objects used for client care. For this reason, the authors introduced a “kinesthetic cart” which contained the physical objects used during the VR scenarios. For example, if a client was given an intravenous medication in the simulation, students were presented with an actual simulation syringe of that medication to capture kinesthetic knowledge that may otherwise be lost in the VR environment. Subsequent learner surveys indicated comparable satisfaction between VR simulation and standardized patients. 

Implications: UbiSim has created larger student-to-faculty ratios, a decreased need for medical equipment and paid standardized participants and a significant reduction at approximately half the cost of live simulation. However, implementing VR simulation requires careful planning for nurse learners’ desire for kinesthetic learning and ongoing costs, including equipment maintenance, cleaning procedures, and faculty training. 

II. Peer-Reviewed Article: Feasibility of VR for Nurse Training in Rural Settings

This qualitative research explored the acceptability and feasibility of using UbiSim immersive virtual reality (IVR) to develop the skills of new graduate nurses (NGNs) working in a rural hospital in Quebec. 11 NGNs participated in an IVR training intervention and completed questionnaires, with 6 also participating in semi-structured interviews. Cybersickness was minimal, with only slight eye strain reported. 

The results showed high acceptability. According to the NGNs, simulation using IVR was rated as ’extremely effective’ (Md = 4), ’extremely appropriate’ (Md = 4) and ’extremely convenient’ (Md = 4). NGNs reported being ’extremely willing’ to receive this intervention (Md = 4).  

The qualitative findings revealed four major themes: 

1. IVR is relevant everywhere and for everyone, making immersive simulation accessible even in remote settings
2. IVR allows the development of various skills, including knowledge, clinical judgment, and prioritization
3. Challenges like cognitive overload and cybersickness can be overcome with strategies like familiarization time and case complexity gradation
4. The realism of IVR provides a sense of safety for skill practice. NGNs recommended IVR be used regularly for training.

Implications: The study provided promising evidence that UbiSim immersive virtual reality is an acceptable, feasible, and effective modality for providing simulation-based training to NGNs in rural and remote hospital settings. The accessibility of UbiSim makes it well-suited to deliver much-needed continuing education to nurses in areas far from educational centers. While some limitations were noted, such as reduced realism for technical and communication skills compared to in-person simulation, the overall findings support its use to help NGNs develop critical competencies. 

III. Peer-Reviewed Article: Implementation of VR in Nursing Professional Development

The journal article “Welcome to the Metaverse: Virtual Reality in Nursing Professional Development” explores the implementation of UbiSim virtual reality (VR) technology as part of a nursing professional development education program at an academic health system. The program used VR simulation as an alternative form of experiential education aimed at preparing clinicians for real-world situations. VR was incorporated into nursing orientation and residency programs across four campuses. 

The project involved 63 participants, primarily staff nurses with less than a year of experience.

Most participants (74.6%) were first-time VR users. A three-phase approach was used in which NPD practitioners received training on VR hardware and software (preparation phase); facilitators guided learners through VR scenarios (implementation phase); and participants reflected on the experience and its implications for practice in a self-reported survey (debrief phase).

Survey participants agreed that VR simulation:

• Enhanced clinical knowledge retention: 98.3%
• Met educational objectives: 77.7%
• Was an enjoyable learning environment: 69.8%
• Was effective for learning nursing clinical skills: 66.7%
• Was easy to use: 55.6%
• Improved their confidence: 52.4%
• Reduced their performance anxiety: 44.4%
• Was preferable to traditional teaching methods: 38.1%

Implications: The study findings suggest that integrating UbiSim into nursing professional development programs could enable health systems to enhance the quality and effectiveness of their nursing education, leading to improved knowledge retention and clinical skills. Improvements in confidence and reductions in performance anxiety indicate that UbiSim could add value as a way for nurses facing new or challenging clinical scenarios to practice and refine complex skills without risk to patients. Additionally, the finding that it was easy and enjoyable suggests that UbiSim could increase engagement in professional development activities.

IV. Dissertation Research: Key Findings About Accuracy, Clinical Judgment, and Soft Skills

The study “Evaluating a Virtual Reality Simulation-Based Tool in Undergraduate Nursing Students for Impact on Accuracy, Clinical Judgment, Fear, and Self-Confidence when Donning, Doffing, and Disposing of Personal Protective Equipment” aimed to determine the effectiveness and acceptability of head-mounted virtual reality simulation VR in teaching PPE procedures to nursing students. It focused on evaluating the impact of VR on accuracy, clinical judgment, fear, and self-confidence and sought to understand its acceptability among faculty and students for PPE training.

The study utilized a small group evaluation design with repeated measures among 38 undergraduate nursing students at West Virginia University. Various validated scales and checklists were used to measure outcomes like accuracy, clinical judgment, and self-confidence. Statistical analysis was conducted to evaluate differences and changes over time.

Results:

1. Enhanced Accuracy and Clinical Judgment: The study's results suggest that VR can improve accuracy in donning, doffing, and disposing of PPE, especially with repeated practice. Improvements in clinical judgment were observed, suggesting that VR can help students become more organized and aware of clinical situations over time.
2. Reduction in Fear: A significant decrease in fear was noted among students using VR, implying a reduction in anxiety and unease related to PPE procedures.
3. Increase in Self-Confidence: Students reported higher self-confidence levels after using the VR tool, indicating a preference for this modality over traditional methods.
4. Acceptance Among Faculty and Students: Despite some previous skepticism, the study found a growing acceptance of VR among faculty for teaching PPE procedures, contrary to some previous studies. Students expressed high acceptance and preference for VR, finding it supportive and life-like. This generation's familiarity with virtual environments for recreation likely contributes to this acceptance, suggesting that VRS is a fitting learning tool for contemporary students. The realistic scenarios provided by VR were particularly appreciated for their contribution to learning.

Implications: By demonstrating improved accuracy, clinical judgment, fear reduction, and self-confidence among students, the study supports adopting innovative platforms like UbiSim for enhanced learning outcomes. This study provides substantial evidence supporting the use of immersive virtual reality, like UbiSim, as a pedagogically proven and preferred modality for nursing education, particularly for critical skills like PPE procedures. As the healthcare industry and students’ learning preferences continue to evolve, utilizing innovative educational tools like UbiSim will be vital for enhancing learning outcomes.

V. Research Study: Key Findings About Psychological Safety and Clinical Judgment

The School of Nursing at Niagara College conducted a research study led by Professor of Nursing Dr. Holldrid Odreman (PhD, MScN-Ed, RN, CCNE, CCSNE). This study aimed to enhance psychological safety in nursing students to improve their performance and clinical decision-making skills. The focus was on identifying which simulation pre-briefing method most effectively boosts student confidence and performance while also fostering a supportive learning environment. 

Dr. Odreman and his team compared three pre-briefing strategies: traditional, concept-mapping, and virtual reality (VR). A total of 38 volunteer nursing students were randomly assigned to one of the three pre-briefing groups. Each group received a 20-minute pre-briefing session specific to their assigned method, intended to prepare them for a nursing simulation scenario. The design of the study aimed to assess how each pre-briefing strategy influenced students' psychological comfort and clinical decision-making abilities.

Results

• Both VR-based pre-briefing and concept mapping were effective in creating a sense of psychological safety among participants.
• Interaction during pre-briefing sessions enhanced active learning and critical thinking.
• Increased psychological safety correlated with improved clinical reasoning and judgment.
• Notably, the pre-briefing intervention using the UbiSim immersive VR simulation achieved the highest scores on the Lasater Clinical Judgment rubric, indicating its effectiveness in fostering clinical reasoning skills.

Implications: The findings indicate that adopting UbiSim's Immersive VR platform could significantly enhance the pre-briefing process, leading to improved psychological safety, better clinical judgment as demonstrated by its high scores on the Lasater Clinical Judgment rubric, and more effective preparation of nursing students. 

VI. Survey Research: UbiSim Impact on Program Growth and User Experience

The Spring 2024 Nursing Simulation Survey was conducted by UbiSim online from May 8-31, 2024, which created the world’s first immersive virtual reality training platform built specifically for nurses. UbiSim surveyed 679 nurse learners, instructors, simulation directors, and program leaders on the impact of headset-based immersive VR technology in nurse training.

82% Nursing Programs Leaders Say UbiSim Helps Them Recruit and Accept More Students

82% of nursing program directors surveyed agreed that headset-based immersive VR has helped their nursing program to attract more students, saying “it helps us with recruitment,” while 72% agreed it has helped their nursing program to accept more students. Significantly, three-quarters of nursing program directors who use UbiSim say their nursing program has grown by at least 5%, or as much as 25%, since implementing UbiSim. Once enrolled and learning in simulation, 91% of nurse learners said they liked UbiSim the same or better than other simulation modalities.

94% Nursing Learners Say UbiSim Prepares Them for Licensure and Practice

There was broad agreement among nurse educator respondents that incoming nursing students are ill-prepared for the rigor of nursing education. 55% of both nursing instructors and program directors agreed that the top challenge facing their nursing program is “students’ lack of academic preparation”. These concerns were closely followed by a “lack of clinical sites/preceptors”, cited as a top challenge by 50% of nursing instructors and program directors. Given these concerns, nursing schools must find a way to overcome skills gaps with fewer resources. Fortunately, students enrolled in nursing programs that use UbiSim viewed it as an effective learning tool, with 94% of nurse learners agreeing that UbiSim helps prepare them for the clinical setting and 90% agreeing that UbiSim helps them prepare for the Next Generation NCLEX. 

78% Simulation Directors Say UbiSim Helps Develop Clinical Judgment

Nearly four out of five simulation directors ranked headset-based immersive VR simulation as the most effective simulation modality for developing clinical judgment skills, superseding both high-fidelity manikin simulation and computer screen-based virtual reality simulation. Suspending disbelief and engaging in hands-on experiences in highly realistic scenarios can help nurse learners develop essential clinical reasoning, collaboration skills, and resilience to become adequately prepared for high-pressure, life-or-death situations.

50% Nurse Learners Say UbiSim is the Most Psychologically Safe Sim Modality

50% of nurse learners said they felt safer and more comfortable learning in UbiSim than in other simulation modalities. They commented that they appreciated the chance to practice without consequences. Respondents said “UbiSim lets me be immersed in situations I may encounter in the hospital setting but in a safe environment” and “it can help me face and overcome fears.” Nursing instructors who teach with UbiSim agreed, saying “The students are able to do things with less fear when compared to a manikin simulation.” 

Implications: UbiSim's immersive VR technology has made a significant impact on nursing programs, with 82% of program leaders reporting it aids in student recruitment and 72% saying it helps them accept more students. The platform is widely viewed as an effective learning tool, with 94% of nurse learners agreeing it prepares them for clinical settings and 90% feeling it helps with Next Generation NCLEX preparation. Moreover, 78% of simulation directors say UbiSim is the most effective simulation modality for developing clinical judgment skills. 

Conclusion: UbiSim and the Future of Nursing Simulation

This research brief highlights how UbiSim aligns with the evolving needs and preferences in nursing education, offering a new way to prepare learners for real-world nursing challenges. As an evidence-based platform with immersive virtual reality (VR) experiences, UbiSim helps address the critical gaps in traditional nursing education by enhancing knowledge transfer, student engagement, and preparation for clinical practice.

In a time of limited resources and increasing demand for nurses, VR simulation technology has become an essential educational tool. UbiSim is bridging the gap between the demand for and supply of qualified nursing professionals by expanding the capacity of nurse training programs and providing standardized and scalable simulations that enhance educational impact.

References

American Association of Colleges of Nursing. (2022, October). Nursing Faculty Shortage Fact Sheet. [pdf] Retrieved from https://www.aacnnursing.org/news-data/fact-sheets/nursing-faculty-shortage

Coughlin, V., Bolanos, G., Jacob, A., & Maydick-Youngberg, D. (2024). Welcome to the metaverse: virtual reality in nursing professional development. Journal for Nurses in Professional Development. 40(5), 236–241.  

Kim, J., Nowrouzi-Kia, B., Ho, E. S., Thomson, H., & Duncan, A. (2023). Appraising occupational therapy students' perceptions of virtual reality as a pedagogical innovation. Computers & Education: X Reality, 3, 100039. Retrieved from https://www.sciencedirect.com/science/article/pii/S2949678023000338 

Lemée, M. H., Lavoie, S., Provost, J., & Ledoux, I. (2024). Exploring the Acceptability and Feasibility of an Immersive Virtual Reality Intervention for Newly Graduated Nurses Working in a Rural Area. Clinical Simulation in Nursing, 91, 101542. Retrieved from https://www.sciencedirect.com/science/article/pii/S1876139924000343 

MacDowell, P., Cabri, A., & Davis, M. (2021, March 12). Medication administration errors. Patient Safety Network. Retrieved from https://psnet.ahrq.gov/primer/medication-administration-errors 

Ondis, A. (2024, August 6). 2024 UbiSim Spring Survey Reveals the Impact of Immersive VR Simulation on Nurse Education. [blog] Retrieved from www.ubisimvr.com/in-the-news/2024-survey-spring 

Russell, S. L. (2023). Evaluating a Virtual Reality Simulation-Based Tool in Undergraduate Nursing Students for Impact on Accuracy, Clinical Judgment, Fear, and Self-confidence when Donning, Doffing, and Disposing of Personal Protective Equipment. Retrieved from https://researchrepository.wvu.edu/etd/11960/ 

Willett, J., Adelman-Mullally, T., Ng, H., & Chung, S. Y. (2024). Virtual Reality Simulation Integration in a Prelicensure Nursing Program: Lessons Learned. Nurse Educator, 10-1097. Retrieved from https://journals.lww.com/nurseeducatoronline/pages/articleviewer.aspx?year=2024&issue=07000&article=00011&type=Fulltext