Nursing CE Central
Virtual reality devices have been in the tech space since the late 1960s, but in recent years have been used to simulate situations nursing students might navigate in the real world.
Academic research has explored the value of the technology, but also urged caution as it relates to potential ethical and legal implications.
Filmmaker and inventor Morton Heilig created what is considered “one of the earliest functioning efforts” of VR — the Sensorama Simulator — in 1962. This set the foundation for Ivan Sutherland, a professor at the University of Utah, to create “The Sword of Damocles,” a VR and augmented reality headset,” six years later with his student Bob Sproull.
Since then, VR has been coopted for use in the video gaming industry (think Sega and Nintendo), space exploration, and education.
Students in the University of Cincinnati’s Accelerated Direct-Entry Master of Science in Nursing program are already using immersive VR to further their skills — something the college has done off-and-on since 2018.
“If it didn’t work for the students, then I wouldn’t be as passionate about it, but the students like it,” Associate Professor Lori Catalano, PhD, RN, who teaches in the accelerated program, stated in a UC news release. “It gets them out of their seats and out from behind their computers and actively experiencing clinical scenarios in a safe, controlled environment.”
Through a partnership with an Ohio-based simulation software company, Catalano translates case studies into “simulated clinical experiences” that allow students to “interview, assess, diagnose, and treat patients that are physiologically responsive and medically accurate,” the release stated.
The program also gives students an opportunity to experience “high-risk, low frequency events” that they’re unlikely to experience in clinical rotations.
“We can’t depend on clinical rotations to give students hands-on experiences for everything they’re learning in class,” Catalano said. “With VR, we can design simulation experiences, and every single student gets to experience it as the nurse.”
Nuvance Health’s Danbury Hospital (Connecticut) and Vassar Brothers Medical Center (New York) also offer a VR pilot program.
“We expect VR simulation will go a long way in strengthening nurses’ ability to make clinical decisions, building confidence in their skills and expediting orientation time so that they can get to the bedside faster,” Jasper Tolarba, RN, CGNC, CNE, FACHE, FAAN, endowed chair of Nursing Practice, Education and Research, stated in a Nuvance Health LinkedIn post.
John Leopold, Nuvance Health’s director of simulation, stated in the same post that the hospital system has used VR for skills training in the past, but “scenario-based simulation” is becoming a reality.
“Simulation is the safest and most effective way to strengthen the skills nurses need to provide high-quality care, but resources and logistical constraints can limit the use of in-person sim,” Leopold stated.
VR simulation in nursing education can have a positive impact on patient safety, as well as increase “interest and immersion” in education, according to a July 2024 study. VR became more prominent during the COVID-19 pandemic and has continued to be used.
“By experiencing scenarios that mimic real-life interactions in a virtual environment, they are able to react and receive real-time feedback, which seems to help them learn communication skills,” the authors stated.
However, the authors noted that there were “no significant differences in outcomes concerning key operation aspects of the programs.”
“This suggests that while VRS provides the benefits of a virtual environment, its impact on learners may differ from traditional face-to-face simulations,” they stated.
Two other studies, published in 2020 and 2023, both examined the effectiveness of VR in nursing education. While both saw value in VR, they differed in exactly how much.
The “BMC Medical Education” study from 2023 found that VR technology resulted in improved theoretical knowledge compared to “other conventional teaching methods,” but there was little difference when it came to critical thinking.
“This could potentially stem from variations in intervention delivery, assessment methodologies, study participants, and research schemes,” the authors stated.
“Consequently, educators must reorient their teaching paradigms, reinforcing the significance of virtual reality technology, and proactively integrating advanced technological tools for educational advancement.”
Meanwhile, the 2020 study from the “Journal of Medical Internet Research” discovered an improvement in knowledge, but no difference from other methods “on the outcomes of skills, satisfaction, confidence, and performance time.”
“In general, the use of VR should be considered to enhance knowledge and as a complement to other simulation strategies to improve the quality and safety of clinical practice,” the authors stated.
While VR can provide recreations of “realistic patient-care scenarios” in a controlled environment, the authors of an editorial from “Annals of Simulation” they noted several ethical considerations to keep in mind:
Designers and educators must take into consideration how users — students — could be affected by their participation in VR and immersive education scenarios.
“Since it is unclear who is legally responsible if users suffer psychological or physiological experiences, it is up to designers and educators to prevent this from occurring,” the authors stated. “By following ethical guidelines that respect the dignity, rights, and physical privacy of users and foster social competence through the use of constructivism, immersive realities can be used to enhance nursing education.”
Virtual reality has been a part of the technology and education landscape for decades but has been thrown to the forefront of the conversation in recent years. Some nursing programs and health systems are using VR to prepare nurses for situations they might come across, and the academic world has largely been in favor of this. However, ethical and legal issues — and how participation in VR scenarios could affect users — must be taken into consideration.
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