By Carol Davis
New technology is enabling nursing students to learn hands-on care through virtual reality programs that present situations practically as real as if they were in a clinical setting.
When the COVID-19 pandemic hit and nursing students were unable to do in-person clinicals in hospitals, Wayne State University College of Nursing in Detroit, like other nursing schools, had to rely on simulation to provide students with the education they needed. And although nursing students are returning to in-person clinical rotations, simulation labs remain in important part of their education.
HealthLeaders spoke with Erik Carter, PhD, MS, APRN, CNS, CCRN-A, PHN, director of undergraduate programs for Wayne State’s College of Nursing, about how virtual simulation is used and how effective it is.
This transcript has been lightly edited for brevity and clarity.
HealthLeaders: How increasingly is virtual simulation being used in nursing education?
Erik Carter: We’ve been using it especially since the pandemic started. We had to do a pivot because, as I’m sure you know, some affiliates during the peak of the pandemic were not allowing clinicals to occur in their institutions. So, we as faculty had to think of ways to provide students with a very sound experience that was centric or related to some kind of clinical experience, so we start utilizing simulation. And when I say simulation, there’s a huge breadth but I’m talking about virtual simulation and specifically the vSim® application that is provided through Wolters Kluwer’s platform.
Other simulations are used here as well. We have a simulation lab where our own homegrown simulations are utilized for students.
When the NCSBN [National Council of State Boards of Nursing] provided guidelines for us to use simulation to evaluate our students’ clinical performance, they allowed us to use simulation as a clinical substitute for these experiences. So that’s one thing that we did to give students the opportunity to have a safe, realistic type of clinical experience that was not in the acute-care setting, in the primary care setting, or in a long-term care facility.
HL: Did Wayne State have a simulation lab prior to the pandemic?
Carter: Yes, we had a fully functional high-fidelity simulation lab prior to the pandemic. We utilize that with all of our clinical courses. We provided students the opportunity to have a simulation experience; it was just building to part of their overall overarching development. But when the pandemic hit, we had to pivot away from that in-person type of experience for the students and we had to think of ways to provide an online experience.
Our simulation techs and faculty put together these online experiences through simulation for the students in our simulation lab, but we also utilized other tools that we had at our disposal. The vSim platform is one that we use in several of our undergraduate clinical courses, such as med surg, maternity, pediatrics, and the fundamentals. It was nice that we had that ability to do that because again, we were perplexed: “How do we provide this for students? We have permission through the NCSBN to do this, but how?” And so we had to think outside the box and think of ways to provide students these rich opportunities to have some form of clinical engagement that wasn’t always centric to them being in the hospital or in a clinical facility.
With the vSim, the student goes in and does pre-reading, and then we do a formative assessment of their understanding of the reading so they are well-prepared before they start the simulation. Once they’re in the simulation, they follow the cues based on their understanding of how they should perform. The best part about that is it provides a formative assessment; it tells them if they were on point with their interventions or their assessments regarding the patient or if they were off somewhat. It then gives clues as to what they can do next time they go back in or when they come back in to perform the simulation again.
We also have some homegrown simulations that we have put together with our faculty, but we have just started using one tool called UbiSim, which is very immersive and a little different than vSim. It’s a headset that puts students into a 3D platform where they’re actually doing things within the simulation; they’re part of the simulation.
HL: Can you explain how that works from the student’s perspective?
Carter: Depending on the clinical situation, the patient is seen in bed. They approach and talk to the patient, and the patient, who is a faculty member who has the headset on as well, responds back.
The student would say, “Hello, my name is [student’s name] and I’m here to do a focused assessment on your respiratory system, so I’m going to listen to your lungs. Can you tell me your name and date of birth?” And then the faculty member who is playing the role of the patient would respond accordingly.
The students have a med card and they have the ability to start an IV, start fluids—there’s a plethora of different things that you can do within that immersive environment with UbiSim. That’s one way we provide a clinical mimicry of a situation where students, if they’re not in clinical, can actually have these experiences here in the college in the simulation lab.
HL: How do the students feel about using virtual simulation technology?
Carter: Once they get a handle on how to utilize, say, the vSim platform, they see how it makes sense. They see that it’s something that can test the boundaries of their knowledge. There’s no worry because we tell them, “This is a safe environment; you have the ability to make a mistake and you’re not going to harm anyone.”
That is a huge driver to have students think outside the box and try things and know that it’s not going to cause harm.
HL: From an educator’s perspective, how effective is virtual simulation in nursing education?
Carter: From my faculty perspective, it’s very effective. When I think about some of the studies that have been done surrounding the use of simulation, one that comes to mind is the NCSBN national stimulation study. That showed that the clinical experience that students normally would have could be replaced with simulation and they were just as effective as a student being in the clinical setting with a clinical instructor.
There’s another one that comes to mind where they did a longitudinal study about how unique experiences and skills that students have, as well as knowledge, were increased, based on the simulation. I think that the utility of simulation is going to get bigger and going to explode. I’m a huge fan of these platforms and I see its utility in nursing education for sure.
HL: How well does virtual simulation prepare nurses for the real world of nursing?
Carter: It provides a safe and realistic environment for students to practice their clinical reasoning and their clinical judgment, and I tell the students all the time, “This is where you want to make a mistake.” Can you imagine if you’re at a clinical site and you gave a drug inappropriately to a patient? The anxieties surrounding that error exponentially pushes their anxiety over the edge, making them almost unfunctional in the clinical realm on that day. So, I tell students that when they’re in vSim to go ahead and make a mistake and see what happens and see what the system tells you, so you think about this before you move forward.
It provides the students a safe haven for practice, and it prepares them for true clinical practice in the clinical setting once they are in the hospital or the clinic or wherever they’re going to do their practicing. It really does prepare them to be a practice-ready, generalist in the clinical setting, for sure.
Carol Davis is the Nursing Editor at HealthLeaders, an HCPro brand.