Faculty Driven Virtual Reality (VR) Scenarios and Students Perception of Immersive VR in Nursing Education: A Pilot Study.

Faculty Driven Virtual Reality (VR) Scenarios and Students Perception of Immersive VR in Nursing Education: A Pilot Study Jeeyae Choi, RN, PhD1, C. Elise Thompson, RN, PhD1 1University of North Carolina Wilmington, Wilmington, NC, USA Abstract Innovative nursing education methods became essential due to the COVID-19 pandemic. Immersive Virtual Reality (VR) education offers nursing students authentic patient encounters in a realistic simulated environment. A pilot study was conducted to identify nursing education clinical scenarios that should be developed for immersive VR and to assess students’ perception of immersive VR in education. We formed a focus group composed of nursing faculty (N=10) with expertise in the clinical setting and simulation. Faculty participants identified important topics and aspects of immersive VR scenarios during focus group discussions. We assessed nursing student participants’ (N=11) perception of immersive VR in nursing education using a VR game (Anatomy Explorer 2020). Most student participants indicated that a VR game was immersive and realistic and recommended using immersive VR to learn clinical nursing skills. Realistic immersive VR clinical education scenarios could result in effective clinical nursing education. Introduction The COVID-19 pandemic forced undergraduate and graduate education to go online unexpectedly1-4. Nursing had already embraced online education to overcome a nursing shortage, the demand for flexible learning, and limited clinical sites5-7. However, it has been challenging for nursing faculty to provide high quality online options that meet the demands of nursing education, especially in areas requiring hands-on experience. Nursing students need to have clinical training such as health assessment, skills training, practice with patient care, and use of health-related information systems such as an electronic medication administration record and Bar-coded Medication Administration (BCMA). Advanced technology opens a new venue, digital education, for nursing faculty. Digital education is often defined as the innovative use of digital tools and technology in teaching and learning. Computer based education, open online courses, virtual reality, augmented reality, virtual patients, gaming, and gamification are types of digital education8. Learning Management Systems (LMSs) provide convenient teaching environments for faculties to create and manage digital education. They also allow students to access deeper learning and facilitate self-regulated meaningful learning9, 10. Although digital education and LMS show benefits, strong supporting evidence is necessary for nursing faculties to use digital educational options effectively. Virtual Reality (VR) education is one type of digital education recognized to offer effective learning opportunities to students11, 12. Research indicates that VR education increases student engagement, allows constructivist learning, and provides authentic experiences. It allows them to see new perspectives, enhance creativity, and to visualize complex models or situations13, 14. VR's simulated clinical cases are specifically beneficial to nursing students since they can observe or experience essential clinical education without inflicting physical harm to patients or themselves in a safe environment. There are three types of VR: non-immersive, semi-immersive, and fully immersive VR. Non-immersive VR has been in existence for a decade. This is a computer-generated virtual environment, but the users are aware of the virtual environment, and they control physical devices such as keyboards, mouse, or controllers. Video games are good examples. Semi-immersive VR provides the perception of being in a different reality, but the users are still aware of their physical surroundings. Examples are flight simulators or virtual tours. Fully immersive VR provides the most authentic virtual reality to the users. In order to be immersed and interact in virtual reality, the users have to use a head mount display (a headset) and haptic (tactic) sensors15. The Lone Echo game developed by Reality at Dawn Studio LLC. is an example. The current study focused on fully immersive VR. Immersive Virtual Reality (VR) VR is a simulated 3-dimensional (3D) environment created by computer technology. Users react in VR as they would in an actual physical environment when they wear the headset and haptic sensors. The human brain actively models the physical world using sensory inputs. VR is created by replacing sensory inputs (e.g., auditory, visual, tactile, and olfactory) with digital ones16. Immersion, proprioception, presence, and interactivity are core 377 characteristics of VR technology. Interactivity is explained as the degree of user interaction in the VR environment. Proprioception is an awareness of the position of one’s body. With vision, it allows for a person to retrieve information about their own body location and movement17. Presence means the user experiences being in the VR created environment while they are in another physical environment. Immersion is a technological aspect creating the perception of presence in a VR world for users18, 19. Figure 1 shows an example of immersive VR. Immersive VR allows users to experience and interact within a computer-generated 3D environment. Current VR technology displays a 360-degree view and creates a high-resolution virtual environment. An individual’s movement and behaviors in this virtual environment are recognized as the most advanced form of human-computer interaction. Researchers in psychology and neuroscience consider the perception of ‘being in the VR created environment’ as a powerful tool for personal change20. VR technology is a good fit for training health professionals and people at high-risk jobs since it can create detailed models of a specific situation without putting them at risk21. For example, it can create an intensive care unit (ICU) environment for nursing students to care for COVID-19 infected patients without any risk of infection. Trainees can learn how to avoid infection risk and correct behaviors through the VR experience. However, few studies assess immersive VR scenarios based on faculty needs or students’ perceptions of immersive VR utilized in their education. The purposes of this study were to find areas of immersive VR scenarios that need to be developed and to explore undergraduate nursing students’ perception of using immersive VR, Anatomy Explorer 2020 game, in nursing education in a public university in North Carolina. Methods Scenarios for immersive VR To form a focus group, we recruited nursing faculty with clinical and simulation expertise from a university’s school of nursing. Simulation Experts: • Inclusion criterion: at least 1-year of simulation scenario building experience • Exclusion criterion: not currently participating in any other VR related study Clinical Experts: • Inclusion criteria: at least 1-year of clinical (...truncated)