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How the nursing profession should adapt for a digital future 

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How the nursing profession should adapt for a digital future 

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How the nursing profession should adapt for a digital future

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Transformation into a digitally enabled profession will maximize the benefits to patient care, write Richard Booth and colleagues Digital technologies increasingly affect nursing globally. Examples include the growing presence of artificial intelligence (AI) and robotic systems; society’s reliance…

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Augmented Reality and Virtual Reality (AR/VR) have the potential to transform health care, delivering altogether new types of treatments and diagnostics, and changing how and where care is delivered. Central to their potential in diagnosis and treatment is their ability to deliver both standard and entirely new types of content in highly immersive and realistic ways, remotely, and tailored to a variety of clinical contexts. Physicians, patients, and caregivers can enlist AR/VR to help them prepare for, or perform, certain treatments or procedures.
On this page:
What Is Augmented Reality and Virtual Reality?

Augmented Reality (AR) is a real-world augmented experience with overlaying or mixing simulated digital imagery with the real world as seen through a camera or display, such as a smartphone or head-mounted or heads-up display (HUD). Digital imagery may be able to interact with real surroundings (often controlled by users). This is sometimes referred to as mixed or merged reality.

Virtual Reality (VR) is a virtual world immersive experience that may require a headset to completely replace a user's surrounding view with a simulated, immersive, and interactive virtual environment.

The term extended reality, or augmented reality and virtual reality, is often enlisted to encompass the two approaches, but for the purposes of this web page, we will use the terms augmented reality and virtual reality.

Some real-world examples of augmented reality and virtual reality applications already being used to treat patients include:

An AR system that overlays medical images onto a patient during an operation to help guide the surgeon's technique.

A VR system that is used to treat post-traumatic stress disorder in army veterans.

A VR rehabilitation therapy that simulates real-life situations to improve physical functions for patients who have experienced a physical disability associated with a stroke or other medical condition.

How Are Augmented Reality and Virtual Reality Impacting Medical Devices?

AR/VR can deliver some types of clinical services-including some normally delivered only in clinics and hospitals-to patients in their homes or other non-clinical settings. This could enable patients, including the socioeconomically vulnerable and underserved communities, the elderly or disabled, to access needed health care services when accessing them in person would otherwise be difficult, and this could make it easier, and more likely, for patients to complete treatment and monitoring regimens.

There are a number of treatment domains in which augmented reality and virtual reality are used to treat patients. Among those domains are:

Pediatric diagnostics and treatments

Pain management

Mental health

Neurological disorders

Surgery planning

Intraoperative procedures

Ophthalmic diagnostics

Telemedicine

Virtual Care

Post operative and other rehabilitation therapies

Relative to current therapies, an AR/VR device may introduce new benefits and novel approaches. Such benefits may be identified across a wide variety of patients, or it may be more beneficial for some patients than others. A device may demonstrate particular benefit for underserved populations (for example, patients with more limited access to medical care) or vulnerable populations (for example, children, patients with mental health or cognitive impairment). However, an AR/VR device may have risks as well, including risks related to the usability of the device (such as neck pain from the weight of the headset), and risks related to the content and images that the AR/VR technologies provide (such as low contrast images, display errors such as location or depth of anatomy, information overload, dizziness, fatigue, or effects on vision).

Examples of probable benefits:

Increase access to necessary health care when accessing in person would be difficult

Improve health care professional's ability to prepare for certain treatments

Fulfill unmet medical needs

Mitigate preoperative anxiety

Make procedures less invasive

Accelerate diagnoses

Allow for self-directed care

Examples of probable risks:

Cybersickness

Head and neck strain

Cybersecurity risks

Privacy risks

Distraction in the operating room

Effects of AR/VR on populations

Unknown side effects and/or risks (particularly in pediatrics or other vulnerable populations)

Potentially worsening disparities in diagnostics and treatment

List of Medical Devices that Incorporate Augmented Reality and Virtual Reality

The FDA has reviewed and authorized for marketing a growing number of devices through 510(k) clearance, granted De Novo request, or Premarket Approval with AR/VR across many different fields of medicine-and expects this trend to continue.

The FDA is providing this list of medical devices that incorporate AR/VR marketed in the United States as a resource to the public about these devices and the FDA's work in this area.

Contents of this list:

The FDA assembled this list by searching FDA's publicly facing information. The list is not meant to be an exhaustive or comprehensive resource of medical devices that incorporate Augmented Reality and Virtual Reality. Rather, it is a list of medical devices that incorporate A/R and V/R across medical disciplines based on information provided in the summary descriptions of their marketing authorization document.

Updates to this list: The FDA plans to update this list on a periodic basis.

Augmented Reality and Virtual Reality News and Updates

FDA Resources

Contact Us

If you have questions about augmented reality, virtual reality, or other digital health topics, please visit Ask a Question About Digital Health Regulatory Policies.

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Augmented Reality and Virtual Reality in Medical Devices

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Augmented Reality and Virtual Reality are transforming health care, delivering new types of treatments and diagnostics, and changing how/where care is delivered

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User experiences of virtual reality technologies for healthcare in learning: an integrative review

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User experiences of virtual reality technologies for healthcare in learning: an integrative review

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User experiences of virtual reality technologies for healthcare in learning: an integrative review

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The aim of this integrative review was to analyse the usage of different virtual reality (VR) technologies in learning and user experiences (UXs) of these technologies in healthcare practice and ed…

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Learn more about quantum computing, a rapidly-emerging technology that harnesses the laws of quantum mechanics to solve problems too complex for classical computers.

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Contributors: Glenn Albright, Ph.D. and Ron Goldman

Gaming has come a long way since the days of Atari. What was once viewed as simply a leisure activity has evolved to be so much more. Video gaming technology is now being used in a previously unexpected way: medical training.

Instead of defeating villains or collecting gold coins, students are using gaming technology to learn, practice, and gain confidence to help real people facing medical and mental health issues.

Kognito, an Ascend Learning health simulation company, is at the forefront of applying simulation technology in training. Kognito has helped organizations like National Healthcareer Association (NHA) give healthcare students and professionals access to highly interactive and individualized training from virtually anywhere, using their computers or mobile devices.

How simulation is being used in healthcare training

Kognito's virtual humans portray patients who present with behavioral health challenges such as alcohol use, opioid addiction, and suicidality. The virtual patients are programmed to act and respond just like real patients. The technology allows users to assume the role of a virtual health professional and to engage in role-playing conversations with the patient. Users receive tailored feedback immediately as they select or deselect dialogue choices, with the goal of using conversation tactics like motivational interviewing (MI) that will best help the patient. This provides training in a low-risk environment, which allows users to experiment and feel comfortable before applying these skills in real life.

In the gaming sense, dialogue is the "weapon." Learning effective conversation tactics for different situations leads to a "win" - a win that when translated in the real world, could help improve or even save lives. These simulated conversations with emotionally responsive virtual patients havetremendous success, especially when compared to traditional textbook learning or even to live role-playing with peers
or instructors.

"It's amazing, and not surprising, that people find it easier to talk to virtual humans," says Dr. Glenn Albright, Kognito co-founder and director of research. "[People] don't get as anxious as when they role play face-to-face with instructors or peers. Virtual humans are easier to talk to; you feel less threatened and you feel like you're not going to be judged, so you are more yourself."

Some concepts can be learned from textbooks, but mastering the art of conversation is best accomplished through practice. As healthcare institutions focus more on patient-provider relationships, simulation training can be a game-changing tool to help train current and future healthcare professionals.

"People learn best through practice. None of us learned how to ride a bike from a movie. We all had to get on a bike," says Ron Goldman, Kognito co-founder and chief executive officer. "Even though we can all agree that's the best way of learning - to learn by doing - the training industry is still dominated by non-interactive, non-simulation training."

Antoinette Schoenthaler, Ed.D., FAACH, a professor at NYU School of Medicine, echoes Goldman's statement that learning through repeated practice is more effective than traditional methods. "I've been doing MI and communication skills training for a really long time, and what we've learned is that a one-time, workshop-based opportunity where there's no real interaction with patients is not effective," she says. "What I find fascinating from the Kognito model is that this gives [students] opportunities to repeatedly practice effective communication skills and learn from their mistakes in a safe environment." ¹

"What I find fascinating from the Kognito model is that this gives [students] opportunities to repeatedly practice effective communication skills and learn from their mistakes in a safe environment."

Simulation training:the way toward patient-centered care?

Patient-centered care is becoming increasingly important across all healthcare venues. According to Goldman, the days of lecturing patients are over. Collaboration with and active participation from patients, their families, and the healthcare team are essential to providing exceptional care. As healthcare organizations work toward a team-based or patient-centered care model, simulation training can be a powerful tool.

Goldman hopes that the rapid adoption of simulation training in sectors like healthcare is the start of a transition to a time when interactivity plays a more primary role in education. Simulation training has the potential to make a huge difference in healthcare professionals' conversation skills and confidence - keys toward more successful patient-centered care. When healthcare workers can more effectively communicate and collaborate with patients, strides can be made to improve their social, emotional and physical well-being.

Can a virtual patient cause real behavior change?

An astounding 65 million Americans will experience a mental health or substance use disorder in their lifetime. This raises their risk of disease and mortality, and increases healthcare costs. ²

Fortunately, there are clinical approaches to help healthcare professionals screen more patients for substance use or mental health disorders, which can lead to early detection and lifesaving, timely interventions. According to a survey of nearly 700 healthcare professionals:

57% don't feel adequately prepared to screen patients, or to provide their patients with information about the impact of substance use and mental health disorders;³

64% don't feel adequately prepared to use MI techniques to enhance their patients' motivation to change their behaviors or to seek help;³

62% don't feel adequately prepared to collaborate with their patients to create an action plan.³

It's clear that there's a lot to gain from more effective screening and an opportunity for healthcare professionals to improve their conversation and MI skills to better serve patients.

Data from providers who have completed Kognito simulations show statistically significant improvement in provider skills.

In the months following use of simulation, health professionals reported a 20% average increase in the number of patients they screened, engaged in brief intervention and referred to follow-up care. ⁴ In addition, it's also shown to:

Be cost effective
Studies have shown that investing in Screening, Brief Intervention, and Referral to Treatment (SBIRT) training for care teams can result in healthcare cost savings ranging from $3.91 to $5.60 for each dollar spent on implementation.

Save time
Goldman says that one of the key ways Kognito measures ROI is a reduction in not only cost, but time, compared to other training modalities such as workshops.

Deliver and scale effective training
Because simulation is easily accessible online, students are able to complete training in their own time, without needing an instructor, manager or peer.

"I was cynical initially about the role that this kind of technology could play," says Adina Kalet, MD, MPH, professor of medicine and surgery at NYU School of Medicine. "I think it has a very, very important role in helping us scale our interventions with patients since what we actually do requires four hours of direct interaction...I think most people don't have that kind of time or resources and this is a way of scaling up the practice parts of what we know works to help people get empowered." ⁶

These results are promising, and suggest a future where simulation plays a greater role in training and in continuing education.

Looking forward: what to expect in the future of simulation training

Simulation training may seem like something from the future, but it's here now, quickly being adopted across healthcare because of its success. Technology continues to evolve at a rapid pace...so what does the future of simulation training look like?

Goldman anticipates better integration of artificial intelligence (AI) in simulation, saying that the future of virtual patients will be even more life-like and will have the capability to understand subtle details, such as the intonation of your voice: "AI and machine learning are going to allow all of us in this industry to increase the value that we can derive from simulation being able to better mimic real life," Goldman predicts.

In addition to better technology, there's also a likelihood for larger reach. Dr. Albright is excited about the future applications of simulation training as it expands into more areas. "Once you experience this technology, you can think about how it can be applied to help so many people," he says. "There are so many important areas where we can make a difference in peoples' lives." Dr. Albright noted examples such as caretakers dealing with the aging population, or with parents of children with autism.

As technology continues to advance and adoption spreads, the possibilities are limitless. Simulation training has the potential to help transform the way we learn and lead to better outcomes for healthcare educators, healthcare providers and ultimately, for the patients they serve.

In this game, everyone wins.
For more information about Kognito's simulation training, visit Kognito.com.
References:
Kognito. (2019, January 15). Antoinette Schoenthaler, EdD, FAACH - Center for Healthful Behavior Change - NYU School of Medicine [video file]. Retrieved from https://youtu.be/294u3Q0EPYw.

Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www.samhsa.gov/data/.

Finnell, DS., Albright, G. (2019). Are Healthcare Professionals Ready to Address Patients' Substance Use and Mental Health Disorders?. Retrieved from https://go.kognito.com/rs/143-HCJ-270/images/Are-Healthcare-Professionals-Ready-to-Address-Substance-Use-Mental-Health.pdf.

"Kognito. (2018, November 29) Kognito's Simulations on Conducting Mental Health and Substance Use Screening and Brief Intervention [video file]. retrieved from https://youtu.be/qo9sxUjZV40.

Koetting, C. Freed, P. (2016, August 1). Educating Undergraduate Psychiatric Mental Health Nursing Students in Screening, Brief Intervention, Referral to Treatment (SBIRT) Using an Online, Interactive Simulation. Archives of Psychiatric Nursing, Volume 31, Issue 3, 241-247. Retrieved from https://www.psychiatricnursing.org/article/S0883-9417(16)30150-9/abstract.

Kognito. (2019, January 15). Adina Kalet, MD, MPH of NYU School of Medicine [video file]. Retrieved from https://youtu.be/CGh6qwdUl3A.

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Simulation: Changing the Game of Healthcare Training

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Contributors: Glenn Albright, Ph.D. and Ron Goldman Instead of defeating villains or collecting gold coins, students are using gaming technology to learn, practice, and gain confidence to help real people facing medical and mental health issues. Kognito, an Ascend Learning health simulation company, is at the forefront of applying simulation technology in training.

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Vocera Report Server

The Vocera® Communication System enables instant, wireless voice communication that users control with naturally spoken commands from the small, wearable Vocera B3000n Communication Badge. The Vocera Communication System consists of three key components: the Vocera System software that controls and manages call activity; the Vocera Badge, a lightweight, wearable, voice-controlled communication device that operates over a wireless LAN; and the Vocera SIP Telephony Gateway server that provides communication between Vocera Badges and other telephony devices. The add-on Vocera Report Server software provides powerful reporting tools that enable customers to manage devices and analyze system usage patterns and performance diagnostics. With Vocera Report Server software, a report scheduler makes it simple to schedule reports that are automatically generated and distributed via email to the appropriate staff.

Features and Benefits

The Vocera Report Server software and the associated report console interface provide administrators, managers, and decision makers the ability to monitor system performance and generate reports for analysis. The Vocera Report Server gathers data and builds reports from data logs created by the Vocera System software. The Vocera Report Server manages the data generated as people use the Vocera System. The report console is a browserbased application used to generate reports and administer the Vocera Report Server. The report scheduler allows administrators to proactively schedule the creation and delivery of reports to an email mailing list. This reduces the amount of time administrators spend
creating reports and puts timely reports in the hands of those who need the information.

Key Benefits

The Vocera Report Server provides powerful reporting tools that let you:
* Analyze system usage patterns by user and department, view overall usage by hour, and view call duration for selected intervals
* Determine frequency of calls to groups, departments, and address book entries
* Identify users, departments or locations that are experiencing speech recognition issues
* Track lost or unused Vocera Badges and view Vocera Badge inventory by department
* Provide proactive notification of actionable information to the right person, at the right time

Key Features

The Vocera System Software generates log files to support the Vocera Report Server. The Vocera Report Server uses this data to generate reports. Some reports identify end-user and network issues related to the Vocera System. Other reports spot usage trends, keep track of Vocera Badges, and monitor call volume.

The system generates the following types of reports:

* System summary -Snapshots of system call volume and speech recognition rates
* Call logs-Information about calls made and received by users, groups, etc.
* Recognition-Pinpoints equipment or users experiencing speech recognition problems
* Device management -Reports based on the device management feature that includes new device attributes such as label, owner, and device status
* Audit -Creates an audit trail of the changes an administrator makes to the Vocera System
* Badge asset tracking -Provides tracking for Vocera Badges that have been placed into service with the Vocera Server

Export Reports

The following raw data can be exported to Excel for customization:
* Outbound calls by Vocera Badge users
* Incoming phone calls
* Recognition results
* Broadcasts
* Device migration

Reporting Admin and Security

Automatic scheduled backups, archiving of old records and restoration of backups or archived data are also supported. Vocera Report Server security is provided via password authentication. In addition, security for the Vocera Server data is provided by a dual-IP registration scheme-this prevents an unauthorized Vocera Report Server from downloading data from a Vocera Server.

System Requirements

The Vocera Report Server must be installed on a dedicated server and should not run any other applications. In particular, do not install the Vocera Report Server on the same computer as the Vocera System software or the Vocera Telephony Server.

Summary

By using the Vocera Report Server with the Vocera Communication System, customers can generate reports that will help them understand their usage patterns and adjust the behavior of the Vocera System accordingly, creating the best environment for system users.

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The Vocera Communication System | Vocera

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Vocera Report Server The Vocera® Communication System enables instant, wireless voice communication that users control with naturally spoken commands from the small, wearable Vocera B3000n Communication Badge. The Vocera Communication System consists of three key components: the Vocera System softwa…

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Designing and Implementing EHR software for Intern-Nurses by Using Advanced Mobile Devices

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Designing and Implementing EHR software for Intern-Nurses by Using Advanced Mobile Devices

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Have you used any of the technology described here? If so, how has it benefited you? How did it make job more difficult? What changes, if any, would you make to it?

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Question 2                                                                                 

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Question 2                                                                                 

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How might voice activated communicators, such as smart speakers, transform nursing workflows and patient interactions in the healthcare settings?

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What ethical considerations must be addressed as new technologies are introduced in nursing informatics, and how can nurses and other healthcare professionals ensure the responsible use of these tools?

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Booth, R. G., Strudwick, G., McBride, S., O'Connor, S., & Solano Lopez, A. L. (2021, June 14). How the nursing profession should adapt for a digital future. The BMJ. https://www.bmj.com/content/373/bmj.n1190
Augmented Reality and Virtual Reality in Medical Devices. (2022, December 7). U.S. Food and Drug Administration. https://www.fda.gov/medical-devices/digital-health-center-excellence/augmented-reality-and-virtual-reality-medical-devices

User experiences of virtual reality technologies for healthcare in learning: An integrative review. (2020, July 1). Taylor & Francis. https://www.tandfonline.com/doi/full/10.1080/0144929X.2020.1788162

Ressler, K. (2023, March). Simulation: Changing the game of healthcare training. https://info.nhanow.com/learning-leading-blog/simulation-changing-the-game-of-healthcare-training

What is quantum computing? (n.d.). IBM - United States. https://www.ibm.com/topics/quantum-computing

The Vocera communication system. (n.d.). Vocera. https://www.vocera.com/nz/resource/data-sheets/vocera-communication-system

Elsayed Rashed, S., Mohammed Eid, N., & Hassan El-sayed, H. (2022). Designing and implementing electronic health records software for intern-nurses by using advanced mobile devices. Journal of Nursing Science Benha University, 3(2), 1001-1023. https://doi.org/10.21608/jnsbu.2022.248703