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Virtual and Mixed Reality for Medical Education

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Virtual reality (VR) is an interactive computer-based technology, which allows its users to experience situations or scenarios. It utilizes the users sensory perception including physical movements, text communication, and speech. The common types of virtual reality include the high immersive head-based VR, medium immersive projection-based VR, and the less immersive monitor-based VR. The use of simulation for nursing education began in 1874. However, virtual reality did not begin until the early 1990s and first made its way into healthcare as a treatment for anxiety disorders. VR continues to grow as a trend by being utilized in the clinical setting, nursing education, and in research. VR allows for a safe, yet realistic environment for pre-graduate nursing students to learn and practice skills. VR has the potential to aid students in developing critical thinking skills in emergent situations by the use of emergent VR scenarios. In the clinical setting VR has been utilized to reduce pain in children with severe burns. It has also been utilized to manage posttraumatic stress disorder and anxiety with adult patients (Jeong, & Lee, 2019). Nursing informatics can aid with the integration of virtual reality technology within the realm of nursing education, and clinical setting by aiding in the development of the virtual reality technology (McGonigle, & Mastrain, 2018).

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Nursing Education

Virtual reality (VR) can be an educational tool for nursing students. Students can learn with real life encounters through VR. These encounters include nurse-to-nurse handoffs, dealing with patient death, and interacting with patients that live in poverty. VR education an also include medical device training and psychomotor skills (Walia, Zahedi, & Jain, 2017). Nursing students’ psychomotor skills are typically taught through demonstration by faculty or by videos. Virtual reality can provide a visualization of anatomical landmarks and internal structures to aid in the students ability to learn a skill. A study was conducted comparing students ability to learn how to place a nasogastric tube by using two samples of students. One sample utilized a video and the school’s didactic content, and the other sample utilized VR to learn the skill. When demonstrating the skill, the group of students that used VR had a higher success rate of placing the nasogastric tube and knowing the cues of patient (Aebersold, et al., 2018). Another study was conducted in comparing students that learned tracheostomy care through the use of VR and the other group of students was taught through laboratory class. The students that were taught using VR scored higher on the post-test. (Bayram, & Caliskan, 2019). In conjunction with aiding in education in skills and patient interaction VR can also aid in learning in different situations. VR can help create emergence situations such as codes in the hospital, traffic accidents, and natural disasters. VR provides a safe environment to experience high stress situations (O’Connor, 2019).

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Innovations in Virtual Reality Data Visualization

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Informatics:  Nursing informatics can bridge the gap between virtual reality developers and clinical nurses. This bridge can help with clinical nurses in providing care through the use of VR.  Virtual reality (VR) can collect data from patients and students.  The collected data may also become interactive with VR (Redmiles, 2018). Nursing informatics may grow into the realm of VR to aid with the management of the data.

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Public: Virtual reality can aid in nursing education, and a safe environment to practice skills (Aebersold, et al., 2018). This can protect patients from a nursing student that has had very little practice in their skills. VR also has the potential of increase the availability of accessing a provider and a support group (Walia, Zahedi, & Jain, 2018).

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On healthcare delivery: Virtual reality (VR) can increase patient engagement and provide an increase access to care providers. Through VR a virtual world can be created to allow for patients and providers to interact through avatars. In the virtual world patients can participate in support groups and meet with their providers for care (Weiner, Trangenstein, McNew, & Gordon, 2016).

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In the future virtual reality (VR) may supplement face-to-face nursing care through the use of virtual worlds. Virtual worlds can allow patients that are unable to physically make an appointment, may be able to receive care through the virtual world. It could also allow for support groups to form with geographical diverse patients. In the future VR may also supplement patient and student education (Walia, Zahedi, & Jain, 2018).

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Legal: There are concerns with maintaining patient privacy and confidentiality. In a virtual world with VR multiple patients and providers can be in the same area together. VR allows for patients and providers to communicate and potentially have the avatars mimic patients’ non-verbal communication. A pilot project on a virtual world required the provider to press a privacy button and have the patient’s room suspended over 200 meters above the ground to prevent audio ease dropping (Weiner, Trangenstein, McNew, & Gordon, 2016). There is a concern that even avatars mimicking a patient’s nonverbal communication providing patient identification and then breaking the Health Insurance Portability and Accountability Act (Dinerstein, 2018).

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Clinical Use

Virtual reality (VR) can help with patient engagement for patients that are computer literate.  VR can allow patients to participate in healthcare visits, and support groups through the use of avatars (Weiner, Trangenstein, McNew, & Gordon, 2016). VR can engage patients and aid in the treatment of diseases. 80 percent of stroke patients have motor impairments including loss of balance and gait. VR works to improve neural plasticity by providing a safe environment for patients to preform task-specific activities. VR also aid in the repetition of the tasks, increase intensity, and can improve patient motivation. It has been shown to improve upper limb joint motion, sensation, function, muscle strength, and reduce pain in patients that have had a stroke. Different VR programs have also been used to improve stroke patients’ balance and lower limb function (Lee, Park, & Park, 2019). VR has also been used for pain management in children. Children with sickle cell disease are often prescribed opioids to manage pain during a sickle cell crisis. VR can be an adjunct treatment of pain to aid in minimizing the use of opioids. VR causes a distraction from their pain, causing a decrease in the patients perception of their pain (Diaz-Hennessey, O’Shea, & King, 2019). VR distraction and VR combined with exercise imagery has also been shown to decrease pain in healthy adults. A study showed that VR combined with exercise imagery has a greater effect on pressure pain and VR distraction had a greater effect on heat pain (Hayashi, Aono, Shiro, & Ushida, 2019).

VR has been shown to be an effective tool in providing patient education. A study was conducting on the effectiveness of VR on teaching patients on the risks of atrial fibrillation and stroke prevention. After one year of providing the education through the use of VR, 92 percent could recall the information (Balsam et al., 2019).

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Challenges

Virtual reality (VR) comes with a few challenges. Users of VR can develop simulation sickness. Simulation sickness can cause vertigo, nausea, and general malaise. This id typically caused by a mismatch with sensory information received visually and what is experienced by the vestibular system. Another challenge of VR is when linear scenarios are used with a 2-dimensional screen on a computer device users often become disengaged. The third challenge of is the initial cost of development, piloting, and training of the educators and researchers. The high cost can potentially continue after the initiation due to troubleshooting, updates to the technology, and maintenance (Jeong, & Lee, 2019).