At Saint Joseph’s University, providing meaningful learning experiences for nursing students is a top priority. One way that shows up at SJU is in their state-of-the-art simulation lab, equipped with environments, supplies, and modalities designed to recreate realistic and immersive simulation experiences mimicking the real-life responsibilities of nursing practice.
Staff and faculty are always looking ahead, finding ways to modernize the curriculum and supplement clinical placements to provide their students a comprehensive approach to learning.
To enhance their simulation experiences and guarantee clinical experiences to nursing students, the team at SJU looked to virtual reality to continue their innovation in nursing education.
The pilot program
Dr. Patrizia Fitzgerald, Assistant Dean of Faculty Development and Curriculum Integration, said incorporating virtual reality into the nursing curriculum “Enhances clinical experiences in areas that students wouldn’t normally have the opportunity to do on a clinical floor.”
Initially, the team started with a pilot program, using OMS in one course, and it continued to expand from there.
As the team looked to incorporate OMS into more courses, the faculty conducted a thorough curricular review, identifying areas of alignment between course concepts and OMS scenarios.
The faculty then determined how to integrate virtual reality into their courses, from asking students to complete simulations as individual homework assignments to live casting simulations for group-based classroom activities.
In their first year of OMS use, the team at SJU delivered 74 VR simulation sessions, and since their expansion, they’ve run an additional 7,295 sessions.
Following the success of their initial pilot, the faculty at SJU looked to scale their use of OMS in the nursing programs. The OMS team was brought in to conduct a consultative workshop, facilitating the expansion of virtual reality simulations across the nursing curriculum.
Enhancing didactic coursework
Some faculty have utilized OMS to support their classroom lectures, live casting OMS scenarios during classroom time to enhance the learning experience for students.
Ashley Derbyshire, a Clinical Professor in the nursing program, is one such faculty member using OMS in this way. She teaches a pharmacology course, and although it does not have a clinical component, Derbyshire said that casting VR simulations is “helping bring clinical pieces to life in the classroom.”
To cast a virtual reality simulation, one student volunteers to be in the headset while the scenario is cast to a larger screen so all students can observe and participate.
Students may break up into smaller groups while one student casts their scenario. The smaller groups can collaborate on interventions needed to meet a patient’s needs and can report to the larger class what they’ve chosen to do and why.
This use case for VR allows students to learn from one another’s rationale and makes for a more robust debrief, according to Derbyshire, as “we all decided how we were treating the patient.”
Specific to the pharmacology course, Derbyshire uses OMS to simulate the actual clinical scenario to demonstrate the expectations for proper medication administration. Students may discuss what they might assess for, how they’ll monitor the patient after medication has been administered, and what signs they’ll look out for to either determine the success of the intervention or a need to escalate care.
Other faculty have noted that this type of environment allows students to have conversations that reflect clinical discussions that would be expected between practicing nurses and interprofessional team members.
Per Derbyshire, this method “takes everything we learned in the lecture and puts a face to the disease process.”
Readiness to practice
For students entering their culminating semesters, OMS has been used to support and bolster their readiness to practice.
According to Dr. Fitzgerald, using virtual reality provides “opportunity for students developing their clinical judgment”.
The faculty at SJU use the OMS Multi-Patient scenarios – a set of scaffolding scenarios that allow learners to manage from one up to five patients simultaneously.
“The reason why we chose the OMS Multi-Patient scenarios is because it’s very often extremely difficult to have a senior student manage more than 2 patients successfully on a clinical floor – it doesn’t normally happen”, notes Dr. Fitzgerald.
As part of this set of scenarios, students must analyze, delegate, and prioritize, pulling together all the skills needed heading into the transition to practice – and it’s not limited to technical skills.
As students progress through the simulations, they must demonstrate skills like leadership, collaboration, care coordination, and ethics and advocacy – all of which are also course concepts.
Dr. Cynthia Snyder, Assistant Clinical Professor, notes that the use of multi-patient scenarios presents “a realistic portrayal of what every day looks like for a practicing nurse”, and compared to other simulation methods, Clinical Professor Ashley Derbyshire says, “VR takes the cake in a lot of ways”.
The Multi-Patient scenarios require students to “critically think through the situation, through patient responses, use their clinical judgment to make a decision, and then act on it,” notes Dr. Fitzgerald.
These simulations provide an individualized and repeatable means for immersive learning that students can return to as much as they need as they prepare to make the transition to practice.
The learner experience
According to Dr. Fitzgerald, the impact of OMS for learners has been “really significant” and has “really supported us in its variability and adaptability.”
Rebecca Demos, a Clinical Instructor in the Associate’s program, has noticed that using VR simulations “helps students think like a nurse” and “students can see how book work applies and affects people.”
Another Clinical Instructor in the Associate’s program is Amanda Botscheller, and she reports that “what’s great about OMS is that it lets students do anything they want, even if it’s the wrong thing.”
This helps to establish accountability for actions and allows students to see, in a safe environment, consequences or implications of intervention choices made by students.
Not only that, virtual reality simulations give students an immersive experience, placing them right in the room, and according to Demos, “aside from actually being at a patient’s bedside, VR gives students the most realistic experience.”
Alongside the immediate feedback students receive after completing the scenario, the analytics dashboard provides another layer of understanding for students and faculty as it relates to progress towards competency.
For students, VR “helps them recognize what they don’t know,” and faculty have found the use of analytics helpful in identifying cohort-level trends in competency, which contributes to informed decision-making around curricular and course needs.
Future plans
Now with over 2,883 hours of simulation delivered via virtual reality and over 300 students enrolled in OMS, the Saint Joseph’s University faculty continues to broaden and expand their use of virtual reality across the nursing programs.
There are also initiatives to optimize the use of the analytics dashboard further and in the decisions needed to identify appropriate benchmarks for students across different courses.
Using the OMS platform will “be an important part of assessing progression indicators” according to Dr. Fitzgerald, who notes that these benchmarks will support the process of adapting the nursing curriculum to align with the CCNE Essentials.
For those just starting to consider using virtual reality to support their nursing curriculum, Dr. Fitzgerald has some advice – first decide on goals and outcomes, consider scaling from a smaller pilot, and bring faculty into the fold.
Be aware of the importance of a structured orientation and prebrief to familiarize students and faculty with any new software, and don’t shy away from hopping into a headset and seeing the impact it can have!