Two years ago, with the global spread of COVID-19 and the subsequent declaration of its spread as a pandemic, unprecedented challenges quickly surfaced.
Norms such as dining in restaurants, congregating with friends and enjoying lifestyle activities were quickly prohibited as social-distancing, mask-wearing and frequent hand-washing became fundamental to an entire population’s health and safety.
Similarly, classroom settings were re-evaluated and digital technology was leveraged to enhance the learning journeys of students across all levels, including National University of Singapore (NUS) undergraduates—notably medical students for whom training in clinical situations was essential.
The dearth of Virtual Reality Technology or VR simulation interventions in the field of peri-operative nursing—a specialty area where nurses work with patients undergoing operative or other invasive procedures—led to the launch of a VR gaming system VISION (Virtual Simulation for periOperative Nursing) in February 2020.
Designed by a team from the National University Health System, it consists of 15-minute virtual lessons designed to immerse students from the Alice Lee Centre for Nursing Studies (NUS Nursing) in an operating theatre setting. Gamified-style learning, facilitated by VR headsets and handheld controllers, were delivered via 12 virtual stations housed at the School’s Centre for Healthcare Simulation.
TAKING ON ROLE OF SCRUB NURSE
Its four-pronged approach aims to help students adopt the role and responsibility of a scrub nurse in the surgical team, demonstrate the key patient safety and infection control considerations in the operative environment, identify the key processes and recognise the working environment of an operating room.
To date, 230 Nursing undergraduates have received training on the system. The programme will run again in April 2022.
Developed over the course of four months, the VR scenarios were achieved through qualitative perspectives obtained from Nursing professionals and hospital clinicians working in operating theatres.
Dr Rosalind Siah, Senior Lecturer at NUS Nursing, says, “The interviews enhanced the understanding of the teaching needs, as well as limitations and interests in using VR simulation as a teaching approach. Once the scenario prototype was developed, both Nursing faculties and hospital clinicians revisited the contents and assessment checkpoints to provide further feedback.
“Revisions were made till both teaching faculties and hospital clinicians agreed that learning objectives were met.”
Dr Siah is hopeful that the Virtual Reality Technology programme can go on to achieve a positive ripple effect—contributing to effective logistics management that will improve clinical placement operations and patient safety, and allow for the effective allocation of resources (hospital placements) and seamless completion of students’ clinical practice remotely.
More importantly, she adds, “VR simulation can provide a limitless array of randomly-generated clinically-realistic patients, and supplement this gap in nursing training.”
What kind of quantitative benefits has NUS enjoyed when it comes to raising their students’ calibre?
Dr Siah says, “The application of Virtual Reality Technology serves as an alternative method to assess students using controlled and standardised scenarios to moderate levels of difficulty and ensure equal opportunities across the cohort.
“The successful implementation of VISION may also serve as a guide for others who are considering developing similar UR simulation activities, and prepare nursing students for their clinical practice by improving their confidence in a safe and effective learning environment.”
GROWING USE OF VR
The healthcare sector has always leveraged technology. Dr Siah notes that the use of VR is rapidly growing in Nursing education.
She adds, “Given the complexity of surgery, it is paramount that one practises safety throughout the whole operation procedure.
From the activity, the participants can understand the Nursing-related aspect of perioperative patient safety, and the aspects of patient safety in pre-, intra-and post-operative surgery.”
But as exciting and engaging as UR simulations may be, they do not fully capture or reflect a real-world medical situation. Dr Siah explains, “Nursing students would not be able to experience the actual touch of an instrument, or talk to a patient to apply their knowledge.
Therefore, they still need to rethink the concept of a virtual instrument, while interacting in a virtual environment.”
This is necessary because attitudes toward VR-simulation learning would influence its effectiveness in the learning process, making the understanding of students’ attitudes towards VR applications crucial in ensuring successful integration of VR technology into peri-operative settings.
VISION has to date been well-received by Nursing students. In spite of the challenges, Virtual Reality Technology provides a platform for them to perform their roles comprehensively in the entire surgery process as scrub nurses, as opposed to the physical simulation setting which provides only a segment of the procedure.
Plans are underway to level up VISION’s training capabilities. Dr Siah is also part of a separate team working on using UR to perform nursing skills, using Oculus, which is currently in the process of development.
She says, “We are aiming to roll it out this year, so students can take home a VR set to practise in the comfort of their homes.”
