In the nursing profession—where practice makes perfect—ensuring a procedure going perfectly could mean the difference between life and death. However, given the logistical challenges of locations and resources, coupled with ever-present manpower woes, practising these skills may not come easy. This is where virtual reality in education proves helpful.
Shortly before the COVID-19 pandemic began, Associate Professor Lydia Lau started looking at virtual reality as a solution to such issues.
Assoc Prof Lau asserted that ensuring students achieve the required competencies and abilities to enter the workforce has been a key driver for the faculty.
“Unfortunately, in the lab, we have a wide range of clinical procedures for students to learn and practice, and time is a factor.
“There are always competing priorities – which procedures are more important, and which procedures do we want to allocate the students time to practice for.” Assoc Prof Lau.
Assoc Prof Lau notes that previously, skills assessments were used for critical procedures, as students have to carry them out correctly and accurately in a clinical setting. Prior to these assessments, students would rush to book labs to practice, which made the situation stressful for everyone involved.
“Firstly, we don’t have the facilities to cater to the sudden high volume of requests for self-directed learning prior to assessment. Hence, there is a need to plan and stagger the time slots for everyone. Secondly, it’s also very costly because each time they practice, requisites are required and with repeated practice, there’s a lot of wastage,” she says.
UPSKILLING
The COVID-19 pandemic accentuated the need for such skills practice.
This prompted Assoc Prof Lau and her team to explore alternative ways for students to hone their skills, in collaboration with the IT department from the National University of Singapore (NUS) for solutions that callow students to practice in their own time. This laid the impetus foundation for the Immersive Virtual Reality – Procedures (IVR-P) program.
Armed with instructional videos developed by her team, IT professionals in the team learned about the procedures, proceeding to then craft a 3D version of the procedures.
Four procedures which were deemed crucial for students to learn and master were then shortlisted for the VR programme: Intravenous (IV) therapy, subcutaneous insulin injection, wound dressing and urinary catheterisation.
“If we are able to overcome these difficulties and allow the students to practise through the use of virtual reality, that would be fantastic,” says Assoc Prof Lau, noting that urinary catheterisation was the most difficult of the four procedures that students had to learn to master.
The first two procedures available in the VR programme—IV therapy and subcutaneous injection—are already accessible after two years of development from the IT team. The remaining two procedures are being worked on concurrently, with the wound dressing scenario almost completely developed.
Using the Oculus Quest 2 and handheld controllers, students are able to practise the two procedures in their own time, wherever they find it convenient to do so.
IMPROVED PRECISION
Hand-tracking, another feature available with the Oculus Quest 2, is also being explored to further increase immersion and precision, making the experience a more authentic one.
The virtual technology in education is currently undergoing multiple rounds of User Acceptance Testing (UAT) to gather feedback from users, and has also been offered to Nursing students from all the year one cohorts, inclusive of the career conversion programme, as well as diploma upgraders.
According to Assoc Prof Lau, students feel less inhibited while practising.
“Sometimes, when they are not familiar with the procedure, they don’t want people to know. But here, they feel more at ease while practicing even though they are not sure, because there are two modes of learning. The practice mode allows the students to refer to the step-by-step guides within the IVR-P, whereas the assessment mode allows them to perform on their own, which resemble the actual clinical setting.
The interactivity of this virtual reality in education programme was also a plus— students were previously issued actual equipment to practice with at home, but that lack interaction and authenticity of clinical environment. With IVR-P, the scenario-based simulated ward environment and nurse preceptor helped provide enough realism for students to meaningfully interact and perform the procedures safety and competently with the equipment.
Another benefit of this virtual reality in education was the deliberate practice. Students are able to compare their actions against a checklist and gauge their performance in a practice mode, before proceeding into an assessment mode to complete the task without guidance.
“I think it encourages independent learning and problem solving as well,” says Assoc Prof Lau.
Given the myriad possibilities of the technology, students have already compiled a wish list of procedures to be included in the programme, such as nasogastric tube insertions and intramuscular injections, as well as mental health scenarios.
Thus far, the programme has also been rolled out to the main Nursing student cohort, with about 400 having already benefited from it.
However, with about 80 Oculus Quest 2 sets shared in a cohort of between 250-300 individuals, students have only been able to loan the units for up to a week at a time, with some feeling the time period to be inadequate.
“If the students find this (programme) to be very useful in their learning, we can look at procuring more VR sets,” says Assoc Prof Lau, adding that the loan period can be increased to two weeks in the future.
“Instead of the tutor dictating what and how long students need to practice, the latter are empowered and self-directed, assessing their own learning needs and meeting them, all at their own time and convenience.”
She hopes to continue introducing other clinical procedures into IVR-P, as well as more complex scenarios to challenge those with a higher skill level to solve problems in dynamic scenarios.
IVR-P has since emerged as the winner of the “Best Use of Emerging Technologies” award category in the CIO Academy Asia’s inaugural 2021 INSPIRE Tech Awards.
