Canadian Journal of Nursing Informatics

Information

This article was written on 20 Mar 2021, and is filled under Current Issue, Volume 16 2021, Volume 16 No 1.

Current post is tagged

, , , , , ,

CVRriculum Program: Outcomes from an Exploratory Pilot Program Incorporating Virtual Reality into Existing Curricula and Evaluating Its Impact on Empathy-Building and Experiential Education

Print Friendly, PDF & Email

Lora Appel, PhD
Assistant Professor Health Informatics, Faculty of Health, York University, Toronto
Collaborating Scientist, OpenLab, University Health Network

Eva Peisachovich, RN, PhD
Associate Professor, School of Nursing, York University, Toronto

Don Sinclair, MA
Associate Professor in the Department of Computational Arts in the School of the Arts, Media, Performance and Design, York University, Toronto

Citation: Appel, L., Peisachovich, E., Sinclair, D. (2021). CVRriculum Program: Outcomes from an Exploratory Pilot Program Incorporating Virtual Reality Technology into Existing Curricula and Evaluating Its Impact on Empathy-Building and Experiential Education Opportunities. Canadian Journal of Nursing Informatics, 16(1). https://cjni.net/journal/?p=8571

Virtual Reality Technology

Abstract

Critical thinking and empathy-building are essential skills for nurses that are often learned in real-life clinical placements. Given that opportunities for experiential education are increasingly limited, we explore the possibility of Virtual Reality (VR) as an alternative tool in nursing education. VR can provide high-fidelity simulated environments that create a feeling of presence, effectively allowing the user to immerse themselves in someone else’s experience. We believe there is an opportunity to use VR technology to complement experiential education and to help create student opportunities for empathy-building with patients/caregivers. We report on the outcomes of a proof-of-concept initiative, the CVRriculum Program, where instructors were recruited and aided in adapting a traditional written assignment into a VR format. A mixed-methods approach, including observations, reflections, interviews, and a focus group, describes feedback from both instructors (n=5) and students (n=19) on the use of VR in the course. Findings suggest that VR is a good tool for teaching empathy, and for creating opportunities for experiential education, but that additional work is needed to make its implementation into curriculum more efficient and effective.

Background

There has been a significant increase in the use of technology in higher education for a multitude of reasons: as a tool to manage classrooms with a higher percentage of students to educators (Revell & McCurry, 2010); because of the ubiquity and inability to limit the use of smartphones and social media in class, and thus to harness their potential for education; and to leverage the unmatched affordances provided by technology to applied learning. Further, technology has improved accessibility for students in more remote locations (Huddle, 2019) who may be unable to physically attend educational facilities, which helps tackle issues of geographical inequality, and perhaps most notably in 2020, helped overcome issues of access to education during a global pandemic. At the same time, technology is increasingly integrated into our healthcare system with continued advancement and modernization. Thus, a heightened use of technology within postsecondary settings can ensure that students are adequately prepared to enter the workforce.

In 2012 the Canadian Association of Schools of Nursing (CASN) made it a requirement that nurse educators teach their students about technology prior to graduating, so they are able to work knowledgeably and safely in diverse healthcare settings (Canadian Association of School of Nursing, 2012). While this initially referred to experience entering data and mastery working with various electronic patient records, it grew to encompass other digital tools viewed as vital and important complements to hands-on clinical training. For example, many schools use high-tech mannequins to simulate a patient’s physical condition, allowing students to hone their skills with no added risk posed to real patients. Most published studies on simulation education have reported positive effects on nursing students’ knowledge, skills, and attitudes (Shin, Park, & Kim, 2015). 

While these simulated patient-mannequins create opportunities to practice, the technology is not without its limitations and drawbacks. A nurse’s role does not exist in a vacuum and is almost always tied to and affected by one’s environment, available resources, and the culture of the healthcare institution where one works. These physical (e.g., lighting, sounds of a busy clinic or emergency department) and social realities (e.g., climate of patient-centeredness, collaboration between inter-professionals, and communication with patients/caregivers) influence how clinical reasoning and, more broadly, critical thinking occur in real life. Critical thinking, to which exploring alternative frames of reference is beneficial, is thought to be a key component of nursing practice (Fero et al., 2010). Engaging in experiential education is one successful means of providing opportunities for critical thinking. However, designing classroom activities that allow students to engage in authentic practices can be challenging, and although bringing students to a local hospital might provide a meaningful, and motivating, context for students, it may not be feasible (Dunleavy et al., 2009). There is a growing difficulty in securing hospital placements for Canadian nursing students (Smith et al., 2010, Ontario Nursing Association, 2018). Luckily, an alternative may exist; Bearnson and Wiker (2005) found that 95% of participants (nursing students and RNs) who took part in a simulation activity, preferred simulation scenarios to didactic learning (e.g. through patient rounds, lectures, or tutorial formats). 

In addition to the difficulty in creating a realistic, comprehensive healthcare environment, simulated mannequins may also produce negative outcomes in students. Huddle (2019) warned that substantial practice with technology, instead of practice in a clinical setting with actual patients, may contribute to a loss of individual bonds, affecting a student’s ability to care (Jelec, Sukalic, & Friganocic, 2016) and understand the value of empathy, both essential skills for nurses (Huddle, 2019). It is well documented that an integral component of the patient–nurse relationship is empathy (McCabe 2004; Stein-Parbury 2005; Innes, Macpherson, & McCabe, 2006). Rogers (1959) described empathy as the state of perceiving the internal frame of reference of another person, with accuracy and with emotional components and meanings that pertain to it, as if one were with the other person, but without the loss of the as-if condition, thus maintaining perspective and objectivity (p. 210).

For both these essential skills, critical thinking and empathy, the ability to perceive diverse frames of reference is fundamental, and, until more recently, we lacked technology that was adequately powerful, portable, and affordable to create such adaptable learning tools. While the term “virtual reality” (VR) is currently used to describe a wide range of hardware and software, from a technological standpoint VR is characterized by, at the very least, a three-dimensional computer-generated simulation controlled, even if only partly, by the user. Because of its ability to stimulate multiple senses simultaneously, it is effective at immersing the viewer and creating a sense of presence, and thus is a good medium for exploring experiences from alternative points of view (Kavanagh et al., 2017). VR is not new to healthcare training; some of the oldest use-cases of the technology have been to help doctors “see” inside the body and allow them to practice surgical skills (Chheang et al., 2019). However, only since 2014 have smaller, more accessible devices hit the consumer market. In its most recent incarnation, VR can be experienced through a mobile, stand-alone, head-mounted display offering a wide field-of-view (occluding one’s ability to see the real environment) and built-in headphones with stereoscopic sound. These tools may be the key to providing opportunities for experiential education where alternatives are not possible.

Although there is debate among experts in pedagogy on the impact of learning styles (such as the VARK Model’s designation of visual, auditory, reading/writing, and kinesthetic styles (Othman & Amiruddin, 2010) on outcomes, there is no doubt that students when asked what mode of instruction they prefer will give a multitude of responses. Research has shown, however, that we learn best when information is presented to us multiple times through different mechanisms (Shah, 2019). And thus, while the debate continues, it is important to provide education and instruction in a variety of ways to ensure at least that student engagement remains high. By virtue of its emphasis on visual stimuli, VR has the potential to move education from its traditional reliance on written text to that of imagery and symbols. VR is known to create immersive experiences that may be the best means of incorporating a constructivist approach to education.

Constructivist teaching is based on the belief that learning occurs as learners are actively involved in a process of meaning and knowledge construction (i.e., experiencing something firsthand) rather than passively receiving information (e.g., in a lecture) (Shah, 2019). In the case of nursing practice, VR can combine the need for tactical training with environmental fidelity – so that a student can feasibly learn clinical skills by examining a patient’s physical symptoms, and also work through critical thinking skills by interacting in a recreated “high-stress environment” such as an emergency department, complete with potential communication and interpersonal and sociocultural scenarios that require empathy. The ability to control variables and elements in the virtual environment allows for student-centered learning, as the experience can be customized for an individual’s skills and abilities (Abichandani et al., 2014). Furthermore, the ability to repeat various experiences is also desirable, as students can offer one another suggestions and reconsider approaches to previously practiced scenarios (Berragan, 2014). Constructivist teaching fosters critical thinking and creates motivated and independent learners, aspects vital for successful nurses. VR gives students the ability to construct or participate in visual worlds and with manipulable objects to represent knowledge, an affordance that traditional learning methods lack. Bearnson and Wiker (2005) reported that student found VR simulations to be interactive, adding variation to learning and “another dimension to education.” (p. 422) Similarly, Hu-Au and Lee (2017) found that VR can lead to increased student engagement; provide active, constructivist learning; increase frequency of authentic learning experiences; allow for empathetic experiences; enable students to exercise creativity; and provide an arena for visualising abstract concepts concretely.

Despite its promise, little is known about how to implement VR in nursing curricula. Given the growing emphasis on simulation training and on improving nursing students’ comfort with technology, and specifically the potential for VR technology to mimic environments and situations with high fidelity, our team developed and piloted the CVRriculum (CVR) Program: an exploratory program that attempts to incorporate VR technology into existing curricula and evaluate its impact on experiential education opportunities and empathy-building.

The objective of the CVR initiative was to both implement a pilot program into existing curricula and evaluate the program and its pedagogical merit. The research questions associated with the feasibility of implementation (RQ1) and resulting set of resources for future implementations are described in a separate paper. In this manuscript we describe the outcomes of its potential to provide empathy-building and experiential education opportunities (RQ2a and RQ2b).

Research Questions

RQ2 a) Is the VR medium an effective medium for teaching empathy to nursing students?

RQ2 b) Is the VR medium an effective medium for experiential education opportunities for nursing students?

Methods

A mixed-methods approach was initially approved for evaluating the effectiveness of the program. Five course instructors were approached (using purposive sampling) to participate, based on one of the co-principal investigators’ deep understanding of their course material. These instructors we encouraged to recruit interested students from their courses. Ethics approval was received from York University (#: e2019-368) for administering pre/post questionnaires that included the Toronto Empathy Questionnaire (TEQ), with the goal of identifying changes in empathy between students who participated in CVR and those who received the traditional assignment, and to see whether any changes occurred after completion of the CVR assignment. The TEQ, which consists of 16 questions, provides a quick and easy way to assess interpersonal sensitivity that is consistent with validated yet significantly lengthier measures of empathetic responding (Spreng et. al., 2009). Evaluation methods also included anonymous student reflections, and structured observations from the research assistants (RAs) assigned to each student group. This structured observation guide is available in the “supplemental materials” (https://docs.google.com/document/d/1Nr2Ho-83s4BbJBAhCVTeFxpgDvKVjhTutLds0BvYFFA/edit?usp=sharing).  At the conclusion of the program, the team conducted focus groups with both participating faculty and students.

Changes to Protocol due to COVID-19

The first wave of the COVID-19 pandemic reached its height during the semester in which the pilot took place and as a result, the university closed its campus and moved courses online. With little preparation, many protocol changes had to be implemented and further recruitment of student groups, which was expected to increase the sample size, was halted. Even some existing groups that had started their CVR projects reverted to traditional written assignments to limit additional “uncharted territory” work for professors and students.

Unfortunately, administering the second set of post-intervention surveys (which included the TEQ) was not possible, limiting the quantitative analysis we could conduct on changes in empathy, as well as other metrics included in the pre/post questionnaire.

Additionally, while the intent was to host a focus group with complete student groups, it was difficult to get in touch with students during the pandemic (few responded to our attempts to reach them via email) and difficult to find common time among those we were able to reach. The research team decided to adapt the focus group script to suit one-on-one student interviews (n=6), which lasted an average of 18 minutes. The team still managed to conduct the focus group with the faculty participants (n=5), which lasted 32 minutes. Both the focus group and the interviews were conducted remotely via video-conferencing software (Zoom); participants were recorded using the embedded software tool. Students and faculty were awarded a $25 Amazon gift card for providing feedback about their experiences. 

Data Analysis

The data collected from these four sources were qualitatively coded using grounded theory. The initial coding infrastructure was devised by one of the co-PIs through open coding after the first reading of the data and was refined and agreed upon by the research team. Three of the identified themes which address program implementation are described in another manuscript. Four elements addressed program evaluation and correspond to our research questions, namely whether the CVR program was an effective medium for teaching empathy (RQ2 a), and experiential education RQ2 b).

Equipment

The VR equipment used throughout this program consisted of an Oculus Go VR Headset, a Yi 360° VR Camera, and a Bushman Panoramic Tripod. The Oculus Go was chosen because it was relatively affordable, wearable, mobile, and portable. Its stand-alone feature requires no external hardware and reduces simulator sickness because of its low motion latency. The Yi 360° is a small, lightweight VR camera equipped with two 180° lenses and captures 4K 360° film. This camera automatically stitches internally without input from the user. Finally, the Bushman Panoramic Tripod has a standard camera mount, and minimizes the footprint captured by the 360° cameras because the legs of the tripod extend only from the base of the stand. Its short length and closeness to the ground allowed 360° panoramic photography and 360° VR videography. It was our goal to minimize the technical barriers identified as a main challenge by Kavanagh et al. (2017) and to focus on evaluating and providing suggestions for improved program implementation.

Results

Despite the difficulties presented by the COVID-19 pandemic, the research team was able to collect 177 pre-surveys from students in five courses. Because we were unable to collect the post-survey data, these results can only be used to describe the nature of students enrolled in participating courses. The mean score of students (enrolled in all five courses) was 51.14, out of a maximum of 64. Higher scores indicate greater empathy, with scores under 45 reflecting less-than-average empathy. Intuitively, this high score among our student sample makes sense, as they are enrolled in a nursing program, a profession that traditionally attracts individuals with higher levels of empathy.

CVR was piloted in four courses (the fifth course was unable to recruit a student group); three were third-/fourth-year nursing courses (NURS 3514: Development of Self as Nurse: Nurse as Leader and Agent of Change; NURS 3524: Health and Healing: Client Centred Care of Individuals and Families in Child and Mental Health Settings; NURS 4546: Global Context of Nursing, and one was a third-year Humanities course (CLTR 3150: Doing Culture: Narratives of Cultural Production). A total of 19 students participated, divided into five groups ranging in group size from two to six and in RA involvement (from only providing technical support to helping ideate the project). The projects varied in style, from storytelling (acting out of a constructed script) to documentary (capturing a cultural event live), and in topic (e.g., pain management, patient-centred care). Student projects were meant to be presented to peers in class, but because of the pandemic, final projects were uploaded online for viewing via a private YouTube channel. 

Example Assignment

In this section we describe one CVR-adapted assignment from the HH/NURS 3524 6.0 – Health & Healing: Client Centred Care of Individuals and Families in Child and Mental Health Settings course, with permission from the instructor. The initial assignment is a “Reflective Analysis” worth 5%; the goal is to help students reflect on a real-life “problematic, or less-ideal” interaction and to be able to practice and improve their communication skills using concepts taught in the course.

For the assignment, students are expected to choose an interaction from a previous clinical lab scenario: for example, a situation where students felt they were particularly attuned to the patient or a situation that was problematic. The interaction may have been a situation where students were simply at a loss for how to respond or what their focus should be. The interaction analysis should demonstrate the back-and-forth nature of a conversation and therefore would need to be a documentation of four to five statements by the student and patient.

In the traditional written assignment, students are asked to write down the scenario (verbatim and non-verbal actions) and the context, describe their thoughts and feelings throughout, analyze the effectiveness of the technique employed, and suggest an alternate and revised response to the situation. Finally, students are expected to identify at least one concept from the course that resonated with them with respect to this interaction and a minimum of two scholarly peer-reviewed references from the nursing literature to support their analysis and new approach.

This assignment can be adapted to a VR medium with little effort. Rather than writing down verbatim the communication, and describing the context, students were able to re-enact the “uncomfortable scenario” in VR. With one student taking the role of patient, and others the role of healthcare provider, all students, with the help of the RA, were responsible for capturing the experience with the VR technology. Figure 1 shows the student group working together during a CVR session.

Figure 1: Participating York students prepare to film their CVR-assignment

After watching themselves in the re-enactment, students reflected on how the interaction occurred, how it may have made them (and their patient) feel, and how it could be improved using methods they learned in their course. Personal reflections were also captured in VR and included all the elements required of the written assignment, choosing which aspects to verbally communicate to their audience (how they might approach a similar scenario in the future) or include as text in the VR film (e.g., listing peer-reviewed references). An example CVR-project for this assignment can be viewed here: Client Centered Care CVR YouTube at https://youtu.be/I6b6mHp0cno

Qualitative Findings

Data from four anonymous reflections, 14 structured group observations, six one-on-one student interviews, and one focus group (including all five participating instructors) identified four recurring elements related to the affordances and benefits of VR in the classroom: (1) perspective-taking; (2) ability to watch oneself; and (3) a shift from traditional teaching styles, that allowed for hands-on creation and exploration of “space” that resulted in increased (4) student engagement.

The element most frequently mentioned was the ability to see a situation from a new perspective. One instructor noted that students “were thrilled about learning the lived experience of someone with a crisis experiencing an MH [Mental Health] issue.”She continued, “When people saw the VR-video from the patient’s perspective, they understood how nonverbal patients experience things. They would not have learned in the same way if it was another form [teaching medium].”

From the same group project, a number of students reflected the same feeling: “I had to see myself through the eyes of the patient who often felt ignored and isolated. [I had to] learn more about how they can communicate.”

Another student shared, “VR was a powerful project – I felt as though I am the patient, even though the patient can’t talk they’re still human. Have to make eye contact and treat them like everyone else.” And another: “Typically we are taught theory but are not taught to understand things from a patient’s point of view. It helps students understand what neglect really feels like.”

Further to the unique experience of patients, instructors reported that VR was a good tool for bridging a gap between those who also live in more remote communities: “[VR] helps students understand the vulnerable population that are geographically isolated. It helps break down barriers and immerse into their lives… Putting ourselves in their space.” There were also specific references to empathy; one student reported, “This taught me that current care can be quite mechanistic, lacking human touch. […] it was Great for empathy.” Another student recalled, “It was very interesting using VR to illustrate patient neglect…This allows the viewer to develop empathy toward this issue and hopefully encourages others to become more empathetic individuals as well.”

In addition to embodying another’s experience, the ability to then “watch yourself” was also described as a benefit to education. One student shared: “It helps to reflect by seeing it. The VR was helpful because we can see ourselves do what we did and allow me then to see which area to improve on and gives me a realistic view of myself and my work.” Instructors agreed; one said, “Definitely because it gives you experience where you can watch back. They [students] do not get to see that [real-life scenarios] until they get into clinical but even then, placements limit viewing opportunities in hospitals. Having this [VR] in lab would be helpful.”

The ability to see oneself on film also helped foster an entertaining work experience. One RA observed in the first team session that “as a fun example the group took a video of themselves and then watched it on the headset right away, experiencing watching themselves and their classmates while being next to them.” This anecdote describes not only the students’ enthusiasm but also the experience of the RA as a witness to the “fun.”

Instructors and students found VR to be a refreshing change from traditional course work. One instructor shared that she was happy to have the opportunity to have “students be more creative with the project theme – Think Global, Act Local.” Similarly, another was “excited because humanities students usually don’t get this opportunity.” Participants appreciated the experiential nature of the VR medium. One student said, “The project was more hands on and engaging than an essay. It helped me to experience the simulated scenario instead of just writing about it. As a result of this project, I am more confident with facing a similar situation in my future practice.” When reflecting on the impact of VR as a tool to better experience real-world scenarios, an instructor noted: “The team were bouncing a lot of ideas around, it seemed like having the whole group present had positive impact – they were sharing a lot of examples of actual (hospital) work experience generating a realistic idea of what can be included in the film – often (with the help of RA) drawing parallels of what a specific real-world situation would feel like in VR given the spatial coordination/perception specifics of the technology.”

Instructors agreed that because the project required direct involvement, it was more engaging; student enthusiasm was almost tangible. When reflecting on two groups from different classes, one RA reported, “Participants were very enthusiastic and eager to contribute ideas for their project. They were more interested in discussing ideas, and planning/setting deadlines and dividing work for parts of the project” and that “students were very positive and joking a lot between themselves and the people at Sunrise [Pseudonym]. The location was surrounded by nature (small forest) so everyone felt very relaxed.” Perhaps the most illustrative feedback was provided by a professor who recalled, “Most of the class showed up early (she was surprised) because the class ran from 7-10pm and looked very excited – like kids on Christmas morning.”

Discussion

Given the feedback observed and provided, we can suggest that the CVR program has a positive impact on our two areas of interest: (RQ2a) whether VR embedded into curriculum is an effective way to teach empathy, and (RQ2b) whether VR is a good way to offer experiential education opportunities to nursing students. A key aspect of both empathy-building and critical thinking is the ability to employ multiple frames of reference in meaning-making. It was clear that VR was an immersive medium that helped students imagine themselves both as a patient and as a healthcare provider. The ability to embody these different perspectives, and to watch oneself on screen and reflect on one’s actions, was directly reported as helping with empathy-building skills (Peisachovich, 2016). Further to this, the hands-on nature of VR creation, the ability to explore and capture real environments (from culturally diverse events to standard clinical rooms), also offers a unique and complementary experience to that of clinical placements. VR clearly provides a novel experience, a shift from traditional teaching methodologies that has a tangible (non-negligible) impact on student engagement. Instructors agreed that “VR is better than a typical PowerPoint. More engaging, helps [students] be aware of or learn concepts like empathy and other interpersonal or communication skills […] Focuses on lived experience […] and this may inspire students in the future to change their own practice.”

There were also some unexpected outcomes that further highlight the benefits of embedding VR in curriculum, specifically the manner of implementation (e.g., incorporating interdisciplinary team members). With the CVR pilot, unexpected outcomes included having a positive learning experience for the RAs, who were employed to provide technical assistance throughout the program. Because of the cross-disciplinary nature of the program, digital media students from the engineering department hired as RAs worked alongside nursing students. In debriefs with the RAs, it was noted that in addition to enjoying the work and observing the “fun” had by nursing students, they themselves were able to reflect on the differences and unique qualities that each discipline attracts and acknowledge that these distinct fields can work together to solve problems in novel ways. As RAs would often accompany student groups during the filming of their project, they too were able to learn and participate in unique teaching moments. One RA recalled, “A lot of cultural exchange between students and festival members, I was helping with filming where possible as well as learning about cultural elements myself from the students, members and the professor.”Another RA was even able to use their observations of nursing students interacting with VR technology to inform a use case for an element of their own thesis work, tangentially affording RAs (other students) an opportunity to “test” in the real environment, again highlighting an opportunity that VR brings to experiential education.

Although VR appears to be a worthy medium for nursing education, it is not without challenges. Through our observations and solicitation of feedback from the program participants, we were able to identify a few improvements critical to the future success and sustainability of CVR, and programs like it. These are discussed in detail in another paper, but they address issues such as necessary technical support and increased assignment clarity. The CVR team has addressed these concerns by creating additional project resources compiled into two documents: a how-to guide for instructors and a step-by-step workbook for students. We intend to create an open-access website providing these resources that will help promote the program and help instructors (a) understand what kinds of assignments can be adapted to VR, (b) recruit interested students, and (c) spread understanding and share experiences from completed CVR projects with students across different departments and faculties.

Limitations

The pilot CVR program was initiated through purposeful sampling; however, this educational opportunity should be explored with users from diverse educational backgrounds. The COVID-19 pandemic affected the completion of this program because of the shift to remote learning. Therefore, the research team was unable to collect any standardized or quantitative metrics to evaluate empathy, a primary outcome measure of the CVR program. The aim of the program was to also compare experiences of students who participated in traditional assignments with those of students who participated in CVR. Future research comparing such student experiences would be beneficial.

Conclusion

The next generation of nursing students will welcome technology in the classroom to complete their learning. It is the responsibility of institutions and instructors to think about innovative and meaningful ways of embedding technologies so that they achieve course objectives, and even augment the learning experience. Our pilot initiative is one attempt at introducing VR into nursing curriculum, and our findings suggest that it is an effective medium for providing opportunities for experiential education as well as empathy-skills building. There was unanimous agreement from all interviewed faculty and students that VR is a tool whose novelty breeds curiosity in students, and whose ability to “immerse” users in an experience is an effective tool for empathy-building, beyond what can be learned from a traditional written assignment.

To date, the use of VR in education has been predominantly set by the computer science community and by VR vendors (Hesel, 1992; Dengel, 2019). VR holds much promise for nursing education, but it would serve the community to have these stakeholders (instructors, learners) involved now to plan for VR’s future development. Our team has taken note of areas of improvement suggested by instructors and students, and we are creating a set of open-access resources so that VR can be implemented into curriculum in a more effective and efficient manner in the future. We believe that the findings from our current pilot serve as a steppingstone for this kind of collaboration in curriculum design and implementation.

Acknowledgement

We would like to thank Vladislav Luchnicov, Elizabeth Sombilon and Eric Lin for their work as Research Assistants on this pilot program.

We would like to acknowledge York University for their generosity supporting this proof-of-concept initiative through the Academic Innovation Fund.

References

Abichandani, P., Fligor, W., & Fromm, E. (2014). A cloud enabled virtual reality based pedagogical ecosystem for wind energy education. IEEE Frontiers in Education Conference (FIE) Proceedings, 1–7.

Berragan, L. (2011). Simulation: an effective pedagogical approach for nursing? Nurse Education Today, 31(7), 660–663.

Bearnson, C. S., & Wiker, K. M. (2005). Human patient simulators: A new face in baccalaureate nursing education at Brigham Young University. Journal of Nursing Education, 44(9), 421-425.

Canadian Association of School of Nursing.(2012, May 11). The Canadian Association of Schools of Nursing and Canada Health Infoway recognize leadership in school of nursing faculty. https://www.casn.ca/2014/12/canadian-association-schools-nursing-canada-health-infoway-recognize-leadership-school-nursing-faculty/

Chheang, V., Saalfeld, P., Huber, T., Huettl, F., Kneist, W., Preim, B., & Hansen, C. (2019). collaborative virtual reality for laparoscopic liver surgery training. AIVR, 1–8.

Dengel, A. (2019) computer science replugged: what is the use of virtual reality in computer science education? Proceedings of the 14th Workshop in Primary and Secondary Computing Education, 1–3.

Dunleavy, M., Dede, C., & Mitchell, R. (2009). Affordances and limitations of immersive participatory augmented reality simulations for teaching and learning. Journal of Science Education and Technology, 18(1), 7–22.

Fero, L. J., O’Donnell, J. M., Zullo, T. G., Dabbs, A. D., Kitutu, J., Samosky, J. T., & Hoffman, L. A. (2010).  Critical thinking skills in nursing students: comparison of simulation?based performance with metrics. Journal of Advanced Nursing, 66(10), 2182–2193.

Helsel, S. (1992). Virtual reality and education. Educational Technology32(5), 38-42.

Hu-Au, E., & Lee, J. J. (2017). Virtual reality in education: a tool for learning in the experience age. International Journal of Innovation in Education, 4(4), 215–226.

Huddle, C. (2019). Benefits, Concerns, and Prospective Use of Technology Within Nursing education. Canadian Journal of Nursing Informatics, 14(3), 1–14.

Innes, A., Macpherson, S., & McCabe, L. (2006, May 12). Promoting person-centred care at the front line. https://www.jrf.org.uk/report/promoting-person-centred-care-front-line

Jelec, K., Sukalic, S., & Friganovic, A. (2016). Nursing and implementation of modern technology. Signa Vitae, 12(1), 23–27.

Kavanagh, S., Luxton-Reilly, A., Wuensche, B., & Plimmer, B. (2017). A systematic review of Virtual Reality in education. Themes in Science and Technology Education, 10(2), 85–119.

McCabe, C. (2004). Nurse–patient communication: an exploration of patients’ experiences. Journal of Clinical Nursing, 13(1), 41–49.

Ontario Nurses Association. (2018, September/October). Nursing student clinical placements – a support or a barrier to sound practice? http://www.ona.org/wp-content/uploads/ona_flfeature_nursingstudents_201810.pdf

Othman, N., & Amiruddin, M. H. (2010). Different perspectives of learning styles from VARK model. Procedia-Social and Behavioral Sciences7, 652-660.

Peisachovich, E. H. (2016). Reflection-beyond-action: a modified version of the reflecting phase of Tanner’s clinical judgment model. International Journal of Nursing and Health Science, 3(2), 8–14.

Revell, S. M. H., & McCurry, M. K. (2010). Engaging millennial learners: effectiveness of personal response system technology with nursing students in small and large classrooms. Journal of Nursing Education, 49(5), 272–275.

Rogers, C. R. (1959). Significant learning: in therapy and in education. Educational Leadership, 16(4), 232–242.

Shin, S., Park, J. H., & Kim, J. H. (2015). Effectiveness of patient simulation in nursing education: meta-analysis. Nurse Education Today, 35(1), 176–182.

Shah, R. K. (2019). Effective constructivist teaching learning in the classroom. Shanlax International Journal of Education, 7(4), 1–13.

Smith, P. M., Corso, L. N., & Cobb, N. (2010). The perennial struggle to find clinical placement opportunities: a Canadian national survey. Nurse Education Today30(8), 798-803.

Spreng, R. N., McKinnon, M. C., Mar, R. A., & Levine, B. (2009). The Toronto Empathy Questionnaire: scale development and initial validation of a factor-analytic solution to multiple empathy measures. Journal of Personality Assessment, 91(1), 62–71.

Stein-Parbury, J. (2005). Patient and person: developing interpersonal skills in nursing (3rd ed.). Elsevier.

Author Bios

Lora Appel, PhD

Dr. Lora Appel is an Assistant Professor of Health Informatics at the Faculty of Health at York University, and a Collaborating Scientist at OpenLab, an Innovation Centre housed at the University Health Network. She leads “Prescribing Virtual Reality (VRx) (https://www.prescribingvr.com/)” a collection of studies that introduce and evaluate VR/AR/MR interventions for patients, caregivers, and healthcare providers. She received several grants from the Centre for Aging in Brain Health innovation to pursue this work in aging and dementia care and has recently collaborated with the Toronto Public Library on “VRCHIVE“ (https://loraappel.wixsite.com/vrchive), a workshop that teaches intergenerational participants to use VR to capture their experiences during the COVID-19 pandemic with the goal of improving communication and relationships between grandparents and grandchildren.

Dr. Appel received her PhD from the school of communication and information at Rutgers University and was awarded the Gerald Miller Outstanding Dissertation award in 2017 for her work defining clinician anonymity and designing “Face-2-Name” a tool to improve interprofessional communication in clinical settings. Dr. Appel has published in premier journals like the American Journal of Medicine and the International Journal of Medical Informatics, and Frontiers in Medicine, she has given talks at Harvard medical school and the Royal College of Physicians in London, and her work with VR has resulted in several national media appearances. Dr. Appel’s expertise is in applying design thinking and science methodologies to healthcare innovation; she is passionate about designing new technological interventions that provide care in the pursuit of a cure.

Eva Peisachovich, RN, PhD

Dr. Eva Peisachovich is an Associate Professor at the School of Nursing at York University, Toronto, Ontario.  Her program of research involves exploring, developing and implementing pedagogies associated with simulation-based environments including human simulation, virtual and augmented reality, serious games, and eLearning approaches to promote professional competence among learners within higher education milieus and their transition to the workplace.

 Don Sinclair, MA

Don Sinclair is an Associate Professor in the Department of Computational Arts in the School of the Arts, Media, Performance and Design at York University. His creative research areas include interactive performance, projections for dance, sound art, web and data art, cycling art, sustainability, and choral singing most often using code and programming. Don is particularly interested in processes of artistic creation that integrate digital creative coding-based practices with performance in dance and theatre. As well, he is an enthusiastic cyclist.


Be Sociable, Share!

Comments are closed.