October 12, 2022

by Dr. Michael Ackerman and Dr. Stephanie Justice

Reinvention. Reimagination. Disruption.

All of these words are associated with changing how we do things in order to improve upon what we do. In the world of nursing education, that means changing how we deliver instruction, promote experience and build confidence in our students so that they’re practice-ready.

And it starts with a headset.

Our Ohio State University College of Nursing received an American Nurses Foundation “Reimagining Nursing Grant” for an innovative pilot program, “Disrupting nursing education using extended reality (XR), artificial intelligence and machine learning,” aimed at reimaging the existing system of preparing pre-licensure nursing students.Mike Ackerman with XR/VR technology

By utilizing technology-enabled learning tools, we are able to observe the learner’s knowledge, skills, values and attitudes and effectively enhance practice skills and decision-making for the learner. These emerging extended reality-based systems create engaging, innovative, highly-effective and scalable clinical learning experiences that offer students the opportunity to enhance and accelerate their learning through XR, aided by machine learning and artificial intelligence. XR does not replace traditional skills training or high-fidelity simulation; students will continue to participate in hands-on experiences. What XR simulations do is increase the number of experiences for each learner. Students will complete simulations as the primary nurse and can repeat the simulation multiple times.

A variety of XR methodologies and products are being utilized to create a bridge between academic and practice environments. The XR technology includes clinical scenarios which include things such as clinical decision-making, pharmacological and pharmacokinetics principles and skills-based interventions. Additionally, life skills are incorporated including therapeutic communication, patient specific history and concerns and data collection pertinent to patient care while addressing social determinants of health. The patient data-based approaches along with life skills all create scenarios that address approaches with decision-making. Student learners will approach the scenarios with a keen sense of using the technology-enabled learning tools both to create an immersive experience and to consider how they will incorporate technology into decision-making. 

This pilot employs virtual reality technology as well as mixed reality, essentially both screen-based and headset-based immersions. The VR programs selected for this pilot were evaluated for content and accessibility to allow students who experience cybersickness (nausea, headache, blurry vision) in VR to complete the same scenarios as an individual on a computer. Feedback on patient care simulations is provided to each student at the end of the simulation, along with rationale and links to patient care guidelines. Students can repeat the simulation as many times as they want because they can access the program on a computer or headset and can log in from anywhere.

In the first month of operation, students completed individual virtual simulations in several courses:

  • Community health students experienced homelessness in the VR headset by entering the tent of a homeless woman and viewing her lived experiences, interacting with the few keepsakes she still possesses and being present in her current living situation. These students also completed a screen-based social determinants of health (SDOH) scenario where they worked with one of four individuals with a variety of backgrounds.
  • Students in several medical/surgical courses experienced patient care simulations both in the headset and on the screen caring for patients across the lifespan.
  • Sophomore students participated in cardiac and respiratory assessment tutorials.
  • Junior students cared for a young child or a pregnant woman experiencing complications.
  • Graduate entry students performed a cardiac arrest scenario.

In less than a month, students completed 1277 individual medical/surgical simulations, 40 homelessness simulations and 40 SDOH simulations for a total of more than 290 hours of individual simulations.

The junior medical/surgical course used the headset to cast or project the simulation onto the screen in the classroom. The student in the headset was guided by her classmates to determine the course of action and which skills and procedures to perform. This turned the experience into a group activity instead of an individual simulation. The simulation was completed a second time to improve the group performance.

All pre-licensure students will be exposed to more XR simulations as the academic year continues. Additional medical/surgical patient care scenarios will be completed, as well as simulations focusing on communication skills to prepare students for practice by learning job interview techniques and how to navigate difficult conversations.

Michael Ackerman, PhD, RN, FCCM, FNAP, FAANP, FAAN is professor of clinical nursing, director of the Master of Healthcare Innovation degree program and director of the Center for Healthcare Innovation and Leadership at The Ohio State University College of Nursing. Stephanie Justice, DNP, RN, CHSE is assistant clinical professor at The Ohio State University College of Nursing. She is one of 16 simulation educators from across the country selected for the National League for Nursing’s year-long Leadership Development Program for Simulation Educators.

 


 
Student testimonials on using XR/VR in the classroom

How has this changed your practice? How will you approach this same kind of patient differently in the future?

“I think this really opens my eyes up to see how real-life this decision-making is and how it is very likely that I can be as hesitant as I was in real life as I was in this simulation. I think I will approach this same kind of patient differently in the future by having a better understanding of what is necessary to do when someone’s having a seizure alongside the stuff I did for Katie.”

“I now know more about what is expected of me as a nurse.”

“This has continued to show how this can be implemented into my daily practice. It also shows how I can learn these things to carry into my practice (check my implicit biases, hospitality, etc.)”

 

What did you learn? What was your greatest takeaway moment?

“I learned how to take charge and how I could do better at leading as a nurse in the future.”

“I learned how to react with a distressed parent. My greatest takeaway moment was guiding the mother to put the child down so my team and I could begin giving CPR. Seeing a distressed mother really taught me that I need to keep my composure not only for the patient’s sake, but for the parents as well.”

“It was really great practicing the adult cardiac arrest algorithm. Doing it helped make it more real and intuitive. It was an a-ha moment to see it in practice.”

 

What would you do differently?

“I did a lot differently between my first attempt and my second attempt, including giving meds at different times after the shock and having a better order of procedures.”

“I am glad that I was able to repeat the scenario multiple times because it helped me learn from my mistakes and apply my knowledge. In the future, I would try my best to remain calm on the first go-around because I could tell that being flustered made the experience stressful.”

“This has changed my practice, because I will now always come prepared, use delegation and prioritize effective communication with my team members during a code situation. These things are all crucial, and I plan on approaching this same kind of patient in a more prepared and educated way in the future.”

 

How did it feel (being in VR)?

“Being in the patient room, feeling like I was actually there, felt real.”

“I thought it was so cool. I feel more confident in doing assessments and knowing where things are.”

“It was very realistic … because you could do all these things through the visualization. I thought it was a good learning experience because it told you what you did well and wrong.”

“[In the homelessness scenario], tt was really sad to watch how she was just trying to pursue her dreams and everything was ripped away. I was really amazed by the whole experience and felt really moved by how emotional she was at the end when they were ripping apart the contents of her tent.”

 

Additional comments:

“Make the VR component mandatory by offering more devices at the [College of Nursing]. Completing this in VR took it to an entire different level.”

“I really enjoyed doing this VR simulation. It was interesting to work at the bedside as a character to gain more experience. I’m very excited for future VR.”

“I felt like it was a useful tool for letting me as a student learn in a safe environment.”

May 24, 2022

American Nurses Foundation chooses 10 bold ideas to transform health care

A collaboration of The Ohio State University Colleges of Nursing and Engineering to use extended reality (XR), artificial intelligence (AI) and machine learning (ML) to revolutionize nursing education has received a highly-competitive grant from the American Nurses Foundation’s (The Foundation) Reimagining Nursing Initiative.

The three-year, $1.5 million grant from The Foundation will support Disrupting Nursing Education with XR, AI and ML, a project which seeks to use cutting-edge technology to better prepare nursing graduates for high-stakes, real-world situations. According to the project’s webpage, deploying technology-enabled learning tools across the core curriculum “will build students’ competencies that can be validated in clinical experience. Extended reality can provide tailored support based on each student’s needs. The artificial intelligence/machine-learning tool can address critical points in patient care when decisive nurse interventions make life-or-death differences.”

“If we want to fulfill our promise to dream, discover and deliver a healthier world for our future, we must prepare our students to create that future,” said Bernadette Melnyk, PhD, APRN-CNP, FAANP, FNAP, FAAN, vice president for health promotion, university chief wellness officer and dean of the College of Nursing. “This awesome project out of our Center for Healthcare Innovation and Leadership will utilize new-age technology and revolutionary design to transform how we educate our students to be evidence-based, confident and innovative clinicians. We are so grateful to The Foundation and to our terrific partners at the College of Engineering who saw our vision and potential to truly disrupt nursing education and prepare clinicians to transform health and improve lives.”

virtual reality image of person standing inside an artery looking at blood vessels
Extended reality with a view inside a blood vessel

The College of Nursing’s lead on this initiative will be Michael Ackerman, PhD, director of the college’s Center for Healthcare Innovation and Leadership; Wendy Bowles, PhD, assistant dean for baccalaureate programs, and Amy Jauch, DNP, director of prelicensure programs, will serve as co-principal investigators. The College of Engineering partnership will be led by Mike Rayo, PhD, assistant professor of integrated systems engineering.

“This initiative is Ohio State in a nutshell. Two seemingly separate disciplines collaborating and converging to improve the human experience,” said Ayanna Howard, PhD, dean of the College of Engineering. “We are seeing AI and machine learning already impacting healthcare in areas like drug delivery, imaging and diagnosis. Now it’s time for nursing education to benefit, and we are ready to partner and lead the way.”

The Foundation today announced $14 million in funding over three years for 10 projects, including Ohio State’s, after reviewing nearly 350 proposals from across the country in three categories: Practice-Ready Nurse Graduates, Technology-Enabled Nursing Practice and Direct-Reimbursement Nursing Models.

“We know that nurses are ready and eager to lead the change that’s necessary in our healthcare system, especially given the recent challenges nurses have been facing with the COVID-19 pandemic,” said Kate Judge, executive director of The Foundation. “The RN Initiative is funding ideas developed and led by nurses with their unmatched perspective on prevention, wellness and delivery of healthcare services. I am truly looking forward to seeing the Ohio State team’s educational disruption in action and seeing how we can scale its innovation to benefit generations of healthcare leaders.”

The College of Nursing/College of Engineering team is expected to report results, deliver evidence demonstrating the project’s impact and provide resources to help scale the innovation within the profession by 2025.

Interviews with leaders of the Ohio State project and b-roll of AI/XR in action (including using headsets in-person or cast to Zoom) available to media.

Media contact: Phil Saken, saken.2@osu.edu, 614-688-3326

April 29, 2022

Program hosted by National League of Nursing focuses on simulation education

Stephanie Justice, DNP, RN, CHSE, an assistant professor of clinical nursing at The Ohio State University College of Nursing, is one of 16 simulation educators from across the country selected through a competitive application process for the National League for Nursing’s year-long Leadership Development Program for Simulation Educators. It is one of two tracks in the NLN Leadership Institute, an initiative of the NLN Center for Transformational Leadership.

The simulation leadership development initiative is designed for the experienced simulation nurse educator who aspires to a leadership role in simulation. Sim Leadership track participants focus on maximizing their leadership potential to advance simulation initiatives in nursing education and practice. They will study for a year under the direction of Susan Forneris, PhD, RN, CNE, CHSE-A, FAAN, and Mary Anne Rizzolo, EdD, RN, FAAN, ANEF, FSSH. Dr. Forneris is director of the NLN Division for Innovation in Education Excellence; Dr. Rizzolo is President of the Global Network for Simulation in Healthcare and Consultant to the NLN.

“It is vitally important that, as the most trusted professionals in healthcare, nurses be prepared to take a leading role in promoting excellence in healthcare delivery, advancing health access and equity, and ensuring cultural sensitivity and inclusion in caring for an increasingly diverse population of patients and their families, especially those encountering acute health crises and managing chronic medical challenges,” said NLN Chair Kathleen Poindexter, PhD, RN, CNE, ANEF, interim associate dean of academic affairs at Michigan State University. “As the nation and the world transitions from a global pandemic to dealing with COVID-19 as an endemic disease requiring ongoing response, the demand for competent leadership in nursing is more urgent than ever.”

“I am so excited to be chosen for this leadership program,” Justice said. “I want to be a leader in simulation here at the College of Nursing and develop experiences for students that will enhance their learning and prepare them for their nursing careers. This program will provide me with the skills and tools to excel in my role in the Extended Reality Lab (XR) that is scheduled to open this fall at our college. The program focuses on developing my strengths as a leader and recognizing the strengths in others to build a successful team.”

Justice carries more than 10 years of experience in simulation and has been a Certified Healthcare Simulation Educator (CHSE) for the last five years. Among her experience:

  • Helped design the Healthcare Education Simulation Station (HESS), a tablet-based set of simulation tools that are inexpensive and portable, at Otterbein University.
  • Taught simulation and moulage (the art of applying makeup to simulate injuries or disease process) in Central America and Australia
  • Serves on the CHSE Advisory Team for the Society for Simulation in Healthcare and participated in writing the CHSE Blueprint Review
  • Working on simulation development for Enhancement of the Public Health Nurse Role in Simulation-based Interprofessional Team Education (EnSITE) sponsored by HRSA
  • Member of the Virtual Reality Simulation Interest Group for the International Nursing Association for Clinical and Simulation Learning (INACSL)

To expand the science of nursing education while developing their personal leadership portfolios, participants spend time engaged in varied activities that examine key issues related to simulation, then focus their efforts in an area of their choice. Justice will work on creating an Operationalizing VR toolkit with colleagues Adriana Rumoro from Rush University Medical Center’s Department of Professional Nursing Practice and JoAnn Tingum from The College of St. Scholastica School of Nursing.

Throughout the year, these simulation educators will be immersed in leadership development webinars; exchange ideas and best practices in simulation in private forums; review existing scholarly research; visit simulation centers around the country to evaluate resources and operations; contribute to a group project that is posted in the Simulation Innovation Resource Center (SIRC); and attend professional conferences.

“The National League for Nursing is delighted to continue our commitment to the Leadership Institute, reflecting our unflagging dedication to professional development and leadership in healthcare education, practice and policy,” said NLN President and CEO Beverly Malone, PhD, RN, FAAN.