The session starts. Nursing student Leslie explains to Jack and Vivian how their mother’s condition worsened since being admitted to the hospital. Jack and Vivian are processing the information. They argue with each other about treatment options, and tensions rise. Unsure of her next move, Leslie says, “Pause," and both Jack and Vivian disappear. 

Jaime Hannans, a UNLV Ph.D. graduate in nursing, and other nurses offer advice on what to say. Restart. Jack and Vivian are back, and Leslie is more confident on how to handle the situation.

This is one example of the work Hannans is doing as a professor at California State University Channel Islands. She’s enhancing nurse education through a combination of mixed reality and virtual reality experiences that take principles of clinical simulation to another level.

Computerizing and Capturing Compassion

Hannans’ work can be divided into three categories: immersive virtual reality (headset-based graphics), mixed reality (students speaking to virtual avatars), and augmented reality (graphics overlaid onto real world via device). Through specially designed programs, she uses these formats to better prepare nursing students for patient interactions; difficult moments; and stronger patient empathy, to make them truly think about what they’re doing and why.

While normal clinical simulations give students a physical presence and tactile learning, Hannans uses virtual reality in a different but equally immersive way. She puts the students directly into patient roles. For example, students can embody Alfred, an elderly African-American man with vision impairment. Hand tracking lets the student look down and see older brown male hands, while the program purposefully obscures their sight with black blobs. “[Students] say, ‘I read chapters about macular degeneration, but I didn't understand the significance of day-to-day living and the impact.’ For me, it was like a magic match,” she says. “This is why I wanted to teach, because this matters. Being able to get the students to understand what it's like for the patient to be able to empathize with them will make them better care providers in every way.” 

Hannans employs at least six different virtual scenarios. There’s veteran Clay who has a terminal diagnosis and speaks with family before his death. “That can be really emotional and hard for students,” Hannans says. “Some of the cues in this scenario they may or may not understand depending on their cultural background and experiences. Going through that as a small group we discovered was really powerful.”

Or there’s Eden, a transgender patient. “You see a picture of her lifespan,” Hannans says. “Who is our 70-year-old transgender woman now and what did they have to deal with in their life? Why would they maybe not trust healthcare providers? How do we navigate their needs? Having these opportunities to connect with important content that students may or may not get exposed to in other areas have opened up valuable deep conversations.”

She says this type of education will not only improve a student’s skills, but a patient’s trust in them. “For the patient, it is wonderful that a nurse is so well-informed about labs and medications, but what they [also] want to be sure of is to feel that they're cared for, whether that be with a warm blanket or adjusting their bedside table so they can see it, and so that they're not frustrated,” Hannans explains. “It's bringing in that whole picture of what matters.” Hannans adds, “[With] VR, you have your ability to really understand the patient and family dynamics and connect your emotions to their needs in some way to understand that this is more than just providing medications and doing assessments. It affects the individual and the whole family.”

Keeping The Real World Real

From patient intakes to monitoring to alert systems, technology has become so integral to healthcare, including nursing, but Hannans isn’t concerned about an overreliance on tech like virtual reality as long as the focus remains on the individual. “We still need to remember that nursing has the human connection aspect that is so critical in care,” she says. “We can't ignore technology. It's too powerful, but I do get concerned about using technology in a meaningful way, and not just jumping to the next greatest, best tool because it looks fun.”
 
Si Jung Kim, assistant professor with the Howard R. Hughes College of Engineering at UNLV (and specialist on augmented and virtual reality), agrees that VR, while used widely in education and health, isn’t the end-all next step in teaching. He cautions users must be aware of what he calls “negative learning."

“It means VR would help us learn or experience something wrong, “ he explains. “For instance, medical students are utilizing VR/AR for their learning of surgical operations, and it went well at their school but when they meet actual situations in the real world, it may not be the same with what they experienced or learned.”

Despite a rise in broader VR adoptions in health care, Hannans isn’t envisioning a “Matrix”-like future where nurses and health professionals can’t differentiate between what’s real and what’s made up.

“One of the things that nurses and nursing students have to be aware of and learn is the need to be flexible and adjust to anything,” she says. “You don't know what's coming next, and I think that makes the real world real. I don't know how easily that will ever be mimicked by virtual reality because the things that happen with a patient or with nursing, you couldn't predict sometimes. There are always anomalies of what occurs.” But just as important as the randomness of life is human interaction. “I would find it difficult to be a nurse and not ever feel connected,” Hannans says. “I don’t know if those moments and feelings and serendipitous things can ever be mimicked with technology.”

Understanding How to Connect

Hannans’ emphasis on living a patient’s experience can be traced through a close friend of hers who was severely injured in an accident in college. Despite an interest in sports medicine, Hannans was moved by the care her friend’s nurses provided. “I stayed at least one night in the hospital and realized how much of an impact nursing had on his day-to-day life as he was going through this traumatic injury and experience,” she recalled. “It was the difference of putting myself in my friend's shoes. The difference between having someone come in and out can either make or break your day because you're so dependent on the support and the direction and the guidance.”

Hannans chose UNLV for her doctoral studies because of the emphasis the UNLV School of Nursing had on nurse education. She earned her Ph.D. in nursing from UNLV in 2013, crediting her growth on UNLV Nursing’s focus on laying the groundwork in teaching and knowing the why behind what is being taught. “The knowledge I gained in nursing education, curricular development, processing, teaching and learning practices, I think, was key in having that theoretical foundation to make sure this work moves in a way that's meaningful and connected and isn't just the next greatest tool. But then having the research courses and practice and the dissertation experience to really think about, ‘How do we make sure it's meaningful and how do we research to make sure this is a practice that has an impact on students?’ which we've been able to do, and that's all because of my Ph.D. education.”