ABSTRACT
BACKGROUND: Children often experience respiratory illnesses requiring bedside nurses skilled in recognizing respiratory decompensation. Historically, recognizing respiratory distress has relied on teaching during direct patient care. Virtual reality simulation may accelerate such recognition among novice nurses. OBJECTIVE: To determine whether a virtual reality curriculum improved new nurses' recognition of respiratory distress and impending respiratory failure in pediatric patients based on assessment of physical examination findings and appropriate escalation of care. METHODS: New nurses (n = 168) were randomly assigned to complete either an immersive virtual reality curriculum on recognition of respiratory distress (intervention) or the usual orientation curriculum (control). Group differences and changes from 3 months to 6 months after the intervention were examined. RESULTS: Nurses in the intervention group were significantly more likely to correctly recognize impending respiratory failure at both 3 months (23.4% vs 3.0%, P < .001) and 6 months (31.9% vs 2.6%, P < .001), identify respiratory distress without impending respiratory failure at 3 months (57.8% vs 29.6%, P = .002) and 6 months (57.9% vs 17.8%, P < .001), and recognize patients' altered mental status at 3 months (51.4% vs 18.2%, P < .001) and 6 months (46.8% vs 18.4%, P = .006). CONCLUSIONS: Implementation of a virtual reality-based training curriculum was associated with improved recognition of pediatric respiratory distress, impending respiratory failure, and altered mental status at 3 and 6 months compared with standard training approaches. Virtual reality may offer a new approach to nurse orientation to enhance training in pediatrics-specific assessment skills.
Subject(s)
Nurses , Respiratory Distress Syndrome , Respiratory Insufficiency , Virtual Reality , Child , Humans , Clinical Competence , Curriculum , Respiratory Distress Syndrome/diagnosis , Respiratory Insufficiency/diagnosisABSTRACT
INTRODUCTION: Simulation is a core aspect of training and assessment; however, simulation laboratories are limited in their ability to visually represent mental, respiratory, and perfusion status. Augmented reality (AR) represents a potential adjunct to address this gap. METHODS: A prospective, observational pilot of interprofessional simulation assessing a decompensating patient was conducted from April to June 2019. Teams completed 2 simulations: (1) traditional training (TT) using a manikin (Laerdal SimJunior) and (2) AR-enhanced training (ART) using a manikin plus an AR patient. The primary outcome was self-assessed effectiveness at the assessment of patient decompensation. Secondary outcomes were attitudes toward and adverse effects during the AR training. RESULTS: Twenty-one simulation sessions included 84 participants in headsets. Participants reported improved ability to assess the patient's mental status, respiratory status, and perfusion status (all P < 0.0001) during ART in comparison to TT. Similar findings were noted for recognition of hypoxemia, shock, apnea, and decompensation (all P ≤ 0.0003) but not for recognition of cardiac arrest (P = 0.06). Most participants agreed or strongly agreed that ART accurately depicted a decompensating patient (89%), reinforced key components of the patient assessment (88%), and will impact how they care for patients (68%). Augmented reality-enhanced training was rated more effective than manikin training and standardized patients and equally as effective as bedside teaching. CONCLUSIONS: This novel application of AR to enhance the realism of manikin simulation demonstrated improvement in self-assessed recognition of patient decompensation. Augmented reality may represent a viable modality for increasing the clinical impact of training.
Subject(s)
Augmented Reality , High Fidelity Simulation Training , Computer Simulation , Humans , Prospective StudiesABSTRACT
An immersive virtual reality curriculum was piloted with new nurse graduates that focused on improving clinical reasoning and situational awareness for pediatric respiratory distress and impending respiratory failure. Learnings from this pilot could inform strategies for development of standardized, efficient, and safe onboarding curricula to increase the likelihood of successful transition to practice.
