Amarillo College Associates Degree Nursing
Images provided by Amarillo College
1. Original Problem:
COVID-19 caused clinical space to become a premium for students with the closing of hospital, clinic, and rehabilitation clinical sites at the beginning of March 2020. As a result, dependency on high-fidelity simulation, and remote teaching modalities increased dramatically Spring 2020, bringing with the closures the realization of further technological support needs, including the need to create “real” practice environments for students to learn in via remote locations. The AC ADN program began looking into Virtual Reality (VR) and Augmented Reality (AR) systems to supplement simulation in a way that would be a safe, relevant, and content-rich addition to remote teaching tools.
Additionally, due to COVID-19, the nursing resource center (NRC) space was limited. The NRC houses 4 practice lab rooms, high-fidelity simulation rooms, and our debriefing rooms. This space was closed or is currently limited to 10 people per lab space, a limitation which does not allow for full clinical courses to utilize equipment needed to prepare students for entering the hospitals and taking patients face to face. The spaces at SIMCentral became non-existent as well due to occupational limitations. Sim Central is currently at 25% capacity, and unable to accommodate larger clinical student groups. Clinical space within any healthcare facility in Potter or Randall counties was not available, but will be opened in limited capacity for students beginning Fall 2020. Facilities at remote campuses in Dumas and Hereford, Texas could not be utilized.
(a) Description of Project Focus
a. Professional development plans for simulation instruction: Due to delays in equipment shipments and on-campus network update issues, Professional development and faculty training session have been scheduled for March 2022. March sessions will include orientation and use of the VR system, how to manage the VR sim environments in non-VR and VR modes, how to facilitate VR simulations with students, and how to adapt the VR system and environments into the course effectively to meet clinical course outcomes.
Dr. Hall and K. Young have had several Zoom meetings for user training with the Acadicus development company creating our Virtual Reality environments and VR sims library. These 5 meetings occurred between 3/2021 to 1/2022. We have 1 more planned for March 2022; date and time to be determined.
b. Curricular modification, lesson design, and scenario development to allow alternative strategies, including through distance education, to help students meet specific clinical objectives:
A review of the clinical courses and course objectives was done by K. Young between January 2021 to May 2021. The Acadicus library available for immediate use was reviewed and specific simulations assigned to each clinical course based on their objectives and clinical student learning needs.
The first group of students to use the VR system included the Transitional LVN to RN (RNSG 1261) students enrolled in the Spring 2021 and Fall 2021 classes. The Level 4 RNSG 2263: Clinical-Professional Nursing Leadership students began use of the VR system in Fall 2021 with the initial Mass Casualty event simulation created specifically for the AC Nursing program.
Multiple Casualty Simulation (assets by Amarillo College and Madison College)
RNSG 1105: Nursing Skills I students will use the VR systems at the end of March 2022 to practice their final Skills safety room and Infection Control PPE scenario. RNSG 1362: Clinical-Principles of Clinical Decision-making student will utilize the safety room and the patient ward simulation settings to prepare for their first clinical rotations in the hospitals. They will also be using the simulation to practice the transfer and safe positioning of patients between beds, wheelchairs, and other equipment pieces once their simulation development is complete.
c. Facilitation of faculty’s debriefing with students, including through online formats, for clinical learning experiences
Student debriefing takes place post simulation in person or via the Acadicus system while students are in the VR environment. All debriefing can be completed in the VR system where students and faculty can interact with the virtual patients and settings in order to see real-time issues that could happen in clinical settings.
d. Simulated clinical learning experiences with high fidelity level that include realistic or interactive patient scenarios.
Students in the VR environment are immersed in their “clinical” sites. The students in the mass casualty event experience the sites, sounds, and stimuli of a basic mass casualty bombing site where there are explosions, sirens, and victims that can be triaged post assessment by students.
The Transition students experienced interacting with a patient who was confused, had 12 safety issues in the room that required intervention, and could administer medications should the patient require them. Due to the real time interactions between students and faculty, the students could also speak with the patient during the assessment phase of their interactions. Each of these scenarios in the Acadicus VR Simulation library are interactive however high-fidelity manikins or other equipment have not been added to this system. The use of these items is not possible, but students can pick up objects or manipulate equipment virtually.
e. Synchronous or asynchronous demonstration and evaluation of skills and competencies
Students and faculty are at the beginning of using this system and have not implemented demonstration of skills and competencies for graded assignments in their respective clinical courses. This process is expected to begin in Fall 2022 once all faculty and student groups have had the opportunity to use the VR system without the pressure of grades or competencies being evaluated.
f. On-campus hands-on practice and demonstration upon resumed access to campus.
The Acadicus VR system was completed by the time students and faculty returned fully to the on-campus schedule. However, due to COVID restrictions, the system does allow faculty and students to engage in a full clinical experience from distances and in the online/virtual environment. This feature will be used as needed during the changes in COVID numbers and available clinical spaces. All clinical students have access to the VR system for clinical experience make ups as well, however, they are being kept within the context of their course outcomes and the Performance Measure and Outcomes of the NIGP Grant requirements.
2. Implementation Methods
Research of the equipment and IT Network requirements:
Phase I: Equipment research and ordering
During Phase I, the IT department and K. Young collaborated and researched the best Virtual Reality system, computer operating system, monitors, and drives specified by Acadicus. This process took approximately 8 months (January to August 2021) due to equipment availability, cost of equipment, ordering processes, and updating the computer network system for the VR platform to operate. See Challenges below as to how these issues were addressed.
Phase 2: Faculty and Student Training
Full faculty training will begin in March 2022.
Student training: Students were brought into the simulation lab during their scheduled clinical simulation times. They were divided into several groups between 2 sim lab rooms. Sim Lab room A holds 8 VR stations and Sim Lab B holds 8 VR stations. Students were introduced to the VR environment in Sim Lab A where they were orientated to how the equipment worked, safety issues, and how to use the controller/headset to navigate the VR environment.
Endotracheal Intubation Scenario available from Acadicus Commons (assets by NSU)
Acadicus created a Commons room where all users in their system can gather and move around a basic VR environment, visit open simulation scenarios, and give students time to acclimate to the new system.
Once students completed their orientation to the system, they were then moved to Sim Lab B where they were placed into the assigned clinical activity and instructed by faculty remotely as to their objectives and goals for that activity. The Performance Measure and outcomes listed were and will be used to measure the effectiveness of the VR system and clinical student learning during the Spring 2022 and Fall 2022 semesters. Further implementation of this system in the remaining clinical courses will occur during the Spring 2022 semester during scheduled training times and simulation events.
Phase 3: January 2022-November 2022
The completion of implementation for all courses is scheduled for the end of the Spring 2022 semester and into the first half of the Fall 2022 semester. However, the use of the VR system past the November 2022 date for the grant will continue. The goal of the Amarillo College
ADN nursing program is to have VR simulations incorporated into all clinical courses by the end of this year (2022).
3. Challenges in Project Implementation
Challenge #1: COVID – due to increased COVID cases in the Texas Panhandle, equipment and shipping delays occurred. This challenge delayed integration of the project by almost a full year.
Challenge #2: Training faculty and students on the new equipment. This type of system has never been used in an education setting in our area. Our nursing student population is diverse, and some students/faculty have never used or experienced a VR environment unless they have a gaming background. Getting students and faculty used to this type of teaching and learning tool is a challenge of its own.
Challenge #3: Updates to the IT computer network to support this type of system was difficult. The previous network servers were not equipped to handle the increased power and graphics needs for this type of system.
Challenge #4: Ordering processes and procedures of the college. Getting the purchases processed through our current purchasing system was very difficult due to the number of people and departments each purchase order had to clear.
Challenge #5: Helping faculty and students understand the learning and teaching values of the VR system. This is a new technology and a new learning/teaching platform. Students and faculty tend to shy away from these types of systems because they are virtual and lack a more tactile element needed or found in the in-person clinical settings.
4. Overcoming the Challenges
Challenge #1: Waiting was the only way to meet this challenge. Once the equipment arrived in August of 2021, our IT department was contacted and installation of the VR system was completed within a week’s time. All 16 stations were up and ready for the beginning of the Fall 2021 semster.
Challenge #2: Training faculty and students on the use of the VR system is ongoing and will continue formally in March of 2022. Faculty will be provided basic operation manuals and in-person demonstrations with the equipment.
Challenge #3: The update to the computer network systems and servers was completed in September 2021. There were also 4 new computer network ports placed in Sim Lab A and Sim Lab B in order to hardwire the stations into the network. This setup is not the most ideal, however, it was the most cost effective. There have not been any issues with the network except for the occasional timeouts when the VR stations are not in use.
Challenge #4: The college ordering processes are under review and revision post completion of this project. This is a college wide system issue and will take some time to address/change.
Challenge #5: Students and faculty will eventually see the value of this system as we get them trained and create a better structure for use in their clinical courses. Faculty will also be presented with research and evidence showing the valued addition of the VR system in their clinical courses. They will also see that VR systems are meant to supplement and enhance clinical experiences, not take the place of real patient care experiences.
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