INDUSTRY
Education
Digitizing education for blended and immersive learning experiences
Highlights
- Nurse educators and practice experts recognize a gap between pre-licensure and advanced practice registered nurse students' academic preparation and readiness as they transition to the clinical arena.
- To bridge this gap, academicians and practice leaders must forge strong partnerships and promote the use of novel technologies that embrace competency-based education and immersive learning.
- Productive academic-practice partnerships can assist graduating students to successfully transition into the practice arena through enhanced skill development, knowledge acquisition, and practice readiness.
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Gap between nursing education and practice readiness
Nursing requires both theoretical knowledge and clinical skills conducive to successful practice.
Nurse educators and practice experts have recognized a gap between the academic preparation of pre-licensure and advanced practice registered nurse (APRN) students and their readiness as they transition to the clinical arena.
At the baccalaureate level, pre-licensure nursing education teaches students to think critically and ethically about clinical care delivery. Students traditionally gain hands-on practice experience during supervised clinical practicums in preparation for a career in a hospital environment.
However, many new graduate nurses feel overwhelmed by practice-setting expectations and unprepared for today’s fast-paced work environment. Despite lengthy hospital orientation programs, gradually increasing patient workloads and clinical mentors, many new nurses cite inadequate patient assessment and critical thinking skills and a lack of time management competencies and leadership support.
Similarly, APRN graduates need support as they enter the workforce. APRN academic preparation at the master’s and doctoral levels hones technical and critical thinking skills while addressing many healthcare issues such as diversity, equity, and inclusion, finance, and leadership. Rigorous coursework and substantial clinical practicum hours prepare them for certification in one of four APRN roles: nurse practitioner, certified registered nurse anesthetist, certified nurse midwife, and certified clinical nurse specialist.
Practice site residency programs assist APRN graduates to enhance their knowledge and skills; lighter patient loads and clinical mentors offer additional support. Staffed by seasoned APRNs and physicians, these programs enable the new APRN to refine skill proficiency, critical thinking, and decision-making.
Despite the best academic and practice site efforts, many new RN and APRN graduates experience reality shock in the hospital environment, evidenced by disillusionment, job stress, moral distress, and, ultimately, burnout. Within three years of graduation, these nurses depart the hospital environment or the nursing profession entirely, and the impact at point-of-service is deafening, with fewer nurses available to fill ever-increasing vacancies.
Therefore, a moral imperative exists for academicians and practice leaders to forge closer working relationships and close the academic-practice gap.
Competency-based education
The healthcare landscape is rapidly changing, leading to a shift toward competency-based education.
Technological advancements in competency-based education and immersive learning can enhance student skill development, knowledge acquisition, and practice readiness, helping the new graduate nurse and the APRN transition comfortably into the practice setting.
Notably, competency-based education has been the driving force behind several studies of immersive technologies in nursing education. Qualitative research regarding student perspectives on using virtual reality (VR) in nursing education reveals three descriptive themes: captivating, empowering, and innovative. Students find virtual reality engaging because it provides a safe and convenient space for trial, error, and problem-solving, even though it requires adaptation to a fast skill-learning process. From a cost perspective, virtual and immersive learning implementation requires forty percent less than high-fidelity simulation, making it a viable and cost-effective option.
Given rapid advancements in immersive technologies, academic-practice partnerships can facilitate curriculum enhancements, ultimately benefitting from integrating novel technology into educational programs and practice settings.
Fusion of virtual reality and nursing education
Today, virtual and augmented reality in the simulation lab includes a custom 3-D viewing headset or a 2-D flat-screen simulation.
Both allow for varied, innovative educational experiences anytime, anywhere. Simulated procedure sites such as the operating room or intensive care unit invite generalized or task-specific fundamental skills training that applies to students' academic training and nurses’ continuing practice-setting education.
Unlike traditional passive learning methods, immersive learning technology allows learners to learn and practice skills simultaneously for a variety of virtual and augmented reality (VAR) products, including whole-body physical assessments and medication administration or advanced skills such as cardiopulmonary resuscitation, dialysis, catheterization, lumbar puncture, tracheostomy tube placement, complicated intravenous line insertion, foley catheter, and chest tube insertion – all most likely welcomed by newly-licensed nurses and new APRNs.
Research suggests that the benefits of immersive learning strategies outweigh any negatives largely due to the user’s unlimited access to learning time and space. Negatives include immersive learning challenges such as motion sickness, anxiety, difficulty manipulating technology, lack of realism, and poorly fitting eyeglasses or headsets.
Additionally, scant research exists measuring the effect of immersive learning on practice readiness, and the lack of uniform language that describes immersive technologies limits the ability to measure critical thinking proficiencies. Research cautions that educators use special care in providing students access to immersive technology with recommendations including providing students a thorough introduction to technological attributes before use, particularly given the increasing realism in depicted scenarios.
Regardless, partnerships between academia, practice, and technology-enabled learning modules can be critical in advancing competency-based nursing education and bridging the gap between theory and required clinical practicum hours. Immersive learning approaches–augmented, virtual, mixed reality–can provide students with an experiential simulation platform using multidimensional, computer-generated environments to mimic real-life experiences. Headsets or haptic sensors enable users to experience a nearly authentic sense of interaction in real-time with patients in a virtual world.
Immersive learning and simulation
Virtual reality simulation as a learning tool in nursing education can improve learners' cognitive performance and psychomotor skills necessary for practice site proficiency.
These immersive simulations can be easily applied to practice competency requirements of experienced nurses, allowing them to maintain and upgrade their skills on demand.
From a cost perspective, simulation immersive learning offers cost savings associated with increased clinical confidence and ability, flexible learning schedules, and objective assessment of clinical skills. Haptic feedback and audio-visual cues create an interactive, life-like experience. However, it cannot replace in-person learning, and some students may not react well to it; faculty may find it burdensome and expensive (infrastructure, software, content, maintenance costs). Future controlled studies can determine the effectiveness of these modalities.
However, in a 2014 multi-site study, the National Council of State Boards of Nursing (NCSBN) concluded that high fidelity or quality simulation could safely replace up to 50% of direct patient contact clinical practicum hours in pre-licensure academic programs. This suggests that the rapidly advancing and ever-increasingly realistic simulation technology, supported by the NCSBN, may enable pre-licensure nursing students to learn practice setting nuances, increase clinical knowledge and skills, excel in critical thinking, and improve practice readiness.
Research on postgraduate APRN residency programs nationwide reveals inconsistent use of educational standards in delivering instructive content and non-accreditation of transition-into-practice residency programs. Findings suggest varied use of national accreditation competencies and inadequate evidence that residency programs successfully prepare APRNs to deliver quality care beyond graduate nursing education. Additionally, data suggests a diminished utilization of more expensive and complex low- or high-fidelity simulations or standardized patients, suggesting employers’ dependence on supervised practice hours. Employing advanced technology may supplement traditional delivery methods so dependent on expensive supervised practice hours.
How virtual learning platforms are preparing graduates
One of the main difficulties for new RN graduates in adjusting to the hospital environment is managing multiple patients with varying needs and problems.
Virtual learning platforms provide an excellent opportunity for student learning because they easily simulate the traditional hospital in-patient unit by focusing on multiple-patient management. By mimicking real-time patient management challenges, students learn prioritization and multi-tasking strategies applicable to the actual practice setting. As a result, the novice nurse better understands transition-to-practice performance expectations in preparation for the work environment.
Notably, virtual learning platforms assist in addressing numerous academic program challenges, including site-based clinical practicum hour limitations and objective competency and sub-competency assessment. Today’s platforms offer multi-patient scenario learning and target critical thinking and leadership development. With frequent simulation scenario practice in the academic setting, graduating novice and APRN students enhance competencies critical to a comfortable transition to their first practice setting.
There is a need for more hands-on skills and experience in inserting intravenous lines, drawing blood, inserting catheters, and more technological aspects of medication administration, such as programming various pump models. Respondents advocated for more challenging academic simulation scenarios and expanding simulation to include virtual reality and artificial intelligence.
In a similar survey of practice leaders, enhancing multi-patient intervention prioritization ranked high as an immersive learning scenario topic, as did patient assessments, medication administration, and management.
Multi-patient virtual hospital simulations for realistic practice
Virtual learning’s potential to prepare students for workplace realities suggests a transformational contribution to healthcare education.
A more realistic virtual hospital model with multi-patient simulations and changeable healthcare variables that increase complexity as the student advances can transform traditional academic practice, focusing on a one-patient-at-a-time virtual simulation.
In this virtual hospital, pre-licensure students experience a realistic hospital environment practicing scenario-based patient care similar to that expected in the practice setting. In addition to providing a safe, educational space for students, virtual hospital lab scenarios enable academic and practice partners to jointly assess student practice readiness, revise scenarios, and modify variables, to best prepare new graduates.
Required technology for the virtual hospital student or new graduate practice environment includes a semi-immersive (flat screen 3D or 2D) and a fully immersive (haptics) environment. Significant benefits include students experiencing a variety of patient case scenarios – up to four or five practice scenarios during one session. Faculty and practice partners can select scenarios for proficiency assessment based on relevant clinical courses and practice setting requirements.
Virtual hospital scenarios would likely include multi-patient assignments reflecting workplace practice expectations, varying patient acuity, and interdisciplinary collaboration. Challenging students with real-time clinical and operational problems in a safe environment will enable them to gain practice proficiencies that necessitate prioritization and multi-tasking in real-world hospital environments. Some of the endless possibilities include the dynamic, ever-changing environment of the intensive care unit, the challenges of running an operating room, emergency department triaging, performing complex clinical procedures, and monitoring critically ill patients.
By building layers of scenario complexity, an essential aspect of the virtual hospital, and updating content to reflect clinical and operational advances, the entire healthcare delivery system can eventually be simulated, assessed, and evaluated in this virtual environment. Likewise, transferring virtual learning technology to the outpatient and home care arena can prepare and improve the proficiency of nurses and non-nurses alike and provide users with a holistic learning experience.
If designed to mirror a partner’s practice setting, the virtual reality environment enhances new graduate nurses’ preparedness for a comfortable transition to the practice facility. With hospitals limiting student clinical practicum hours and the demand to integrate more objectively assessed competencies and sub-competencies, the simulated hospital environment offers a plausible alternative for student education and transition to practice partners’ practice settings.
Closing the academic-practice gap with technological advancements
Dramatic changes in the practice and academic landscapes shape today’s challenges and create new opportunities for academic-practice partnerships.
Fueled by technological advancements in immersive learning and the need to close the traditional academic-practice gap, virtual learning technology has emerged to invite educators and practice experts to fuse their ideas, resources, and responsibilities in mutually beneficial collaborative partnerships. Envisioned partnerships benefit all nurses, especially when these collaborations help to produce high-quality nursing graduates well-prepared to meet the clinical and business demands of nursing today.
We must capitalize on the benefits of simulation, artificial intelligence, and immersive learning to enhance new graduate practice readiness and transition to the workplace, improve nurse recruitment and retention, offer wider professional visibility, and promote greater unity within the nursing profession.
