The virtues of simulation in nursing education are well documented. Simulation is so highly effective that the National Council of State Boards of Nursing (NCSBN) determined nursing programs could replace up to 50 percent of traditional clinical practice with simulation.

High-fidelity simulation was predominant when that landmark study was conducted, but its strides were shortly eclipsed by the advent of computer-based virtual simulation. Today, newer technologies, such as extended reality (XR), provide even more authentic and experiential learning opportunities.

To explore the potential of extended reality as a teaching tool, I have invited Sentinel U® Thought Leadership Advisory Council member Michelle L. Aebersold, PhD, RN, CHSE, FAAN, to share her insight on this subject.
_____________________________________________________________________________________

Before one can delve too deeply into this topic, it’s important to define what we are talking about. Extended reality (XR) is an umbrella term for different modalities such as virtual reality (VR), augmented reality (AR) and mixed reality.

Multiple Modalities

It’s important to distinguish that when discussing XR, we are referring to immersive virtual reality viewed through a head-mounted display. This can include both software-generated imagery, like what is used in video games, and 360° video, which is basically what you see when using Google maps. For educational purposes, 360° video is becoming increasingly popular. I was privileged to create a series of 360° immersive videos for the University of Michigan to support health care providers when caring for military veterans.

Augmented reality is another component of XR. This is an overlay of digital content over a real-world environment. Chances are you are familiar with AR but might not realize it. Zoom and Instagram filters are a form of AR; so is the game Pokémon Go.

Mixed reality is a bit more complex and not as easy to define. As its name suggests, it’s a combination of VR and AR. The best way to explain mixed reality is that it mixes real-world content with digital content in a very interactive and immersive way. I consider it a really robust augmented reality, which makes it perfect for nursing simulation.

With mixed reality, the possibilities are endless. Using a product such as the Microsoft HoloLens, you have access to a computer in your periphery. This can provide visual access to documents or instruction manuals. When coupled with a manikin, mixed reality can guide users through a procedure. So, say you want to practice putting an IV into a patient. Mixed reality can place a digital overlay over the manikin arm and the onscreen guides can instruct you on the steps to properly perform the technique.

Enter the Metaverse

If you want to take your immersive experience to the next level, you will want to enter the metaverse. Facebook even changed its name to Meta to reflect its commitment to what it considers to be the future of the internet.

Essentially, the metaverse is a way of interacting with others in a virtual environment using digital representations, also known as avatars. Its uses are infinite. A company could build a virtual office in the metaverse, where employees could sit around a conference table (in their digital avatar forms) for a constructive meeting.

In terms of nursing, the metaverse provides the perfect place to hold debriefing sessions after a virtual simulation experience. Being immersed in a virtual environment, even if it’s avatar to avatar, helps heighten the level of participation. The metaverse creates a safe space, and the level of anonymity allows students to try things they might have been scared to do previously because it offers a once-removed experience.

The metaverse can also be used in the professional realm, particularly for training purposes. For instance, if you needed to teach hospital fire safety skills to a team of nurses, you could create an entire unit in the metaverse. In it, the nurse would go from room to room evacuating patients and they could also practice using a fire extinguisher. This meaningful exercise allows the user to develop a level of muscle memory that they would not necessarily gain otherwise through a lecture.

Of course, these benefits are not limited strictly to nursing education, and medical programs are tapping its potential. A study in the Journal of Educational Evaluation for Health Professions explored how XR and the metaverse are being used to successfully train doctors in South Korea to perform a delicate lung cancer surgery.

Holistic Approach to Nursing Education

XR is just one tool in our education toolbox, but it is highly effective. As nurse educators, we must first always evaluate our learning objectives before selecting the tool – in this case technology – that will best deliver that outcome. I do not think it is a choice of either/or as nursing education requires a mix of high-fidelity and virtual simulation. Ultimately, it’s about matching where XR and the metaverse best fit into nursing education. _____________________________________________________________________________________
Michelle L. Aebersold, Ph.D., RN, CHSE, FAAN, is a clinical professor at the University of Michigan School of Nursing. She is an XR (Extended Reality) Faculty Innovator in Residence through the University of Michigan XR Initiative at the Center for Academic Innovation and developed the Simulation Model to Improve Learner and Health Outcomes (SMILHO).