It is commonly known that physical access to care can be difficult for some patients. Nurses have begun to incorporate virtual world technology for efficient access to patients in practice with the goal of decreasing healthcare disparities, as well as patient morbidity and mortality rates (McNeal, 2014). This type of virtual access may promote improved clinical outcomes because more individuals may be able to access the nurse or healthcare provider. Patient care coaching in this virtual world format opens a new venue for patients to seek advice from a nurse (Miller & Jensen, 2014). With the likelihood of increased virtual reality for healthcare, it is important to determine whether patients would be accepting of this method of interaction. Whether group care in a large virtual room or individual care in a separate, private virtual room, patients may have differing opinions about this mode of communication. Thus, the purpose of the study was to determine comfort and ease of participation in a simulated, virtual nurse coaching session.
Addiction to devices and social media on the Internet has been shown to impact the users’ lifestyles and linked to psychosocial concerns (Sharma, Rao, Benegal, Thennarasu, & Thomas, 2017). In addition, negative consequences from technology overuse can impact persons behaviorally, affectively, and cognitively. Counseling interventions are discussed as methods to reduce effects of technology addiction and help patients find balance in connecting to the real world (Scott, Valley, & Simecka, 2017).
Design: This study design is a one-group, post-test quasi-experimental study in progress. Data collection is about 50% complete and expected to be finished by late spring 2019, with analysis complete by summer 2019. The simulated virtual world in this study is a computer-based environment that uses avatars to represent each subject and nurse. The “patient” avatars are assigned numerical names to protect subject anonymity. The “nurse” avatars use names such as Nurse Smith to better identify the caregiver.
Methods: After approval from the institutional review board, we obtained a convenience sample of subjects (n=30). Five simulated sessions were conducted over a period of one week. Each session ranged from 3 - 10 participants, a typical size range for a group office visit. Once assigned a participant number, participants were provided information about avatar operation, navigation in the virtual world, how to use the communication tools, and expected group interaction. Technology support was available throughout each session.
The study intervention is a simulated mock scenario of coaching for stress management related to technology addiction. The study sessions were conducted by a registered nurse who coached a sample of patients who, for the purpose of the study, identified as having technology addiction. Participants in each group were randomly assigned to low, moderate, and high levels of technology addiction, with accompanying levels of symptoms to report and discuss in an anonymous group format.
The researchers included one doctorally prepared business professor with technology expertise, two nurses with doctoral degrees, and one nurse with a master’s degree. This team collaborated to create the simulated scenarios and avatars. The simulated mock scenario for the levels of technology addiction and symptom education strategies were evidence-based and reflected current best practices.
Protocols for conducting the sessions were developed by the doctorally prepared nurses to assure accuracy and consistency among the nurse providers as they guided the group sessions. Several practice sessions were held among the nurse coaches to increase reliability and to enhance the comfort of the nurse coaches in this virtual clinic setting. A prior pilot study was conducted with 12 total participants in three sessions, leading to extensive revision of the simulated scenario for clarity and flow of the session.
After each 30 to 45-minute session, subjects were given the opportunity to complete a study-specific survey tool, developed and previously validated (Zahedi, Walia, & Jain, 2016; Walia, Zahedi, & Jain, 2017). This survey tool measured perceptions of trust in the online nurse, group effectiveness, willingness to use a simulated, virtual world setting for healthcare, and experienced ease in use of the avatar for obtaining coaching from the nurse on technology addiction. All participants thus far have completed the post-session survey.
Findings: Because this study is in progress, the abstract reflects preliminary findings available at this time; the poster will contain additional data per the timeline above. However, early findings have suggested that users are comfortable with the simulated mock scenarios presented to them for stress management related to technology addiction. Participants felt at ease communicating symptoms based on their randomly assigned level of addiction to technology as defined by frequency and severity of behaviors.
Conclusions: This study is limited in generalizability due to the convenience sample; however, we added rigor with the use of a large variety of diverse avatars and random assignment to technology addiction. Implications for research include further study with a larger sample of actors. The next step will be to invite actual patients who experience technology addiction. Also indicated is replication with different scenarios. The use of virtual worlds in nursing practice has implications for improving access to health and wellness care for a wide variety of populations. It may also be helpful to increase awareness of common challenges, educational needs, and health management strategies for specific populations related to a given illness or preventive measure.
Clinical Relevance: This is one of the first studies to use virtual worlds to provide group coaching sessions at a virtual medical facility. The early study findings suggest that participants are comfortable with nurses coaches aiming to reduce stress from technology addiction via wellness instruction and group discussion using the virtual simulation format. Given the rise of access to and increased use of technology, with subsequent potential for addiction, nurse coaching via virtual worlds has relevance to address this current clinical concern, and likely others as well.
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