Virtual Immersive Environments, Situtional Awareness, and Critical Thinking

Monday, 22 July 2013: 11:05 AM

Marisa L. Wilson, DNSc, MHSc, RN-BC
Organizational Systems and Adult Health, University of Maryland School of Nursing, Baltimore, MD

Learning Objective 1: Compare and contrast gaming theory and situational awareness as models of learning using virtual immesive environments.

Learning Objective 2: Assess usability and situational awareness of two enviroments.


Nurse educators focus on student acquisition of knowledge; however, nurses must know how to use that knowledge in practice.  Benner et al indicate that teaching strategies, such as situational cognition and thinking in action, are essential in classrooms, simulation laboratories, and clinical settings. The purpose of this mixed methods study was to determine the usability and utility of a virtual immersive environment (VIE) for nursing educators to use as an adjunct to high fidelity simulation, standardized patients, and direct clinical learning in order to accomplish thinking in action. 


A convenience sample of 5 nurse educators  participated in a test of a VIE simulation of an inpatient scenario with a complaint of shortness of breath and chest pain.   The participants evaluated the environment for usability using the System Usability Scale (SUS), a 10 item Likert scale. The participants provided feedback via “think aloud” and focus group on the Situational Awareness (SA) of the scenario.  Decision making regarding the scenario was analyzed via measuring SA via Situation Awareness Global Assessment Tool (SAGAT).   


Utilizing the SUS, the mean usability score was 68.5.  A SUS score above 68 indicates acceptable usability but may not indicate acceptability to use the product.  Focus group and “think aloud” results provided information on increasing acceptability of the VIE as an education tool beyond usability. 


The virtual immersive environment can be a usable strategy to potentially increase situational cognition and thinking. However, the VIEs must be built to increase the acceptability of the tool for educators.  Some important concepts/functions to consider are: 1) ease of ambulation within the environment; 2) realism of the scenario; 3) ability to get a reaction and to be able to reassess after an intervention; 4) interactive Help; and 5) interdisciplinary team members with whom to interact in the VIE.