Background: Simulation is a widely accepted educational strategy used to create realistic patient care opportunities for nursing students in a safe learning environment (National League for Nursing, 2015). Further, the National Council of State Boards of Nursing (NCSBN) landmark study exploring the role and outcomes of simulation in pre-licensure nursing education across the United States, concluded that simulation can be used as a substitute for up to fifty percent of traditional clinical experiences when delivered in a way that is evidence based (Hayden, Smiley, Alexander, Kardong-Edgren & Jeffries, 2014). Currently, multiple modes of simulation are being used in various educational contexts to allow nursing students to apply theory into practice including the use of computers, low-to-high fidelity manikins, task trainers, standardized simulated patients, and standardized human patients. Unfortunately, many of the modalities used within simulation are expensive and not quantifiable in terms of return on investment. Newer technologies such as augmented reality (i.e., Microsoft Hololens ®) may be an answer to this dilemma. Augmented reality devices provide a computer-generated reality through the use of specialized ear and eyewear, which allow a student or group of students to experience a variety of visual and auditory stimulation. Overall, augmented reality devices are less expensive than traditional high-fidelity simulators, can be used anywhere and are technologically advanced (INACSL Standards Committee, 2016). However, its use has not been fully explored for reliability and validity within baccalaureate nursing education.
Purpose: The focus of this study will be to determine whether the use of a Virtual Standardized Patient delivered with the Microsoft Hololens ® can improve the knowledge, skill, and confidence of nursing students with regards to nursing assessment and intervention in a low-frequency, high-stakes scenario.
Methods: This quasi-experimental study will utilize the virtual standardized patient scenario for anaphylaxis, which is a low-frequency, high-stakes scenario developed by Microsoft Hololens ® as its augmented reality education treatment. The study sample will include over 150 pre-licensure medical-surgical students at the sophomore, junior, and senior-level at a large school of nursing on the West Coast. In addition, approximately 20 Registered Nurse-Bachelor of Science students at the university’s satellite campus will also participate in the study. After the theory for caring for a patient who is experiencing anaphylaxis has been reviewed in the classroom during the Fall 2017 semester, students will be randomly assigned to one of the following groups: 1). Full Dose-students who individually experience the anaphylaxis scenario utilizing the Microsoft Hololens ® technology, 2). Partial Dose-students watch a video of taped Microsft Hololens anaphylaxis experience from the student’s perspective, or 3). Control-students work through a written anaphylaxis case study. Following the experience, each student will have their knowledge regarding anaphylaxis, their nursing skill related to caring for a patient experiencing anaphylaxis, and their self efficacy (confidence caring for a patient with anaphylaxis) assessed using validated instruments. Analyses of variance will be conducted to examine differences among and between study groups. In addition, focus groups will be conducted to allow students to provide feedback on their experience with the Microsoft Hololens ®.
Implications for practice: According to the National League for Nursing (2015), nursing faculty should become experts in simulation. The NLN further denotes that nurse educators should strategically integrate simulation into curriculum with concrete connections to student learning outcomes. The debate exists regarding what technology is best, how the technology can be fully integrated to produce measurable student learning outcomes, and what is the right combination of simulation versus real-life clinical experience. This study helps bridge the gaps identified by the NLN. Newer technologies such as augmented reality (i.e., Microsoft Hololens ®) have the potential to transform nursing education. The technologies are less expensive than previous modalities, are mobile, and can provide a safe environment for students to improve knowledge, skill, and confidence with nursing assessment and proactive intervention in a low-frequency, high-stakes scenario. This study will provide quantitative and qualitative data not currently found in the literature regarding the reliability and validity of using an augmented reality virtual standardized patient simulation experience in nursing education. This data can be used by policy makers, educators, students, and clinical partners to better provide evidence-based teaching methodologies that prepare student nurses and licensed nurses to have the knowledge, skill and confidence in caring for low-frequency, high-stakes scenarios that can’t otherwise be practiced in real life.