Objective: As a result of terrorist threats, both military and civilian health care personnel will increasingly need to learn how to provide patient care in biological and chemical environments. The purpose of this study was to evaluate an improved method for training health care personnel to provide care to victims of biochemical terrorism. Virtual reality (VR) technology was proposed as a more realistic, hands-on type of training.
Design: A randomized, two group, quasi-experimental design was used for this study.
Population, Sample, Setting, and Years: Self-identified intravenous (IV) insertion experts were recruited from a major military medical center. The sample consisted of various levels of personnel including certified registered nurse anesthetists, anesthesiologists, senior level registered nurses, staff registered nurses, licensed practical nurses, and medics. Comparable IV experience levels and demographics were represented in the groups. Data were collected from January through April 2000.
Intervention and Outcome Variables: The experimental or intervention variable consisted of the Cath-Sim Intravenous Training System (VR group) compared to a standard intravenous infusion (IV) arm for teaching and achieving competence about IV insertion while wearing chemical protective clothing. Outcome measures included (a) a computer-generated score sheet measuring time to success and criterion success/non-success using the Cath-Sim; (b) time and success rating for the actual IV insertion on the IV arm model; and (c) a satisfaction evaluation completed by the participant. Demographics were also collected to provide descriptive data about participants.
Methods: After informed consent was obtained, participants were enrolled in the study. The overall training exercise was grounded in adult psychomotor learning principles, and the evaluation process was consistent with the model developed by Holzemer (1988) from the work of Donabedian (1981) and Chater (1975). Participants were tested at baseline, with and without protective clothing, in order to establish time ratings and success scores on both the VR and standard IV arms. Next participants were stratified according to their success levels with IV insertion and then randomly assigned to practice on either the Cath-Sim or the standard IV arm while wearing protective clothing. One week later, participants were tested again on both IV arm models while in protective clothing.
Findings: A final sample of 51 complete data sets was achieved for the study (VR group, n=26; standard IV arm group, n=25). Independent t-tests and chi square analyses revealed no significant differences between the VR and IV arm groups for time to success or success rate (slightly better for IV group). Only sixteen participants were successful on both the VR and IV baseline and final testing (VR group=8; standard IV=12). All sixteen participants had longer Cath-Sim times at the final testing. Fourteen of the sixteen participants improved IV arm times compared to Cath-Sim times. The IV group performed better on the Cath-Sim at final testing, but not in a significantly different manner. There were conflicting evaluation scores for recommending one IV training model over the other. Participants felt that there was some benefit to each model depending on the user, setting, and purpose.
Conclusions: The results of this project demonstrated no significant differences in success rates or times to success between the use of the virtual reality Cath-Sim model and the standard IV arm model for IV insertion while in protective clothing. Both advantages and disadvantages were noted with each model. Each model would suffice for particular types of training, such as use of the standard IV arm for training in field environments, and the Cath-Sim for ongoing or refresher training in fixed facilities. Realism was felt to be critical in perfecting IV skills under biochemical conditions. While the Cath-Sim, in contrast to the IV arm, offered increased realism in some cases, the general consensus was that additional improvements are needed in both training models to decrease artificiality and introduce more biochemical specific scenarios.
Implications: VR simulations such as Cath-Sim provide an alternative to standard IV training arms without ever leaving the classroom. The virtual reality simulator offers unlimited opportunities to experience and achieve competence before the biochemical casualty ever needs medical and nursing care. Additional testing and development of virtual reality is recommended as evidenced by the positive features identified by participants in this study, but adaptation of this model solely for biochemical training is not warranted at this time.
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