Virtual reality-based training helps pediatric nurses identify respiratory distress

Key takeaways:

• Training via virtual reality led to better recognition of respiratory distress and impending respiratory failure.
• Virtual reality was also linked to increased recognition of altered mental status in patients.

Among new nurses, receipt of virtual reality-based training vs. usual orientation led to more correct identification of respiratory distress in pediatric patients, according to results published in American Journal of Critical Care.

Matthew W. Zackoff

“This further reinforces the need to invest time and energy towards supporting experiential training for clinicians, and that we cannot simply rely on time practicing clinically to gain the necessary experience and expertise,” Matthew W. Zackoff, MD, MEd, assistant professor of pediatrics in the division of critical care at the University of Cincinnati College of Medicine, told Healio.

In this study, Zackoff and colleagues analyzed 168 new nurses (54.2% aged 20 to 24 years; 88.7% women; 89.3% white) to find out if virtual reality (VR) training plus a standard orientation curriculum led to better recognition of respiratory distress and impending respiratory failure among pediatric patients as compared with a standard orientation curriculum alone. Results were evaluated at both 3 months and 6 months after receiving the training.

The group exposed to VR consisted of 83 nurses, and the control group (standard curriculum only) consisted of 85 nurses.

VR group participants experienced the virtual inpatient hospital setting and assessed the virtual patient through an Oculus Rift headset.

Main findings

Correct recognition of impending respiratory failure occurred significantly more frequently in the group of nurses who participated in the VR training vs. standard orientation alone at the 3-month mark (23.4% vs. 3%; P < .001). More nurses in the VR group also correctly identified this outcome when assessed 6 months after training (31.9% vs. 2.6%; P < .001), according to researchers.

At the 3-month mark, 57.8% of nurses in the VR group correctly identified respiratory distress, which was significantly higher than 29.6% of nurses in the standard orientation group who achieved this outcome (P = .002). Researchers observed a similar finding at 6 months after training, with more nurses in the VR group correctly identifying respiratory distress in pediatric patients (57.9% vs. 17.8%; P < .001).

“What was surprising was that the differences still existed at 6 months of clinical practice, and that time practicing clinically did not close that gap for the control group participants,” Zackoff said.

Additional findings

As an additional outcome, researchers evaluated which group was better at recognizing patients’ altered mental status and again found significantly more instances of correct recognition in the VR group vs. the standard orientation group alone at both time periods for patients with impending respiratory failure (3 months, 51.4% vs. 18.2%; P < .001; 6 months, 46.8% vs. 18.4%; P = .006).

Notably, the VR group was also better at correctly recognizing altered mental status among patients with respiratory distress; however, the difference was only significant at 3 months after training (37.5% vs. 14.8%; P = .006).

Significantly more nurses in the VR group correctly considered work of breathing in patients with impending respiratory failure at 3 months compared with the usual orientation group (97.3% vs. 84.8%; P = .01).

Researchers did not find a significant difference between the two groups at the 6-month mark when assessing correct recognition of the need for escalation of care among patients with impending respiratory failure.

When compared with performance assessments at 3 months, assessments at 6 months did not significantly differ in terms of correct identification of respiratory status, mental status or work of breathing in either group. However, in both groups, the rate of correct recognition of the need for escalation of care among patients with impending respiratory failure significantly dropped between 3 months and 6 months (VR, 71.6% vs. 42.6%; P = .001; usual orientation, 59.1% vs. 23.7%; P < .001).

“The exciting finding from this study was that it supported foundational theory as to how adults learn — through experience,” Zackoff told Healio. “This study demonstrated that VR was able to replicate real clinical care to the degree that participants were able to apply that experience to future clinical scenarios.”

Importantly, Zackoff added that these results are only possible if institutions take the step to improve training.

“Work like this can only be done at an institution that recognizes the need to invest in training its staff to provide the best care possible and is willing to provide the resources to have that training be impactful,” Zackoff said.

In terms of future studies, “the goal is to measure the impact of exposure to innovative experiential-based training on actual patient care outcomes,” Zackoff said.

Reference:

• VR curriculum improves PICU nurses’ assessment skills. https://www.aacn.org/newsroom/vr-curriculum-improves-picu-nurses-assessment-skills. Published March 1, 2024. Accessed March 5, 2024.