Introduction With increasing use of virtual reality simulation (VRS) in nursing education, there is a paucity of research exploring learning outcomes following training with VRS as compared with traditional mannequin-based simulation. Given the resource intensive nature of mannequin-based simulation, especially for disaster education, understanding outcomes from newer technologies like VRS are needed. Methods A quasi-experimental design was used to examine the differences in learning outcomes for the disaster skill of decontamination, based on type of simulation. The study was framed by the National Leage for Nursing (NLN) Jeffries Simulation Theory, with participant outcomes identified by the framework (satisfaction, self-confidence and performance). Outcomes were measured using the NLN Student Satisfaction and Self Confidence in Learning scale and a Decontamination Checklist. Senior nursing students in the final semester of a baccalaureate nursing programme were recruited to participate during one of their scheduled laboratory days. Following a didactic presentation, students were randomly assigned to one of two treatment groups (VRS or mannequin-based simulation training) to learn the skill of decontamination. Results A total of 121 participants took part in the study. No statistically significant results were noted for any of the study outcomes: performance (accuracy and time), satisfaction and self-efficacy. Results of the study demonstrate that VRS is as effective as mannequin-based simulation in training participants for the skill of decontamination. Conclusions Simulation-based education experiences must be matched to learning outcomes and evaluated for effectiveness. As evidence emerges regarding use of newer technologies, like VRS, educators will have more options for providing students with opportunities that best match available resources.

ABSTRACT Objective This study examined differences in learning outcomes among newborn intensive care unit (NICU) workers who underwent virtual reality simulation (VRS) emergency evacuation training versus those who received web-based clinical updates (CU). Learning outcomes included a) knowledge gained, b) confidence with evacuation, and c) performance in a live evacuation exercise. Methods A longitudinal, mixed-method, quasi-experimental design was implemented utilizing a sample of NICU workers randomly assigned to VRS training or CUs. Four VRS scenarios were created that augmented neonate evacuation training materials. Learning was measured using cognitive assessments, self-efficacy questionnaire (baseline, 0, 4, 8, 12 months), and performance in a live drill (baseline, 12 months). Data were collected following training and analyzed using mixed model analysis. Focus groups captured VRS participant experiences. Results The VRS and CU groups did not statistically differ based upon the scores on the Cognitive Assessment or perceived self-efficacy. The virtual reality group performance in the live exercise was statistically ( P <.0001) and clinically (effect size of 1.71) better than that of the CU group. Conclusions Training using VRS is effective in promoting positive performance outcomes and should be included as a method for disaster training. VRS can allow an organization to train, test, and identify gaps in current emergency operation plans. In the unique case of disasters, which are low-volume and high-risk events, the participant can have access to an environment without endangering themselves or clients. ( Disaster Med Public Health Preparedness. 2019;13:301–308)

Adoption of virtual reality technology may be delayed due to high up-front costs with unknown returns on that investment. In this article, we present a cost analysis of using virtual reality as a training tool. Virtual reality was used to train neonatal intensive care workers in hospital evacuation. A live disaster exercise with mannequins was also conducted that approximated the virtual experience. Comparative costs are presented for the planning, development, and implementation of both interventions. Initially, virtual reality is more expensive, with a cost of $229.79 per participant (total cost $18 617.54 per exercise) for the live drill versus $327.78 (total cost $106 951.14) for virtual reality. When development costs are extrapolated to repeated training over 3 years, however, the virtual exercise becomes less expensive with a cost of $115.43 per participant, while the cost of live exercises remains fixed. The larger initial investment in virtual reality can be spread across a large number of trainees and a longer time period with little additional cost, while each live drill requires additional costs that scale with the number of participants.

Head-mounted displays (HMDs) and large area position tracking systems can enable users to navigate virtual worlds through natural walking. Redirected walking (RDW) imperceptibly steers immersed users away from physical world obstacles allowing them to explore unbounded virtual worlds while walking in limited physical space. In cases of imminent collisions, resetting techniques can reorient them into open space. This work introduces categorically new RDW and resetting algorithms based on the use of artificial potential fields that “push” users away from obstacles and other users. Data from human subject experiments indicate that these methods reduce potential single-user resets by 66% and increase the average distance between resets by 86% compared to previous techniques. A live multi-user study demonstrates the viability of the algorithm with up to 3 concurrent users, and simulation results indicate that the algorithm scales efficiently up to at least 8 users and is effective with larger groups.

Immersive Virtual Environment systems that utilize Head Mounted Displays and a large tracking area have the advantage of being able to use natural walking as a locomotion interface. In such systems, difficulties arise when the virtual world is larger than the tracking area and users approach area boundaries. Redirected walking (RDW) is a technique that distorts the correspondence between physical and virtual world motion to steer users away from boundaries and obstacles, including other co-immersed users. Recently, a RDW algorithm was proposed based on the use of artificial potential fields (APF), in which walls and obstacles repel the user. APF-RDW effectively supports multiple simultaneous users and, unlike other RDW algorithms, can easily account for tracking area dimensions and room shape when generating steering instructions. This work investigates the performance of a refined APF-RDW algorithm in different sized tracking areas and in irregularly shaped rooms, as compared to a Steer-to-Center (STC) algorithm and an un-steered control condition. Data was generated in simulation using logged paths of prior live users, and is presented for both single-user and multi-user scenarios. Results show the ability of APF-RDW to steer effectively in irregular concave shaped tracking areas such as L-shaped rooms or crosses, along with scalable multi-user support, and better performance than STC algorithms in almost all conditions.

Virtual reality users wearing head-mounted displays can experience the illusion of walking in any direction for infinite distance while, in reality, they are walking a curvilinear path in physical space. This is accomplished by introducing unnoticeable rotations to the virtual environment-a technique called redirected walking. This paper gives an overview of the research that has been performed since redirected walking was first practically demonstrated 15 years ago.

AIM:The aim of the study was to assess two levels of immersive virtual reality simulation (VRS) to teach the skill of decontamination.BACKGROUND:Little is known about the use of VRS in providing disaster education, including retention.METHOD:Quasiexperimental design with repeated measures, supplemented by qualitative data, using a convenience sample of senior baccalaureate nursing students (n = 197) from four Midwest campuses was used. Students were randomly assigned to a group (two levels of immersive VRS and a control group) to learn the skill of decontamination. Cognitive learning, performance, and performance time were measured pre/post and at six months.RESULTS:Outcome measures were significant with immediate postintervention improvements and lower retention scores at six months. No significant differences were noted between groups. Students were satisfied with the VRS but found immersive VRS more interactive.CONCLUSION:VRS provides another alternative for simulated learning experiences; best practice approaches for its use still need to be explored.

Presents paper reviewers for the 2018 Virtual Realty Conference.

AIM:The purpose of this study was to examine the longitudinal effects of virtual reality simulation (VRS) on learning outcomes and retention.BACKGROUND:Disaster preparation for health care professionals is seriously inadequate. VRS offers an opportunity to practice within a realistic and safe environment, but little is known about learning and retention using this pedagogy.METHOD:A quasiexperimental design was used to examine the use of VRS with baccalaureate nursing students in two different nursing programs in terms of the skill of decontamination.RESULTS:Results indicate that VRS is at least as good as traditional methods and is superior in some cases for retention of knowledge and performance of skills.CONCLUSION:VRS may provide a valuable option for promoting skill development and retention. More research is needed to determine how to prepare nurses for skills that may not be required until months or even years after initial introduction.

Background: Development of virtual reality simulations requires an interprofessional team, but effective communication is inhibited by a lack of structured methods for sharing information. A review of the literature found a paucity of tools available for virtual reality storyboard development. This paper's purpose is to provide an overview of the storyboard process developed by an interprofessional team of researchers studying Neonatal Intensive Care evacuation.Method: Using Standards of Best Practices in Simulation and Jeffries model as framework, the researchers developed processes and templates for storyboarding.Results: The outcomes provide a vehicle for simulation development based upon best practices.Conclusions: The storyboard format that includes objectives, scenes, actions, challenges, redirection and opportunity to debrief, enabled the interprofessional team to build a virtual simulation that is reflective of best practices and the Neonatal Intensive Care evacuation scenario. (C) 2016 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.

Disaster training is crucial to the mitigation of both mortality and morbidity associated with disasters. Just as clinical practice needs to be grounded in evidence, effective disaster education is dependent upon the development and use of andragogic and pedagogic evidence. Educational research findings must be transformed into useable education strategies. Virtual reality simulation is a teaching methodology that has the potential to be a powerful educational tool. The purpose of this article is to translate research findings related to the use of virtual reality simulation in disaster training into education practice. The Ace Star Model serves as a valuable framework to translate the VRS teaching methodology and improve disaster training of healthcare professionals. Using the Ace Star Model as a framework to put evidence into practice, strategies for implementing a virtual reality simulation are addressed. Practice guidelines, implementation recommendations, integration to practice and evaluation are discussed. It is imperative that health educators provide more exemplars of how research evidence can be moved through the various stages of the model to advance practice and sustain learning outcomes.

Nurses must be prepared to care for patients following a disaster, including patients exposed to hazardous contaminants. The purpose of this study was to examine the use of virtual reality simulation (VRS) to teach the disaster-specific skill of decontamination. A quasi-experimental design was used to assign nursing students from 2 baccalaureate nursing programs to 1 of 2 groups to learn the disaster skill of decontamination-printed written directions or VRS. Performance, knowledge, and self-efficacy were outcome measures. Although students in the treatment group had significantly lower performance scores than the control group (p = 0.004), students taking part in VRS completed the skill in a significantly shorter amount of time (p = 0.008). No significant group differences were found for self-efficacy (p = 0.172) or knowledge (p = 0.631). However, students in the VRS treatment group reported high levels of satisfaction with VRS as a training method. The disaster-specific skill of decontamination is a low-volume, high-risk skill that must be performed with accuracy to protect both exposed patients and providers performing decontamination. As frontline providers for casualties following a disaster event, emergency nurses must be prepared to perform this skill when needed. Preparation requires cost-effective, timely, and evidence-based educational opportunities that promote positive outcomes. Further investigation is needed to determine the benefits and long-term effects of VRS for disaster education.

Nurses must be prepared to care for patients following a disaster, including patients exposed to hazardous contaminants. The purpose of this study was to examine the use of virtual reality simulation (VRS) to teach the disaster-specific skill of decontamination. A quasi-experimental design was used to assign nursing students from 2 baccalaureate nursing programs to 1 of 2 groups to learn the disaster skill of decontamination—printed written directions or VRS. Performance, knowledge, and self-efficacy were outcome measures. Although students in the treatment group had significantly lower performance scores than the control group (p = 0.004), students taking part in VRS completed the skill in a significantly shorter amount of time (p = 0.008). No significant group differences were found for self-efficacy (p = 0.172) or knowledge (p = 0.631). However, students in the VRS treatment group reported high levels of satisfaction with VRS as a training method. The disaster-specific skill of decontamination is a low-volume, high-risk skill that must be performed with accuracy to protect both exposed patients and providers performing decontamination. As frontline providers for casualties following a disaster event, emergency nurses must be prepared to perform this skill when needed. Preparation requires cost-effective, timely, and evidence-based educational opportunities that promote positive outcomes. Further investigation is needed to determine the benefits and long-term effects of VRS for disaster education.

We describe WeaVR, a computer simulation system that takes virtual reality technology beyond specialized laboratories and research sites and makes it available in any open space, such as a gymnasium or a public park. Novel hardware and software systems enable HMD-based immersive virtual reality simulations to be conducted in any arbitrary location, with no external infrastructure and little-to-no setup or site preparation. The ability of the WeaVR system to provide realistic motion-tracked navigation for users, to improve the study of large-scale navigation, and to generate usable behavioral data is shown in three demonstrations. First, participants navigated through a full-scale virtual grocery store while physically situated in an open grass field. Trajectory data are presented for both normal tracking and for tracking during the use of redirected walking that constrained users to a predefined area. Second, users followed a straight path within a virtual world for distances of up to 2 km while walking naturally and being redirected to stay within the field, demonstrating the ability of the system to study large-scale navigation by simulating virtual worlds that are potentially unlimited in extent. Finally, the portability and pedagogical implications of this system were demonstrated by taking it to a regional high school for live use by a computer science class on their own school campus.