In the realm of healthcare, where errors can have dire consequences, embracing curated trial-and-error simulations is important. Basically, in the realm of Virtual Reality (VR) holds immense potential for reducing patient risk in high-acuity scenarios. Furthermore, with a growing shortage of nursing faculty and an aging nursing workforce approaching retirement, virtual reality simulations offer a viable solution to bridge the gap between aspiring nurses in need of supervised clinical experiences and time-pressed preceptors. Especially, when they juggle patient care responsibilities alongside mentoring novices in clinical settings.
The contemporary healthcare landscape is marked by a critical shortage of skilled nurses. Moreover, it is compounded by pandemic-related burnout and an aging nursing workforce. A glaring issue is the fact that most licensed nurses do not possess the readiness required for patient care.
In 2015, approximately 23% of novice nurses met the competency standards for entry-level clinical judgment. However, this percentage has alarmingly dwindled to a mere 9%, as reported by a study in the Online Journal of Issues in Nursing. This decline in competency standards occurs at a time when nurses are expected to shoulder an increasing patient load. Chiefly, due to the baby boomer generation requiring care for complex medical conditions. It was indicated by an annual survey conducted by a nurse staffing company.
In response to this urgent need, we must produce more qualified nurses at an accelerated pace. Nurses play a pivotal role in providing feedback to guide patient care plans and optimize the utilization of healthcare providers’ time with patients. The challenge lies in providing nurse learners with opportunities to practice making critical, potentially life-altering decisions in high-acuity environments, where failure is not an option, akin to the Apollo 13 rescue mission.
Fortunately, we possess the means and tools to make a significant difference. The role of a nurse has evolved significantly in recent years, emphasizing the need to act as the eyes and ears of the entire healthcare team. Healthcare providers often have limited time with patients, whereas bedside nurses are present throughout the day, allowing them to observe trends in patient conditions, communicate assessment findings, and recommend interventions for the patient’s benefit.
Importance of clinical judgment in nursing
The National Council of State Boards of Nursing (NCSBN) defines clinical judgment as an iterative decision-making process. In this process nurses observe and assess clinical situations, prioritize client needs, and generate evidence-based solutions to ensure safe client care. Notably, research reveals that nurses were involved in 50% of patient errors, with 65% of these errors attributed to a lack of clinical judgment. These statistics are a driving force behind the recent changes to the 2023 NCLEX nurse licensing examination. Also, the exam places greater emphasis on assessing clinical judgment.
While clinical rotations offer students opportunities to develop clinical judgment, these experiences are primarily observational. Therefore, securing suitable placements can be challenging, especially during the height of the pandemic. As during this time, the rotations were limited for both patient and learner safety.
How to develop clinical judgment
The NCSBN Clinical Judgment Measurement Model (NCJMM) outlines six cognitive steps for developing clinical judgment, which include recognizing cues, analyzing cues, prioritizing hypotheses, generating solutions, and evaluating outcomes. However, when taking nurses into clinical settings, educators often find that many patients remain stable throughout the entire 12-hour shift. In the rare event of patient instability, the supervising nurse typically intervenes, leaving students with limited opportunities to exercise and develop their own clinical judgment. Although such experiences are valuable, they do not provide a safe space for trial-and-error learning.
The role of VR
Virtual reality (VR) simulation emerges as a valuable solution to this challenge. VR offers a safe and controlled environment with a multitude of practice scenarios, eliminating the risk of patient harm. Nursing students can engage in curated, structured opportunities to apply the six critical steps that underpin robust clinical judgment. Immersive VR, facilitated through headsets, allows learners to interact with diverse patients in unique situations, practice therapeutic communication, and self-reflect on their patient care approaches. Thus, these virtual experiences serve as a foundation for developing clinical judgment. Hence, empowering students to draw upon this rich repository of scenarios when making real-life decisions.
Importantly, virtual reality simulations not only permit but actively encourage students to make mistakes. These mistakes become invaluable “a-ha!” moments that enable students to identify errors. Also, discuss alternative approaches with their instructors, and devise strategies for future improvements. Given the scarcity of nursing faculty and the impending wave of retirements among experienced preceptors, VR simulations emerge as a powerful tool to bridge the gap. VR offers critical feedback on performance gaps, promoting reflection, and fostering engagement with unfolding cases.
Example of Virtual Reality
However, it’s essential to acknowledge that immersive VR may not be suitable for every scenario. Learning objectives must be carefully considered. For instance, if the goal is to teach learners how to perform CPR, manikins remain advantageous because VR currently lacks the capability to replicate the tactile feedback (depth and recoil) associated with chest compressions. Nevertheless, when the aim is to assess a distressed patient and practice therapeutic communication, VR shines by allowing patients to make eye contact and display dynamic facial expressions. Patients within VR simulations evolve realistically, mimicking the dynamic nature of real-life patient encounters. They do this without the need for reprogramming or additional enhancements. Immersive VR, with its headsets, engenders a high level of presence and suspension of disbelief. Thus, making the multisensory experience feel authentic.
In essence, different simulation modalities, such as manikins and VR simulations, can coexist harmoniously to provide students with a diverse range of learning experiences. These can prepare them to make swift, well-informed decisions and engage empathetically with patients. Educators can select the modality that aligns best with their learning objectives, available resources, and educational spaces.
Virtual reality serves as a valuable tool for nurses to develop essential skills in communication, prioritization, and clinical judgment. Institutions like the Mennonite College of Nursing in Illinois have already recognized the potential of VR-equipped simulation centers. Thus, signaling a broader trend in the adoption of VR solutions. By offering a multitude of evidence-based, lifelike patient scenarios and interactive simulations, VR enables nursing students to enhance their cognitive, affective, and psychomotor skills. All the while honing the essential steps of the clinical judgment process. Well-prepared nurses, who have honed their skills through virtual reality simulations are on the rise. They are emerging as more confident and competent decision-makers upon graduation, ultimately contributing to improved patient care outcomes.
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