Chapter 2: Virtual Simulation

Virtual Simulation

Another type of healthcare educational simulation that has significantly improved and that has become more widely available since 2014 due to cheaper technology, accessibility to computers, higher speed internet, and the fast-processing capabilities of computers are virtual simulation programs (Cant, Cooper, Sussex, & Bogossian, 2019). Virtual simulation is defined as a desktop computer-based simulation that provides “[a] simulation-based learning activity designed to provide an experience with inputs and outputs exclusively confined to a computer” (Lopreiato, 2016; Tsuda, Scott, & Jones, 2012, p. 7) whereas virtual reality is when haptic devices are used to transport and completely immerse the user in a digital environment (Lopreiato, 2016). Unlike manikin-based simulations, virtual simulations can be completed anywhere without needing to be physically present. The virtual simulation is not installed on the participant’s computer but rather the program is accessed through servers on the Internet. Nursing participants can access and complete these programs on their personal computer from anywhere as long as they have available access to the Internet.

When looking for a virtual product to fit nursing participant’s needs; explore possible options such as virtual products that are amenable to configuration. There are also many virtual products that are “off the shelf”, “ready to go” or “out of the box” as opposed to those that require customization and development which demands changes to the software code.

Virtual Simulation Modalities

The definition for virtual simulation has evolved since the 1980s and is generally interpreted in the literature as the use of a digital screen or computer (Foronda, Fernandez-Burgos, Nadeau, Kelley, & Henry, 2020). However, there are ongoing issues of clarity in the research literature where the term virtual simulation is used interchangeably with screen or computer-based, web-based, or game-based. Virtual simulations can be delivered as a two-dimensional (2D) computer-based virtual program or a three-dimensional (3D) virtual reality computer program.

Virtual Reality Simulation

Virtual reality is when haptic devices are used to transport and completely immerse the user in a digital environment (Lopreiato, 2016). Virtual reality simulation is a three-dimensional simulation where the participant wears 3D glasses. These glasses have a screen that covers more than 180 degrees of the participant’s field of vision and graphics are projected onto the screen of the glasses. The participants may also have handheld devices that allow them to perform some functions on the simulator. The simulator can be installed on the nursing participant’s personal computer or be available over the Internet from the simulation developer servers.

Mixed, Extended, or Hybrid Reality Simulation

Mixed reality is the merging of the real world with a virtual object (Frost et al., 2020) and is a new category of simulation that includes augmented reality and virtual reality. Mixed reality, hybrid or extended reality are becoming more common in simulation due to the availability and variety of virtual simulation modalities. Simulation facilitators can choose to use complementary simulation modalities to provide the best learning experience for nursing participants. For example, there are computer programs that can be linked via Bluetooth-enabled stethoscopes, and participants can use a static manikin to practice proper placement of the stethoscope while being able to hear realistic heart and breath sounds rather than the mechanical sounds that are presently produced by high fidelity manikins.

Mixed reality and three-dimensional (3D) printing technology are some of the latest contributions to simulation. 3D printing has become cheaper and nursing labs can use them to create their own partial task trainers such as injectable pads or anatomical body parts such as limbs for intravenous insertion.

Video Recorded Standardized Patient

In recent years, some facilitators undertook the task to create a ‘virtual’ product by using real people, video recording, and attaching some learning activity to it and then identified it as being a virtual simulation. Nursing participants are unable to interact with the patient on the video, therefore, their level of interaction with the patient is considered passive (Cant et al., 2019).

The difference in quality, specifically the acting and scripts, of these products that are not vetted by simulation experts needs to be addressed as it makes it problematic for reading and evaluating the research.