Introduction

An important aspect of a virtual gaming simulation is the visual content. Actors bring life to the characters in your virtual simulation through their movements, gestures, emotions, voice (e.g., intonations, rhythm, intent, tempo), and interpretations of the client’s experience. They can make the enactment phase of the simulation memorable for the learners. Incorporating actors into virtual simulation can occur at various levels — through filming, images, and audio. With each of these modalities, actors can enhance the realism of your virtual simulation.

Reflecting back to Chapter 1, you want to infuse diversity into your virtual gaming simulation. Be sure to include a wide range of characters in your simulation that illustrates “different backgrounds, abilities and attributes including ethnicity, race, colour, religion, age, gender and sexual orientation” (Ontario Human Rights Commission, n.d.) when possible. Diversity in characters can be reflected in the client, family, and interprofessional healthcare team.

It is important for students to see a physical representation of themselves in their ideal professional role. For example, seeing the nurse look like them in the virtual simulation makes it realistic and more tangible for them to achieve this goal. Including diverse characters supports the importance of representation and helps to create a world in your virtual gaming simulation that is more reflective of the true diversity in our communities.

When filming your virtual simulation from a first-person point of view, you can only see the nurse’s arm and hear their voice. Diversity could be incorporated in the physical appearance of the arm, the tone of the voice, the name and pronouns that the nurse uses as they introduce themselves to the client. For other healthcare team members and/or clients in the scene, you can incorporate diversity at a larger scale.

When incorporating actors into virtual simulations, there are many benefits, as well as some limitations.

Benefits to Using Actors

• Actors can portray the complexity of human relationships, highlighting the authenticity of a situation/scenario.
• Project lead/director is able to guide the actions and behaviours portrayed and how the scenario unfolds. If any errors occur, you can refilm the scene.
• Actors can express intense and diverse emotions, and humanize the clinical experience. An actor can stimulate a visceral response from the learners by triggering feelings of compassion and empathy towards the client/scenario environment. This response by the learner can enrich the debrief process.
• The actors’ voice and physical actions highlight non-verbal communication through their subtle sounds, and expressions in their facial and body movements.
• You are able to see actor’s reactions to the various options the learners choose during their decision-making throughout the virtual gaming simulation.
• Able to perform realistic procedures, skills, and interactions (e.g., moving client, auscultating abdomen, other techniques) when providing simulated care.
• Can manipulate various procedures/skills to mimic real life with assistance through technology (e.g., adding abnormal heart or lung sounds) or adding moulage (e.g., creating wounds, incisions).
• Actors bring a sense of realism and increase the fidelity related to real-life environments (e.g., room, medical equipment) and clients (e.g., emotional and physical responses)
• Increases relatability for learners by engaging learners emotionally and cognitively.
• Actors are able to be flexible with their ability to perform multiple emotional responses during a scene.

(Allan, 2019; Bell et al., 2014; Ferrandini Price et al., 2018; Walsh, 2011; Webster, 2019)

Limitations of Using Actors 

• Unable to perform certain invasive procedures on an actor. For example, inserting an IV into the arm or a catheter. You can address this limitation by using a manikin body part.
• Emotional response from the actor may not reflect a real client’s response. A client’s emotional response in a given scenario can be varied. An actor’s response will only show one possible interpretation.
• Challenge to locate/recruit experienced, diverse actors for various parts (e.g., age, ability, culture, experience), especially with a limited budget.
• Various costs to hire actors (e.g., union, non-union, volunteers). Your budget will determine the type of actors you can hire for your virtual simulation.
• Skills of an actor vary, and can impact scenario realism and fidelity.
• Time commitment and training will depend on the experience of the actor. The project lead and content expert will need to train actors on the scenario’s focus and the overall learning objectives of the VGS (e.g., medical, emotional and behavioural reactions, equipment, posture, tone, physical presentation and appearance).

(Crow, 2012; Ferrandini Price et al., 2018; Jack et al., 2014; Tyerman et al., 2021)

Reflect on your goals regarding why and how you would like to incorporate actors into your virtual simulation. This will help you to achieve the full benefits of using actors and decrease the risk of potential limitations.

References 

Allan, C. (2019). Actors in nursing simulations: A balanced interdisciplinary approach. The Midwest Quarterly, 60(3), 290+.

Bell, S. K., Pascucci, R., Fancy, K., Coleman, K., Zurakowski, D., & Meyer, E. C. (2014). The educational value of improvisational actors to teach communication and relational skills: Perspectives of interprofessional learners, faculty, and actors. Patient Education and Counseling, 96(3), 381–388. https://doi.org/10.1016/j.pec.2014.07.001

Crow, K. M. (2012). Families and patients as actors in simulation: Adding unique perspectives to enhance nursing education. Journal of Pediatric Nursing, 27(6), 765–766. https://doi.org/10.1016/j.pedn.2012.08.003

Currie, J., & Heslop, D. (2022). Playing Sick and Injured: The Experiences of Undergraduate Nurses as Casualty Actors in a Mass Casualty Simulation Exercise. Clinical Simulation in Nursing, 62, 73–82.https://doi.org/10.1016/j.ecns.2021.08.005.

Ferrandini Price, M., Escribano Tortosa, D., Nieto Fernandez-Pacheco, A., Perez Alonso, N., Cerón Madrigal, J. J., Melendreras-Ruiz, R., García-Collado, Á. J., Pardo Rios, M., & Juguera Rodriguez, L. (2018). Comparative study of a simulated incident with multiple victims and immersive virtual reality. Nurse Education Today, 71, 48–53. https://doi.org/10.1016/j.nedt.2018.09.006

Jack, D., Gerolamo, A. M., Frederick, D., Szajna, A., & Muccitelli, J. (2014). Using a trained actor to model mental health nursing care. Clinical Simulation in Nursing, 10(10), 515-520. http://dx.doi.org/10.1016/j.ecns.2014.06.003

Ontario Human Rights Commission. (n.d.). Appendix B: Glossary. http://www.ohrc.on.ca/en/human-rights-and-policing-creating-and-sustaining-organizational-change/appendix-b-glossary

Tyerman, J., Ziegler, E., Carroll, B., & Luctkar-Flude, M. (2021). LGBTQI2S virtual simulation: Lessons learned using actors with lived experience. Clinical Simulation in Nursing, 54, 40–44. https://doi.org/10.1016/j.ecns.2021.01.016.

Walsh, M. (2011). Narrative pedagogy and simulation: Future directions for nursing education. Nurse Education in Practice, 11(3), 216–219. https://doi.org/10.1016/j.nepr.2010.10.006

Webster. (2019). Lights, camera, action: Lessons learned from a nursing and theater collaboration. The Journal of Nursing Education, 58(6), 369–371. https://doi.org/10.3928/01484834-20190521-10