Student Learning and Virtual Reality: The Embodied Experience

CSU Channel Islands (CSUCI) faculty made the decision to dive into virtual reality (VR) with a focus on student learning outcomes. Whereas we saw other campuses focus on research and development, we chose to use available resources to learn about the ways VR can impact student learning. Specifically, we explored the potential for how virtual reality can help create a more empathetic nurse, which, we hypothesize, will lead to increased development of nursing students' knowledge, skills, and attitudes. We aim to integrate these virtual experiences into early program coursework, with the intent of changing nursing behavior by providing a deeper understanding of the patient's perspective during clinical interactions.

In partnership with Embodied Labs, 77 nursing students individually "embodied" Alfred, a 74-year-old African American male with macular degeneration and hearing loss. Using an Oculus Rift VR headset, each student is immersed in the environment where they interact with characters and objects in the virtual space. Alfred is initially with his family, celebrating his birthday in the dining room. Surrounded by five family members, commentary is hard to hear, and there is a large black spot in the center of his vision. Alfred accidentally knocks over his drink at the table, causing a disruption and drawing frustrated looks from family members.

The scene transitions to a physician appointment, which brings us from the waiting room to the office visit. Throughout the visit, Alfred struggles with audio interpretation and visual obstruction. When asked to complete a pencil and paper test, students embodying Alfred labor to successfully complete the tasks on the form. Alfred meets with the physician for test results and discovers his hearing is significantly improved after wearing hearing aids.

Junior (n = 41) and senior (n = 36) pre-licensure nursing students completed surveys before and after the experience. Initial responses were indicative of the potential for VR in coursework:

"I learned that up until this point, we could read symptoms and books and perform simulations with patients in the lab, but very few experiences have allowed us to embody and be aware of the sensory deficits of degenerative diseases."

"It was really a wonderful and eye-opening experience that made me appreciate that I am healthy, don't have any visual/hearing impairments, and all my senses are functioning. I think as a nurse remembering to have empathy and putting yourself in the shoes of the patient will allow healthcare providers to become the best at caring for a patient."

Senior students (n = 34) also embodied Beatriz, a middle-aged woman with newly diagnosed Alzheimer's disease (AD). Through the lens of Beatriz, students advanced through three scenarios, which took them from early to late stages of AD. As Beatriz, students first explored the AD-affected brain. The scenario continued as students had to contend with Beatriz's inability to keep track of time, feeling a sense of confusion and frustrated as she struggled with language processing. Ultimately, students experience the feelings associated with watching caregivers strain with her care and the inevitable burden on the family. CSUCI student responses from before and after surveys reflected the powerful impact of the experience:

"It was really valuable to experience the sensory deficits that a person with Alzheimer's may have. I was surprised by how much hearing and vision were impaired. Experiencing the difficulties this disease may bring was really uncomfortable, but I know it will stick in my memory."

"I learned just how much this disease really affects someone's life. I got so emotional at the end because Beatriz could not communicate and hardly recognized her own family. It was heartbreaking. I feel that I can offer more compassionate care to patients who experience this because I got to see a little glimpse of what they go through."

"I thought it was a very realistic experience to see what the patient with Alzheimer's sees from their end of care. It is a scary experience for an individual. You also get to see how it affects the family process from this virtual experience as well. A little bit of brain education too!"

"I got a small taste of what it would feel like to progress through the stages of Alzheimer's disease. I didn't realize that they experienced visual and auditory disturbances to the extent they do. In the later stages, I couldn't understand most of the words people were saying. It must be really confusing and frustrating for people progressing through Alzheimer's."

Evidence of the powerful impact of the virtual reality experience was observed the week after students embodied Alfred. Nursing students in clinical rotations on the cardiac unit gave their report as usual, but this time, the reporting consistently included patients who had hearing or vision loss. In the weeks prior to embodying Alfred, students' clinical reports focused solely on the reason for admission, understanding of the disease process, and medications rather than on any evidenced awareness of hearing or vision loss. After the Alfred exercise, students included hearing and vision as a priority, clearly indicating a positive shift to patient-experience-centered care. With hospitals striving to improve the patient experience, this approach to teaching the patient perspective has the potential to greatly impact the type and quality of care provided by graduates of the CI nursing program.

In addition to these compelling student reflections and the nearly immediate change in reporting practice, survey findings show that students unanimously felt that this type of patient-perspective VR experience should be integrated and become a staple of the nursing curriculum. Seeing, hearing, and feeling these moments results in significant and memorable learning experiences compared to traditional classroom learning alone. The potential that this type of immersive experience can have in the field of nursing and beyond is only limited by the imagination and creation of other virtual experiences to explore. We look forward to continued exploration of the impact of VR on student learning and to establishing ongoing partnerships with developers.

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Jaime Hannans is Associate Professor of Nursing at California State University Channel Islands.

Jill Leafstedt is Executive Director of Teaching and Learning Innovations at California State University Channel Islands.

Talya Drescher is Assistant Professor of Education at California State University Channel Islands.