The COVID-19 pandemic has had a significant effect on the delivery of nurse training in higher education (Health Education England (HEE), 2020). This has mainly been caused by the changes to placement provision and placement capacity. In recognition of this, the new Nursing and Midwifery Council (NMC) recovery standards offer an additional 300 hours of simulated learning on top of the 2300 validated practical learning hours, or where clinical practice is not possible (NMC, 2021).
The additional simulation hours are considered an effective alternative way of learning (Royal College of Nursing (RCN), 2021). As an educational strategy, simulated practice is an opportunity for experiential and immersive learning. It is offered as a technique to replace or amplify real experiences with guided experiences, often immersive in nature, that evoke or replicate substantial aspects of the real world in a safe, instructive, and interactive fashion (HEE, 2020).
As a result of the pandemic, several third-year students, particularly those in mental health and learning disability, required additional training and assessment in Annexe B proficiencies (NMC, 2018) due to limited opportunities in placement. Virtual reality was used to teach and assess these students so they could complete their registration on time.
The purpose was to ensure students had appropriate educational opportunities, to maintain and improve students' practice learning experience, and to support the achievement of the physical health proficiencies and skills required by the NMC.
Virtual reality simulations show nursing students what it is like to be in a real-world clinical setting and what problems they may encounter there, helping them to develop skills, build confidence and demonstrate procedures. They were taught to use the equipment before the assessment and issued with individual licences to practise the scenarios at home or at a campus computer two weeks in advance.
In addition, supplementary, pre-recorded materials were provided to demonstrate skills, alongside clinical skills procedure documents and best practice guidelines. The virtual reality scenarios presented were an older male with an upper gastrointestinal bleed and a younger male with sepsis. The scenarios allowed the students to investigate the presenting complaint, patient history, situation-background-assessment-recommendation components, complete a National Early Warning Score chart, escalate to senior colleagues, access results and do a full A-E assessment comprising all medical assessments in parallel with NMC proficiencies and communication skills (2018).
Following the virtual reality scenario, students received a full set of analytics, identifying areas of good practice and areas for improvement.
In the evaluation, students made positive comments on this experience, including that using the virtual reality simulation helped them understand complex concepts. Students noted that this way of learning and assessment is particularly valuable to visual learners and those with specific processing and learning difficulties. They enjoyed the gamification aspect of the software. Students appreciated the opportunity to practise and build their skills and solidify their knowledge.
Feedback from our practice assessors and lecturers has been extremely positive. Most commented on the realism of the clinical setting, allowing students to fully immerse themselves in the environment.
Some students had difficulty accessing the software at home despite technical support. We have addressed this for future groups by including a virtual reality induction at the start of the academic year.
The goal of nursing education is to promote the application of theoretical knowledge in clinical practice. However, limited clinical practice time and the pandemic has reduced the opportunities for students to have clinical experience with real patients. In future, nurse training using virtual reality will require significant investment, but is essential, particularly in areas such as learning disability and mental health, where there are notable workforce shortages (Nuffield Trust, 2018).