Exploring the Usability of Game-Based Virtual Reality for Development of Procedural Skills in Undergraduate Nursing Students

Providing safe, high quality patient care requires that undergraduate nursing students learn and apply extensive content knowledge as they also begin to develop clinical judgment. Nursing students must learn several procedural skills and be ready to remember and competently perform these skills when the need arises during patient care. Some procedures require strict adherence to aseptic technique in order to protect patients from hospital-acquired infections. Consequently, nurse educators are challenged to find innovative and interactive ways to help students develop and remember these important fundamental skills while ensuring patient safety. This study used a mixed methods design to explore the usability of, and user-reaction to, a game-based virtual reality (VR) system. The unique system combines headgear and haptics to place the nursing student in a patient’s room in order to practice inserting a urinary catheter virtually. The study also compared control and experimental participants’ time-on-task, number of procedures completed in one hour, and ability to demonstrate aseptic technique during urinary catheter insertion two weeks post-practice session. All study participants were given one hour to practice catheter insertion, either on a task trainer or virtually. User reactions to the VR game were observed during gameplay and collected via survey immediately after each individual VR game practice session. Subjects rated the system solidly in the Acceptable range using the System Usability Survey (Brooke, 1996) and between Good and Excellent when including a comparative adjective rating scale (Bangor, Kortum, & Miller, 2009). Inclusion of minimal game elements (points and a timer) motivated participants to continue to practice in order to improve their scores and procedure completion time, as well as engage in competition against their peers. Subjects in the experimental group spent more time practicing and completed more procedures than subjects in the control group and rated the experience as highly engaging and enjoyable. The pass rate at two week follow-up catheter insertion demonstration was 60% for both groups. Results of this study suggest that combining VR technology with game-based learning provides an innovative and useful way for students to practice procedural skills prior to performing the procedure on patients. The next iteration of the system will include an emphasis on providing clearer feedback to promote more accurate practice and should then be tested on larger numbers of students at multiple sites