- Email: [email protected]
Developing a Virtual Simulation Game for Nursing Resuscitation Education
Clinical Simulation in Nursing (2020) 39, 51-54
www.elsevier.com/locate/ecsn
Innovations in Simulation
Developing a Virtual Simulation Game for Nursing Resuscitation Education Evan Keys, MNSc, RNa,*, Marian Luctkar-Flude, PhD, RNa, Jane Tyerman, PhD, RNb, Kim Sears, PhD, RNa, Kevin Woo, PhD, RNa a b
School of Nursing, Queen’s University, Kingston, Ontario K7L 3N6, Canada School of Nursing, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada KEYWORDS ACLS; BLS; cardiac arrest; cardiac resuscitation; cardiopulmonary resuscitation; clinical simulation; CPR; nursing education; nursing innovation; resuscitation science; serious game; serious games; ventricular fibrillation; virtual simulation game; virtual simulation gaming
Abstract: Virtual simulation gaming (VSG), also known as educationally purposeful gaming, is a new and innovative teaching method which warrants further exploration. In 2018, researchers from Queen’s University in Kingston, Ontario, Canada, created an innovative VSG depicting optimal nursing care for patients in cardiac arrest secondary to ventricular fibrillation. This educational tool was created in response to global calls for increased education in the field of resuscitation science. This VSG complements a growing collection of educational games created by CAN-SimÓ to best help students and experienced learners meet their educational goals. Cite this article: Keys, E., Luctkar-Flude, M., Tyerman, J., Sears, K., & Woo, K. (2020, February). Developing a virtual simulation game for nursing resuscitation education. Clinical Simulation in Nursing, 39(C), 51-54. https://doi.org/10.1016/j.ecns.2019.10.009. Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Disclosures: None of the authors have any financial disclosures. However, 4 authors are affiliated with the Canadian Alliance for Nurse Educators Using Simulation (CAN-SimÓ) mentioned in the body of this manuscript. Ethical approval: Ethical approval was obtained from the Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (File # 6024874). Funding: This innovation in simulation did not receive any specific funding. Conflict(s) of interest: The authors declare no financial conflict of interest in publishing this article. * Corresponding author: [email protected] (E. Keys).
Caring for patients in cardiac arrest can be stressful for students and experienced members of the healthcare team. Despite advances in care, outcomes remain poor for persons who experience in-hospital cardiac arrest. Between 2000 and 2014, only 16.8-20.6% of such patients in the United States survived to discharge from hospital (Ofoma, Basnet, Berger, Kirchner, & Girotra, 2018). Quality of patient care and patient outcomes improve when healthcare providers are adequately educated and competent in providing cardiac resuscitation (Vincelette, Quiroz-Martinez, Fortin, & Lavoie, 2018). This is especially true for nurses, who are often the most likely providers to first encounter a patient in cardiac arrest (Vincelette et al., 2018).
1876-1399/$ - see front matter Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2019.10.009
Virtual Simulation in Resuscitation Education Resuscitation of patients in cardiac arrest is complex and coordinated; high-quality care among members of the healthcare team has been shown to significantly improve patient outcomes (Heart and Stroke Foundation of Canada [HSFC], 2015). Unfortunately, for many undergraduate nursing students and new graduate Key Points nurses, adequate education Virtual simulation on caring for patients in gaming is a costcardiac arrest is not always effective, accessible, provided (Kim & Roh, engaging, and self2016). In addition, pracdirected platform that tising nurses often struggle enables students to to retain their knowledge learn in a low-stress, of basic life support nonjudgemental (BLS) and Advanced Carenvironment. diovascular Life Support There is a need for an (ACLS) guidelines (Smith, increased focus on the Gilcreast, & Pierce, efficacy of cardiac 2008). Therefore, an resuscitation educational solution is ureducation. gently needed to ensure Virtual simulation students, new graduates, gaming may be beneand experienced clinicians ficial in assisting are equipped to provide learners to better unthe highest quality of paderstand resuscitation tient care. concepts. An innovative teaching tool, virtual simulation gaming (VSG), also known as ‘serious games’ (Tan et al., 2017), is becoming increasingly popular to address this knowledge gap. A VSG is ‘‘an interactive computer application, with or without significant hardware component, that has a challenging goal, is fun to play and engaging, incorporates some scoring mechanism, and supplies the user with skills, knowledge, and/or attitudes that are useful in reality’’ (Tan et al., 2017, p. 39). VSG provides students with an educationally purposeful opportunity to apply theoretical concepts in a simulated clinical environment that is safe, allowing for learning through error while promoting self-directed learning. As detailed in Ericsson, Krampe, and Tesch-R€ omer’s (1993) theory of deliberate practice, expert performance can be traced back to practice which involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behaviour. As addressed by Yockey and Henry (2019), students often experience high levels of simulation anxiety. VSG addresses many of the recommendations made by Yockey and Henry (2019) to decrease simulation anxiety. With VSG, learners’ academic and psychological safety is protected, and they are encouraged to explore the subject matter more deeply without the fear of judgement or repercussion common to clinical simulation.
52
Innovation in Simulation In 2018, researchers at Queen’s University in Kingston, Ontario, Canada, developed a VSG in resuscitation science. The need for a VSG on care for patients in cardiac arrest was identified because of the importance of quality care during situations involving patients in cardiac arrest (Ofoma et al., 2018) and the lack of quality education being provided (Kim & Roh, 2016). An initial search found that most currently available VSGs were either cost prohibitive, costing as much as $120 USD per student, restricted to only the content creators, lacked generalisability outside of the United States, or were too primitive to provide learners with an immersive educational experience due to a lack of realism. Therefore, the creators developed an openaccess interprofessional cardiac resuscitation VSG that provided learners with a realistic portrayal of the expectations of care during resuscitation efforts based on the HSFC’s (2015) guidelines.
VSG Design and Creation In accordance with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation Design (2016), and the HSFC-endorsed BLS and ACLS guidelines (2015), the creators developed learning outcomes which served as the basis for focused, preselected, decision points with corresponding responses. The video scripting was prepared by content experts to ensure accuracy and relevancy within the Canadian healthcare context. The video portions of the game were filmed using GoProÒ technology and included a high-fidelity manikin as the surrogate patient in cardiac arrest, a manual training defibrillator to portray energy delivery, and standard simulated medications. VSG assembly used ArticulateÒ software and a predeveloped Canadian Alliance of Nursing Educators Using Simulation (CAN-Sim)Ó game template which integrated edited filmed clips corresponding to predetermined decision points and written rationales to enhance learning. The creators of the VSG are content experts in nursing education and emergency nursing as well as simulation design, facilitation, and evaluation. The lead author is an experienced emergency nurse with involvement in simulation training for nursing students, emergency residents, and emergency physicians. The coauthors are all assistant or associate professors at academic institutions. The third author is a current BLS, ACLS, and Paediatric Advanced Life Support instructor and the second and third authors serve as copresidents of CAN-SimÓ.
VSG Content The VSG depicts the collaborative actions of an interprofessional healthcare team attempting ACLS for a patient pp 51-54 Clinical Simulation in Nursing Volume 39
Virtual Simulation in Resuscitation Education experiencing ventricular fibrillation. The focus on a shockable rhythm supports all learning objectives set out for cardiac arrest care, including instructions on the safe use of a defibrillator. The VSG is filmed from the perspective of the nurse who first encounters the patient. This helps provide an immersive experience for the learners and provides realism to the portrayal (Gorisse, Christmann, Armand Amato, & Richir, 2017), which is a key guideline of the INACSL (2016) standards. A patient report is provided, outlining current and relevant information. The learner is then immersed within a simulated resuscitation environment where they are required to function as part of the resuscitation team. Learners are then prompted to respond to a series of multiple-choice critical thinking questions with three response options. Each potential answer details a unique direction for the patient’s care and changes with each question. If learners make the correct decision, they are shown a video clip depicting the results of their actions and a written rationale on why their decision was correct. Correct responses then advance learners to the next video and decision point. If learners make an incorrect decision, they are also shown a video depicting the results of their actions and a written rationale on why their decision was incorrect. Learners are then redirected to select a more appropriate response to the question. On completing the VSG, learners are provided with a review of all decision points and correct responses. The created VSG provides no time limit, is focused on a specific task, offers feedback with each choice made, and allows unlimited repeated attempts. Learners are encouraged to replay the game as many times as they wish to maximise learning.
Benefits of VSG There are several benefits to VSG’s use as an educational tool within undergraduate education and for practising nurses. Verkuyl, Romaniuk, Atack, and Mastrilli (2017) detail the cost savings of nursing programs incorporating VSG. These include lower start-up and maintenance costs as well as not needing to pay personnel to facilitate student learning. Because these games can easily be developed by nurse educators, they can present culturally relevant content with contextually representative clinical environments that expose learners to situations not readily available in clinical practice and address the specific needs of learners. Appealing to the millennial learner, VSGs are an engaging platform for them to acquire and maintain their resuscitation skills to meet the requirements of certification with minimal financial burden. Having the opportunity to repeat objectives, without penalty, until proficiency is achieved, is crucial to positive skill development (Ericsson, Krampe, & Tesch-R€ omer, 1993). With VSG, learners are also often expected to act as the team leader, promoting critical thinking, which may not always be possible during live simulation,
53 given time and resource restrictions. Finally, experienced clinicians may use the VSG at any time to refresh their knowledge on certain life-saving practices during the time which their BLS/ACLS certification is valid to help ensure competency between recertification. This could help mitigate the skill deterioration noted by Smith et al. (2008).
Limitations of VSG As with any new technology-based learning platform, VSG has limitations. The use of VSG requires learners have access to computers and high-speed internet, which could be challenging within rural and remote regions. Although VSGs are cost-effective when compared with clinical simulation, traditional VSGs and augmented reality resources can still impose a sizable financial burden and can be cost-prohibitive to learners. Owing to the relative ‘newness’ of this learning tool, its efficacy in improving learners’ knowledge and performance requires further investigation. Finally, it is unknown how well simulation best practices for implementation, facilitation, and debriefing of traditional clinical simulation will translate to VSG. Thus, more research is required before recommendations can be developed to guide nurse educators.
Discussion VSG offers a safe, cost-effective option to engage learners in targeted educational opportunities that may otherwise be unavailable. VSG, in its current state, should not replace selfdirected textbook review, clinical placements, and/or clinical simulation education to meet learners’ educational benchmarks, as these are all valuable components of students’ learning. Current research indicates that VSG can be used as an adjunct to traditional presimulation and preplacement educational review (e.g., textbook readings; online modules). Thus, additional preparation with VSG is likely to help students gain the most from their educational experiences.
Empirical Evaluation During the 2018-2019 academic year, a pilot randomised controlled trial was conducted at Queen’s University to empirically evaluate the game’s impact on the resuscitation skills of senior-level nursing students. Results of the study are pending publication.
Conclusion In 2018, researchers created a VSG in the field of resuscitation science. The VSG’s content adheres to the BLS and ACLS guidelines set out by the HSFC (2015). VSG is an pp 51-54 Clinical Simulation in Nursing Volume 39
Virtual Simulation in Resuscitation Education innovative step toward using technology to help meet the educational demands of 21st century healthcare. This process is gaining recognition within undergraduate nursing education across Canada and internationally. Nurse educators, through collaboration and sharing of resources, are leading the transformation of simulation-based learning. Those interested are encouraged to join CAN-SimÓ to access this and other games, plus learn about how to create their own VSG.
Acknowledgment The authors thank Julia Kruzinga and Nicole Ng, undergraduate research assistants at the Queen’s University School of Nursing who volunteered to be actors, as well as Brianna Flude, who volunteered as an audio-visual assistant.
References Ericsson, K. A., Krampe, R., & Tesch-R€omer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363-406. https://doi.org/10.1037//0033-295X.100.3.363. Gorisse, G., Christmann, O., Armand Amato, E., & Richir, S. (2017). Firstand third-person perspective in immersive virtual environments: Presence and performance analysis of embodied users. Frontiers in Robotics and Artificial Intelligence, 4(33), 1-12. https://doi.org/10.3389/frobt. 2017.00033.
54 Heart and Stroke Foundation of Canada. (2015). Advanced Cardiovascular Life Support: Provider Manual. Ottawa, Ontario, Canada: First Heart and Stroke Foundation of Canada Publishing. INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM simulation design. Clinical Simulation in Nursing, 12, S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005. Kim, S., & Roh, Y. (2016). Status of cardiopulmonary resuscitation curricula for nursing students: A questionnaire study. Nursing & Health Sciences, 18(4), 496-502. https://doi.org/10.1111/nhs.12301. Ofoma, U., Basnet, S., Berger, A., Kirchner, L., & Girotra, S. (2018). Trends in survival after in-hospital cardiac arrest during nights and weekends. Journal of the American College of Cardiology, 71(4), 402411. https://doi.org/10.1016/j.jacc.2017.11.043. Smith, K., Gilcreast, D., & Pierce, K. (2008). Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation, 78(1), 59-65. https://doi. org/10.1016/j.resuscitation.2008.02.007. Tan, A., Lee, C., Lin, P., Cooper, S., Lau, L., Chua, W., & Liaw, S. (2017). Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial. Nurse Education Today, 55, 38-44. https://doi.org/10.1016/j.nedt.2017. 04.027. Verkuyl, M., Romaniuk, D., Atack, L., & Mastrilli, P. (2017). Virtual gaming simulation for nursing education: An experiment. Clinical Simulation in Nursing, 13(5), 238-244. https://doi.org/10.1016/j.ecns.2017. 02.004. Vincelette, C., Quiroz-Martinez, H., Fortin, O., & Lavoie, S. (2018). Timely recognition of ventricular fibrillation and initiation of cardiopulmonary resuscitation by intensive care unit nurses: A high-fidelity simulation observational study. Clinical Simulation in Nursing, 23, 1-9. https://doi.org/10.1016/j.ecns.2018.07.005. Yockey, J., & Henry, M. (2019). Simulation anxiety across the curriculum. Clinical Simulation in Nursing, 29, 1-7. https://doi.org/10.1016/j.ecns. 2018.1.
pp 51-54 Clinical Simulation in Nursing Volume 39
www.elsevier.com/locate/ecsn
Innovations in Simulation
Developing a Virtual Simulation Game for Nursing Resuscitation Education Evan Keys, MNSc, RNa,*, Marian Luctkar-Flude, PhD, RNa, Jane Tyerman, PhD, RNb, Kim Sears, PhD, RNa, Kevin Woo, PhD, RNa a b
School of Nursing, Queen’s University, Kingston, Ontario K7L 3N6, Canada School of Nursing, University of Ottawa, Ottawa, Ontario K1H 8M5, Canada KEYWORDS ACLS; BLS; cardiac arrest; cardiac resuscitation; cardiopulmonary resuscitation; clinical simulation; CPR; nursing education; nursing innovation; resuscitation science; serious game; serious games; ventricular fibrillation; virtual simulation game; virtual simulation gaming
Abstract: Virtual simulation gaming (VSG), also known as educationally purposeful gaming, is a new and innovative teaching method which warrants further exploration. In 2018, researchers from Queen’s University in Kingston, Ontario, Canada, created an innovative VSG depicting optimal nursing care for patients in cardiac arrest secondary to ventricular fibrillation. This educational tool was created in response to global calls for increased education in the field of resuscitation science. This VSG complements a growing collection of educational games created by CAN-SimÓ to best help students and experienced learners meet their educational goals. Cite this article: Keys, E., Luctkar-Flude, M., Tyerman, J., Sears, K., & Woo, K. (2020, February). Developing a virtual simulation game for nursing resuscitation education. Clinical Simulation in Nursing, 39(C), 51-54. https://doi.org/10.1016/j.ecns.2019.10.009. Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
Disclosures: None of the authors have any financial disclosures. However, 4 authors are affiliated with the Canadian Alliance for Nurse Educators Using Simulation (CAN-SimÓ) mentioned in the body of this manuscript. Ethical approval: Ethical approval was obtained from the Queen’s University Health Sciences & Affiliated Teaching Hospitals Research Ethics Board (File # 6024874). Funding: This innovation in simulation did not receive any specific funding. Conflict(s) of interest: The authors declare no financial conflict of interest in publishing this article. * Corresponding author: [email protected] (E. Keys).
Caring for patients in cardiac arrest can be stressful for students and experienced members of the healthcare team. Despite advances in care, outcomes remain poor for persons who experience in-hospital cardiac arrest. Between 2000 and 2014, only 16.8-20.6% of such patients in the United States survived to discharge from hospital (Ofoma, Basnet, Berger, Kirchner, & Girotra, 2018). Quality of patient care and patient outcomes improve when healthcare providers are adequately educated and competent in providing cardiac resuscitation (Vincelette, Quiroz-Martinez, Fortin, & Lavoie, 2018). This is especially true for nurses, who are often the most likely providers to first encounter a patient in cardiac arrest (Vincelette et al., 2018).
1876-1399/$ - see front matter Ó 2019 International Nursing Association for Clinical Simulation and Learning. Published by Elsevier Inc. All rights reserved.
https://doi.org/10.1016/j.ecns.2019.10.009
Virtual Simulation in Resuscitation Education Resuscitation of patients in cardiac arrest is complex and coordinated; high-quality care among members of the healthcare team has been shown to significantly improve patient outcomes (Heart and Stroke Foundation of Canada [HSFC], 2015). Unfortunately, for many undergraduate nursing students and new graduate Key Points nurses, adequate education Virtual simulation on caring for patients in gaming is a costcardiac arrest is not always effective, accessible, provided (Kim & Roh, engaging, and self2016). In addition, pracdirected platform that tising nurses often struggle enables students to to retain their knowledge learn in a low-stress, of basic life support nonjudgemental (BLS) and Advanced Carenvironment. diovascular Life Support There is a need for an (ACLS) guidelines (Smith, increased focus on the Gilcreast, & Pierce, efficacy of cardiac 2008). Therefore, an resuscitation educational solution is ureducation. gently needed to ensure Virtual simulation students, new graduates, gaming may be beneand experienced clinicians ficial in assisting are equipped to provide learners to better unthe highest quality of paderstand resuscitation tient care. concepts. An innovative teaching tool, virtual simulation gaming (VSG), also known as ‘serious games’ (Tan et al., 2017), is becoming increasingly popular to address this knowledge gap. A VSG is ‘‘an interactive computer application, with or without significant hardware component, that has a challenging goal, is fun to play and engaging, incorporates some scoring mechanism, and supplies the user with skills, knowledge, and/or attitudes that are useful in reality’’ (Tan et al., 2017, p. 39). VSG provides students with an educationally purposeful opportunity to apply theoretical concepts in a simulated clinical environment that is safe, allowing for learning through error while promoting self-directed learning. As detailed in Ericsson, Krampe, and Tesch-R€ omer’s (1993) theory of deliberate practice, expert performance can be traced back to practice which involves immediate feedback, time for problem-solving and evaluation, and opportunities for repeated performance to refine behaviour. As addressed by Yockey and Henry (2019), students often experience high levels of simulation anxiety. VSG addresses many of the recommendations made by Yockey and Henry (2019) to decrease simulation anxiety. With VSG, learners’ academic and psychological safety is protected, and they are encouraged to explore the subject matter more deeply without the fear of judgement or repercussion common to clinical simulation.
52
Innovation in Simulation In 2018, researchers at Queen’s University in Kingston, Ontario, Canada, developed a VSG in resuscitation science. The need for a VSG on care for patients in cardiac arrest was identified because of the importance of quality care during situations involving patients in cardiac arrest (Ofoma et al., 2018) and the lack of quality education being provided (Kim & Roh, 2016). An initial search found that most currently available VSGs were either cost prohibitive, costing as much as $120 USD per student, restricted to only the content creators, lacked generalisability outside of the United States, or were too primitive to provide learners with an immersive educational experience due to a lack of realism. Therefore, the creators developed an openaccess interprofessional cardiac resuscitation VSG that provided learners with a realistic portrayal of the expectations of care during resuscitation efforts based on the HSFC’s (2015) guidelines.
VSG Design and Creation In accordance with the International Nursing Association for Clinical Simulation and Learning (INACSL) Standards of Best Practice: Simulation Design (2016), and the HSFC-endorsed BLS and ACLS guidelines (2015), the creators developed learning outcomes which served as the basis for focused, preselected, decision points with corresponding responses. The video scripting was prepared by content experts to ensure accuracy and relevancy within the Canadian healthcare context. The video portions of the game were filmed using GoProÒ technology and included a high-fidelity manikin as the surrogate patient in cardiac arrest, a manual training defibrillator to portray energy delivery, and standard simulated medications. VSG assembly used ArticulateÒ software and a predeveloped Canadian Alliance of Nursing Educators Using Simulation (CAN-Sim)Ó game template which integrated edited filmed clips corresponding to predetermined decision points and written rationales to enhance learning. The creators of the VSG are content experts in nursing education and emergency nursing as well as simulation design, facilitation, and evaluation. The lead author is an experienced emergency nurse with involvement in simulation training for nursing students, emergency residents, and emergency physicians. The coauthors are all assistant or associate professors at academic institutions. The third author is a current BLS, ACLS, and Paediatric Advanced Life Support instructor and the second and third authors serve as copresidents of CAN-SimÓ.
VSG Content The VSG depicts the collaborative actions of an interprofessional healthcare team attempting ACLS for a patient pp 51-54 Clinical Simulation in Nursing Volume 39
Virtual Simulation in Resuscitation Education experiencing ventricular fibrillation. The focus on a shockable rhythm supports all learning objectives set out for cardiac arrest care, including instructions on the safe use of a defibrillator. The VSG is filmed from the perspective of the nurse who first encounters the patient. This helps provide an immersive experience for the learners and provides realism to the portrayal (Gorisse, Christmann, Armand Amato, & Richir, 2017), which is a key guideline of the INACSL (2016) standards. A patient report is provided, outlining current and relevant information. The learner is then immersed within a simulated resuscitation environment where they are required to function as part of the resuscitation team. Learners are then prompted to respond to a series of multiple-choice critical thinking questions with three response options. Each potential answer details a unique direction for the patient’s care and changes with each question. If learners make the correct decision, they are shown a video clip depicting the results of their actions and a written rationale on why their decision was correct. Correct responses then advance learners to the next video and decision point. If learners make an incorrect decision, they are also shown a video depicting the results of their actions and a written rationale on why their decision was incorrect. Learners are then redirected to select a more appropriate response to the question. On completing the VSG, learners are provided with a review of all decision points and correct responses. The created VSG provides no time limit, is focused on a specific task, offers feedback with each choice made, and allows unlimited repeated attempts. Learners are encouraged to replay the game as many times as they wish to maximise learning.
Benefits of VSG There are several benefits to VSG’s use as an educational tool within undergraduate education and for practising nurses. Verkuyl, Romaniuk, Atack, and Mastrilli (2017) detail the cost savings of nursing programs incorporating VSG. These include lower start-up and maintenance costs as well as not needing to pay personnel to facilitate student learning. Because these games can easily be developed by nurse educators, they can present culturally relevant content with contextually representative clinical environments that expose learners to situations not readily available in clinical practice and address the specific needs of learners. Appealing to the millennial learner, VSGs are an engaging platform for them to acquire and maintain their resuscitation skills to meet the requirements of certification with minimal financial burden. Having the opportunity to repeat objectives, without penalty, until proficiency is achieved, is crucial to positive skill development (Ericsson, Krampe, & Tesch-R€ omer, 1993). With VSG, learners are also often expected to act as the team leader, promoting critical thinking, which may not always be possible during live simulation,
53 given time and resource restrictions. Finally, experienced clinicians may use the VSG at any time to refresh their knowledge on certain life-saving practices during the time which their BLS/ACLS certification is valid to help ensure competency between recertification. This could help mitigate the skill deterioration noted by Smith et al. (2008).
Limitations of VSG As with any new technology-based learning platform, VSG has limitations. The use of VSG requires learners have access to computers and high-speed internet, which could be challenging within rural and remote regions. Although VSGs are cost-effective when compared with clinical simulation, traditional VSGs and augmented reality resources can still impose a sizable financial burden and can be cost-prohibitive to learners. Owing to the relative ‘newness’ of this learning tool, its efficacy in improving learners’ knowledge and performance requires further investigation. Finally, it is unknown how well simulation best practices for implementation, facilitation, and debriefing of traditional clinical simulation will translate to VSG. Thus, more research is required before recommendations can be developed to guide nurse educators.
Discussion VSG offers a safe, cost-effective option to engage learners in targeted educational opportunities that may otherwise be unavailable. VSG, in its current state, should not replace selfdirected textbook review, clinical placements, and/or clinical simulation education to meet learners’ educational benchmarks, as these are all valuable components of students’ learning. Current research indicates that VSG can be used as an adjunct to traditional presimulation and preplacement educational review (e.g., textbook readings; online modules). Thus, additional preparation with VSG is likely to help students gain the most from their educational experiences.
Empirical Evaluation During the 2018-2019 academic year, a pilot randomised controlled trial was conducted at Queen’s University to empirically evaluate the game’s impact on the resuscitation skills of senior-level nursing students. Results of the study are pending publication.
Conclusion In 2018, researchers created a VSG in the field of resuscitation science. The VSG’s content adheres to the BLS and ACLS guidelines set out by the HSFC (2015). VSG is an pp 51-54 Clinical Simulation in Nursing Volume 39
Virtual Simulation in Resuscitation Education innovative step toward using technology to help meet the educational demands of 21st century healthcare. This process is gaining recognition within undergraduate nursing education across Canada and internationally. Nurse educators, through collaboration and sharing of resources, are leading the transformation of simulation-based learning. Those interested are encouraged to join CAN-SimÓ to access this and other games, plus learn about how to create their own VSG.
Acknowledgment The authors thank Julia Kruzinga and Nicole Ng, undergraduate research assistants at the Queen’s University School of Nursing who volunteered to be actors, as well as Brianna Flude, who volunteered as an audio-visual assistant.
References Ericsson, K. A., Krampe, R., & Tesch-R€omer, C. (1993). The role of deliberate practice in the acquisition of expert performance. Psychological Review, 100(3), 363-406. https://doi.org/10.1037//0033-295X.100.3.363. Gorisse, G., Christmann, O., Armand Amato, E., & Richir, S. (2017). Firstand third-person perspective in immersive virtual environments: Presence and performance analysis of embodied users. Frontiers in Robotics and Artificial Intelligence, 4(33), 1-12. https://doi.org/10.3389/frobt. 2017.00033.
54 Heart and Stroke Foundation of Canada. (2015). Advanced Cardiovascular Life Support: Provider Manual. Ottawa, Ontario, Canada: First Heart and Stroke Foundation of Canada Publishing. INACSL Standards Committee. (2016). INACSL standards of best practice: SimulationSM simulation design. Clinical Simulation in Nursing, 12, S5-S12. https://doi.org/10.1016/j.ecns.2016.09.005. Kim, S., & Roh, Y. (2016). Status of cardiopulmonary resuscitation curricula for nursing students: A questionnaire study. Nursing & Health Sciences, 18(4), 496-502. https://doi.org/10.1111/nhs.12301. Ofoma, U., Basnet, S., Berger, A., Kirchner, L., & Girotra, S. (2018). Trends in survival after in-hospital cardiac arrest during nights and weekends. Journal of the American College of Cardiology, 71(4), 402411. https://doi.org/10.1016/j.jacc.2017.11.043. Smith, K., Gilcreast, D., & Pierce, K. (2008). Evaluation of staff’s retention of ACLS and BLS skills. Resuscitation, 78(1), 59-65. https://doi. org/10.1016/j.resuscitation.2008.02.007. Tan, A., Lee, C., Lin, P., Cooper, S., Lau, L., Chua, W., & Liaw, S. (2017). Designing and evaluating the effectiveness of a serious game for safe administration of blood transfusion: A randomized controlled trial. Nurse Education Today, 55, 38-44. https://doi.org/10.1016/j.nedt.2017. 04.027. Verkuyl, M., Romaniuk, D., Atack, L., & Mastrilli, P. (2017). Virtual gaming simulation for nursing education: An experiment. Clinical Simulation in Nursing, 13(5), 238-244. https://doi.org/10.1016/j.ecns.2017. 02.004. Vincelette, C., Quiroz-Martinez, H., Fortin, O., & Lavoie, S. (2018). Timely recognition of ventricular fibrillation and initiation of cardiopulmonary resuscitation by intensive care unit nurses: A high-fidelity simulation observational study. Clinical Simulation in Nursing, 23, 1-9. https://doi.org/10.1016/j.ecns.2018.07.005. Yockey, J., & Henry, M. (2019). Simulation anxiety across the curriculum. Clinical Simulation in Nursing, 29, 1-7. https://doi.org/10.1016/j.ecns. 2018.1.
pp 51-54 Clinical Simulation in Nursing Volume 39