A Wireless Non-networked Virtual Reality Solution for Intensive Care Training: Using Immersive Technology to Bring the Simulation Center to the Learner

Introduction: Nursing care of critically ill and injured patients covers a wide range of procedures and clinical competencies, all within the high-pressure environment of an intensive care unit (ICU). Medical simulation training is an evidence-based approach to teaching and assessing clinical providers with the goal of decreasing medical errors. However, traditional simulation modalities require learners to travel to a dedicated simulation center to participate in training. A novel solution is to use wireless Virtual Reality (VR) training platforms to bring immersive, realistic simulation training directly to the learners. Training for ICU-level nursing care in a deployed prolonged casualty care setting uses similar tools, evaluation checklists, and interventions that would be performed in a civilian ICU setting for prolonged management of critically ill and injured patients. We developed a novel training platform to train around intensive nursing ICU-level nursing care initially in a deployed military setting with iterations planned for a civilian hospital ICU. The platform is fully wireless, portable, and can be set up in any available space with or without network connectivity.

Description: An interdisciplinary working group was formed consisting of physicians, registered nurses, VR simulation experts, and military medicine educators. Two members independently reviewed published Joint Trauma System Clinical Practice Guidelines relating to prolonged casualty care. The members also identified learning objectives that could translate to civilian ICU nursing care as well. From these, they abstracted a curriculum designed around training for sepsis management, extensive burns, crush syndrome, multiple trauma, and traumatic brain injury with a focus on intensive care nursing care and medical decision-making. The full curriculum descriptions were shared with the working group, who then provided input and revisions.

Discussion: The VR ICU nursing in prolonged casualty care curriculum working group identified learning objectives across six medical decision-making simulation scenarios and one virtual manikin scenario with an open scenario design. Key learning objectives included demonstrating the ability to provide patient care for extended time periods, monitor patient vitals, understand ventilator management, perform indicated diagnostics, provide nursing care and hygiene, and prepare patients for the next phase of care. Simulated procedures included airway management, intravenous access, fasciotomy, and lateral canthotomy. These simulation exercises were developed in a novel immersive environment set in a field location, or "building of opportunity," to replicate what military providers would experience in a prolonged casualty care mission providing ICU-level nursing care. These scenarios were developed to allow for multi-player interaction and interprofessional team exercises. Responses from military educators indicated that these learning objectives cover substantial depth and breadth that would be of high value for training ICU nursing providers. While the initial interaction of the curriculum was developed specifically for military teams, this curriculum also shows potential to be adapted for civilian ICU nursing care.