Emerging Trends and Challenges in 21st Century Nursing Education
Executive Summary
Nursing is a busy field and due to shortages in the field, many nursing students are being trained by professionals who lack experience. This puts nursing students at a disadvantage when called upon in professional nursing practice. However, with the implantation of virtual reality (VR) technology in nursing education, students will be able to effectively practice their skills, receive positive and negative feedback pertaining to skills, as well as better retain their knowledge. This proposal describes five articles relating to the use of VR clinicals in nursing education. Furthermore, the literature review goes into the information gathered by each article in relation to how effective VR clinicals are in nursing education. This need was supported by a developed curriculum technology need-gap analysis that identified nursing students as being trained by nurses who have only been in the field for as little as two years. A proposal was presented to the board for the creation of standard VR clinicals provided by the national council of the state board of nursing so there would be a standardized version of these clinical skills. These would ensure that nurses would receive the same technical information regarding VR clinicals. In order to achieve the proposed change, effective collaboration between stakeholders was held at a meeting over Zoom to discuss the implementation of VR into the curriculum. Stakeholders included students, IT specialists, and the American Academy for Nursing with the meeting offering them an opportunity to share their input and what they think would be most effective. In addition, a force field analysis was created, and forces for and against the proposal, including the cost, effectiveness, quality, and maintenance with the use of cognitive learning changed theory, was addressed. In conclusion, this proposal describes the effectiveness of applying VR clinicals into nursing curriculum. In addition, it provides an integration of VR to help with community prevention efforts. Overall, this proposal presents VR as potentially impactful on the broader nursing field because it presents nurses with a resource through which they can strengthen their skills Emerging Trends and Challenges in 21st Century Nursing Education.
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Literature Review
Technology is “the application of scientific knowledge for practical purposes” (Oxford, 2022). Technology is an essential part of our society; applied in many different ways to solve the problems encountered in society. The different applications of technology can be found in things like communication, productivity, keeping a record, research, and more. Education and technology go hand-in-hand with one another. As technology has evolved, it has been applied in making nurses’ jobs easier. During the Covid-19 pandemic education had to be modified and adapted for medical practice more than it has ever before in history. In nursing education going fully virtual puts the students at a disadvantage due to the inability to gain real patient care experience. Delivering nursing education solely through virtual tools means that nursing students would be unable to get the clinical hours required and cause them to miss a lot of hands-on experience. Although Covid-19 pandemic was an unexpected circumstance for nursing education, virtual simulation offers an opportunity to educate and equip nursing students such that they would be able to practice, interact with patients effectively, and learn proper standards of care.
To find the proper research and literature to help me research my topic my keywords were virtual, technology, online, hybrid, and simulation. These keywords help me find articles operating to teach hybrid although the need for the hands-on aspect of the program Emerging Trends and Challenges in 21st Century Nursing Education.
Evidence Summary
The first article “Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial” talks about the importance of clinical practice in providing nurses with enough practice to make decisions with confidence and assurance. Clinical nurses can take the knowledge they have gained and apply it to real-life scenarios. Clinical virtual simulation creates real-life scenarios and puts the person going through the simulation in the central role of the exercise. “It is a type of simulation that places people in a central role through their exercising of motor control skills, decision skills, and communication skills using virtual patients in a variety of clinical settings.” Through virtual simulation, students cannot only put their knowledge into action. Students are also able to learn from their mistakes and receive a thorough explanation of how they can improve and where they messed up. This provides students with an effective way of learning within comfort of students. In this study provided in the article, a group of fifty-six nursing students was split into two groups. the first group of nursing students each group was given a 45-minute class on effective airway clearing and hypoxia while the first group was given the class in person the other class was given through a virtual simulation. The results of the experiment showed that patients in the experimental group that was given the virtually simulated course did better in retaining the information given in the course. This study helped show that virtual simulated courses provided students with more effective clinical reasoning and knowledge retention. Furthermore, this proves that with strong virtual clinical apps students will effectively be able to learn and retain information Emerging Trends and Challenges in 21st Century Nursing Education.
In the article “Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis” the article describes the effectiveness of virtual reality learning in nursing education. Virtual reality provides “areas of knowledge, skills, satisfaction, confidence, and performance time” in nursing education. Based on the meta-analysis of virtual relations provided in the article proved the suggestion that virtual reality in nursing education was effective. Due to the shortage of nurses throughout America, virtual reality provides an effective way for nursing students to receive the education they need. In the nursing field, nurses must take the theoretical knowledge they have learned and apply it to real-life clinical scenarios. “Simulation is a valuable teaching-learning strategy to support the changing world of nursing education and to help optimize the teaching process (Lange et.al. 2020)”. Virtual reality clinical help educators control the environment in which the student is learning and focus on key skills or components of the lesson. Not only are the students learning hands-on, but they are also able to understand thoroughly what they need to understand. “VR simulation refers to the use of a variety of immersive, highly visual, 3D characteristics to replicate real-life situations and health care procedures, incorporating physical or other interfaces such as a computer keyboard, a mouse, speech/voice recognition, motion sensors, or haptic devices (Padilha et. al. 2019)”. Virtual reality gives real knowledge -time situations for nurses to apply their knowledge to clinical situations. The article also describes how some researchers believe virtual reality may be ineffective compared to traditional methods of learning. So, during the meta-analysis study, the conclusion of the study showed that virtual reality learning was more effective than traditional teaching methods by implementing more virtual reality clinical students can practice their skills more often and on their own time meaning they can become more efficient in time more effective in the skill and obtain more knowledge. The fact that the realities can be altered can help nursing students focus on their weaknesses and help them build more strengths. Some researchers argue that virtual reality does not give the one-on-one patient experience that you would receive in person but due to the fact that simulations could be based on real people and make real sounds in real-time, this provides nursing students with the closest clinical hands-on patient experience they can get versus the one-on-one patient care experience. The virtual reality clinical experience also gives students a chance to mess up. Instead of being in the real world and messing up and risking a patient’s life, nursing students can get assessed on their clinical skills and provide positive and negative feedback on things they need to work on and things they did well during the virtual reality clinical. Virtual reality applications can be used to train nurses for challenges they might encounter in the field with the development of virtual reality technology and continuous development. It will be a vital tool for the forever-changing demographics of nursing, with virtual reality providing three-dimensional views of field activity this could prevent future mistakes from occurring. Emerging Trends and Challenges in 21st Century Nursing Education The addition of virtual reality to nursing education will also provide a fun way for students to learn. In the article “Learning with Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model ” researchers started by asking nursing students about their background use of technology. After using the virtual reality students were then asked about their experience. Most students rated their virtual reality experience highly. The study showed that people who had a positive attitude towards technology were more likely to have a better experience. This also brought about the observation that social influence also played a key factor. If peers had a more positive attitude towards the virtual reality application students are more likely to have rated their virtual reality experience higher. So, this article based most of its data using the theory of acceptance and use of technology (Chen et al 2020). This shows that the use of virtual reality applications correlated with the person’s acceptance of technology. People who are more likely to have a positive attitude towards virtual reality clinical saw the benefits and enjoyed the use of technology. The article also notes that virtual reality technology is still evolving and as it evolves more studies should be taken on the possibilities and how it affects nursing education.
Virtual reality is such an advanced technology that has the potential to change traditional teaching approaches. The article “The integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review” describes how the application of virtual reality and nursing, and midwifery education can be an extremely useful tool. Virtual reality clinics that are used in nursing and midwifery education provide an easy and effective method in allowing midwives and nurses to perfect their skills and provide provision for what they need to work on. Including virtual reality in nursing and midwifery education will increase the confidence of the students and competence by providing students with a safe space to learn from their mistakes. but for these virtual realities clinical to be most effective educators need to be involved in the design and creation of these virtual reality technologies to make them fully effective. Technology is a forever expanding thing and students can get information anywhere at any time so to make studying and clinical more effective virtual reality provides students with a way to practice without being scared to make a mistake. This article focuses on immersive virtual reality which is a computer-simulated interactive system that gives feedback to one or more senses. A non-immersive virtual reality would be a virtual reality clinical done through a computer screen. immersive virtual reality systems proved to be more time efficient by giving students more time to practice and complete more procedures. immersive virtual reality also proved to help nurses and midwifery with catheter insertion by 70%. This proves that immersive virtual reality technology is not only effective in providing education and helping retain information but also is time efficient. “It is well known that there are many benefits including knowledge retention and confidence building from using various forms of clinical simulation such as high and low fidelity and Second Life® in the provision of teaching clinical skills (Cobbett and Snelgrove-Clarke, 2016; Sherman and Craig, 2018; Ulrich et al., 2014) Emerging Trends and Challenges in 21st Century Nursing Education”.
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In the article “Exploring the experiences of nursing students in using immersive virtual reality to learn nursing skills” The objective of this article was to understand the experience of nursing students using virtual reality as an educational skill program. The study shows that students describing their experience with virtual reality learning could be put into five categories. One of them is “convenient practice but requires adaptation” meaning it is a good study tool but took a while to get adjusted to. The second one is the “fast skill learning process” meaning providing a fast and efficient way for them to learn. The third one is a “stress-free learning environment” Meaning students felt like it was a safe space for them to learn and they did not feel anxious as they would in a traditional setting. The next one is “environmentally friendly” due to the resources saved because clinical care is provided virtually. The last category was “lacks a sense of reality” meaning the virtual reality did not help depict the real interactions between nurses and patients. The article suggests that instead of replacing traditional teaching methods, virtual reality should be used as a self-learning tool to help students practice and develop their skills. The virtual reality education given to nursing students should help students learn the material and practice for their practical’s Emerging Trends and Challenges in 21st Century Nursing Education.
All of the articles provided all state that virtual reality technology could be beneficial in nursing education. All simultaneously agree that Nurses can retain more information and knowledge through virtual reality and can practice practical skills in a safe fail free environment. Although many of the article’s state that virtual reality technology has proven to be more effective than traditional learning, they also counter claims that it would be a better self-study tool provided to students. Even though virtual reality is proven to be an efficient educational tool in time and provides knowledge through feedback, the approach toward virtual reality education is dependent on the attitude of the student in receiving education through non-traditional methods. That is why students have different reactions and experiences when dealing with virtual reality education. Nursing educators need to help create these simulations and real-life scenarios on what nurses are going to see in the field in order to provide that sense of reality while using the virtual reality program. Educators should also help promote virtual reality learning to their students as even a simple study tool because it provides feedback on the students’ performance and also provides students with the repetition, they need to master clinical skills. Virtual reality is an effective learning tool whether it is used as the main education tool or used as a self-study tool.
Gaps
The common gap in all of these articles is the change in nursing demographics. Due to the evolving field of nursing and the national shortage of nurses. Technology must be used in order for nursing education to be efficient and effective. That is why the use of virtual reality in nursing education will provide a tool for educators to use. This will help students not only help students strengthen and practice their practical skills but will also aid students in learning and retaining information. Due to the high demand for nurses. Many nurses are being trained by untrained professionals. and with under qualified nurses teaching the new generation of nurses coming this provides a whole new set of problems. That is why they need virtual reality education in Nursing will provide a standard of clinical learning and studies for nurses everywhere. However, the gap in virtual reality learning is that it would be costly and difficult to keep up with software and curriculum updates. Virtual reality software is timely and costly to constantly be renewing. This provided a problem for nursing education because the field of nursing is always evolving.
Needs Assessment
To discuss a change in education technologies I had a meeting with the American Academy of Nursing. In the meeting, the national shortage of nurses was discussed and the effect the shortage has on nursing students. Nursing students are being trained by inexperienced nurses “In US nursing schools, 75,029 qualified applicants for bachelor’s degrees and nursing postgraduate courses were rejected in 2018 due to an insufficient number of faculty, clinical sites, classroom space, clinical preceptors, and budget constraints” (Chen 2020). Nursing students are being trained by nurses that have not been in the field for as little as two years. I presented to the board creation of standard virtual reality clinicals provided by the national council of the state board of nursing so there would be a standardized version of these clinical skills so nurses could receive the same technical information regarding clinical. This will also provide the student with an amazing study tool available to them at all times. “Simulation is a valuable teaching-learning strategy to support the changing world of nursing education and to help optimize the teaching process” (Chen 2020). Through VR students will have the opportunity to practice their skills more often which would lead them to learn the proper step-by-step process because virtual reality systems give feedback both negative and positive. A great aspect of virtual reality is that it allows students to catch and learn from their mistakes before even getting onto the field. The idea of virtual reality being incorporated into nursing education is a realistic goal. “As VR technology advances and becomes increasingly affordable, nursing education is being transformed” (Chen 2020). Virtual reality is affordable and provides a viable education option for nursing students. The student who had a more positive outlook on using virtual technology had a better experience. If the use of virtual reality simulation is encouraged by educators and nursing programs all over the country, students would be more open to the tool as something that increases comprehension and knowledge. These virtual reality simulations can be created by nurses who have been in the field and know what problems these students might face once they enter the field. The use of one virtual reality clinic provided by field nurses and educators will encourage students that this application is needed to help them understand and pass their state boards.
Need-Gap Analysis
A gap analysis was conducted with a focus on comparing the current nursing education tools and technology against the desired state, then building an intervention plan on how to bridge the identified gap. There is a general understanding that nursing curriculum needs are changing faster than any other areas. As such, there is a pressure to continually enhance nursing curriculum while staying ahead of nursing practice needs. In addition, technology is similarly evolving such that there is a pressure to continually enhance the existing technologies applied in nursing education while staying ahead of emerging technology needs. Besides that, there is a need to meet compliance requirements and regulatory standards in order to ensure that nurses meet competence standards before being allowed to practice (McGonigle & Mastrian, 2022).
Given this awareness, a five-step gap analysis was conducted to identify opportunities for leveraging VR technology to improve nursing education delivery and outcomes. The first step involves establishing the goals. The overall objective of the gap analysis is to evaluate the performance, technical and functional gaps of the existing nursing education system versus the desired state. Doing this requires a strategic goal: providing nursing students with a risk-free environment in which to practice clinical skills to improve confidence and effectiveness. The second step is taking inventory of the nursing education system in question, capturing the current curriculum technology, and desired curriculum technology. The third step is defining the gaps – where the curriculum technology is not meeting current and near-future nursing education needs with a focus on the weaknesses, opportunities and threats. The fourth step is determining solutions by figuring out how to close the gap and which trade-off decisions should be made in terms of which technology tools to replace or upgrade. This includes creating a wish list of baseline capabilities and functionalities. The final step is creating a roadmap for the future that shows the “why,” “what,” and “when” of the new curriculum technology (Huber & Joseph, 2022). The results of the gap analysis are reflected in the Curriculum Technology Need-Gap Analysis table (see Table 2).
Traditional learning is still effective today. The only thing is most curriculums and nursing resources are found virtually through textbooks and files. I propose a national clinical VR program be created by the America Academy of Nursing so nursing students can practice clinical skills effectively at any time. There is nothing wrong with the current curriculum but the need for VR programs will help provide nurses with a safe environment to practice their clinical skills effectively. The safe fail free environment provides nurses to boost confidence and effectiveness when practicing. Furthermore, the shortage in nursing will help provide nursing students with adequate education to execute and practice their nursing skills. Clinical standards need to be reviewed for a virtual version of the clinical can be accurate and effective. “The use of high-fidelity simulators has improved the acquisition of knowledge and skills and strengthened quality and safety in clinical practice” (Pahdilia et. al. 2019). For clinical nursing students, teachers and field nurses must come together to make sure virtual reality clinical are accurate and provide challenges students may experience on the field. After the program is created educators must approach the incorporation of VR learning with a positive attitude. “Social influences can also increase the participant’s acceptance if peers have a positive attitude towards such applications” (Lange et. al. 2020). Virtual Reality technology is still fairly new. The idea of advanced technology may overwhelm a lot of students. But if educators provide a positive outlook on the program and encourage students to use this study tool, the study shows it has been more effective. Also, the virtual reality program has to be made accessible to all nursing students. A program should be made where students could rent VR headsets or pay through installments. A library should also be made to allow students who do not have the option of either to practice without stressing about the cost or availability. A board of directors needs to also be in place for the curriculum to be kept up to date. Nursing is still developing new protocols are always being put into effect to ensure nursing students are kept up to date a board should oversee and track that the virtual reality clinicals are kept current. The board will also oversee that simulations mimic real-life scenarios so nursing students are better prepared in the field. Emerging Trends and Challenges in 21st Century Nursing Education
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Collaboration with Stakeholders
The building of a national virtual reality clinic will need the help of the America Academy of Nursing. They all have elevated levels of experience in nursing education and can help make the virtual reality clinic as realistic as possible. As well as provide this curriculum to their students to see if it is effective. The information gathered by the American Academy of Nursing will provide what clinical skills need to be incorporated and also provide feedback on what needs to be improved upon. Another stakeholder would be an IT specialist to help design the program best equipped for nursing students. The IT specialist would help the American Academy of Nursing bring the reality of nursing into virtual reality so students can learn in a safe area how to practice clinical skills efficiently. The IT specialist will specialize in virtual reality technology and create the program nursing students will use. They will also assist in fixing any glitches and updating the technology to ensure that the curriculum stays current. The last group of people to help with the collaboration of a national virtual reality clinic would-be students. Based on the feedback of the student after using virtual reality programs for clinical use tests and surveys should be given so that it could be understood how the system could be improved upon by IT specialists. These surveys will consist of questions relating to the effectiveness, quality, and improvement of the virtual reality simulation. This will be a study and learning tool used by students, so the experience these students have must make it a simple straightforward experience.
Collaboration with the stakeholders will follow a dynamic, two-way shared model. This belongs to a dynamic engagement approach that occurs in a continuous basis, with the shared responsibility for the health of the project. The relationship between the stakeholders and project is a two-way exchange of information that is not constrained. Because of their experiences, power and position, the stakeholders have high-interest and high-influence in the project, and are accepted as contributors. This requires that they have access to all the documentation and reports, to include shared files and project communication, thereby giving them access to the project current files and archives. In addition, the project would take advantage of their unique value to the project by allowing them to author and co-author documents and processes in the project. As high-power stakeholders, the have this kind of value that allows them to contribute to authoring the project documents and processes. Besides that, they will be an integral part of the project decision-making process. This means that collaborating with them directly helps in getting their buy-in so that the decision-making process becomes easier and smoother. Additionally, these stakeholders are accessible and recognized by name in the project communication plan (Finkelman, 2019) Emerging Trends and Challenges in 21st Century Nursing Education
Communication with the stakeholders will be conducted using digital tools, particularly emails and Skype. Connecting with the high-power stakeholders using digital tools makes the process of collaboration much easier and quicker than relying on traditional communication methods. The time saved in using digital communication tools can be reinvested in keeping the project moving forward while the dynamic and proactive digital communication would keep the stakeholder concerns from “slipping through the cracks”. In essence, using digital communication tools is anticipated to give the collaboration greater power at minimal cost. Another benefit of using the digital communication tools is that it streamlines the collaboration, makes the work simpler and faster, and makes it easier to track correspondences (Garcia-Dia, 2019).
Comparing Technologies
Another technology that can be used in nursing education is artificial intelligence. Artificial intelligence allows technology to have the intelligence of a human. Furthermore, artificial intelligence nurses can spend more time doing patient care and spend less time on administrative tasks. Although the application of artificial intelligence can be especially useful in nursing care settings it provides low use in nursing education. Artificial intelligence and interesting education could be used as a tool that gives feedback to nurses and makes recommendations on practices that should be put into place using critical thinking. But this does not serve as a tool for educating nursing students where virtual reality can be used so nurses could practice clinical skills. The use of virtual reality is more beneficial and educational settings versus artificial intelligence virtual reality could be used for several things in both nursing care settings and educational settings whereas artificial intelligence provides more help and nursing settings by providing information.
VR is a form of interaction between computers and humans in which an imaginary or real environment is simulated. Artificial intelligence (AI) algorithms are integrated into VR to make the simulation more realistic in terms of environment and response, improve security, ensure high integrity of resources, and secure privacy of nodes. Users interact with the VR simulated world and manipulate. This understanding identifies VR as a disruptive technology that improves the performance of computer graphics while improving interaction between humans and computers (Sherman & Craig, 2018). Emerging Trends and Challenges in 21st Century Nursing Education
VR has four key elements. First, a virtual world presented as an imaginary space that exists independent of the free world. Computer graphics render visual elements to present a simulation as the created space. The rules defined by the creator determine the interactions and relations between the visual elements. Second, immersion as the users are placed in a virtual space with their senses cut off from the real world. The user is immersed in the virtual world using a VR headset that occupies the whole field of vision, and headphones that block out outside sound. Third, sensory feedback as the VR headset and headphones track the user within the simulated space with the computer rendering any changes in position. If the user moves the body, then it will create the illusion of movement within the virtual world. The input is close to reality as possible. Fourth, interactivity as it includes virtual elements that the user can interact with, such as picking up an item or operating a machine (Sherman & Craig, 2018).
VR use in schools is still at an early stage. However, it is highly favoured as it engaged doing, hearing and seeing, thus allowing for better retention among students. The technology offers detailed visualization, such as human anatomy. This makes the technology useful for training in nursing and medicine. Nursing students do not always have the opportunity to practice enough to fully master a technique or procedure; which can result in errors with grave consequences for patients. VR simulations allow for an almost unlimited amount of training opportunities for the nurses without posing a threat to patients. It is a training tool that lowers the number of errors (Staat, 2021).
It is clear VR technology use in training nursing students offers significant advantages. First, it makes nursing education easy and comfortable, with the nursing students able to retain more information. Second, it allows the students to experiment with a virtual environment. Third, it creates a realistic world that improves confidence, experience and safety. Fourth, it is handy, detailed and increased learning possibilities. Although VR is advantageous, it presents some disadvantages. First, it cannot completely simulate the real world. This means that although the responses and reactions are modelled against the real world, there is a possibility of inconsistencies. Second, VR equipment is expensive to set up and maintain. Third, it is intransigent and does not offer flexibility in making changes to the pre-set program sequence (Staat, 2021).
Current Technology Challenges
Three problems with current technologies in nursing education are that some students do not have access to technology to access all e-books and textbook files, students also may struggle learning through e-textbooks and files, and e-book and files may not always be available. Many nursing students do not have the adequate resources to access e-books and files at home. Students may not have a secure internet connection, have access to the internet at home, and more. Also, students may find it harder to comprehend material through online learning due to other distractions, the strain computer may put on their eyes, and more. Another problem with e-books and files is nursing students may not have the financial resources to access e-books and files which put nursing student at a disadvantage.
Overcoming the Challenges
To overcome the challenges of e-books and files students should have an option to receive a paper copy of all virtual material given. Students should also be provided with office hours to help resolve any technical issues or barriers nursing students might face. Students should also be able to borrow laptops or tablets from their facility to ensure they have adequate resources to have access to all e-books and files online at no charge Emerging Trends and Challenges in 21st Century Nursing Education.
Summary of Findings
The need for virtual reality application in nursing education would provide a strong tool for educators and students because educators will be able to understand where each student may struggle to understand personally. In addition, students may practice their skills in a safe low-risk environment which releases a tremendous amount of stress for students. However, nursing is a high-stress field students must be able to think in high-stress situations and respond effectively. The virtual reality simulations provided by the America Academy of Nursing will be timed real-life scenarios so students can understand firsthand decision-making in the field of nursing. Students will fail the simulation if not done proficiently but through the simulation, they can learn what areas in the skill they need to work on. Students can keep practicing these simulations until they master them.
Stakeholder Consensus
As earlier indicated, a collaborative approach will be applied in the project to include collaborative problem solving and consensus building. These are processes that will be used within the project to make plans, solve problems, develop recommendations and make decisions in a collaborative way, rather than confrontational, competitive or isolated way. In this case, the representatives of all the necessary stakeholders with a stake in the project will work together collaboratively. The participants will make a good faith effort to meet the interests of all the stakeholders, while making plans, recommendations and decisions that, if not unanimous, are at least ones that they can live with. To facilitate this, the participants will design the collaboration processes (with the help of a mediator/facilitator). This is intended to allow for considerable flexibility about who can participate in the project, how they can participate, and what outcomes will be considered (Garcia-Dia, 2019) Emerging Trends and Challenges in 21st Century Nursing Education.
The collaboration processes will move through seven stages. First, assessing the situation by gathering information on the issues, identifying the incentives and barriers, having a time frame for the process, determining how people will work together, and the desired outcomes. Second, deciding who will lead the process and how to manage meetings. The leader can be from among the participants or from an impartial third-party outside source. Third, developing the ground rules. Fourth, deciding on the information needed for planning, frame the issues and discuss perspectives. Fifth, collect, exchange, verify and assess information, discuss points of view, and frame issues. Sixth, generate and evaluate different options, and negotiate while moving towards the desired goals. Seventh, checker whether the decisions, recommendations, agreements and plans are implementable, and whether they will work for all the authorized decision makers. The agreement/decision is formalized once it has been through the seven stages even as it is implemented and outcome monitored (Garcia-Dia, 2019).
In addition to the seven stages discussed, ten features will characterise the collaboration to ensure that it reaches consensus and forms feedback. First, clear connection between the collaboration processes and how outcomes are implemented. Second, continual, consistent and careful process management. Third, full communication and participation. Fourth, opportunities for capacity building and learning. Fifth, provision of sufficient resources. Sixth, establishing clear objectives. Seventh, agreement on the scope of the collaborative processes. Eighth, clear accountability and effective representation. Ninth, incentives to participate. Tenth, inclusion of all affected stakeholders (Schmidt & Brown, 2019) Emerging Trends and Challenges in 21st Century Nursing Education.
The American Academy of Nursing liked the idea of a virtual reality clinic provided to students. To pay for the IT specialist it was agreed that students will buy or rent a package that came with a Virtual reality headset and a subscription which will help keep all clinical up to date. Although people on the board questioned if everyone could afford these subscriptions. After further discussion, it was agreed that a financial aid option where students can apply will be given. After the council had set the standards for the IT specialist and what they felt would be effective. The IT specialist made a compelling case and answered the academy’s comments and concerns regarding virtual reality technology. After the meeting, the specialist made a demo, and it was immediately sent to a nursing program for feedback from the nursing students. The feedback came back positive, from both the academy and the students. Many students said they would use the program as a study tool to practice their clinical skills. One thing that was a concern for students was the efficiency of updating the program. The IT specialist appointed a coordinator to keep up to date with the curriculum and supervise the VR software that was kept up to date for the program.
Force Field Analysis
Force field analysis is a structured, effective decision-making tool that improves the quality of the decisions while increasing the chances of success. The idea behind this tool is that a situation is maintained by an equilibrium between the forces that drive and the forces that oppose change. For the desired change to happen, the driving forces must be strengthened and/or resisting forces weakened (Garcia-Dia, 2019).
The proposal change is the inclusion of VR technology in delivering nursing education. The force field analysis has identified three forces that support the proposal to change nursing curriculum by including VR technology. First, VR can be leveraged to help nursing students obtain knowledge. It engages the students within a simulated environment where they can learn clinical skills and knowledge. Second, VR technology would provide students with an unlimited clinical study tool. Within the simulated environment, students can practice the clinical skills in an environment that does not punish failure or errors. Third, VR technology provides a safe environment in which nursing students can learn from their mistakes. The simulated environment allows the nursing students to make mistakes and learn from them, thereby acting as an opportunity to improve proficiency and competence (see Table 3; Sherman & Craig, 2018).
In addition, the force field analysis identified three forces that work against the proposal to change nursing curriculum by including VR technology. First, there is limited accessibility to VR equipment, particularly the headsets and headphones. Secondly, it takes much effort to update the VR programs to reflect advances in nursing education modules. Third, VR equipment is expensive and requires high initial cost and maintenance fees (see Table 3; Sherman & Craig, 2018).
Organizational Factors
A review was conducted to identify the organizational factors that influence nursing curriculum development. In this case, three internal factors were identified as influencing the project. First, resources within the organization and internal economic situation, particularly the ability to acquire and maintain VR technology given the cost implications. Second, the organization mission, purpose, philosophy and goals. It is important to understand the purpose of the organization and linking how it intended to achieve that purpose to the project. An organization that is intended on delivering the best possible nursing education would find it easier to leverage VR technology as an investment for improving the delivery of nursing education. Third, organization structure, specifically the presence of an office for improving curriculum and exploring the possibility of including and leveraging technology to improve education outcomes. Good leadership can help to direct and inspire the curriculum change (Huber & Joseph, 2022).
In addition to the three internal factors, three external factors were identified as influencing the project. First, competition from other organizations. If other organizations are already using VR technology in nursing education, the dealing with the completion would require the organization to similarly implement VR technology in nursing education. Second, politics and government policy has an influence through determining what technologies can be adopted in delivering nursing education. Third, present of mature VR technology for nursing education. Mature technology would be helpful as it already contains the nurses training programs so that they do not have to be developed. Furthermore, mature VR technology would not have significant implementation problems, meaning that it can be implemented as is with minimal changes to the technology framework (Huber & Joseph, 2022)Emerging Trends and Challenges in 21st Century Nursing Education.
Forces for Integration
An evaluation of the forces of integration identified forces that will facilitate integration of VR technology in nursing education. For individual nurses, nursing education paves the way to acquire new skills, develop analytical know-how and critical thinking, shape nursing career, develop a sense of purpose, and contribute to economic welfare. As such, the impact of VR technology, as it improves nursing education, is undeniable (Sherman & Craig, 2018).
This is especially the case when considering the Covid-19 pandemic in which nursing education institutions were closed across the country and world for weeks and months at a time. A speedy return and continuity of learning was only ensured by support from digital resources, programmes and tools. In fact, many institutions leveraged and rolled out online learning education tools. Although these solutions were crucial for learning continuity, they are mostly focused on knowledge transfer, not in-person and practical experiences that nursing students need to grasp clinical concepts. After all, while some nursing concepts can be learned through theory, other must be learned through practice. It is this awareness that creates the need to address experiential learning. VR technology is positioned to address this need while creating a competitive advantage for the stakeholders involved (Staat, 2021).
Four reasons have been identified for integrating VR technology in nursing education. First, disruption and innovation. The education sector is becoming digitalized to help with improving affordability, enhancing quality and increasing accessibility. These are pressures that increase the need to adopt VR technology in nursing education. Second, VR technology expedites the process of developing nursing students. VR enables experiential learning, allowing nursing students to immerse themselves in an interactive experience where they can visual their actions and outcomes first hand. Third, coupled with the metaverse, nursing students and tutors can share and communicate while immersed, thereby overcoming time and space limitations. Fourth, VR technology can be integrated with traditional learning approaches, thereby creating a unique learning experience that is adapted to the drive to learn, pace, style and ability of each nursing student. This ensures that nursing students are ready to advance through robust assessment (Staat, 2021).
Identification of Change Theory
Planned Change Theory developed by Lippitt, Watson and Westley has been considered appropriate for the current situation. This is a linear change model that expands on Lewin’s three-step change model by focusing more on the responsibility and role of the change agent, rather than on the change process. The theory presents a seven-step process that emphasizes the participation of affected stakeholders during the planning steps. The first step is to diagnose the problem. The second step is to assess the motivation and capacity for change within the organization/system. The third step is to assess the resources and motivation of the change agent. The fourth step is to establish the change strategies and objectives. The fifth step is to determine the role and responsibility of the change agent. The sixth step is to maintain the change. The final step is to gradually terminate the helping relationship as the change becomes part of the organization culture. These seven steps as presented by the change theory place emphasis on the stakeholders affected by the change, focusing on establishing feedback mechanisms, strategies for solving problems, building rapport and communication skills (Murray, 2022)Emerging Trends and Challenges in 21st Century Nursing Education.
Justification of Change Theory
The proposed change will be implemented with the understanding that there are various forces that drive change in the nursing education setting, to include advances in science, new technologies, risks costs, and pursuit of quality goals. The identified Planned Change Theory is considered appropriate for the project as it helps in balancing and leveraging the forces. Change is an essential component of any organization. However, leading change can be a challenge amid the difficulties and complexities of evolving the nursing education environment in providing quality-nursing education. The theories presents a structured framework to effectively support the change environment in shaping an effective nursing education environment. In addition, the selected model presents a strategy for understanding, identifying and responding constructively to resistance to change. In essence, the change model provides guidelines for change leadership practices and behaviors for encouraging and facilitating the desired change in the nursing education setting (Cherry & Jacob, 2019).
Potential Resistance to Technology
Although VR technology offers opportunities to improve nursing education and be beneficial to the stakeholders, resistance to change is anticipated. First, the cost of VR tools is high. The organization must operate with the realities of tight budgets and competing demands for the available funds. The high cost of VR headsets and limited financial resources in the nursing education institutions is a primary barrier for VR adoption in nursing education. Second, there is a lack of knowledge about what VR really is. Some stakeholders are likely to balk at the idea of adopting a new educational technology that involves changing the curriculum, at least not until the technology proves effective. However, waiting for the technology to prove effective presents a flawed argument since the technology cannot be effective until there is a fundamental change in the curriculum to allow for VR to be meaningfully integrated. Third, there is anxiety about effect of VR on users. While there is enthusiasm about VR use in education, there are concerns about negative health effects, particularly eye strain, motion sickness and nausea. Overall, resistance to VR technology is likely to arise from cost concerns, lack of knowledge about the technology, and health concerns among users (Sherman & Craig, 2018).
The Planned Change Theory will act in seven ways to help in address resistance to change. First, creating the foundation for the change strategy. This helps in clarifying what the change seeks to achieve, aligning the change outcomes with the organization, improving credibility, and avoiding miscommunication. Second, testing assumptions by forcing critical reflection on the problem definition, planned activities and hoped outcomes. This helps in provoking hard conversation and realizing among the stakeholders, thus allowing for healthier information processing and strengthening buy-in. Third, opening communication and presenting opportunity for participative collaboration. The change theory offers the stakeholders a unified understanding of how the change will happen, sharing that information in a succinct, comprehensive manner. Fourth, it sharpens messaging by ensuring that the stakeholders have the same understanding. Fifth, it creates a pathway for change. Articulating the change theory makes it easier to identify the possibility of shared action that allowing for effects to be leveraged for systemic change because specific complementary gaps and areas of focus become obvious. Sixth, serving as a guide for measuring success in terms of understanding failure, achieving and progress. Subsequently, this aids in developing strategic implementation decisions, key performance indicators, and achievement measures. Finally, it provides a decision-making framework. From tactical to strategic decisions, the change theory helps in driving decision making forward around investments of resources and time at all levels of the change management (Murray, 2022).
Plans to Implement Change Theory
The change will be implemented using the seven-step process as described by Planned Change Theory. The first step is diagnosing the problem by identifying a need that VR would fill in nursing education. The second step is assessing the motivation and capacity for change. This involves exploring the gains and losses from adopting the technology and ensuring that the gains are leveraged while the losses are minimized/controlled. The third step is assessing the motivation for change and availability of resources. This involves getting the key stakeholders on board with the change and availing resources for implementing the change. The fourth step is selecting the progressive change objectives. Change occurs over a period of time, and there should be goals to be achieved with each stage of the change being implemented. The fifth step is choosing an appropriate change agent role. This determines how the change manager gets the support and buy-in of the stakeholders for the change. The sixth step is maintain the change by implementing the change, tracking progress and making revisions where necessary and appropriate based on outcomes. The final step is terminating the helping relationships by turning the change into an established organizational culture (Murray, 2022) Emerging Trends and Challenges in 21st Century Nursing Education.
Purpose of Proposal
The proposal is to use VR technology in nursing education. This is expected to provide an opportunity for experiential learning in a safe, controlled environment as nursing students will be practicing their clinical skills without fear of making errors. The technology creates an entire digital environment, an immersive, 360-degree user experience that feels real. Within the digital environment, uses can interact with what they see as they would in the physical, real-world environment. VR technology being integrated into delivery of nursing education offers five significant benefits. First, the convergence of other learning approaches with VR technology boost learning by manipulating objects in a virtual world, transducing otherwise imperceptible information sources, and reification of abstract ideas that defy representation. Second, it allows for constructivism even as education applications of VR are developed. Third, it inspires student creativity and sparks imagination, this motivating them to explore new interests. Fourth, it allows nursing students to be culturally competent as they acquire technology skills that are becoming today. Finally, the immersive learning experience furnishes first-person non-symbolic experiences specifically designed to helps nursing students learn clinical material (Sherman & Craig, 2018).
Explanation of Proposal and Needs Gap
The gap analysis conceded that while there is nothing wrong with the current nursing curriculum. However, VR technology presents an opportunity to improve nursing education outcomes by providing nursing students with a safe environment in which to practice their clinical skills effectively. VR presents a safe, fail free environment that boosts the confidence and effectiveness of nurses in clinical practice. VR would improve nursing education by giving all nursing students, of all backgrounds and levels, the same opportunity to experience their learning in an engaged and more immersive way. In using the technology, nursing students are able to better understand information that they would find difficulty in understanding when presented using traditional education approaches that typically focus on fact retention. In essence, the inclusion of VR technology in nursing education would allow the students to interact with their clinical lessons and experience them in a different way (Staat, 2021).
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Importance and Impact of Proposal
Integrating VR technology in nursing education curriculum would offer significant benefits for the stakeholders. First, it benefits the students through providing them with a safe, fail free environment that boosts their clinical skills, confidence and effectiveness nursing practice. Second, it benefits nursing education institutions by providing an immersive virtual education space that overcomes time and space limitations. Third, it benefits the faculty by making it easier to tech more students. Finally, it benefits the community by presenting skilled nurses who have extensive clinical practice experience and can provide them with the best possible nursing care (Staat, 2021) Emerging Trends and Challenges in 21st Century Nursing Education.
Conclusion
In conclusion, VR programs in nursing education will provide a solid foundation in providing knowledge to students. Virtual reality gives students a space to learn their clinical skills step by step in a controlled environment. Although many factors may affect the effectiveness of the virtual reality program, all of these barriers can be solved with effective management and problem-solving. In addition to the effectiveness of virtual reality in learning it also provides a way to create a standard that can be practiced nationally. The creation of national standards and studying tools will put all nursing students at an equal advantage. Virtual reality programs also prove effectiveness in time and understanding the improvements needed by the student as an individual. The implementation of virtual reality in nursing education is the technology that is needed for this constantly evolving field Emerging Trends and Challenges in 21st Century Nursing Education
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Table 1
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| Literature Review Summary Table
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| Chang & Lai (2021) | “Exploring the experiences of nursing students in using immersive virtual reality to learn nursing skills” | To gather data on the experience of nursing students using virtual reality | Sixty nursing students in Taiwan that took an adult nursing course
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VR systems should be used as an interactive study tool instead of taking over traditional learning completely. | Provides data on how VR is a strong tool that could be used by nursing students | Level of Evidence:
VI Strength: ● Provided evidence from actual nursing students ● Got opinions from students directly Weaknesses: ● Only based on students in Taiwan ● Only based on adult nursing students
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| Chen (2020) | “Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis. Journal of medical Internet research” | Evaluate the effectiveness of VR in nursing education | Analysis based on studies explaining effectiveness of VR on knowledge, skills, satisfaction, confidence, and performance time | VR was more effective than the control conditions in improving knowledge | Provides evidence on effectiveness of VR on helping students obtain knowledge | Level of Evidence:
I Strengths: ● Provided a lot of diverse sources ● Provided both qualitative and quantitative data Weaknesses: ● More analysis of data needed ● Needs larger sample size |
| Fealy (2019) | “The integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review” | To review the integration of VR technology in midwifery and nursing school | Based on Joanna Briggs Institute methodology for scoping reviews a standard criterion was created, and ten databases were searched. | VR has the potential to give students confidence and competence by providing a safe fail space for them to practice their skills | Provides evidence that VR will be a great educational tool. But nursing educators must help create the VR programs. | Level of Evidence:
VI Strengths: ● Control group extremely specific ● Gives a new outlook on potentials of VR Weaknesses ● Lacks evidence ● Not a large enough sample size |
| Lange (2020) | “Learning With Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model.” | Observe the acceptance of VR applications by nursing students in Germany | Twelve participants were first asked to fill out a quantitative questionnaire on their sociodemographic characteristics and the extent to which they valued and liked using technology | VR curriculum was actually related highly mostly to students who had a positive outlook on technology. | Provides evidence that student outlook on technology affects their experience. | Level of Evidence:
V Strengths: ● Viewed personal outlook of students’ thoughts on technology. ● Controlled sample group Weaknesses ● To small of a sample size ● Based only on nursing education in Germany |
| Padilha (2019) | “Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial. Journal of medical Internet research” | Evaluate the effectiveness of VR technology in education. | A controlled trial with forty-two nursing students from Portugal. The groups were given the same curriculum but were split in half and given the information through two forms of learning. Emerging Trends and Challenges in 21st Century Nursing Education | VR proved better retention in knowledge long term versus traditional learning | VR is effective in helping nursing students retain information so should be used as an educational tool. | Level of Evidence:
II Strengths: ● Controlled ● Proved effectiveness of VR Weaknesses ● Larger sample size needed ● Lacks statistical data |
Table 2
Curriculum Technology Need-Gap Analysis
| Current curriculum technology | Desired curriculum technology | Need-gap | Action steps to meet the need-gap |
| Traditional learning is still effective today. The only thing is most curriculums and nursing resources are found virtually through etextbooks and files. | I propose a national clinical VR program be created by the National Council of state board nurses so nursing students can practice clinical skills effectively at any time. | There is nothing wrong with the current curriculum but the need for VR programs will help provide nurses with a safe environment to practice their clinical skills effectively. The safe fail free environment provides nurses to boost confidence and effectiveness when practicing. Emerging Trends and Challenges in 21st Century Nursing Education | ● Clinical standards need to be reviewed
● Nurses must come together to create effective VR program ● VR needs to be approached with positive attitude from both professor and students to be most effective ● VR has to be made available to all students so there are no disadvantages ● Nurses must analyze how to keep curriculum updated within VR system ● Simulation created by VR have to mimic real world scenarios nurse might encounter |
Table 3
Force Field Analysis
| Forces FOR
curriculum proposal |
Curriculum proposal | Forces AGAINST curriculum proposal | ||
| Helps students obtain knowledge. | Virtual reality clinical funded by the American association of nursing.
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Accessibility to virtual reality headsets. | ||
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Provides students with an unlimited clinical study tool
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Keeping VR programs up to date | |||
| Allows students a safe environment where they can learn from their mistakes
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The cost of VR |
References
Chang, Y. M., & Lai, C. L. (2021). Exploring the experiences of nursing students in using immersive virtual reality to learn nursing skills. Nurse education today, 97, 104670. https://doi.org/10.1016/j.nedt.2020.104670
Chen, F. Q., Leng, Y. F., Ge, J. F., Wang, D. W., Li, C., Chen, B., & Sun, Z. L. (2020). Effectiveness of Virtual Reality in Nursing Education: Meta-Analysis. Journal of medical Internet research, 22(9), e18290. https://doi.org/10.2196/18290
Cherry, B., & Jacob, S. R. (2019). Contemporary Nursing: Issues, Trends, & Management (8th ed.). Elsevier, Inc.
Cobbett, S., & Snelgrove-Clarke, E. (2016). Virtual versus face-to-face clinical simulation in relation to student knowledge, anxiety, and self-confidence in maternal-newborn nursing: A randomized controlled trial. Nurse education today, 45, 179–184. https://doi.org/10.1016/j.nedt.2016.08.004
Fealy, S., Jones, D., Hutton, A., Graham, K., McNeill, L., Sweet, L., & Hazelton, M. (2019). The integration of immersive virtual reality in tertiary nursing and midwifery education: A scoping review. Nurse education today, 79, 14–19. https://doi.org/10.1016/j.nedt.2019.05.002
Finkelman, A. (2019). Professional Nursing Concepts: Competencies for Quality Leadership (4th ed.). Jones & Bartlett Learning, LLC.
Garcia-Dia, M. (2019). Project Management in Nursing Informatics. Springer Publishing Company.
Lange, A. K., Koch, J., Beck, A., Neugebauer, T., Watzema, F., Wrona, K. J., & Dockweiler, C. (2020). Learning With Virtual Reality in Nursing Education: Qualitative Interview Study Among Nursing Students Using the Unified Theory of Acceptance and Use of Technology Model. JMIR nursing, 3(1), e20249. https://doi.org/10.2196/20249
Murray, E. (2022). Nursing Leadership and Management for Patient Safety and Quality Care (2nd ed.). F.A. Davis Company.
Oxford References (2022) Science and Technology. https://www.oxfordreference.com/page/scienceandtech/science-and-technology
Padilha, J. M., Machado, P. P., Ribeiro, A., Ramos, J., & Costa, P. (2019). Clinical Virtual Simulation in Nursing Education: Randomized Controlled Trial. Journal of medical Internet research, 21(3), e11529. https://doi.org/10.2196/11529
Schmidt, N., & Brown, J. (2019). Evidence-Based Practice for Nurses: Appraisal and Application of Research (4th ed.). Jones & Bartlett Learning, LLC.
Sherman, W. R., & Craig, A. B. (2018). Understanding Virtual Reality: Interface, Application, and Design (2nd ed.). Elsevier Science.
Staat, D. W. (Ed.) (2021). Virtual Reality in Higher Education: Instruction for the Digital Age. Rowman & Littlefield. Emerging Trends and Challenges in 21st Century Nursing Education