As co-editors we are pleased to present this special issue of Clinical Simulation in Nursing on virtual simulation. This international collection addresses diverse topics such as creating psychological safety, debriefing virtual simulation experiences, and the use of virtual simulations in undergraduate nursing education, advanced practice nursing, and rural and remote practice.

This issue was planned prior to the COVID-19 pandemic but has taken on greater relevance due to the resulting restricted access to traditional clinical, laboratory and classroom settings that led to a dramatic and unprecedented shift to online learning. Although some schools of nursing had previously used some virtual simulations, many had not, and none to our knowledge had previously used virtual simulations to replace all of their clinical hours. Although virtual simulations have demonstrated similar outcomes to traditional live simulations, barriers to adoption of virtual simulations have included costs of commercial products and lack of faculty time or expertise for development or implementation.

To illustrate the rise of virtual simulation in nursing education, we looked back at past issues of Clinical Simulation in Nursing. In the first six months of 2019 only two articles with the term “virtual simulation” in their title were published in the journal, representing 5% of the articles. In the first six months of 2020, this number had increased to four articles, representing 10.5% of the articles published during this period, all of which would have been accepted prior to the onset of the pandemic in March 2020. Fast forward to the first six months of 2021 and we have fourteen articles about virtual simulation representing 18.9% of articles and six articles in press representing 27.3% of in press articles. These numbers do not include articles that specifically mentioned “virtual reality” or “escape room” simulations in their titles. Given the uptake of virtual simulation during the pandemic, we can only expect this number to increase in upcoming months as nurse educators document their recent innovations and experiences.

To date, there has been much confusion surrounding the term virtual simulation, which has been used interchangeably with “computer-based simulation”, “screen-based simulation”, and even “virtual reality simulation”. In a recent editorial, INACSL past-president Dr. Cynthia Foronda introduced a definition of virtual simulation that we have adopted for this special issue: “Virtual simulation is the use of partial immersion through a digital learning environment (e.g., computer, tablet, phone, screen, etc.) to foster a perceived lived experience for an intended outcome (e.g., learning, entertainment, etc.)” (). This definition distinguishes virtual simulation from virtual reality simulation which involves 360o immersion using a head-mounted display.There has been considerable debate within the simulation community recently regarding the need for a specific standard for virtual simulation. However, we would argue that the current INACSL 2021INACSL
Healthcare Simulation Standards of Best PracticeTM., developed by INACSL with the support and input of the global community, apply equally to virtual simulation as they do to traditional simulation typologies such as high-fidelity simulators, standardized patients, and hybrid simulations. Regardless of the type of simulation, best practices involve incorporating the components of simulation design, preparation, briefing, facilitation, debriefing and professional development. In turn, these components are applied flexibly with consideration given to the targeted learner in terms of their clinical and simulation experience levels, and the intended learning outcomes of specific simulations, and course and program objectives.

However, educators would benefit from explicit guidelines or recommendations related to how best to implement virtual simulations with different levels of learners while recognizing constraints in terms of technological and human resources, including facilitator expertise. We propose that faculty development for virtual simulation design and facilitation is as essential as for other simulation modalities to support the delivery of high-quality learning experiences in healthcare education.

Virtual simulations, including virtual simulation games, offer several advantages in comparison to in-person simulations. Primarily, all learners are placed in the decision-making role in contrast to in-person simulations where learners typically interact with a simulated patient in groups of two to five. Virtual simulations are more accessible, with learners able to engage at any time, from anywhere there is a stable internet connection. They are repeatable and generally provide immediate feedback to learners related to their clinical decision-making. Additionally, virtual simulations provide psychological safety for learners who able to make mistakes without fear of embarrassing themselves in front of their peers or instructor. And finally, virtual simulations may be a cost-effective method to provide standardized educational modules to large groups of learners in both academic and clinical settings, and we offer the Canadian Alliance of Nurse Educators using Simulation (CAN-Sim) model as an exemplar (Tyerman et al., 2021Tyerman J. Luctkar-Flude M. Baker C. Rapid development of a COVID-19 assessment and PPE virtual simulation game.).

Even once it is safe to return to in-person instruction, we anticipate that virtual simulations will continue to provide high-quality healthcare educational options to augment or replace traditional classroom, simulation, and clinical learning for years to come. We extend a call for continued innovation and research in this field, as we present you with a selection of curated papers on virtual simulation in healthcare education.

References

What is virtual simulation?.

Clinical Simulation in Nursing. 52: 8https://doi.org/10.1016/j.ecns.2020.12.004

Healthcare Simulation Standards of Best PracticeTM.

Tyerman J. Luctkar-Flude M. Baker C.

Rapid development of a COVID-19 assessment and PPE virtual simulation game.

Clinical Simulation in Nursing. https://doi.org/10.1016/j.ecns.2021.03.002Article InfoIdentification

DOI: https://doi.org/10.1016/j.ecns.2021.06.008

Copyright

© 2019 Published by Elsevier Inc. on behalf of International Nursing Association for Clinical Simulation and Learning.

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