Virtual Reality Is a Tool for Education, Relaxation for Nurses and Patients

VR headset holographic low poly wireframe vector banner. Polygonal man wearing virtual reality glasses, helmet. VR games playing. Particles, dots, lines, triangles on blue background. Neon light.: © matrosovv - stock.adobe.com

Simulated experiences using virtual reality (VR) can help oncology nurses alleviate a patient’s anxiety before undergoing treatment, provide comfort in palliative care settings, and serve as an educational tool for both nurses and patients.

Oncology Nursing News spoke with Emery Bergey, MSN, RN, OCN, HNB-BC, clinical nurse specialist at Moffitt Cancer Center in Tampa, Florida, to learn more about how her institution and others are using VR to help patients and educate nurses.

How is VR is currently being used in oncology nursing?

VR is currently being used as a way to relieve patients’ anxiety and stress, in particular, during procedures [and] during chemotherapy to reduce anxiety. We actually did a project here at Moffitt, where we provided the patients with VR headsets on their first day of chemotherapy treatment, when everything's very overwhelming, when they're very scared. And when we put that headset on, we noticed patients immediately calmed down. There was one patient that stated that she was feeling tremors. When she put the headset on, her tremors ceased, and then they didn't come back after the activity was completed. That was very rewarding.

It's also being used in palliative care settings. It’s associated a lot with that concept of a “good death.” Sometimes patients are hospitalized and providing them the opportunity to be on a beach or somewhere that brings them joy, that can really help with that peaceful passing. In addition, there's a program that allows family members the opportunity to record their voices or to be present through an avatar or their photos, so the patient can actually see that on the VR headset. So that's been really, really peaceful.

It has also been used for patient education, specifically in radiation oncology. It is a really cool system, where they can upload the patient's scan—so a CT, MRI—and they can see a 4-dimensional visualization of their tumor. Especially if it's a complex tumor, like if it's around the carotid artery or the spine, they can see where exactly the treatment beams are going to come in, where they might see side effects, and conceptualize that a little bit easier.

VR is also being utilized in nursing education. Talking about how to perform different procedures, therapeutic communication is huge. In VR, you can actually be in that particular space with a few different classmates or members of the interprofessional team. You're not limited by time and space. It makes it accessible to everyone, regardless of where they are, and depending on what our schedule looks like. This can involve practicing how to talk with patients at end of life, if there's ways of delivering some challenging news or even practicing how to educate patients about their chemotherapy or a procedure that they might be undergoing. It's always great to practice that information in that virtual setting before we get to the point where we're providing patient care.

Is it easy to implement a VR system in a patient and/or nurse education setting?

There's a variety of programs that are accessible. The great thing about it is they're customizable. So they give you a base layer of a simulation setting, but organizations can align that with their policies, protocols, procedures. A lot of the times, they're set up very generally. So making sure that they align with oncology practice, common procedures that we might be performing like bone marrow biopsy and things. So they're very moldable to our particular care setting.

Going back to what you mentioned, how patients can use VR to pretend they’re on a beach or somewhere peaceful. What do you think it is about that approach that decreases stress in patients?

A lot of it is our brain being able to focus on one source of stimuli at a time. When we're directly visualizing that particular scene, when we're immersed in the sight and sounds, it takes that attention off of anything that might be causing us pain and anxiety, anything that's distressing in the environment. It's taking us away and putting our focus elsewhere.

Can this technology be used for all patients, or are there certain patients who may not be suited for this?

It can be implemented with pediatric and adult patients across the spectrum of oncology care. There are a couple of considerations. For example, if a patient is experiencing a mental health condition that causes them to have visual and auditory hallucinations, or they may be sensitive to visual and auditory stimuli, if they have vertigo or balance issues, moving around, just everything follows them. It might be a little bit inappropriate if they're having acute episodes of nausea and vomiting, where that motion can irritate them, or if they have any sort of visual difficulties.

Our biggest concern with VR is patient safety. A lot of those headsets have a lockout feature, where the nurse can establish a boundary. And if the patient moves or tries to ambulate and steps outside of that boundary, the simulation goes away, and all they can see is the floor. That is meant to discourage patients from ambulating while all of that stuff is going on and potentially putting them at risk for injury.

How do you envision VR being used in the future?

I would love to see it used more for nurse relaxation efforts, and also as a means of evaluating competency within nursing. Currently, I work in an educator role, and it takes a large volume of our staff to provide those comprehensive education programs for nurses. As a result, I don't think we're being as intentional as we could be. If we have VR, the nurses can do this education when they have a break on the unit, if that headset is present in a work room or break room. They can do it from anywhere at any time, and we would get score reports sent to us. There's definitely opportunity there. There's actually a program that was developed overseas for chemotherapy administration. We don't currently have that available to us, but there's an opportunity to develop things that are more oncology-centric.

Are there any challenges with nurses using VR for education?

There's a lot of that tactile sensations. You're pretty much operating a handheld controller. If it's procedure setup, sterile technique, communication, code situations, all of those conceptual points of the simulation are easily implemented. But if you are trying to actually feel how far to insert a port needle, if you're actually reaching the back of the port, if you're doing a PICC dressing change the correct way, you need that tactile aspect of it. That's very challenging to do through VR.

What advice would you give oncology nurses about using VR?

Don't be afraid of it. It's a lot easier to implement and workflow than it may seem. A lot of the time, these applications come pre-loaded, and they come already set to go. So the nurses’ primary responsibility is turning on the headset and making sure the program is accessible, and then providing that to the patient. It's basically monitoring patients throughout to make sure that they don't have any adverse symptoms. Nurses should generally be open to it, learn more about it, and experiment with that, themselves, if they can get their hands on a VR headset to get familiar with the technology. I would encourage that as well, even if it's just playing a game that your child has loaded on the headset.

You mentioned some VR projects at Moffitt. Is VR being used in many institutions or are we just scratching the surface?

I know a lot of nursing schools have implemented it for clinical skills-based things. A lot of oncology centers have used it with their pediatric population undergoing radiation therapy, because sometimes children struggle to stay still on the table, as well as adults undergoing procedures in an interventional radiology setting, and in pre-op before they're going into their surgical procedure.

With the palliative care aspect, it's being used there quite a bit. Especially with our geriatric patients, they do a lot of remembrance therapy. And then putting those VR headsets on them before sleep can also help increase their sleep quality.

This transcript has been edited for clarity and conciseness.