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Fostering learning through interprofessional virtual reality simulation development.


This article presents a unique strategy for improving didactic learning and clinical skill while simultaneously fostering interprofessional collaboration and communication. Senior-level nursing students collaborated with students enrolled in the Department of Interactive Media Studies to design a virtual reality simulation based upon disaster management and triage techniques. Collaborative creation of the simulation proved to be a strategy for enhancing students' knowledge of and skill in disaster management and triage while impacting attitudes about interprofessional communication and teamwork.


Interprofessional Education--Collaboration--Disaster Management Education--Virtual Reality Simulation--Nursing Students


Ongoing communication across disciplines in today's health care landscape is essential. In the Institute of Medicine Future of Nursing report, nurse educators are challenged to develop new models of interprofessional education (2011), defined by the World Health Organization (2010) as an experience that "occurs when students from two or more professions, learn about, from, and with each other" (p. 13).

Although interprofessional communication must be present across all disciplines represented in the health care milieu, technology specialists are often overlooked, even as universal health care records are rapidly infused into health care systems. This article presents a unique strategy for improving didactic learning and clinical skills while also fostering interprofessional collaboration and communication. Collaboration among nursing students and students in the Department of Interactive Media Studies led to the creation and implementation of a virtual reality simulation designed to reinforce concepts of disaster triage.


Social constructivist theories provided the foundation for this unique learning experience. Learning-by-teaching and cooperative learning, important frameworks of constructivist theory, nurtured the mutual construction of knowledge and promoted meaningful learning between two student groups.

With learning-by-teaching, activities involved in the teaching process are an effective method for learning content (Grzega & Schoner, 2008). To collaborate effectively on the development of a virtual reality simulation (VRS), nursing students in this project were required to teach interactive media studies (IMS) students about disaster triage and management. The student groups defined objectives, developed a storyboard, and created learning challenges within the simulation. Deep learning was achieved as nursing students adopted the educator role. Summative evaluation measures noted that students were able to apply their knowledge, not only in a simulated environment, but also in case scenarios on course exams.

Cooperative learning concepts were also reinforced through the shared development of the disaster simulation. Cooperative learning involves learning by working together in constructive interdependence to achieve learning outcomes (Tsay & Brady, 2010). For this learning strategy, students had both individual and group accountability within the learning task and for project outcomes. Comprehensive knowledge of disaster management and the Simple Triage and Rapid Treatment (START) algorithm (Benson, Koenig, & Shultz, 1996) served as an antecedent to the development of the simulation. The blending of cooperative learning and learning-by-teaching theoretical frameworks provided an environment that enhanced knowledge acquisition and improved students' ability to effectively triage disaster victims.


Adoption of VRS as a teaching methodology is becoming increasingly popular in academic settings (Kilmon, Brown, Ghosh, & Mikitiuk, 2010). Recognition of the value of this type of simulation in preparing future nurses for the medical crises they may encounter in the field has led to increased support for this pedagogical strategy (Cant & Cooper, 2010; Farra & Miller, 2013). Simulation experiences are increasingly studied and reported in the literature as a means of developing teamwork (Leigh, 2008). However, this article describes how the interprofessional creation of a VRS aided in the understanding and application of disaster management concepts taught in a community health nursing course while simultaneously facilitating collaboration and communication between interprofessional student groups.

Using a flipped classroom methodology, an independent online instructional module was presented prior to the development of the VRS (Harridan, McKnight, McKnight, & Arfstrom, 2013). The instructional module provided an overview of disaster management and described the START algorithm (Benson et al., 1996). Senior-level nursing students collaborated with the IMS students to design a VRS based upon disaster management and triage techniques presented in the module.

The nursing students had control of the instructional design of the simulation and began the process by identifying measurable learning objectives for the scenario. From the objectives, a storyboard of the events contained within the simulation was developed. The storyboard included the disaster setting, development of the characters (victims, incident commander), learning challenges the player would encounter, and triage equipment. Learning challenges included the skills of assessment, planning, triage identification of victims, and implementation of initial first aid. Ongoing virtual dialogue took place between the nursing and IMS students throughout the development process to ensure that ideas were executed appropriately.

Creation of the disaster simulation took place over a five-week period. Google Docs, Google Groups, and Google Hangouts served as venues for students to interact and collaborate outside traditional class time and designated synchronous sessions. Ideas, photos, drawings, and drafts of the simulation were shared by the student groups. Realism of the experience was heightened by the addition of sounds and three-dimensional scenery added by the IMS students. Enthusiasm for the project fostered the development of the interactive dialogue that later became a component of the simulation experience.


Nursing students developed a deeper understanding of disaster content through collaborative development of a virtual reality simulation. Comprehension of content was enhanced as nursing students worked with a student group that had limited understanding of the disaster content. Summative evaluation measures noted students that were able to apply knowledge, not only in a simulated environment, but also in case scenarios on course exams. Learning was continually reinforced as nursing students answered questions and educated the IMS students about the role of the nurse during disaster events.

Qualitative responses to open-ended survey questions showed that this teaching strategy promoted communication and collaboration skills. Responses to the learning experience were strongly positive as measured by the KidSim ATTITUDES questionnaire (Sigalet, Donnon, & Grant, 2012) developed to measure student perceptions of and attitudes toward interprofessional education, teamwork, and simulation as a learning modality (Farra, Nicely, & Hodgson, 2014).

Collaborative development of the simulation resulted in a greater appreciation for interprofessional collaboration and communication, and working together fostered a sense of inquiry in both student groups. Nursing students gained a deeper appreciation for the technical skills involved in creating a virtual reality simulation as pieces of graphics, text, and audio sound bites were shared. The IMS students developed an awareness of the nurse's role during a disaster event, while simultaneously learning more about the steps of the triage process and disaster response.


In this curriculum case report, it is shown that creation of a virtual reality simulation enhanced student knowledge and skills in disaster nursing. Student learning was reinforced as students taught and explained the steps of the triage process to individuals outside the discipline. Collaborative creation of a VRS proved be a strategy for enhancing students' knowledge and skills while also affecting student attitudes about interprofessional communication and teamwork.

The team approach used to create this disaster simulation provided a foundation for students to acquire the competencies needed for interprofessional practice. Virtual reality simulations continue to be an emerging teaching methodology for nurse educators. This report is unique in that it reports not on the impact of student interface within a virtual reality simulation, but discusses the learning acquired as a result of the simulation development process.

Stephanie Nicely, EdD, RN, is an assistant professor, Miami University Department of Nursing, Hamilton, Ohio. Sharon Farra, PhD, is an assistant professor, Wright State University, Dayton, Ohio. For more information, contact Dr. Nicely at

doi: 10.5480/13-1240


Benson, M., Koenig, K. L., & Schultz, C. H. (1996). Disaster triage: START, then SAVE: A new method of dynamic triage for victims of a catastrophic earthquake. Prehospital Disaster Medicine, 11(2), 117-24.

Cant, R. P., & Cooper, S. J. (2010). Simulation-based learning in nurse education: Systematic review. Journal of Advanced Nursing, 66(1), 3-15. doi:10.1111/].1365-2648.2009.05240.x

Farra, S. L., & Miller, E. T. (2013). Integrative review: Virtual disaster training. Journal of Nursing Education and Practice 3(3), 93-101. doi:10.5430/jnep.v3n3p93

Farra, S., Nicely, S., & Hodgson, E. (2014). Creation of a virtual triage exercise: An interprofessional communication strategy. Computers, Informatics, Nursing [epub], doi:10.1097/CIN.0000000000000090

Grzega, J., & Schoner, M. (2008). The didactic model LdL (Lernen durch Lehren) as a way of preparing students for communication in a knowledge society. Journal of Education for Teaching: International Research and Pedagogy, 34(3), 167-175. doi:10.1080/02607470802212157

Hamdan, N., McKnight, R, McKnight, K., & Arfstrom, K. M. (2013). A review of flipped teaming. Flipped Learning Network. Retrieved from LitReview_FlippedLearning.pdf

Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. Washington, DC: National Academies Press.

Kilmon, C. A., Brown, L., Ghosh, S., & Mikitiuk, A. (2010). Immersive virtual reality simulations in nursing education. Nursing Education Perspectives, 31(5), 314-317. doi:10.1043/1536-5026-31.5.314

Leigh, G. T. (2008). High-fidelity patient simulation and nursing students' self-efficacy: A review of the literature. International Journal of Nursing Education Scholarship, 5(1), 1-17. doi:10.2202/1548-923X.1613

Sigalet, E., Donnon, T., & Grant, V. (2012). Undergraduate students' perceptions of and attitudes toward a simulation-based interprofessional curriculum: The KidSIM ATTITUDES questionnaire. Simulation in Healthcare, 7(6), 353-358. doi:10.1097/SIH.0bO13e318264499e

Tsay, M., & Brady, M. (2010). A case study of cooperative learning and communication pedagogy: Does working in teams make a difference? Journal of the Scholarship of Teaching and Learning, 10(2), 78-89.

World Health Organization. (2010). Framework for action on interprofessional education & collaborative practice. Retrieved from hq/2010/WHO_HRH_HPN_10.3_eng.pdf
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Title Annotation:Innovation Center
Author:Nicely, Stephanie; Farra, Sharon
Publication:Nursing Education Perspectives
Article Type:Report
Date:Sep 1, 2015
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