Dr Heidi Singleton

Heidi has conducted a research study comparing the use of a virtual reality training simulation to traditional nurse education methods. The study was chosen as a Fusion Case study and the link can be found here: https://www.bournemouth.ac.uk/why-bu/fusion/using-virtual-reality-train-nurses Together with diabetes expert Dr Janet James and diabetes specialist nurse Simone Penfold, Heidi focused on developing a patient case study to teach student nurses how to effectively treat a diabetic emergency - hypoglycaemia. Hypoglycaemia is a medical emergency experienced by diabetics where their blood sugar drops too low. Hypoglycaemia was chosen as the focus of the work because an increasing number of patients admitted to hospital also have diabetes as a secondary condition so it’s becoming ever more important that nurses understand how to treat hypoglycaemia. In the case study, a patient is admitted to hospital and then experiences hypoglycaemia. The patient’s condition deteriorates and throughout the scenario the student is given a number of choices and their decision affects the patient’s outcome. Technology company Daden worked closely with the BU team to create an app based on the case study that simulates the emergency. The software can be used on computers, immersive technology including Oculus Rift and mobile phones with virtual reality (VR) headsets to really bring the experience to life. The simulation was carefully created to be both accurate and realistic - the setting is based on wards at Royal Bournemouth Hospital that the student nurses have worked in and the software has replicated the same equipment used within the wards so the experience is familiar to the student nurses. When using the software, students go through the scenario and must make choices on what care to give the patient. The exercise instantly provides feedback on the choice, allowing students to ascertain what the correct treatment options are.

Heidi's doctoral thesis was entitled Singleton, H., 2020. Virtual technologies in nurse education: the pairing of critical realism with partial least squares structural equation modelling as an evaluation methodology. Doctoral Thesis (Doctoral).

Abstract:
Background: Virtual technologies have been, and continue to be, of significant interest to Higher Education (HE) educators. There have been many research studies carried out into the efficacy and acceptability of these technologies. But, this research (via a systematic literature review) found that there are significant methodological shortcomings in many of those studies, particularly with respect to understanding the mechanisms of the effect of virtual technologies on learning. Most papers were superficial and concentrated on the Technology Acceptance Model (TAM) of usability and ease of use. Some carried out perfunctory assessments of learning effect, but predominantly by measuring student enjoyment via subjective self-reporting. This thesis responded to this gap in the literature by implementing a non-immersive virtual reality (VR) (accessed via a laptop), educational simulation of a deteriorating diabetic patient and creating a novel and powerful method to evaluate the effect of that simulation on nurse education. Method: The systematic review of the literature led to the creation of a diabetes VR simulator. A novel approach was designed to evaluate this simulator which consisted of the pairing of a randomised controlled trial (RCT) (n=171), analysed via Partial Least Squares-Structural Equation Modelling (PLS-SEM). The conceptual pathway model for this PLS-SEM approach was drawn from a Critical Realist (CR) review. Hence the main aim was to assess the effectiveness of CR paired with PLS-SEM as a method to evaluate the impact of VR simulations on undergraduate nurse education. The RCT enabled comparison of the VR simulation with normative teaching methods which addressed the two objectives: to determine the effect of pairing CR with PLS-SEM as an evaluative method, and to determine how using this novel evaluative method can inform our understanding of the impact and future use of VR simulations for undergraduate nurse education. Findings: The effect of pairing CR with PLS-SEM was that deep insight was gained into how VR simulations can benefit student nurses. VR was found to be significantly (P=<.001) better in terms of hypoglycaemia knowledge than normative methods. Moreover, the novel method also enabled identification of the key point of action of the simulation, via analysis of the conceptual model which evidenced that the “engagement to immersion” pathway was responsible for leading to higher knowledge scores in the VR group. This thesis is claiming addition to knowledge about how the novel methodological approach taken has the potential to deepen understanding of how virtual technologies can affect learning. Recommendations for policy, practice, and further research have been made on this basis. Future studies could use PLS-SEM combined with CR in order to ascertain both measurable and rich data about how new technologies can improve nurse education.

Eczema Igloo (A BU Heif funded project): Immersive virtual reality to distract from itch for children with moderate to severe eczema.
Atopic eczema, (atopic dermatitis (AD) is a long-term inflammatory skin condition and one of the commonest childhood illnesses. It is a debilitating disease with high levels of disease burden for the patient (Blakeway 2020). The main symptoms are itch and dryness. AD is the most common long-term disorder, affecting up to 20% of children in industrialised countries (Tsakok 2019). Standard treatment is trigger/irritant avoidance and regular application of emollients and topical steroids/calcineurin inhibitors (Wollenberg 2020). There have been concerns around steroid withdrawal amongst some patients who have very severe AD. Hence, non-pharmacological treatments are being sort.
In addition to educational programmes, a range of psychological therapies are used to treat children. These include mindfulness, relaxation, and guided imagery techniques to distract children from the scratch itch cycle that contributes to insomnia and impacts on quality of life (LeBovidge 2021). The last Cochrane review of Psychological and Educational interventions revealed no robust interventions to enhance effective guided imagery in this context (Ersser et al 2014). Furthermore, virtual reality (VR) has not been sufficiently applied to intervention development in dermatology.
Traditionally, guided imagery has been used in the form of audio scripts spoken to the patient to guide their imagination away from any stress and the itching sensation (Vagnoli 2019). The use of VR works to focus attention, distracting the patients in relation to different environmental stimuli (Carrougher 2009). Whilst we have found no previous studies that have evaluated VR to treat eczema, it has been used to treat anxiety, burns and pain (Barros 2014; Scapin 2018). Since itch and pain can be triggered from the same receptive fields in the skin (Behrang 2020), it is proposed that VR could be used as a more sophisticated and immersive version of guided imagery. VR displaces a person to an imagined ‘other’ location, with complete immersion as the goal (Brigham 2017), physically blocking out the real world and replacing it with a computer-generated world which includes visual, auditory, and haptic stimuli. VR may potentiate the distractive effect, building on what would be the more limited reach of existing guided imagery interventions. Therefore, our hypothesis is that VR would provide immersive diversion from unpleasant symptoms of eczema. Heidi is leading a Cochrane review of the evidence base, due for publication in 2023.
Through gathering perspectives from key stakeholders’- families, we aim to develop a prototype eczema igloo (with eye tracking, breath, and heart rate control features) that will distract children from their itchy eczema and reduce stress. The aims of this project align with the NHS long term plan, which encourages innovation and technological revolution in clinical practice.
This is a collaborative HEIF funded project working with the following experts:
-Professor Steven Ersser, FHSS- Professor of Nursing & Dermatology Care
-Professor Debbie Holley, FHSS Professor of Learning Innovation
-Dr Xiaosong Yang, FMC, Associate Professor of Computer Animation
-Dr Emily Arden-Close, SCITECH, Senior Lecturer
-Dr Sarah Thomas, BCRU
-Richard Glithro- SCITECH, Demonstrator
-John Moran, FHSS, Simulation Lead Technician
-Amanda Roberts- Nottingham Support Group for Carers of Children with Eczema