Developing Innovative Virtual Reality Simulations to Increase Health Care Providers' Understanding of Social Determinants of Health.

INTRODUCTION: Health care providers (HCPs) who work primarily with Medicaid patients must be competent in identifying and addressing social determinants of health (SDH). A curricular gap exists between promoting an understanding of SDH and teaching HCPs how to recognize and increase empathy to manage them. The project aim was to develop two virtual reality simulations (VRSs) as innovative methods to teach HCPs to identify and manage SDH. A secondary aim was to decrease unconscious bias and increase empathy by experiencing SDH from their patients' perspective. METHODS: Scripts for two VRSs were created by two HCP educators and clinicians. Scripts were evaluated by experts using an index of content validity (CVI). An advisory panel critiqued the scripts for appropriateness for VRSs, adequacy of evidence-based practice, and use of VRS equipment and software. The panel participated in a focus group and completed a final evaluation. The VRSs then were pilot tested with five HCPs who assessed content and utility and participated in interviews. This led to iterative improvements. Qualitative data were analyzed using a content analysis approach. RESULTS: The VRS scripts demonstrated adequate content-related validity evidence with CVI scores of 0.81 and 0.75. The expert panel found the VRS easy to use, useful as an educational tool, while promoting empathy for patients. Overall, participants were satisfied with using the VRS as an educational experience. DISCUSSION: Through VRS technology, this project addresses a curricular gap in HCP training on SDH. VRS can be a useful tool to increase HCPs' understanding of SDH and, potentially, their empathy for patients.

Impact of immersive virtual reality simulations for changing knowledge, attitudes, and behaviors.

BACKGROUND: Virtual reality has promise as a training method within the affective domain, but investigation is still needed for intention to change behaviors based on social determinants of health. OBJECTIVE: The objective of this study was to describe the self-reported changes in knowledge and/or attitudes and planned behavior changes by healthcare workers for their future care of persons with challenges to their social determinants of health following completion of a first-person virtual reality experience. DESIGN: A descriptive qualitative design was used. SETTINGS: This study was conducted in clinics and private practice settings in Ohio (United States). PARTICIPANTS: This study was conducted with 206 healthcare workers. METHODS: Participants completed a virtual reality simulation followed by qualitative, open-ended questions about changes to their knowledge, attitudes, and behaviors. Responses were analyzed using a content analysis method. RESULTS: Four overarching themes were derived from the qualitative data: (1) Acknowledgement of Social Determinants of Health, (2) An Improved Provider Experience for Patients, (3) Patient as a Person with Complex Needs, and (4) The Learning Experience. CONCLUSION: Findings suggest virtual reality has strong merits for impacting affective domain of learning demonstrated by increased empathy. Virtual reality along with increased empathy also helps improve attitudes and behaviors for the betterment of patients.

Telehealth in Psychiatric Nursing Education: Lessons From the Field.

BACKGROUND: This article summarizes the experiences that a Midwest college of nursing had when telepsychiatry was introduced for psychiatric-mental health post-master's nurse practitioner students to use in a clinical internship. AIMS: Implications for nurse practitioner educators will be identified, and recommendations for future research will be explored. METHOD: Described are the following: (1) policies and procedures the institution considered, (2) challenges that were encountered by faculty and students, and (3) strategies and limitations of these strategies defining best practice, what didactic content should be taught, and how clinical placements needed to be structured. RESULTS: Implications for nurse practitioner educators, practice, and research are identified. CONCLUSIONS: It is clear that telepsychiatry has an important role in the clinical education of psychiatric-mental health nurse practitioners. It is working well as a clinical internship option. The college of nursing is continuing to examine and address issues and is looking forward to enhancing the telepsychiatry experiences for students in the future.

What Interventions Improve Outcomes for the Patient Who Is Depressed and in Pain?

SPECIFIC CLINICAL ISSUE: The purpose of this clinical consultation is to offer nurses evidence-based strategies to provide holistic care to their patients with comorbid depression and pain. The combination of depression and pain is common and, if not managed effectively, has negative outcomes. Treatment-resistance is one negative outcome. The worst-case scenario for unrelieved depression and/or pain is suicide. MAJOR PRACTICE RECOMMENDATIONS BASED ON BEST EVIDENCE: Antidepressants, particularly duloxetine, have had efficacy for pain and depression. Cognitive behavioral therapy, an evidence-based treatment for depression, has been found to decrease pain. Examples of additional interventions include exercise, relaxation techniques, mindfulness, and music. Providing holistic nursing care and working with other disciplines optimizes more effective management of these co-occurring conditions.