TAPPING INTO TECHNOLOGY Nursing Education Gets a Second Life

JOY DON BAKER, PhD, RN-BC, CNE, CNOR, NEA-BC; JENNIFER M. BRUSCO, BS, CNA

econd Life (SL) is a three-dimensional world created by its users who interact with each other online for activities such as nursing education, business meetings or networking, and entertainment (eg, music, art). Each user is represented by an avatar (ie, a digital representation of oneself that is created, customized, and manipulated by the user1). Individuals use SL for a variety of reasons. For example, musicians may join SL and put on a concert, which helps increase exposure to their music and boost their careers in SL and in real life. Artists use SL to display their work in virtual art galleries. Perioperative nurses can create poster exhibits, similar to those displayed at AORN Congress, to showcase quality improvement practices and perioperative research (Figure 1). Individuals are able to reach more people in less time using this virtual platform than they would in real life. Business and health care professionals may use SL to establish their brand, share their products and services with users, announce and hold virtual events (eg, fundraising, educational), and conduct business meetings. Using SL as a platform allows businesses and health care providers to extend their reach to potential customers and patients whom they may not have been able to reach using other means. Perioperative nurses also may come to SL as a means for social interaction and entertainment.

Today, hundreds of colleges, universities, and other learning organizationsfrom nearly every countryare either augmenting their current curriculum with a virtual learning component or they are holding classes and entire programs exclusively in the immersive learning environments in Second Life.2 Nursing schools are among the many educational settings embracing SL for educational purposes, including lectures and simulation activities. Student and faculty interaction via distance learning modalities can prove challenging in keeping the students engaged and the instruction effective and meaningful. Second Life offers a way to increase engagement and reinforce content. For nursing students, simulation offers a safe environment to put into practice the lessons learned in lectures. Instructors can create various clinical scenarios using simulation to help teach students how to react to particular situations. For example, an instructor may serve as the patient avatar while the student conducts the procedure or responds to preidentied case scenarios. Anything that is an algorithm process, such as learning basic cardiopulmonary resuscitation steps, can be successfully duplicated in the SL environment. Another example might be the management of a hyperthermia crisis situation in the OR.

If you have an idea for a column or a technology-related question that you would like to see addressed, contact Jennifer M. Brusco at journalcolumns@aorn.org.
doi: 10.1016/j.aorn.2011.09.004

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Figure 1. University of Texas at Arlington College of Nursing poster exhibits. (Image courtesy of JD Baker.)

Recently, Judy Leore, PhD, RN, NNP-BC, CPNP-AC/PC, led a University of Texas at Arlington (UTA) joint project in SL in which the students donned gown and gloves and cared for an infant. They had to wash their hands rst even in the SL scenario. Each student followed the instructions posted on the wall of the room and then went to the patients bed, where he or she could assess the baby, who in this case had a slight fever; the students could use suction for the baby as needed and give medications based on the outcomes of the assessment conducted. Figure 2 shows one of the UTA College of Nursing pediatric SL simulation rooms. Occasionally, unintended effects occur in SL. For example, when a student tried to take her gown off to dispose of it, all of her SL clothes came off with the gown. Certainly not something one wants to

have happen in real life, but in SL even embarrassing moments can be easily overcome. The UTA pediatric simulation room in SL, created by Cathy Thombs, research assistant, Learning Innovation, Coventry University Technology Park, United Kingdom, and UTA SL Administrator Sarah Jones, MS, MLS, is almost identical to the real-life UTA Smart Hospital simulation laboratory.

REGISTERING WITH SL If you do not already have an account with SL, you will need to create one and build an avatar. To begin exploring the three-dimensional, virtual reality of the SL world of serious gaming, visit http://secondlife.com. There are several navigational options on the SL homepage that allow the user to learn more about SL, purchase land, go shopping, and engage with other SL community members. To learn more Second Life Education Opportunities about SL and to view the Competency simulation training Quick Start Guide, select Scrub person skills training What is Second Life? Patient assessment from the top naviga Equipment use and troubleshooting tion bar. To search for a Inservice education sessions and training specic location such as a RN rst assisting skills training school campus, store, entertainment venue, or art gallery,
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select the World Map from the top navigation lows you to customize your avatar and access SL. bar. There are opportunities to buy land that The premium account offers the same features as equates to server space to build in the virtual enthe free account in addition to a private threevironment, access blogs and forums for sharing dimensional home location and weekly rewards in and creating work environments, and utilize meetthe form of virtual currency that can be used in ing spaces, to name only a few options. To join SL. Click Select to indicate the chosen account SL, select Join Now either in the top right coroption. ner or lower left corner of the center image on The next step is to download and install SL on the homepage. your computer. Select Download & Install SecNext, choose an avatar. Once created, this initial ond Life to begin the process. Depending on the avatar will represent you. Avacomputer operating system, you may need to tars may be customized later at your convenience and as you acquire skills to change Nursing Education in SL Videos the appearance. Scroll through Duke University School of Nursing the avatar options until you nd one that you like, http://www.youtube.com/watch?vsL3D-59MbnY and then select Choose Ohio University Second Life Campus This Avatar. http://www.youtube.com/watch?vaFuNFRie8wA Next, enter a username San Diego State University (eg, IrisRN) and select http://www.youtube.com/watch?vjDKESGsO3JM Check Availability to ensure that the username has Tacoma Community College not already been taken by http://www.youtube.com/watch?v2fw0qx0B7o0 another SL user. If the userUniversity of Texas at Arlington KDAF News (2011) name is available, select http://www.the33tv.com/news/kdaf-second-life-uta-story,0,4890069.story Next Step. The next University of Wisconsin Oshkosh Accelerated BSN Second Life prompt will ask you to enter Community Clinical more information, including your e-mail address, date of http://www.youtube.com/watch?vKeK1bBTF9m8 birth, and desired password Virtual world for new nurse avatars as well as a security queshttp://www.youtube.com/watch?vRzm8T0esUh8&featurerelated tion with the answer. This is Second Life catheterization laboratory simulation done to ensure that you are a http://www.youtube.com/watch?vqMmbVlgc-DU real person and can be held accountable for your own Training simulation in Second Life actions in SL, just as in real http://www.youtube.com/watch?vDJTzNSV8pb0&featurerelated life. When you have nished, Second Life strategies for companies and future use Interview select Create Account. with Philip Rosedale, founder and chief executive ofcer of There are two account options Linden Labs from which to select, a free http://www.youtube.com/watch?vJBFtpOrA6lg account or a premium account Web site access veried August 23, 2011. for a fee as low as $6 per month. The free account alAORN Journal 601

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Figure 2. University of Texas at Arlington College of Nursing Second Life pediatric simulation room. (Image courtesy of JD Baker.)

planning, implementing, and ultimately evaluating the outcomes by reviewing the participants evaluations. The event functioned similarly to that of a real-life event in which participants preregister online and then sign in when arriving at the location (Figure 3). In this case, registrants typed their SL avatar name and real name in the chat eld, making it possible to nd the person on the preregistered participant roster and record a list of SECOND LIFE IN PERIOPERATIVE attendees to the conference. Approximately 37 NURSING EDUCATION RNs attended the event, including two from forOne example of how SL can be used for educaeign countries and several from states other than tional purposes is hosting a continuing education Texas. This type of scenario can be applied to (CE) event. The UTA nursing informatics course perioperative practice CE sessions as well as students sponsored a CE event, which involved inservice education sessions in a hospital, ambulatory setting, or any setting in Glossary of Terms which perioperative nurses Avatar: A digital representation of oneself that is created and are employed. manipulated by the user. The speakers used headSecond Life: A three-dimensional world created by its users sets with microphones to who interact with each other online for activities such as educatalk with the participants tion, business meetings or networking, and entertainment. and were able to show their Smartphone: A mobile telephone with computer features that PowerPoint slides for may enable it to interact with computerized systems, send e-mail, all to view in real time and access the Internet. (Figure 4). The screen on the right allows conference select Open File to begin the download process. When the download dialogue box pops up on the screen, select Run and then Install. A green bar will appear at the bottom of the download box, indicating the progress. When installation is complete, navigate to SL using the shortcut icon located on the computer desktop or by selecting SL from the computers programs list.
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Figure 3. University of Texas at Arlington College of Nursing registration desk. (Image courtesy of JD Baker.)

participants to view the presenters slides; however, the slides must be in a .jpg format, which does not allow the animation that is possible in normal PowerPoint presentations. The left screen, however, offers access to the Internet, and a speaker may show YouTube videos or use any type of webcasting that can be posted on the Internet. Figure 5 illustrates the moderator and two speakers on the stage area. Behind them are two signs that a participant may select; by selecting one, the participant can pose a question

to the speakers if he or she does not wish to voice the question live in SL; by selecting the other, the participant can submit the evaluation for the event, which is similar to evaluations that are a part of the process for all CE events. PERIOPERATIVE PROFESSIONAL NURSING IMPLICATIONS Perioperative nursing professionals are beginning to access and use tools such as SL as alternatives to real-life settings that also provide a method to maintain connection. A connection provides a

Figure 4. University of Texas at Arlington College of Nursing presentation screens. (Image courtesy of JD Baker.)

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Figure 5. Signs allow access to the question-and-answer function and the evaluation form. (Image courtesy of JD Baker.)

means for forming a relationship that may be physical, mental,3 or spiritual.4 The environment of trust is important to creating the atmosphere for connections to develop.5,6 Traditional ofce hours for faculty members or perioperative managers, for example, can be conducted from a distance and yet provide a sense of reality in SL (Figure 6). Students from the nursing informatics course reported that they felt as though they were really in the environment, experiencing the events as if they were there and not just sitting in front

of the computer. Virtual reality settings such as SL provide an opportunity for private meetings that do not require any of the parties to be face to face, thus reducing driving time and cost of travel. Unfortunately, there are some limitations of SL related to the issue of access, creating a situation of haves and have nots, just as there is in real life. Computer equipment is required and the nurse educators time is signicant in working with technical staff members, which increases the

Figure 6. Professors ofce. (Image courtesy of JD Baker.)

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TAPPING INTO TECHNOLOGY labor costs for the creation of virtual environments in SL. As this type of environment becomes more readily accessible, however, perioperative professional nurses will likely integrate the use of these environments in their daily work, as many have with smartphone technology today. The virtual world is a tool that perioperative professional nurses could use to help facilitate the learning needs of others. Settings in this environment could represent a location in which health care providers disperse patient information in real time. Nothing can replace the live touch of the RN; however, voice and the sense of connection may be a very powerful way to consider supporting the future of perioperative professional nursing in virtual world settings. CONCLUSION The use of SL in perioperative nursing education provides students with a safe environment through which they can take chances, make mistakes, and learn valuable lessons that they will be able to use in real-life situations. Nursing instructors, both in academic settings and in staff development, have the ability to manipulate an avatar in the patient role to present with a variety of symptomsthat the instructor can modify as the assessment or event progressesto reect real-life situations that the nursing student may encounter. This provides a signicant learning tool to increase competency and condence in providing appropriate and effective patient care. Nursing schools have already embraced this technology in their nursing curricula, and as health care industry professionals become more technologically savvy, the use of virtual environments such as SL will become even more commonplace in work settings. Many organizations, including AORN, also

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are looking into SL technology and exploring whether there is a need for this technology among their constituents and how it can be harnessed to deliver their products and services. Editors note: Second Life is a registered trademark of Linden Lab, San Francisco, CA. Smart Hospital is a trademark of the University of Texas Arlington. PowerPoint is a registered trademark of Microsoft Corp, Redmond, WA. YouTube is a trademark of YouTube, LLC, San Bruno, CA.
References
1. 2. Avatar. Merriam-Webster. http://www.merriam-webster .com/dictionary/avatar. Accessed July 21, 2011. Second life education: the virtual learning advantage. Linden Lab. http://lecs-static-secondlife-com.s3 .amazonaws.com/work/SL-Edu-Brochure-010411.pdf. Accessed July 21, 2011. Golberg B. Connection: an exploration of spirituality in nursing care. J Adv Nurs. 1998;27(4):836-842. Miner-Williams D. Putting a puzzle together: Making spirituality meaningful for nursing using an evolving theoretical framework. J Clin Nurs. 2006;15(7):811-821. Gillespie M. Student-teacher connection: a place of possibility. J Adv Nurs. 2005;52(2):211-219. Stovall S, Baker JD. A concept analysis of connections relative to the aging adults. J Theory Construction Testing. 2010;14(2):54-58.

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Joy Don Baker, PhD, RN-BC, CNE, CNOR, NEA-BC, is a clinical associate professor and director, Distance Education, at the University of Texas Arlington. Dr Baker has no declared afliation that could be perceived as posing a potential conict of interest in the publication of this article. Jennifer M. Brusco, BS, CNA, is an editor at AORN, Inc, Denver, CO. Ms Brusco has no declared afliation that could be perceived as posing a potential conict of interest in the publication of this article.

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