Interpersonal communication during preoperative handover. Status of current practices and the effect of a desktop virtual reality intervention for learning handover skills in nursing education

Abstract

Background: When a patient undergoes surgery, a substantial exchange of information occurs among healthcare providers. Structured communication emerges as a crucial skill for healthcare professionals during patient transfers. To enhance such communication, a general, transferrable nontechnical approach, such as the identification-situation-background-assessment-recommendation (ISBAR) approach, can be applied. This necessitates knowledge about effective learning methods and the development of new learning activities in nursing education. One such emerging learning activity is desktop virtual reality (VR). However, successful integration of VR into nursing education requires knowledge of current practices and an exploration of the usability and effectiveness of new learning activities. Aim: The overall aim of this thesis was to gain knowledge about pre- and postoperative learning activities for nursing students, develop an application in desktop VR to learn interpersonal communication for a preoperative patient handover, and assess the usability and learning outcomes of the developed VR application. The thesis had the following three sub-objectives: 1) to systematically map and summarize the body of knowledge about pre- and postoperative nursing care learning activities for undergraduate nursing students (Paper I), 2) to investigate how second-year undergraduate nursing students evaluated the usability of the Preoperative ISBAR Desktop VR Application (Paper II), and 3) to investigate whether second-year nursing students self-practicing the ISBAR approach during handovers in a preoperative setting in a desktop VR application experienced a noninferior learning outcome compared with self-practicing the traditional paper-based method to sort patient information (Paper III). Research design, methodology, and samples: This study comprised three separate papers: a scoping review (Paper I), a qualitative study involving observation and interviews (Paper II), and a noninferior parallel group randomized controlled trial (RCT) (Paper III). The scoping review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses–Extension for Scoping Reviews (PRISMA-ScR) and the modified PRISMA 2020, along with Johanna Briggs Institute guidelines. A desktop VR simulation application was developed, and usability was evaluated by nine undergraduate second-year nursing students using the think-aloud method and focus group interviews, along with the system usability scale (SUS) questionnaire (Paper II). A revised version of the application was used as part of the simulation training sessions iv for second-year undergraduate nursing students for clinical placements. Students were randomly assigned to self-practice the ISBAR approach for 45 minutes in groups of three using either the desktop VR application (N = 87) or a conventional traditional paper-based (TP) simulation practice (N = 88). The primary outcome was the proportion of nursing students who sorted all patient information in the correct ISBAR order within a time limit of five minutes. The predefined one-sided noninferiority limit was 13 percentage points in favor of TP.