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Smith Sherrill; Farra, Sharon
Simulation in Healthcare: Journal of the Society for Simulation in Healthcare: December 2014
doi: 10.1097/01.SIH.0000459328.29470.da


Approximately one major disaster is declared weekly causing widespread destruction.1 The Joint Commission, the American Nurses Association and others support disaster preparedness training in nursing curricula.2 While the opportunity to participate in disasters is limited, virtual reality simulation (VRS) offers a method for disaster training within a realistic, safe environment. With the increasing number and complexity of disasters, there is a need to prepare new nurses in decontamination procedures. Yet there is a paucity of literature related to effective training methods for this skill. This study seeks to explore an innovative method of training (VRS) in decontamination with the following research questions: 1) What is the effect of VRS decontamination training in student nurses who receive only web-based modules compared to students who receive VRS in addition to web-based modules? and 2) How do student nurses describe the experiences of participation in a VRS?


A mixed-method approach was implemented to assess senior nursing students (n=106) at two campuses who were taught the skill of decontamination. A 20-question multiple choice exam from the Federal Emergency Management Administration (FEMA) was used as a cognitive pre-test. The Emergency Preparedness Information Questionnaire (EPIQ) measured self-reported familiarity with emergency preparedness competencies prior to the intervention. Both experimental and control groups then received web-based decontamination training but the experimental group also took part in an immersive 10-minute VRS reinforcing decontamination steps. Following the intervention, students repeated the cognitive test and EPIQ. Students were also evaluated performing decontamination on a manikin using a researcher-developed competency assessment instrument. Students who participated in the VRS were also invited to participate in a focus group to provide feedback about the VRS.


Preliminary results suggest a significantly higher level of performance was found in students who experienced the VRS (p=0.008) based on a t-test. No significant differences were noted between the VRS and non-VRS groups in terms of the EPIQ cognitive scores (p=0.096) or FEMA self-assessment of skills scores (p=0.918) based on a t-est. An additional ANOVA analysis is pending. However, focus group interviews indicated students enjoyed the interactive nature of the VRS using the webcam and motion sensing software which allowed them to virtually experience the steps of decontamination. They also felt that VRS helped them to remember how to perform the steps of the skill when they demonstrated performance of decontamination on a manikin.


While the use of VRS did not indicate an increase in knowledge or self-assessment of decontamination skills, students experiencing a decontamination VRS module were able to perform the skill of decontamination significantly better than those students who did not. In addition, students reported how participation in the VRS helped them to remember the movements and steps of the skill that was supported in the performance findings. As educators identify best practice approaches for students to learn disaster skills in a safe, interactive environment, the use of VRS may be one strategy for ensuring safe, quality care for those affected by disaster.


1. Federal Emergency Management Agency [FEMA]. Disaster Declarations by Year: 2013. Available at: Accessed January 4, 2014

2. National League for Nursing. Emergency: Educating nurses and nursing students to handle disaster. NLN Report; 2013. Available at: Accessed March 4, 2014.


This study was supported by the Zeta Phi Chapter of Sigma Theta Tau and through a facutly seed grant from the College of Nursing and Health at Wright State University. Sharon Farra receives grant support from Sigma Theta Tau.

© 2014 Society for Simulation in Healthcare