Stepping into the Future: The Big 10 Practice Ready Nurse Initiative and the Transformational Role of Virtual Reality in Nursing Education

Are you prepared to step into the future of nursing education? We're thrilled to bring you an in-depth exploration of the Big 10 Practice Ready Nurse Initiative, an innovative project funded by an American Nurses Foundation grant. Joining us on this journey are the brilliant minds behind the initiative, Michelle Abersold and Cindy Bradley. They're here to share the transformative model they're developing to enhance nursing education through the use of virtual reality (VR) and debriefing techniques. Their work is not only altering the teaching landscape but also smoothing the transition for new nurses into practice.

How does the development process work for such a ground-breaking project? Michelle and Cindy offer a behind-the-scenes look at the technology and partnerships required. They discuss their experience navigating the grant's acquisition, managing contracts, and outlining a development timeline. Hear about the exciting plans they have for testing the program with a new nurse residency initiative. But remember, this isn't just about technology. It's about creating a more realistic and enriching experience for nursing students.

We also delve into the world of Immersive Virtual Reality Simulation (IVRS) and its profound impact on learners. With insights from Jeremy Balanson, a VR expert, we unpack how IVRS is being used to reduce pain, decrease discomfort, and even help with memory and dementia. We explore the unique partnership between Purdue, Michigan, and Minnesota that was formed for this Big Ten Project and discuss what this could mean for the future of nursing education. So, are you ready to reimagine what's possible in nursing education? Let's do it together. Tune in!

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Transcript

Disclaimer/ Intro/ Sim VS ad: 0:00

The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors. Thanks to SimVS for sponsoring this week's podcast. Looking for some activities to enrich your clinical experiences? Then look no further. SimVS has the optimal product at a reasonable price. SimVS can be used in your simulation center, on the clinical site or in the firehouse for trainings. The versatility of this product makes SimVS the Swiss Army Knife of available simulation products. SimVS Everywhere, anytime. Everything you need all at once. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions and edited by Shelly Houser. Join our host, deb Tauber, and co-host Jerrod Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.

Deb Tauber: 1:27

Welcome to another episode of The Sim Cafe. Thank you, and Jerrod. How are you doing out there??

Jerrod Jeffries: 1:33

Doing great thanks. I'm excited for our guest here. We've got Michelle and Cindy, but I'll let you do a proper introduction, deb. This thing's just to get into it.

Deb Tauber: 1:41

Oh, so am I. We are going to talk about virtual reality, and we have two subject matter experts with us today. We have Michelle Abersold and Cynthia Bradley, or Cindy and Michelle. Thank you so much for joining us, and why don't each of you start with Cindy, talk a little bit about yourself and your role, and then, Michelle, you can chime in.

Cindy Bradley: 2:03

Thanks, Deb. Yeah, I'm Cindy Bradley. I'm at the University of Minnesota. I'm in the School of Nursing where I'm the Director of Simulation for all of our nursing programs, so VR was a little bit new-ish for me. We've been looking at some development on our own at the School of Nursing, with colleges of science and engineering, but when this opportunity came up, when the American Nurse Foundation put out this call for proposals, it just seemed like VR was a really good fit, and I knew that Michelle was the national and international expert. So we reached out and said, hey, Michelle want to join. And she did.

Michelle Abersold: 2:42

Yeah so it was actually really cool to join on with this project.

Michelle Abersold: 2:45

So, as has been alluded to, I'm Michelle Abersold.

Michelle Abersold: 2:49

I'm a clinical professor at the University of Michigan School of Nursing, been around the Sim community for a long time and have always really sort of done a lot of virtual reality, even way back in the second life days if anybody ever remember second life, which was this kind of online virtual world, that was my original foray and then really got involved as headsets and things came out into more of the immersive virtual reality, augmented reality, and really transitioned a lot of my simulation work over to that.

Michelle Abersold: 3:20

And then I also have to say, because it's just cool, I have this really cool title. I don't get paid for it, it's just like one of those extra titles you get, but it's called XR Faculty Innovator in Residence, and it's with our Center for Academic Innovation on campus and so XR stands for Extender Reality, which is kind of all the different realities, but it gives me an opportunity to connect with people across campus and the cool thing and we'll talk a little bit more about this project once we get into it but we were able to leverage some resources from our Center for Academic Innovation to really help us with this whole grant, which has actually really kind of helped it be successful, I think.

Deb Tauber: 4:00

Overall Thank you and we are thrilled to have you guys once again and just really learn about all the things that you're doing. And why don't you tell us a little bit about the American Nurses Foundation grant that you received?

Cindy Bradley: 4:13

Yeah. So the American Nurses Foundation put out a call so it would have been the end of 2021. And they were looking for projects that were bold interventions. They wanted projects that would have like fast impact, broad impact, but really looking at transforming nursing, and so we submitted a proposal in the track that's about improving practice readiness. So that's the purpose of our project.

Cindy Bradley: 4:37

We felt very honored to get the funding for this grant. I know there were around 350 submissions. I thought there wasn't a any chance at all that we would get this, so it was very exciting that we did. And in hindsight, you know, when we look back at just our original plans and where we are now, I think it's a really solid project and I think we're very excited of where it will go. We appreciate the support of the American Nurses Foundation. We're one of 10 projects totaling $14 million, so they put a lot of energy, a lot of funds, just a lot of support for us as a project team. So they've given us a lot. So we're thankful for that. And then we're just very focused on what can we do to help improve the readiness of nurses when they transition into practice.

Jerrod Jeffries: 5:23

And Cindy with the money aside, but it seems, since you and Michelle are both from two different academic institutions, how many different schools are part of the grant? I know there's 10 different ones that I got awarded, but are you awarded for the same grant or is it different one of collaboration? Can you go into that a little more?

Cindy Bradley: 5:40

Sure, yes. So our project is between the University of Minnesota, the University of Michigan and then Purdue University, and our co-investigator there is Anne Lumis, who has just an extensive background in simulation and in debriefing. So our project is called the Big 10 Practice Ready Nurse Initiative. And so we thought about this long and hard of we're Big 10 schools, we're big schools, we're research institutions, we have a lot of resources available, a lot of infrastructure to support this amount of grant, the money, the business side of it, and then also just implementing everything. And so we really purpose to leverage the resources that we have to be able to develop and test this model using VR and debriefing.

Cindy Bradley: 6:26

But our heart is that we want to be able to just fully test this. We find out all of the challenges, troubleshoot and any problems we think a school might encounter, kind of knowing. We can't, you know, cover everything, but we're really trying so that in the end we essentially have like a toolkit that we can just hand over and say here, schools, pick this up, if you have a headset, you have a Wi-Fi connection. We want to have all of the resources they need as far as training, their faculty for the student prep, just everything all in a nice tidy package. So that's our heart. So right now we have the three Big 10 schools we're currently interviewing to add a couple of Big 10 schools, hopefully in the spring, more likely next fall and spring of what 25. So that way we'll have the data from at least five big schools, of the outcomes of the VR, of the debriefing, and just the total package, so that we've got a really good product to put out there for other schools to use.

Deb Tauber: 7:24

I love this. I love that you know that we have nurses that are kind of behind this and help guide with good decisions, because this is really what we need. We need people who are passionate about doing this for the right reasons. Right transition to practice.

Michelle Abersold: 7:39

So I think, just to sort of add on to that a little bit too, one of the things that Cindy and I have been sort of bantering around is this whole idea of, yes, this will be great, we'll train our you know, sort of senior level or you know kind of end of their schooling, because this would apply to associate degree schools as well. So you know, when they're in that sort of capstone course, you know they're getting ready to graduate. The set of scenarios that we have, because they focus on caring for multiple patients, managing priorities, communicating with providers. In fact, I just did a recorded scenario for today and you have four patients you have to take care of, and so right off the bat, I made a choice of which patient I wanted to see, kind of went in the room, you know, and I'm halfway through getting this, my patient discharged, and the charger comes in and I got something going on with my other patient. So it's like, oh no, oh no, do I leave the room and go take care of my other patient? Do I stay with this patient, you know? So I picked, leave the room, and then I got a little, some feedback, you know, some in-scenario feedback. That said, maybe you want to rethink that decision. You know this. Maybe you should finish with this patient first. So it's kind of cool because you kind of get that in-scenario feedback but they don't give you all the clues. So you know I continued on.

Michelle Abersold: 9:01

But as I'm going through that I'm sort of thinking how useful this would even be for orientees. So prior to becoming an educator, working on the academic side, I used to work in the practice side and I hired countless number of new graduates every year and the biggest challenge that they faced, particularly on the acute care neuro unit I ran was how do I care for four and five patients? And now you know we're seeing upwards of six and seven patients at some of these institutions. So not only does this have a place in academia, but we also think it has a place in onboarding nurses into particularly new grads but onboarding nurses into healthcare areas. And we've have invited some of our educators at the hospital side and I know Cindy's doing the same out of Minnesota and I've got a group coming in a couple of weeks to try this out and to see can we also leverage this for use in onboarding nurses, because it's expensive, it's time consuming and this might help us kind of move that along a little faster.

Deb Tauber: 10:07

And what about even to take it back a step and use it during hiring decisions?

Michelle Abersold: 10:13

That is an interesting comment, and I will tell you that I know a group and they their specialty group. It's an air medical transport group and they have actually used simulation as part of their hiring decision, in conjunction with other things, because it's such a specialized area. So I think that's a really interesting idea. I had not thought of it like that, but that is a really fascinating concept. I don't know, Cindy, if you have any thoughts.

Cindy Bradley: 10:45

No, agreed, and that was never our original intent. But as we started developing these scenarios which they're all multiple patient because we know in clinical students are really limited with what they can do and so some students never take care of more than one patient, which is not realistic. So looking at the multiple patient scenarios, just to back up just a teeny bit technologically, I guess what I didn't understand before we started working on this was that the VR requires like a totally different platform technologically to be able to go in one room, leave it and go into the next room. And my kids are gamers so I always saw them tromping around outside and in and out of buildings and I thought, well, this is what we want, just do it. I didn't understand how much work was involved, but now that there's a model for it so we can put different scenarios in there, we can put different patient situations. Ours are kind of an acute care med surge environment. You could easily do OB or PEDS or ER or any of those other scenarios. We have a model, so we're really testing the model.

Cindy Bradley: 11:44

But then to Michelle's point about transitioning into practice or even for hiring purposes. You think about the senior nursing student who they're right here about to graduate, they graduate and then they're right here, so not much time has passed. So the senior nursing student isn't so different from the new nurses in practice, and so when we hear that what was the, I think in 2022, the national average turnover rate for a bedside RN reached like 22 and a half percent, and it costs around 50 some thousand for every nurse that a hospital loses. We know what it looks like right now If you're bleeding because the nurses are not prepared for what they're getting into, or maybe it's really not what they thought it was going to be. You know. Whatever the reasons are, we want to do what we can on the education side, but also have this available for new nurses in practice. So we are planning to test this with a new nurse residency program in the Twin Cities next year, so we're very excited about that.

Jerrod Jeffries: 12:42

Incredible how much progress you guys are making. So when did you start here?

Cindy Bradley: 12:46

So I think the funding cycle actually started March of 21. Michelle, correct me if I'm wrong, but you know, another big learning thing for me was how much time it takes to get through all of the contracts. And you're working with a company and you're working with our students, you have student data. So all of that really took far longer than any of us anticipated. It delayed development of our VR scenarios a little bit. We were able to test with students in the spring and then this fall we did our full launch at all three sites. We'll have between three and 400 students just with our three sites by the end of May of 24. And I might add, so the funding cycle started March 1st of 21 and it will go through the end of February of 24. Is that right, michelle? Correct me if I'm wrong 25, 25.

Michelle Abersold: 13:35

Yes, yeah, 25. And I think the biggest thing, that well, I think one of the biggest takeaways from all of this and Cindy alluded to this is that whole area of industry, academic partnerships and contracting and hiring a company that is going to actually develop this for you, because, she's absolutely right, the development time is big. I mean, I've had a little bit of experience developing very basic VR programs and you've got to have people who can do the programming either using Unity or Unreal Engine and you have to have people who can do the graphic design and then you have all the branching stuff that goes in. So there's just a really a lot of work involved in that and we originally toyed with the idea of doing it ourselves. Should we just create these ourselves? But I'll say, from a VR perspective and the more that I've been in the industry and the more that I've learned, I think we were smart in actually going with a company. And this is why Because I have a little VR program I developed called Under the Skin, and it's great. It's available in the app lab and you can download it for free, but it doesn't come with any feedback and it's something that would require me, you know, money and funds and time. If I wanted to update it and things like that.

Michelle Abersold: 14:54

By going with a company, we basically have all that company's infrastructure, so we don't have to worry about is there a server to host this on? We don't have to worry about how are the updates going to happen. And then what do we develop it for? We developed this. It runs on MetaQuest, it runs on Pico, so it runs on two of the more commonly used headsets. Then the company is able to take this and again, I don't wanna violate some of the confidentiality, but you negotiated things around intellectual property and copyright and all of that.

Michelle Abersold: 15:28

But then at the end of that the company is able to actually sell this product so that now it becomes part of their suite of VR scenarios that are available, and this then makes it so much more accessible for people outside of our little research community. I mean, how often do we develop something? It sits in that little research bubble and then it never goes anywhere because there's no funds to maintain it afterwards. So I think that was sort of the upside of going with a company to do the development of the scenarios. I mean, it's no secret, it's Oxford Medical Simulation. They were the company that we ended up going with, and they've been a really good partner, and probably one of the more from my perspective this is just me talking one of the more mature VR companies out there when it comes to healthcare VR, for what we are looking at doing.

Jerrod Jeffries: 16:23

So I love this and I love this bridging of professional, industry, company-wise with academic, because and I think Deb alluded to this too is like seeing nurses take this at the forefront to say this is what we need, and I think it's a common. I used to be a product manager and it's like if you don't talk to your customers, you're never going to know what you want. When nurses are actually helping produce, you're almost working with engineers, testing directly with students. All we get in the learning injective is across, all we get in our goals and our milestones. I absolutely love this thought. My question to you is is the timeline to get this out to students? Cindy, I think you mentioned that you're testing with 300 or 400 students across the three campuses. Is the goal to get this out to market? I put that by selling, you know, to market, being sold externally. Is that February 24 or could we see that before? What's the timeline for that?

Cindy Bradley: 17:17

Yeah, so great question, because actually they're available now. So if the school wanted to use this, they could start using it now. Now we it's not been tested, as we are testing it empirically. You know we want to have our outcome data so we can show like this is what we can say it generates. These are the outcomes that we get. You can use the scenarios now. You won't have the data behind it, but there's still great scenarios to use. Again, that was one of the things that was important to us, but also to the funders. So we're really eager to hear feedback from others that are using the scenarios right now.

Cindy Bradley: 17:54

I think something that I didn't think it all the way through before we started was the data analytics. So when Michelle said we chose to not develop this in-house, we knew that we, at the end of the day, we didn't want to be a VR company, we didn't want to host a dashboard, the data analytics so I knew that part of it, but I think it wasn't until we actually had students start doing the scenarios and we saw what does the computer generate? You know, because it's all AI driven what does the computer generate for the feedback, for this student and then just looking at how we can measure clinical competence, clinical judgment. So that's kind of a gem from this project. We knew we would have measures. I think the measures that we will come out with are going to be extremely helpful for nursing education at a time when everything is moving to competency-based education. And so, with the data analytics, I'm super, super excited because we're looking at it and evaluating what we read from a feedback log.

Cindy Bradley: 18:54

But why A computer could do that right, and so I know this all takes time. I get very excited about some of these things and want it to happen yesterday, but over time I do think this is a way that we can assess clinical judgment and think about inter-rater reliability. You have no problems with it. Then, if it's programmed how you want it to be programmed, it generates here's student, here's how you're doing with clinical judgment. Here are the specific things you could improve upon, and that's what we need now. We're lacking measures and a way for students to practice, but a way for us to assess them and give them that feedback that's not relying on our own subjectivity, our own styles and opinions, but the gold standard. What's the gold standard that we want students to achieve? So I'm excited about that. I didn't anticipate that, but we look for that to come in the future too.

Michelle Abersold: 19:46

So I think just to add on to what Cindy has said as well is, when you think about this from deliberate practice or mastery learning perspective, we want students to be able to practice on their own, but we don't want them to do it in a way where they just reinforce bad habits. The nice thing about this VR is what they can do it in the headset, they can do it on the computer, but they can do these scenarios over and over again, and so they're complex enough that playing them again will help them sort of think about well, maybe I might want to try it this way, or maybe there's some things I didn't do the first time, I'm going to do it this time, and then they will always get the feedback at the end that tells them these are the things that you did. Well, here's some things to consider, here's some things you didn't do, and so, once again, you're able to do that with that feedback. And then we've had to sort of work through some of the debriefing I don't want to say challenge is not the best, that's not really the right word but some of the debriefing application. So how do you debrief a scenario that you've really not seen the students do Now.

Michelle Abersold: 20:47

The feedback is great because we can look at that, but so we're really sort of kind of, you know, moving our way through best ways to debrief this, and that, I think, is one of the things that that we will definitely come out with in the end is some recommendations for how to debrief these types of scenarios, and I just want to say that Margaret for Kyle has done a tremendous amount of work in this area. So, you know, I think that we're really looking at hoping to build upon some of the work that she has already done. She's laid a really nice groundwork for us to follow, and so then we'll be able to sort of say okay, if you're using immersive VR in this situation, with this kind of feedback in a program, how could you debrief that in a way that is psychologically safe for our students and effective and all of that. So and I know Cindy and Anne both have deep expertise in the debriefing areas too that is really going to be helpful.

Cindy Bradley: 21:40

It's interesting seeing this in a different setting also. So my past, a lot of my research, has focused on debriefing, but mostly in traditional simulation and in clinical, not with VR, and so, as Michelle said, each student has their individual experience. We put them together to talk about it, so we are kind of learning now how best to move forward with debriefing for immersive.

Deb Tauber: 22:05

VR Right, and I'm glad that you brought up Meg, because she has done an outstanding job in Canada with the work that she's done. I want to take a minute, though, to really consider for some of our listeners what is IVRS, or Immersive Virtual Reality Simulation? What does that mean to you, so that they can have a clear picture of what we're actually talking about?

Michelle Abersold: 22:29

Yeah, great question. We just kind of dove right into it, right? I am so excited to talk about this. So when we coined this sort of IVRS, I think of, I think of this this is just a nice way to describe what we're doing that is different from screen based VR. So if you think of some of the work out there and these are great simulations so this does not detract from their power and their work. But people are familiar with things like the SIM or some of the work that SentinelU has done, where you log into your computer and you actually do those scenarios on the computer. That's a great experience.

Michelle Abersold: 23:08

We're differentiating this by calling it IVRS because it's Immersive Virtual Reality Simulation, and Immersive means basically you have a headset on, you do not see the world around you. You have 360 degree view of what's happening. And so Jeremy Balanson, who has done a lot of work in this area and I just have to say like I was like a fan girl I got to meet him. He's one of the people that I've always looked up to his work in VR, and so it was super exciting to hear him talk. We brought him out to Michigan and share with him some of the work we're doing.

Michelle Abersold: 23:43

But Jeremy talks a lot about this whole idea of presence and immersion inside the virtual reality environment, and so you really want to be able to get sort of in there, connected, and feel like you're actually there. When you go into these scenarios you feel like you are in that room, like you literally have to physically turn your body and your head around to see all the things in the room. But you can do that and you can kind of maneuver around the room and walk over and there's the phone and things like that, which is a different experience than the screen base, and research is showing us that it's a much more powerful experience and creates that memory. In fact, we even had a student say once okay, I just had an experience like it's going to stick with me, and it's like, yeah, that's really good. So that's the difference between like immersive virtual reality and then just what really is screen based VR.

Cindy Bradley: 24:40

And if I can add a little bit to that, when we think of immersion with VR, but using just that power of immersion, there's a lot of work that's happening now where VR is being used as sort of a non pharmacological agent to reduce pain, to reduce symptoms of PTSD. It helps with memory and patients with dementia. This is used a lot with kids to decrease discomfort with just very common procedures blood draws, things like that. So if the power of immersion can help me minimize my pain, what is it doing for our learners? So I think it's a very, very powerful tool that we are just beginning to really understand its impact on learners.

Deb Tauber: 25:23

Those are great points. I want to make sure that we go ahead and thank our sponsors at SimVS. They have their new IV pump simulator. So thank you, simvs, for sponsoring. And we do have a couple more questions. So are the scenarios available to others? I think you said they were. How would people go about getting them? Where would you direct them to go?

Cindy Bradley: 25:46

Yes, they would need to be in contact with Oxford Medical Simulation. That's the company we have worked with and you can go to their website and probably contact anyone that comes up on the website and they would be happy to talk with you. I am sure they have been great to work with. As far as just giving good demos of their product From the very beginning even before we started developing they were really good at showing us all of the things that they were capable of doing, and so they would do a great job demoing that for anyone who's interested.

Jerrod Jeffries: 26:15

And moving into part of the academic piece again, you mentioned that it was called the Big Ten Project, but why was it formed with Purdue, Michigan and Minnesota? How did that partnership come? Were you all vying for the A&F grant, or can you give us a little more background there?

Cindy Bradley: 26:31

Well, it's probably a little serendipitous. I don't know that it was so scientific from the start. But so Ann and I have known each other for quite a while and so some of our career and personal lives have paralleled each other. We knew Michelle. We didn't know Michelle really well. Some of the others on the project team that were kind of helping with some of the oh just their originating thoughts New of Michelle. We all knew of her work. We brought her in and she became a best, A best buddy quickly. So it's been really fun to work together.

Cindy Bradley: 27:02

So I don't have a real scientific answer for you, except sort of what I said before. We know that we have a lot of resources available. I know from having worked in teaching institutions and other smaller schools that not all schools are equipped to manage a $1.4 million grant. And when I think about just the enormity of that alone, with Prime Award, two sub-awards, it takes a whole village of people to keep everything moving through, Just all of the legal requirements, all the payments, all of that there's no way I would want to try to figure that out on my own. And so we just kind of acknowledged yep, we think we've got what it takes to get this done.

Deb Tauber: 27:43

Now what if another big 10 college wants to get involved with you? Would you encourage them to reach out to one of the two of you?

Cindy Bradley: 27:51

Absolutely yes, we've talked to several schools already. So, yeah, if anyone is interested, please reach out to us. We'd be happy to talk more about it.

Deb Tauber: 28:00

Why don't we go ahead and talk just a little bit more about the practice readiness piece and describing how you feel like it's going to impact new nurses?

Michelle Abersold: 28:09

So I'll start. We knew we were like practice ready, like that was sort of a little bit of our kind of message that we were sending. But what was interesting is when we went to our first A&F grant meeting in Washington, I can remember very clearly sitting around the table and I tend to be a little bit opinionated sometimes. You would never guess that. But people were talking about, you know, practice ready. Like everybody knew what it was and it just kind of struck me I'm like do we even have a common definition of practice ready?

Michelle Abersold: 28:38

If I say practice ready, that probably means something different to me, might mean something different to you guys, and I distinctly remember this. I'm walking around like Cindy and I are talking, because we're probably talking about I don't know some grant related something or other that we had a problem solve. We're talking and we just and we started talking about practice readiness and I'm like, oh, you know, you should ask some people like I'm doing this, this talk. You know I can ask people like their definitions. And then Cindy just kind of jumped all over that and turn this into a whole survey. So talk a little bit about that survey, cindy, because I think this has just been sort of a fascinating you know expedition in asking people what practice readiness means.

Cindy Bradley: 29:19

Exactly. I remember those early conversations to Michelle and then when we started talking about like, oh, we need to ask people, and I remember you said, oh, I'm going to go talk to this group, and I and you said also that somebody was going with you and they could take notes, and I said, because I'm all about like QR codes and Qualtrics, I said, you know what, I'll make you a QR code and then people can just, you know, scan it, type in what they think about practice readiness. Okay, so then I thought, well, you know what, let's go bigger, go home, let's put it out there, and then we'll make them one QR code and go out to you know how many nurses. So we sent it out to gosh, I don't know the a and f, sent it out to their whole listserv just within our schools, the professional organizations, and we just asked, like, what are the words or phrases you would use to describe what a practice readiness should be?

Cindy Bradley: 30:09

Right now, there's a wide range of opinions, but you know, really kind of fell into a couple of categories that are not surprising. I think that it was very exciting that these were not all people in like faculty. They weren't all from academia. Over half of the respondents were a hospital staff nurses so we felt like that's a really good representation of what nurses should look like, supposed to be developing the nurse generalists. Just thinking at that level, like this is what it should look like. So we are still working on the data analysis of that, which has been an exciting journey and a lot of learning points there. Michelle, do you want to speak to that? I do.

Michelle Abersold: 30:54

I'm like, so excited about this, all right. So you know how we're all about everybody's about AI, right, chat GPT and pretty doing kind of cool stuff with it. And I have some colleagues one of them is over in the UK and so we did actually like this little workshop on AI. So I'm just kind of holding up the wall because it's like it's not. I mean, I know enough, know how to write my termination letter and pirate language in chat GPT, and if you've never done that, it's fun, is you know? Hey, maybe.

Michelle Abersold: 31:24

Anyways, so I'm standing there, I'm listening to one of my colleagues talk about using chat GPT for data analysis, for qualitative data analysis, theme analysis. So I come back to Cindy. I'm like, oh, we just have to try this, even if we write a paper about comparing how we normally do a call analysis with chat GPT. But it was great. In fact, I think we have another meeting this week to kind of look at our data. Oh my gosh, I mean it was just amazing. So we're writing this up, of course, and city's going to be our lead author, and I think we're going to have this really cool paper about using chat GPT to do thematic analysis. So the trick will be. Will anybody publish it? So hey, hopefully I'm sure they will right.

Cindy Bradley: 32:09

I have no doubt that it will be published, but I I'm very fascinated with GPT and all of the models, so when Michelle told me about this, I'm like yes, and teach me how to do it. That is so exciting.

Deb Tauber: 32:20

Awesome. Talked about the practice readiness definition. Did you guys land on a full definition? Do you have something to articulate?

Cindy Bradley: 32:27

Well, no, we didn't seek a solution or a acknowledged definition. We just wanted to hear what are the things. So it's about critical thinking, clinical thinking, clinical judgment, just those, you know, the higher order reasoning skills. Then it's about more of the technical, the proficiency, those types of skills, teamwork, collaboration, a little bit of professionalism and then a lot about patient, like a patient centered focus. So these are all things that we probably would not disagree on. I think the disagreement would probably come with what are benchmarks? What is enough? How much of how much clinical judgment do you need to be practice ready? Do we have realistic expectations? Right now, I don't know, because we're still having a hard time measuring clinical judgment. So how can we say hey, student, you need to look like this. We don't have that benchmark, but when you're talking about thinking and reasoning skills, it's so hard to teach those and and even harder to assess that you know. So when Michelle talked about debriefing, I think that's. A big, big takeaway now is just listening to these students talk about the scenario they just did, where they had three patients or two patients or whatever it was, and they'll say things like I noticed he seems short of breath. Okay, well, noticing is a piece of thinking, which is a piece of clinical judgment. Responding to that, you know, interpreting what they see, and so for for debriefing, you know really calling out those thinking words I think will help students, which will help them improve their clinical judgment so that they do come to, you know, a work situation where they are more practice ready. I think it will just take a lot of partnering with our practice partners to have.

Cindy Bradley: 34:17

Do we have realistic expectations? Are we expecting too much? But we also know we can't really change a lot in our care environments Now. They're so fatigued coming out of the pandemic. There are staffing shortages. You got all kinds of things happening. So what is practice ready Last year? What is it today? What is it next year? You know, I think that's going to change a lot, which is kind of always one of the challenges in nursing education.

Cindy Bradley: 34:41

I think it's a. It's an even bigger challenge now, but I think we are very passionate about not that we have some magic fix to it, but we're passionate about trying to figure it out. We can make even a little bit of an improvement. As nurses, we have a responsibility to the new nurses that are joining our ranks. You know we have a responsibility to do this better for them, to help them. Even if they onboard into a new hospital or whatever situation they're in, they're not leaving in three years, they're not leaving the profession altogether. So that's our passion. We hope that we can improve practice readiness, but also more so that we can help define some of these things, help measure these things. If we can make it measurable, we can teach it and students can learn it.

Jerrod Jeffries: 35:24

I see the applause there. I think I've really well said. I love that.

Michelle Abersold: 35:29

And you know what's interesting? You know we didn't hear. We didn't hear in any time. I've asked somebody to tell me what practice ready means, and all of the data we've looked at we didn't hear anything like, well, they need to know all of this stuff, right? What do we do in our curriculum? We're like, oh, we have to teach them this and we have to teach them this, and we have to teach them this.

Michelle Abersold: 35:48

And what we heard from people just in talking is they have to have some doubt. Right, we can all agree on that. But they don't have to know everything because, you know, we can teach them those things because when they go to work, they're often going to work in an area that might specialize in a certain, you know, adult gerontology, ed, whatever it is. But what's harder is? Cindy said what's harder to teach them is how do you organize your care. One of the students said I've learned how to cluster care. I'm like that is amazing. I wouldn't have even used that word and I just thought that was so impactful. Of course, it was great because she said it when, you know, Kate judge from the American Nurses Foundation was doing a little site visit, you know.

Deb Tauber: 36:32

It's good.

Michelle Abersold: 36:34

But, yeah, I think that it's it's been interesting and, I think, reaffirming that we're on the right track.

Deb Tauber: 36:41

This has just been a fascinating discussion. I appreciate and applaud you for what you're doing and thank you for what you're doing for nursing. Are there any closing thoughts that you guys want to finish up with?

Michelle Abersold: 36:54

I'm going to go first so Cindy can have the last word on the podcast. I just want to say thanks to Cindy and company for inviting me to be part of this, because if I hadn't gotten invited and we hadn't gotten this grant and I saw it happening I would have been really jealous. I wasn't part of it, so it's been an amazing team to work with. I will spend hours working on this because it is like some of the funnest, coolest stuff that I believe is going to have a significant impact on our new grads.

Cindy Bradley: 37:22

Thank you, Michelle. You're very kind. We are so happy to be working with you. It's been a great learning experience in so many ways.

Cindy Bradley: 37:30

I think my last comment I was really thinking about this whole immersive VR and how you hear so many schools are quick to say, oh, we want to do VR, we want to integrate VR, and in some ways, it is a form of simulation. For sure it's a form of simulation, and so, in many ways, you can align what you're doing with VR, how you're integrating it. You can align it with the standards of best practice. You know the things we already know about pre-brief debrief, objectives, outcomes. I just think, though, it's not just another form of simulation. It's much, much more than that, and so I don't even have a list I could give you of things to think about, but I think we will come up with some guiding principles as we move through this project, because it is very different when you have students doing this individual experience.

Cindy Bradley: 38:18

One thing students have been saying is I'm the nurse, I get to be the nurse, I get to be alone, and they even said they like this better than simulation. When I asked why, you know, I kind of thought I knew what they would say. They said it's because they got to do this alone. They didn't go in with a partner, it was them calling the shots alone. They never, ever, ever have that opportunity in clinical. For sure. It's pretty rare in simulation. So just something to think about that. Yep, it's another form of simulation, but it's way more than just a simulation. I totally attribute that to the power of the immersion.

Deb Tauber: 38:52

Thank you. Thank you both for what you're doing and, with that, happy simulating.

Michelle Abersold: 38:59

Thanks for having us.

Deb Tauber: 39:00

Thank you.

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