Virtual Reality Simulations in Healthcare & Nursing Education

Ryerson University partners to create non-immersive virtual gaming clinical simulation for nursing

Providing practical experience for nursing and healthcare students in clinical application can be costly. Laboratory space, specialized equipment, resources, and the personnel to manage it can be expensive. Together, Toronto-based Ryerson University, Centennial College, and George Brown College created realistic scenarios to replace the need for live clinical simulations.

They created three self-study modules to teach foundational therapeutic communication and mental health assessment skills using a simulation game for learners to apply principles learned. Called the non-immersive, virtual gaming clinical simulation (NIVGCS), a series of video scenarios have been created using actors on a script.

One simulation, for example, portrays a client and a nurse home visit.

“Would you like to sit down?”


The simulation depicts situations that require a series of decision points. For each response made, the coordinating response scenario plays out. Various scenarios give the students the opportunity to practice skills in handling domestic violence, suicide risk, and more.  This is a great model for providing online clinical application.

A journey to Ontario, Canada reveals an innovative approach taken by three higher education institutions to replace the need for traditional live clinical simulations. Ryerson University, George Brown College and Centennial College embarked upon a collaborative project to create a learning resource for healthcare and nursing students, by looking at virtual simulations to replace quite expensive laboratory space, specialized equipment, and other resources.

Virtual Clinical Simulations in a non-immersive game

Simulation is the act of imitating the behavior of a situation, problem, or process in order to create realistic opportunities to practice skills and apply knowledge. Virtual simulations increase access and reduce costs by not requiring physical space and equipment. A prominent benefit is that it promotes learning by trial and error in a safe environment, which is especially valuable within the medical field.

Learning modules and a virtual interactive game were designed to promote active learning and improve the student’s retention of knowledge, problem solving and critical thinking skills.

Virtual Clinical SimulationsThree self-study modules augment the teaching of foundational therapeutic communication and mental health assessment skills. They include short videos from experts, development skills videos, and learning objects with quizzes and matching exercises. The complementary simulation game, coined non-immersive virtual gaming clinical simulation (NIVGCS), provides a virtual clinical situation that allows learners to apply the principles they learn in the three modules that include:

Module 1: Therapeutic Relationships and Communication Techniques
Module 2: Mental Status Assessment, Depression and Suicide Risk
Module 3: Interpersonal Violence

Virtual Nursing Simulation Scenarios Play Out

To portray a client and nurse home visit, the partners created a series of videos using actors that follow a script. They felt that virtual simulations using live actors instead of avatars made the experience more realistic. Students comment often that the scenarios were realistic and immersive making the game a fun and engaging way to practice communication and assessment skills.

The student participating assumes the role of a community health nurse assigned to complete a home visit. The various scenarios provide them the opportunity to practice skills in handling domestic violence, suicide risk, and depict situations that require a series of decision points.

As students embark upon the experience provided in the virtual clinical simulation, they are faced with a series of decisions. They must constantly be using critical thinking skills to determine how to respond throughout the exercise. If they make a choice that could put them or the patient at risk, they are provided a reason for why there is a better choice. They continue to work through the game simulation until they have mastered the skills needed to make the best decisions. By replicating real-life situations learners can practice their problem-solving and decision-making skills in a safe environment.

Interestingly, the project was designed to have students take the modules first and then practice through the nursing simulation game. However, the standalone game can be played before and/or after taking the modules.

The learning modules can also be used to prepare for the NCLEX or CPRNE exams. A study is underway to compare student knowledge gains, self-efficacy and learner satisfaction between those who participate in traditional laboratory simulations with those in non-immersive virtual gaming clinical simulation.