Vital Views

Music 0:20
Music.

Cassandra Taloma 0:32
Welcome to another episode of vital views, a UNLV School of Nursing Podcast. I'm Cassandra taloma, the Director of Marketing and Communications at the school today, I'm super excited to be joined by Carissa Hernandez, a Doctor of Nursing Practice program student at the School of Nursing. She is also the American Heart Association program director for the VA in Southern Nevada. She oversees the CPR and emergency response training across multiple facilities with a passion for veteran care and nursing education. Her dissertation will showcase the use of virtual reality to enhance med surg nurses confidence and skills in responding to cardiac arrest situations. Welcome Carissa, thank you so much for being here today. Thank you so much for

Carissa Hernandez 1:17
having me on I really appreciate it. Yes, so we mentioned

Cassandra Taloma 1:21
that you're currently a student in our DNP program. Can you tell us a little bit more about your nursing career journey?

Carissa Hernandez 1:27
So yeah, absolutely. So I graduated from Nevada State University in 2019 with my BSN, and then I obtained my master's in nursing education from UNLV in 2022 so I decided to return to UNLV to obtain my DNP, and I'm due to graduate in May. So my gosh, I'm thrilled about that. So I decided to become a nurse, because I've always been fascinated with the health sciences. So when I was younger, I was a professional Flamingo dancer. I was very fortunate to have had an amazing career that took me all over the world, and I got to perform for some amazing people. But you know, however, as I got older, I began to think about having a family and settling down, and I kind of wanted something a little bit more stable. So when my husband and I decided to make our home in Las Vegas and start a family, I made the decision to return to school. So when I was still in nursing school, I got hired at the VA as a nurse apprentice under the VA valor program, which I believe is now called the VA step program. So getting selected for that program was life changing for me. So I met some amazing mentors, and they have helped guide me throughout my career and are still in life, in my life today. So that's a shout out to Dr Kimberly Fauci and Dr RACHEL So Ryan, so um, once I graduated with my BSN, you know, I began working in the VA as an emergency department nurse, and that was a wild time to start working in the ED, because shortly after I graduated in 2019 the COVID pandemic hit, and man, that was a roller coaster. So that was truly a tough time for me, because during the COVID pandemic, I lost my husband to COVID. It was very unexpected, very sudden, as he was perfectly healthy. Frankly, he was probably healthier than I was. So here I found myself as a widowed mom with three daughters to support. I was terrified. I was alone. I had just lost my soulmate, and my three daughters just lost their father, who loved them more than life itself, and I had these three little girls that were looking at me to be there for them. And I found that it was during this time I found myself at a crossroads. So I had to make a choice. I loved working in the ER. It was my favorite thing in the entire world. But it was tough because, you know, I was seeing patients coming in that were struggling to breathe, and it really caused me to have some PTSD. But you know, I had a moment when I returned to work and I had a patient that was sick with COVID, and it was about to be intubated, and he was my patient, and I went to the bathroom, and I looked at myself in the mirror, and I literally cried my eyes out. And it I had, I had a I had to make a choice in that moment, that I was here for a reason. And as hard as everything was, personally for me, I was given a gift, and that gift was to have an understanding of what it's like to be a patient and a patient's family member. And that really gave me a sense of empathy, that I could truly look at patients and family members who were scared and terrified and say, yeah. I do know what you're going through. I know exactly what you're going through. And I can't tell you how many times I've hugged patients and family members and I said, I know how you're feeling. Let me be here for you. And I saw things from a completely different perspective, and honestly, I feel it made me a better nurse. And, you know, I stayed working in the ER until I obtained my master's degree, where I was then hired as the American Heart Association program director. So essentially, what I do is I handle all CPR and emergency response training for the VA Medical Center in all of the outpatient primary care clinics in Southern Nevada. I'm in charge of the mock code program, cardiac arrest reviews, stop the bleed training, things like that. I'm also the daughter and a granddaughter of Navy veterans, and every male member of my family has served either in the Army, the Air Force or the Marines, and it is such a profound honor to be able to serve those who have dedicated their lives to protecting my freedoms. And I couldn't be prouder to say that I play a role in improving cardiac arrest response, that I help to train an entire workforce to save lives when it matters the most, at those most critical moments. You know, I witnessed a nurse, or I witnessed nurses performing CPR on my husband, and they did an amazing job. They did the best they could. But I find myself now that I'm in a position to make sure that through the training that I provide, I can help to ensure that every nurse feels confident in their ability to save lives when it matters the most.

Cassandra Taloma 6:44
Wow. Thank you so much for sharing that I you know, I can't help but think about some of the things that you say, some of those skills and experiences that you have they're really not taught in school. So, you know, like holding the hand of a dying person are really empathizing with not only a patient, but the family as well, which I feel like is really important for nurses as they're, you know, doing bedside care. There's more than just the patient there. It's also their loved ones who need that support as well as they're going through something, it's fascinating. I really feel like you are in the right field for that, you know, just being able to to connect with your patients in any individual that you encounter, and I love that, you know, in in some sort of way you are, you know, training those who are at the bedside or who can provide emergency care and really tough situations like, I love that you are, you know, making it an effort to make sure that they are being able to provide that care for patients in the future, so patients and families can have similar experiences that you did, and in that very hard situation with your with your husband,

Carissa Hernandez 7:54
absolutely. And I think that's one of the reasons why my project is so close to my heart. And emergency preparedness and emergency response is so close to my heart I have I take it very seriously. I take it very personally. And you know, my father and my own family members get care at the very hospital that I work at, and so I really believe in treating every patient and every veteran or even every humanitarian that walks through the VA doors just being able to play a part in ensuring that they receive world class care. And so it's something that I truly take, take personal, and I think that's one of the reasons why I'm so passionate about my project. Yes,

Cassandra Taloma 8:38
absolutely. And you know, let's talk about your project a little bit more. Your dissertation is titled accelerating initial cardiac arrest response in medical surgical nurses through virtual reality training. Can you walk us through your project and tell us what inspired you to focus on virtual reality?

Carissa Hernandez 8:55
Sure, so my dissertation is about using virtual reality to train medical surgical nurses on how to respond to cardiac arrests. So one of the biggest challenges for med surg nurses is that they don't encounter code blues or cardiac arrests very often. So it's kind of one of those high risk yet low frequency events in their area. They don't see it as often as an emergency department or an ICU. So when they do run into these situations, the high pressure nature can lead to unhesit or hesitation and uncertainty. If you're just don't see it that often, you know. So traditional training methods like Mont codes are great, but they're not always frequent, and they can be resource intensive. So I do mock codes a minimum of once a month in my facility, but due to the sheer size of the facility, as well as the multiple outpatient clinics we have, it's impossible to do a mock code that hits every area as frequently as I'd like to do them. So that's kind of where VR comes in. So it gives a realistic hands on training experience without having to disrupt patient care. So the simulation I created is only eight minutes long, so they can do this simulation without taking too much of their time. So a mock code can take anywhere from a traditional mock code can take anywhere from 30 minutes to 45 minutes after you do your pre briefing debriefing. So being able to scale that down to only eight minutes is huge. And so the simulation that I created was I created it using a 360 degree camera, and that was filmed on their unit so they can practice responding to emergencies in that immersive environment that looks and feels just like the actual unit, with the same equipment that they use every day. And so what really inspired me to explore VR was seeing the gap between what nurses know in theory and how they apply that knowledge in real time. So by allowing these nurses to have the opportunity to repeatedly practice in that familiar setting with those realistic stressors, VR can help to build that confidence and enhance their response time. And it's really an exciting way to make training more effective and engaging. And ultimately, the goal is to lead to better patient outcomes. I

Cassandra Taloma 11:31
love that detail. I love that you actually are portraying the actual floor that they would perform these emergency services on and I, you know, I think like, like, you said, like, it's going to be, it's going to positive, positively affect the way that they handle the situation, knowing that they're around familiar surroundings, and even you know faces, I'm sure that they might see on your floor, for sure, what, let's talk about, What you're measure, measuring in your research, what are some of those key factors that you're looking at? And do you have any initial results that you can share?

Carissa Hernandez 12:08
Yeah, absolutely. So my project focused on three main areas. I was specifically looking at their confidence in cardiac arrest response. So basically, you know how they felt when responding to these Code Blue situations, I was looking at their adherence to the American Heart Association, basic life support algorithm. So wanted to see how well they followed the correct sequence of life saving, you know, interventions. And I was also looking at their documentation accuracy. So I wanted to ensure that our BLS nurses accurately recorded the actions they needed to record before the advanced responders arrive. And so I was really excited about the results. So some of the key findings that I had was a huge confidence boost. I think one of the biggest takeaways was a significant increase in nurses confidence. So before the training, the average confidence score was 44.63 and after completing the VA, the VR training, it jumped to 49.61 which was a statistically significant improvement, which really meant that VR really helped the nurses feel more assured. They were less hesitant when dealing with cardiac arrests. As far as to the adherence to the BLS algorithm, we saw a big improvement in how well nurses followed the correct steps of BLS protocols. So in their first attempt at the simulation, the average performance score was a 72 but by the second attempt, that number increased to 86 and that was after just one attempt, which tells me that the VR training really did reinforce that adherence to the BLS algorithm. And as far as documentation accuracy, many of the nurses said that the training helped them to better understand about what to document, and when I haven't had someone tell me, you know, like, oh my gosh, you know, now I actually know what I need to document and when, because, you know, in these chaotic situations for nurses that don't do this very often, oftentimes, they're so focused on the task at hand of trying to save a life that they forget, you know, details about what they need To be documenting. And so I found that a lot of the participants were saying that that repetition of being able to do that was was very helpful, and obviously proper documentation is is super important. So I was really excited about that outcome. And one thing I was really kind of interested to know is, what if anybody had experience with technology, such as such as doing VR before, versus people that didn't have any experience with technology as to whether or not that was going to affect their ability to feel comfortable with the technology. And I was really excited that prior VR experience did not matter. So, um. Um, both First Time Users of VR and experienced users of VR showed the same level of improvement, which meant that this training is actually accessible and effective for everybody. And some of the other feedback I got was that the realism, of course, was a huge plus, that they loved that that training mirrored their work environment they had the opportunity to work in, you know, in their work setting and using the same equipment that they use every day. So they really love the realism. They appreciated the opportunity to to repeat, they could, you know, repeat the scenario. And they loved that they had the opportunity to correct any mistakes that they may have made the first time. And I was really excited to hear almost all of the nurses said they really loved it, and we're looking forward to future VR training. So that high level enthusiasm for more VR training was also super, super exciting.

Cassandra Taloma 15:59
That's That's awesome. I was going to ask you, I know you said this was primarily focused on med surg nurses, but do you think something like this could be offered to nurses of different specialties? Oh,

Carissa Hernandez 16:12
absolutely. We are already planning to expand our VR training, like we're already in the works of trying to create additional scenarios. For instance, we're looking at potentially making some scenarios on difficult conversations. We are in the plans of creating a mass casualty triage training for our emergency department. We're looking at emergency response training for our VA outpatient clinics. And that's another thing, I think one of the biggest advantages of virtual reality is the ability to reach those rural areas in our rural clinics. So we have clinics in Laughlin and Pahrump, and getting training in person to those areas can be a challenge. So VR offers a practical solution that would allow us to deliver this training remotely, so we can ensure that these staff, no matter where they're located geographically, they're going to receive the same level of education and preparation that the nurses and staff do when they're at the main facility.

Cassandra Taloma 17:16
I love that. I think it's super awesome that there's a potential to reach the rural communities, because I think that's definitely a gap in care that we see in healthcare is reaching the far communities. And how can we equip them with the same type of supplies and equipment that we have in a regular, you know, city hospital, or what have you? And I love that you provided different examples on how VR can help, you know, evolve nurse training in different areas. So in terms of nursing education, how do you envision VR tech? Could, you know, improve certain concepts or topics, like you said, maybe having those tough conversations. And do you have any advice for other educators who want to consider similar innovations with VR?

Carissa Hernandez 18:05
Oh, yeah, absolutely. So, you know, I think VR, like in nursing education, is just kind of scratching the surface. So, you know, as technology advances, and I think we're going to see even more and more realistic and interactive simulations, especially as people start incorporating artificial intelligence. And, you know, we're having that ability to provide that real time feedback and branch scenarios that are able to adapt, you know, based on learner decisions within the virtual reality scenario. So there, there is so much. I mean, I think it's infinite into where VR can expand, you know, into other areas of nursing education. I think we're only limited by our imaginations. You know, I think for any educator or anybody that's thinking about using VR or incorporating VR into their training programs, I think my biggest advice would be, would be to start small and build from there. So, like you don't have to completely revamp a training program overnight. I would say that they would need to start with one high impact scenario, so kind of see how it works. You know, implement it, get some feedback and refine it before you try to expand into something more. Another thing is, is, I think it needs to be kept real and relevant. So I think, you know, making making sure scenarios mirror those real life challenges and the real challenges that nurses are facing in their day to day work. So the more realistic the training, I believe, the more useful and engaging it's going to be with users. And I think educators really need to involve frontline nurses, frontline nurses, the educators leadership, get out there and talk to the staff. You need to get them involved early. Early, get that buy in early, talk to them and see what kind of challenges that they're facing daily. Go out there and get that needs assessment and see what are they facing in their day to day. Work, because that input is going to help you tailor your training to what your facility actually needs. And it's also going to get their support early on by getting them involved as stakeholders, which is going to definitely make any implementation much, much easier. So I think my advice would be to start practical, make the make the training meaningful, and make sure you're involving the right people. And once you get all those things together in a perfect mix. That's what's going to help make any VR training successful.

Cassandra Taloma 20:46
I love that, and I love that you're really emphasizing how much of a team effort it is on all ends. So it's not just one sided or one person leading the charge. It's great to see it as a team come all together absolutely well. Thank you so much Carissa for being on the show with us, and thank you so much for being here and sharing your expertise and your stories. It was great to talk to you today.

Carissa Hernandez 21:09
Oh, it was so awesome to be here. Thank you so much for having me, and thank you to all of your listeners. Thank you

Cassandra Taloma 21:15
to our listeners for tuning in to another episode of vital views. You.