Don't Panic! - Influence of Virtual Stressor Representations from the ICU Context on Perceived Stress Levels

Title of the Paper

Don’t Panic! - Influence of Virtual Stressor Representations from the ICU Context on Perceived Stress Levels

Paper Information

• Topic Area: Application of virtual reality in medical training, specifically stress inoculation training
• Keywords: stress, nursing, virtual reality, time pressure, task interruption, ICU, training simulation, physiological measurement
• Conference Information: CHI 2023, Hamburg, Germany
• DOI: 10.1145/3544548.3581189

Research Background and Problem

• Issues and Challenges:

  • Nurses in ICU environments often face task interruptions and time pressure, which can lead to acute or chronic stress.
  • Stress negatively impacts nurse and patient safety, including reduced cognitive abilities, decision-making efficiency, and physical performance.
  • Traditional nursing training methods, such as role-playing and skills labs, lack realism and are costly.

• Importance of the Research:

  • Stress is a major reason for premature resignation among nursing staff.
  • Effective management of occupational stress can enhance job satisfaction for nurses and improve patient care quality.

• Motivation and Related Work:

  • Virtual reality technology offers low cost, high customizability, and repeatable scenarios, making it a promising solution for stress inoculation training.
  • Virtual reality has shown effective training results in safety-critical fields such as firefighting and construction, but its application in nursing remains underexplored.
  • This study aims to investigate the impact of virtual stressors on psychological and physiological stress levels in nursing staff using Stress Inoculation Training (SIT).

Solution

• Approach:

  • Develop a high-fidelity virtual ICU environment.
  • Design virtual representations of two typical stress factors (task interruption and time pressure) to simulate stress in nursing environments.
  • Conduct typical ICU tasks, including syringe operation and patient vital sign recording.

• Innovations:

  • First implementation of task interruption stress induction simulation in virtual reality.
  • Multimodal representation of stress (visual and auditory interaction).
  • This study addresses the gap in empirical research and data on virtual reality-based stress training in the nursing industry.

• Implementation Steps and Technical Details:

  • Develop the virtual ICU environment using the Unity3D platform, generating high-fidelity multimodal background sound effects.
  • Use professional physiological measurement devices (e.g., heart rate, respiratory rate, respiratory depth sensors) to monitor participants' stress states.
  • Quantify subjective stress levels through surveys such as PSQ, Likert scales, and NASA-TLX.
  • Conduct randomized controlled experiments (26 participants) to test the stress-inducing effects of "task interruption" and "time pressure."

Research Outcomes

• Specific Findings:

  • Virtual stress factors (task interruption and time pressure) significantly increased participants' stress levels, particularly evident in heart rate and respiratory rate.
  • A high proportion of participants reported high immersion in the virtual reality environment (IPQ scores near maximum).
  • Both time pressure and task interruption induced stress, but the intensity of stress between the two factors showed no significant difference.

• Advantages:

  • Virtual stress induction technology poses no risk to real patients, making it suitable for stress management education in nurse training.
  • Compared to traditional role-playing or skills labs, this technology is more cost-effective and offers reusable environments.

• Experimental or Evaluation Results:

  • Heart rate showed a significant increase from baseline to the stress phase (e.g., "task interruption" mean heart rate increased from 77.7 to 89.5 bpm).
  • Participants reported a significant sense of task completion stress, with Likert scale scores increasing by over 50% from baseline to the stress phase.

• Limitations and Future Directions:

  • The effectiveness of virtual stress may be limited by participants' experience with virtual reality, potentially leading to a cognitive load ceiling effect.
  • The small sample size (26 participants) restricts the generalizability of conclusions.
  • Future work will compare virtual stress effects with real-world stress and expand the diversity of tasks and stress factors.
  • Collaboration with educators is planned to develop adaptive training tools that flexibly meet the needs of different students.