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Nursing students at Tacoma (Wash.) Community College (TCC) are going to the virtual world to learn how to work with real-life patients.

As part of the curriculum for second-year nursing students, instructors John Miller, RN, BSN, MN, ADN, at TCC, and K. David Bodily, RN, BSN, at Western Wyoming Community College in Rock Springs, have created a 3-D virtual ER simulation in Second Life, an online virtual reality network.

Last year, 54 students at TCC donned headsets, created their own computer-generated avatars (on-screen representations of themselves), and entered the ER simulation in Second Life.

During the simulation, students role-played using their avatars to select interventions for a patient suffering chest pain and cardiac dysrhythmia. The patient's vital signs were projected on the back wall of the ER bay and were updated throughout the session.

Students chose from a group of simulated real-life interventions, including oxygen hookups, medication, CPR, defibrillation, or IV therapy, with their avatars doing the work on screen. Then the simulated patient, controlled by either the instructor or another student, responded realistically to what the students chose.

Decisions made by the students are compiled into a printable log that instructors review with class after the session.

Miller says the experience can add to nursing students' knowledge and will influence their reactions once they are in the workforce.

"You just can't read the textbook and suddenly be at the patient's bedside," he says. "The chances of their seeing something like a myocardial infarction during their clinical rounds is zero."

The virtual simulation allows students to practice their critical-thinking skills in an environment where there are no real patients who can be harmed, Miller says.

Bodily says the virtual concept bloomed from the real-world need for connecting with students in remote areas.

"Distance education is critical here," he says. "Last year, I started looking at Second Life as a delivery platform and decided to do proof-of-concept with the ER simulator."

The prototype simulator, dubbed "NESIM," is installed on Cousins Pau Island and open to anyone in Second Life (www.secondlife.com), Bodily says.

"Virtual simulation is rife with possibility," he says. "I think we're on the cutting edge of the use of it."

Miller says there are several other simulations the two instructors are pursuing, including working with a burn patient. TCC students also use Second Life simulations to build a brain, move parts of the liver together, and manipulate a stack of vertebrae to see how they affect other parts of the body.

"Our goal is to expand it more," Miller says. "The idea is to create a patient with problems and let the students react to those problems."

While many students are tech-savvy and able to grasp this method of learning quickly, others are challenged before they even begin the simulations, Miller says.

"Students who have some technical ability do really well with the simulations," he says. "The ones who have barely used e-mail have a lot of anxiety about it and are having a harder time."

Miller says he plans to pair students more experienced with the technology with novices next semester.

Nursing student Marisa Aslanian says she found the simulations easy to navigate.

"I did not find the technology hard to use because I've grown up on computers and I enjoy using them," she says. "If you know how to operate the arrow keys, use the mouse, and right-click, then one should have no problem in Second Life."

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Teresa McUsic is a freelance writer. To comment, e-mail editorNW@nurseweek.com.