For years, I’ve talked about the “care between the care,” which occurs between patients’ visits to the hospital, clinic, or ER. It’s abundantly clear that the real action is happening in everyday life, yet so much of our clinician education, information technology development, and standards of practice address only that very short time when patients are in the presence of physicians, nurses, pharmacists, or other providers.
We need to devise more interventions that target the care that happens between provider visits.
Like many directors of National Institutes of Health (NIH) Institutes, I have an active research program on the NIH campus. My lab, the Advanced Visualization Branch (AVB), is in the Division of Intramural Research at the National Institute of Nursing Research (NINR). The lab is motivated by one simple question: How can we help people with chronic conditions who are living at home better self-manage?
To address this question, we’re using a whole new set of methodologies involving immersive virtual reality (VR). VR is emerging as a robust research tool that lets investigators create realistic-appearing environments to study human behavior. This approach is particularly important for research on the challenges of self-management at home because the systematic study of behavior requires that we visit the same space repeatedly — something that’s hard to do with people in their homes in real life!
The AVB develops and evaluates augmented reality (AR) and VR experiences that engage participants in multisensory activities and examine their impact on health behaviors. Specifically, we develop interactive VR simulations that present health information to people with a variety of complex health conditions. These simulations provide visual cues that immerse participants in everyday settings.
Research demonstrates that teaching self-management skills is more successful and has a greater impact if those skills are taught in the environment where they will be used. There’s something about visual cues and spatial layouts that seems to reinforce the teaching process and help people develop new patterns.
Simulations that enable people to rehearse problem-solving behaviors in familiar, realistic-appearing environments foster improved health outcomes at home. AR/VR simulations also allow us to experiment with new ways of presenting information that aren’t possible right now but could be in the future.
We could investigate, for example, whether a display of nutrition facts that hovers over a food container leads people to make more appropriate food choices. In addition, we’re developing methods to measure the impact of using AR/VR technology as a tool to aid disease-management nursing strategies during the transition from acute care settings to outpatient environments. Our work will help generate recommendations for how to best use emerging technologies in all types of patient care.
The cross-disciplinary AVB team comprises staff with expertise in nursing research, informatics, neuropsychology, and digital engineering. The team creates virtual environments to observe, quantify, and assess objective indicators of behavior (e.g., performance, physiological) and subjective perceptions (e.g., mood, user experience, self-rated symptoms) in controlled, complex environments. The results are then used to evaluate individual differences in symptom expression, the delivery of effective health care education, and the utility of VR in engaging patients and improving health-related behaviors.
Currently, the AVB’s research focuses on environments for studying the impact of fatigue on everyday activities, evaluating interventions targeting dietary choices by individuals with chronic medical conditions, and helping people better use pillboxes for safe medication management at home.
While the main focus of my work life is leading NLM, conducting a program of research at NINR enriches my thinking and helps me envision new ways for the Library’s resources to reach people. My research as a nurse-investigator will engender new ideas and help us devise new strategies for delivering the important, consumer-oriented information provided by NLM through our outreach initiatives and MedlinePlus.
Maybe you could help us, too! Researchers interested in the use of technology for patient self-management might consider submitting an application to our Personal Health Libraries for Consumers and Patients grant opportunity.