Living the dream
Have you ever had a dream that you wish would never end; one that transcends you into another person, place, or time? Perhaps in your dream, you were flying above an endless seascape or being lifted by a bouquet of helium-filled balloons creating a feeling of complete freedom deep within your soul. Perhaps you were swimming underwater with a school of vibrantly colored fish so near that you could touch them. What if you were standing on the highest peak that felt like you could see forever over cavernous ranges of glistening, snow-capped mountains making you feel like you were right up there next to the clouds and never wanted to come down?
But then you wake up only to be reminded of that gnawing, nagging pain that the cancer brought with it into the very depths of your bones. All you want to do is return to that place of peace and splendor, to forget about the discomfort that plagues you—a place where a great feeling of awe overshadows the burden of the disease. Virtual reality (VR) is a credible method used to treat palliative care patients who want to sustain meaningful activities in life, but who are physically unable to do so. VR brings the experience home when you cannot go somewhere to experience the thing you want to do or the place you wish to go. Immersive virtual reality is used to escape from symptoms such as pain, fatigue, and depression in patients with chronic and terminal illnesses.
The awe experience
A leading voice in VR therapy, Teri Yarbrow found a way to duplicate that same sense of amazement and wonder you experience in some dreams using VR which fabricates a synthetic digital world. I was lucky enough to sit down with her to learn how immersive VR is being used in patients with serious illnesses to reduce pain and anxiety by “inducing awe.” Using an ocular headset, participants are immersed in a different world with a 360-degree, multi-dimensional fantasy land. The burden of a chronic or terminal illness encompasses much more than annoying symptoms. People often develop a sense that they have become a burden to others, and they blame themselves for their condition. Some feel angry and depressed, while others feel helpless, hopeless, and lost. She explained that the experience of immersive reality “gets the eyes off the diagnoses and transforms the experience they are living through,” thereby enhancing the patient’s quality of life by escaping into another realm for a time.
To do this, Teri and her partners created “Radiance VR - An Immersive Experience.” In this experience, a cascade of lights showers down upon the viewer in brilliant streams falling from a geometric pattern in space. When a viewer looks down, they see a mirrored effect of light penetrating space and defying gravity. So, the viewer is enmeshed in beautiful, peaceful, calming, and comforting rays of radiant lights, allowing an absence of true reality for a short time. Teri shared that one suffering participant was so impacted by her experience that her fear of dying went away. Other participants made inspiring statements including, “This is what heaven must be like,” and some expressed feelings of peacefulness.
There are a variety of definitions, explanations, or descriptions of what awe is, but essentially, it is a total body experience affecting a person’s mind, body, spirit, and emotions that leads to a sensation of joy, serenity, peace, and in some cases an overwhelming feeling of pure glory that words cannot describe. Designers, researchers, and innovators are working tirelessly to make the VR experience available to the healthcare industry as a valuable resource for those who suffer mentally and physically from chronic or terminal illnesses.
Nursing application
Virtual reality is a strategy nurses use for a holistic approach to care for their patients. Nurses use VR after they have assessed the patient’s level of pain, anxiety, fatigue, and depression and have identified the problem areas. This technology can be used in addition to other traditionally prescribed medications or interventions such as heat and cold applications, repositioning, relaxation techniques, and counseling.
The headset or ocular device itself is lightweight and easy to use. It is paired to a smartphone or other device that opens apps to many different experiences. The headset can be adjusted to make the process more comfortable. For instance, if the patient has chronic neck pain, an adjustment in the positioning of the patient can be made to negate neck discomfort. Exploring patient-centered goals is important to identify what the patient is expecting and would like to achieve. An assessment of the patient’s response to the experience is the same as in other symptom control interventions, primarily subjective—either they got relief and felt better, or they did not. If the nurse observes the participant with goosebumps, which is an autonomic response typically indicating a positive outcome, it suggests the participant is experiencing awe and getting relief from the burdensome symptom. Notation of any change in vital signs should also be documented where applicable. The participant may subconsciously comment aloud reflecting an awesome experience that should be documented. Adverse responses such as feelings of claustrophobia or anxiety should also be noted. As with other interventions, there are so many options for the participant to engage in using virtual reality that if they are willing to try another reality, they may be able to reach their goals if it does not work the first time.
Measuring outcomes
As Teri explained, VR for symptom control can be measured to support the validity and legitimacy of its use as a therapeutic intervention in palliative care. The participants in an IRB-approved clinical study currently underway through the Steward Center for Palliative Care in Savannah, Georgia, report their pain rating on a numeric scale of 1-10 before the experience and then again after the experience, anticipating the rating will show an improvement in the expressed symptoms. Other studies used the participant’s subjective preference on a 10-point scale of “benefit/helpfulness.” A systematic review of research found that the qualitative outcomes were largely positive for physical and psychological manifestations of discomfort. Academics recognize that more quantitative studies should be conducted to substantiate virtual reality as an evidence-based standard of care.
Looking to the future
As a nurse who makes home visits to clients participating in the Johns Hopkins School of Nursing’s grant-funded CAPABLE program (Community Aging in Place—Advancing Better Living for Elders), I see many clients suffering from chronic pain, anxiety, depression, and other debilitating symptoms. At our site, we hope that VR will be utilized by these demographics and other home-based programs to help clients and patients improve their quality of life by reducing the burden of the symptoms. When people feel better, they are more likely to participate in life and do the things they love.
While it is primarily being used in inpatient and clinical settings, VR is available and can easily be taught to patients for home use. It is no secret that the nursing and other healthcare provider shortage is projected to grow right along with the aging and ill population. Technology such as VR is anticipated to become a practical means of providing symptom control for a growing, suffering society. Nurses have always been known as patient advocates, and using VR is an effective way to advocate for symptom control for suffering patients.
Toby Balke, MSN, RN, CHPN, is an experienced nurse who has worked for over 25 years in home health and hospice care. She is a member of Sigma’s Nu Upsilon Chapter.