CNA Simulations VR

What are we solving?

CNA Simulations VR is the first-ever virtual training for certified nurse assistants. With the recent hit of the pandemic, senior homes had to close their doors to keep their residents safe and healthy. However, this caused tension for many CNA students and instructors as that was the main way for training CNA students to practice what they’ve learned in real practice. Because of this, the government started to allow for virtual training, but there was nothing specifically for CNAs. This is where CNA Simulations VR comes in and alleviates this pain for the student and instructors.

Our team of 3 was tasked to enhance the user experience of online CNA training through engagement, immersion, and critical thinking specifically in the hand hygiene module. In this project, I led the UX strategy and design while also assisting in the research phases.

The Project Snapshot

The Discover Phase

What are we working with?

Although the hand hygiene module section was not fully built out on the simulation, our team wanted to conduct a heuristic evaluation of what was currently live on the simulation. This helped us find opportunities on how to make the simulation more usable in general. Upon evaluating the current simulation, we found four violations:

1. User control and freedom: We noticed there was no way the students can go to the previous scene, or exit to the main dashboard. 
2. Visibility of system status: We also noticed that there was no indicator to allow students to know where in the simulation they were. 
3. Consistency and standards: The call-to-action of “Click to continue” is not consistent throughout the simulation as on some screens, you can click anywhere, while others you must click on the inline button.
4. Flexibility and Efficiency of Use: Nurse Johnson seemed to be a bit interruptive throughout the simulation as she provides feedback everytime a question is answered, whether it was right or wrong.

Interviewing the Users

Initially, we met with our client and talked about the main stakeholders being the instructors as they gave many insights as to what the training module should look like. While we knew the instructors were main stakeholders, our team ideated around interviewing students as well, but we decided to focus on the instructors first. After chatting with the instructors, we were supported in our initial thoughts of talking to the students as they are the main users of the simulation. Here are some key insight from our user interviews. What we are hearing from instructor is to apply critical thinking and from the student we are hearing “ wanting engagement in their training.

Scoping the Market

Because all the indirect and direct competitors of CNA Simulations VR did not have public information on their simulations, we decided to turn to narrative-based games for comparative research. The two games we compared were Life is Strange and Tell Tales Games. Here is what we found:

• 1st vs 3rd Person: Learning that engagement was a top priority for both the students and instructors, our team looked into how 1st or 3rd person perspectives compared in helping users feeling more immersed. We learned that it was very subjective, and would take too many resources to switch up at this point in the project, so we decided to move this into a parking lot idea to explore if we had more time later on. 

• Immersive Environments: This was a repeated gaming convention that calls the user to interact with objects in their environment. After doing research, we found that this helps the user feel more immersed. 
• Timers: We also found that timers and visual status keeps them engaged and informed of where they’re at, at all times. We did research on timers to help bring timing concepts into the hand hygiene module. 
• Progress Bars: As I mentioned earlier regarding system of visual status as one of the heuristics,  a progress bar would be necessary to allow users to know where they are in the module, so we researched various progress bars to implement into the final deliverable.
• Dialogue Boxes: While there aren’t any direct conversations within the hand hygiene module, we explored the way dialogues was shown in the games to make recommendations for the rest of the simulation. As you can see in the examples the dialogues are presented in white text against the game background and at time this can be hard to read, making it not accessible. Because of this we learned that we could not follow this structure of dialogue, so we didn’t bring this into the design phase.

The Define Phase

Who are we solving for?

During our research phases, our team concluded that there are two user groups we need to cater to. While our

Mapping the User Journey

To visualize the journey of our end-user, the students, I created a journey map for our users as it stands today. This helped our team identify opportunities for CNA Simulations VR to meet students in their CNA education/training. We see here our biggest opportunities for growth are providing virtual instruction early-on where they can not currently practice in-person clinical rotations. We hope this would keep them optimistic in the face of this pandemic.

Defining Our Area of Opportunities

The Design Phase

In the design phase, our team conducted a design studio to ideate around the various gamification components. After sketching these rough ideas onto paper, our team came together to vote on which one to move forward with into grayscale fidelity.

The Timer

We had ideas around hiding or showing the real time passing. If the time is showing, we thought it could show on the upper right hand corner so it’s not disruptive. For the hidden timer, the student would click on the start timer button and the timer would count in the back, and then the student would count aloud the seconds passing by and stop the timer. The reason why we ideated around a hidden timer is because we wanted to ensure student engagement and critical thinking, which is a high priority for the instructors. So basically we wanted to force the students to count the 20 seconds themselves.

‍

The Progress Bar

To ensure users knew where they were in the simulation and modules, we thought it would be important to design a progress bar. Keeping in mind that there is limited real estate, we wanted to ensure the progress bar is visible, but does not take up too much space. We also wanted to include a numerical value to assist students understand their progress.

‍

‍

‍

Nurse Johnson Screens

Something our team discussed after evaluating the current simulation was around how Nurse Johnson was very helpful throughout the simulation, however, after some time she felt a little interruptive. So we played around with the idea of displaying Nurse Johnson’s tips as a pop up notification or taking up only half the screen, so it feels less disruptive.

‍

‍

Usability & A/B Testing

After finalizing which sketched designs to move forward with, I created all the low-fidelity gaming components that my teammates would then use to create two different prototypes to test. The first version would show the real time passing by on the front-end so students know exactly how much time is passing. The second version would not show the real time passing on the front-end until the student clicks on the 'stop timer' button, which the time passed will then reveal itself. Our team wanted to A/B test the two versions to better understand which version is more helpful and engaging for our students.

The results?

The system usability score came out to be 82% while version B (with real time showing) ranked higher in engagement, critical thinking, and helpfulness.

The Final Deliverable

The prototype

Final Conceptual Iterations

For our final iterations, we made the environment more immersive with highlighted items and click to reveal answers. Also made progress bar clickable for a dropdown menu to show all the previous steps the user has taken and which steps are left.

‍

The Critical Thinking Scenarios

A Non-Emergency

In this scenario, Ms. Sophie (the patient) is asking for Teresa, but it is not an emergency. As you can see, while Teresa is washing her hands, Ms. Sophie yells for Teresa because she wants to tell her about her grandchildren. The answer here is to continue washing your hands and nicely reassure Ms. Sophie that you will be there in a minute.

‍

An Emergency

The second concept scenario we thought of was Ms. Sophie, who now is in an emergency as she fell off the bed. This is a tricky question because the student will need to critically think and make decisions that were not necessarily taught in a controlled environment (ie. school).

‍

Paper Towel Shortage

The third concept scenario is around not having the proper tools to complete the hand hygiene module. Paper towels are essential to starting and completing the hand hygiene process. Without it, the students would recontaminate their hands, which can cause an infection outbreak. The second option is the correct answer.

‍

An Infection Outbreak

The last concept scenario is focused on an infection outbreak at the nursing home. This scenario will present a list of next steps that will continue to drive the narrative further for the student. Because we want the simulation to mimic real clinical rotations, we want to ensure the students feel the impact of their decisions through the simulation.

Next Steps

If we were given the opportunity to continue working with CNA Simulations VR in another design sprint, we would like to focus on:

1. Researching sounds: While there are sounds in the current simulation, we would like to A/B test different sounds for increase in engagement. While pur team believes that utilizing sounds makes the simulation more accessible, we would like to see the user have the flexibility to turned off voice over, as for some user this can be disruptive.
2. Critical Thinking Scenarios/Paths: We would also like to further our ideation and design process to continue building on the critical thinking paths and scenarios.
3. A/B Testing: Our team decided that testing between 1st or 3rd person perspective was not a high priority for our MVP, so we put that in the parking lot to explore later if we had more time. In the next design sprint, we would like to do more research and test to see if there is higher immersion and engagement on one versus the other.