Nurse researcher Cynthia Foronda’s daughter was 17 when she brought her to the UHealth Pediatric Allergy and Immunology clinic for an allergic reaction she developed after COVID. Though medication eventually cleared up her teenage daughter’s allergy, Foronda’s connection to the clinic has only grown stronger.
The Miller School of Medicine physician who treated her daughter, Gary Kleiner, M.D., Ph.D., happens to be the chief of the Division of Pediatric Allergy and Immunology. “He asked me what I do for a living,” said Foronda, PhD, RN, CNE, CHSE, ANEF, FAAN, assistant dean of innovation and clinical scholarship at the University of Miami School of Nursing and Health Studies. “Since then, we have been collaborating on a number of projects with our school’s Doctor of Nursing Practice (D.N.P.) students.”
The team recently completed a pilot project to evaluate whether virtual reality headsets can help distract children from the anxiety and pain often associated with allergy testing—typically a skin prick test (SPT), during which providers press a pointed piece of plastic containing different allergens into the skin to assess which cause a response.
As a result of this collaboration, they were recently welcomed by Food Allergy Research & Education, Inc. (FARE), the largest private funder of food allergy research, to join the collaborative organization’s third cohort of FARE Clinical Network (FCN) sites. The FCN 3.0 Community of Practice will be led by about 50 selected members from diverse health care institutions nationwide, with FARE staff providing administrative support.
The successful interdisciplinary application to join FCN 3.0 reflects the success and promise of their VR program, completed in Dr. Kleiner’s clinic.
“Allergy testing is a crucial part of identifying potentially fatal food and other allergies in young people,” explained Dr. Foronda. “Being able to use distraction through virtual reality devices as a nursing intervention has the potential to distract patients while alleviating pain and anxiety associated with medical tests and procedures.”
In their initial pilot project with seven young patients and their caregivers, Dr. Foronda and the team demonstrated successful translation of research into practice. Their findings suggest VR may be a useful non-pharmacologic intervention for nurses to use during allergy testing to improve the patient and family experience. “Anecdotally speaking, the VR application did not noticeably affect procedure time, nor hinder patient flow,” they stated. “As nurses strive to improve the patient and family experience, VR is a low-cost and anxiety-reducing distraction for potential use at pediatric allergy clinics and various other contexts in health care.”
To obtain the resources and training essential for the VR program, the team reached out to associate director of VR/AR Initiatives, Thomas Merrick. He assisted with set up involving a Meta Quest 3 head-mounted display and Engage’s 4K Theater environment to create an immersive and visually rich setting where children could watch a show of their choice from a curated list of popular children's programs. The setting resembled a traditional movie theater, complete with a stage and curtain backdrop.
Researchers found satisfaction scores high among both caregivers and patients, with all indicating they liked the VR and would choose to use it again in future. Staff reported satisfaction responses ranging from neutral to highly satisfied, the team found.
“This project demonstrated that VR may serve to reduce anxiety for children during allergy testing,” they concluded. “There was a greater decrease in perceived anxiety in the patients aged 4 to 9 vs. those aged 2 to 3 years old.” Practically speaking, the headset fit better on children in the older age group and those patients became more engaged in the VR experience than patients under 3. However, they noted, if VR is used as a distraction tool from allergy testing, providers should be mindful of the length of exposure to the technology.
Based on the pilot project findings, the team received an endowment from the Vicencio family to continue the program. With equipment purchased for continued use at the clinic, future work will include an analysis of workflow efficiency when VR is used as well as a cost-benefit analysis, stated the researchers.
“Through forming an interdisciplinary team inclusive of nurses, nurse practitioners, a technologist, and the Chief of the Division of Pediatric Allergy and Immunology, multiple monthly meetings and planning allowed for the successful coordination of project activities and evaluation,” they stated.
