Virtual reality (VR) has been a part of the world since the 1950s but didn’t make its way into commercial video games until the mid-1990s. Since then, VR has exploded into many different uses, not just for gaming but also for learning. During the height of COVID, nursing schools began to find a new method for training their students that did not rely so heavily on traditional bedside experiences. Before the pandemic, only 65% of nursing schools used VR training, but now it has become mainstream ¹. There are many reasons for this growth in VR, one of which has to do with the nursing shortage. The United States alone needs 350,000 new nurses to fill direct patient care roles, and that’s a conservative estimate². How is the industry to train that volume and then retain those nurses once they enter the field? Many believe VR to be a promising tool that will allow for this growth. And while nursing schools are growing their VR labs, TRU Community Care is stepping into the proverbial ring to offer continuity between nursing school education and bedside practice. 

 TRU Community Care is one of the few hospice organizations that will hire new graduate nurses and support them through their first year of practice with our nurse residency program. Part of that support includes virtual reality simulations, for our own staff along with other new graduates from around the country. The beauty of VR is that the shared lab can be accessed from any location, giving us the opportunity to partner with other organizations. All of TRU’s clinical staff were introduced to VR in 2024, and our use of VR training will continue to grow as an evidence-based tool. There is significant data to back up the use of VR as a superior learning method. From increasing knowledge at a rapid rate to integrating social-emotional memories, VR labs have demonstrated their value in learning. So, let’s take a look at the evidence base. 

 A study in 2018 by Lamb et al.³ compared VR simulation with using video content and hands-on activities. They measured learning outcomes and neural activation through the different groups. Results found that those in the VR group had better learning outcomes (did better on their test scores) and had higher rates of neural activation during the simulation than those who watched a 2-D video education. The brain activity for those in the VR group during the simulation was equivalent to that experienced by a person doing a hands-on activity. This means that from a neurobiological lens, VR is comparable to actually having the real experience. 

 As a healthcare educator, I can simulate all kinds of situations and not put a real person at risk of a poor outcome. My students have the chance to think critically, make mistakes, and learn from those mistakes without an adverse event for a live patient. It also allows for situations that students may not encounter by chance during their training. For example, our nurses often want training on attending a death visit in hospice, but death doesn’t always happen when a new nurse is on the clock. With VR, we can simulate a death visit and allow for learning to be just as effective as having had the real experience. 

 This is the pedagogical rationale behind using VR simulations. Often there is a mismatch between theoretical knowledge about a topic (e.g., the steps to accessing a subcutaneous port) and the procedural knowledge related to the topic (e.g., actually using the port to give medications). Since there is often limited time to train a new nurse (related to the nursing shortage mentioned above), nurses often get one chance to practice the procedure in orientation before being expected to perform it in a competent manner. With VR, we can practice accessing the port over and over until the nurse is confident in their procedural knowledge. 

 While there are many studies related to this topic, there is one more that is particularly thorough and relevant. Pande et al. explored the long-term effectiveness of VR to get a sense of how VR training sticks with a person, compared to video instruction⁴. The pre-test given to the two groups (VR group and video group) showed the video group had better pre-knowledge of the topic. After the learning intervention, the first post-test showed the VR group had a slightly higher understanding of the topic. Post-test 2 occurred two days later and showed similar levels of understanding between the groups. The final post-test occurred five days later, and the VR group had retained more of the information. In total, the non-VR group experienced nearly a 10% knowledge increase using video instruction, while the VR group experienced a 30% knowledge increase. This is significant because often students will understand a topic taught but easily forget the information afterward. The saying “live and learn” makes sense here; the experiences you have in life will teach you lessons far faster than hearing someone else tell you about it. This is exactly what VR is tapping into. 

 The second part of the Pande et al. study was related to the enjoyment of learning. Their students reported more enjoyment in learning using VR than the video group, who reported feelings of boredom. This makes sense; it’s easy to be engaged in learning when you are in the center of the experience, rather than just observing something. If you are interested in this topic, I’d encourage you to read the full study yourself, cited below. 

 No research is deemed valuable without an honest look at the limitations of what is being studied, and for VR education, the limitation lies in logistics. Software is pricey and hardware is temperamental. Aside from the technology requirements, running a VR simulation requires skilled educators who can run the pre-brief, simulation, and debrief in a way that facilitates learning, allows for mistakes, and encourages the group to critically think through the simulation. 

In 2024, TRU Community Care navigated many of these hurdles and is in the process of partnering with other organizations in supporting their new graduate nurses using VR. Our sights are set on developing a VR lab where our clinicians can learn simultaneously, our clinical educators can facilitate groups across the country, and at the end of the day, our patients can receive exceptional care from highly skilled clinicians. 

 

Sources: 

1.  Virtual reality in nursing education goes mainstream. Wolters Kluwer. (2023, March 28). https://www.wolterskluwer.com/en/expert-insights/virtual-reality-in-education-goes-mainstream 
2. Berlin, G., Lapointe, M., Murphy, M., & Wexler, J. (2022, May 11). Assessing the lingering impact of covid-19 on the nursing workforce. McKinsey & Company.  https://www.mckinsey.com/industries/healthcare/our-insights/assessing-the-lingering-impact-of-covid-19-on-the-nursing-workforce
3. Lamb, R., et al., (2018) ‘Comparison of virtual reality and hands on activities in science education via functional near infrared spectroscopy’, Computers & Education, vol. 124, pp. 14–26. doi: 10.1016/j.compedu.2018.05.014 
4. Pandea, P., Thit, A., Sørensen, A. E., Mojsoska, B., Moeller, M. E., & Jepsen, P. M. (2021, January 18). Long-term effectiveness of immersive VR simulations in undergraduate science learning: lessons from a media-comparison study.     https://files.eric.ed.gov/fulltext/EJ1293535.pdf 

Our seventh annual TRU Cares Fundraising Luncheon, presented this year by Frasier, took place last week at Frasier in Boulder, where nearly 200 individuals – TRU leadership, staff, volunteers, board members, and friends and partners in the community – came together for an afternoon of gratitude, storytelling, and remembrance of those we have lost.

This year’s theme, “Innovate for Impact: Progress and Possibilities,” reflects the rapidly evolving healthcare landscape and represents TRU’s commitment to growth and to continually improving the lives of those we serve. In the words of President and CEO Scott Gresser, “We believe that by embracing innovation, driving progress, and exploring new possibilities, we can elevate the standard of care and reach more people.”

Chief Operating Officer Jim Woodard showcased Innovation at TRU in a keynote presentation highlighting, among other things, our work in telemedicine, use of predictive analytics, and our enhanced educational efforts using virtual reality.

Thanks to generous contributions from sponsors and attendees, including matching gifts totaling $50,000 from the Anderson Family Foundation and Bob von Eschen Sr. and Jr, our TRU Cares Fundraising Luncheon generated nearly $140,000 to support the vital services, including:

• Hospice care for the uninsured and those who are homeless in our community
• Grief support for anyone in the community coping with the loss of a loved one
• Palliative care for improved pain and symptom management
• Inpatient and respite care at our Care Center

Thank you again to our sponsors, donors, founders, board members, volunteers, staff, advisory council members, patients, participants, and families. We are grateful for you all.

If you missed this year’s luncheon but would like to support our mission with a donation, please consider donating online.

As TRU Community Care approaches its 50th anniversary, we’re excited to share key highlights from our Fall 2024 Newsletter. This edition showcases our commitment to compassionate care and innovative services across various fronts:

• We’re exploring an affiliation with St. Paul’s Senior Services in San Diego to expand our programs and ensure another 50 years of impactful service.
• Our PACE program is enhancing participant experience by introducing an in-house transportation fleet, improving flexibility and reliability.
• True to our mission, we continue to provide a safety net for those unable to pay, projecting to spend approximately $2,575,000 on uncompensated care in 2024.
• And our unique equine-assisted grief support programs, offered in partnership with Heartlight Center and Dancing Spirit, continue to provide innovative support for both adults and youth navigating loss.

You can read the full newsletter here to learn more.

Thank you for your continued support as we strive to meet the evolving healthcare needs of our community.

From June 10-13, Volunteer Coordinator Becki Parr represented TRU Community Care (TRU) at the National Hospice and Palliative Care Organization’s (NHPCO) Hospice Action Week in Washington D.C. As a We Honor Veterans Level 5 partner, TRU joined over 100 hospice and palliative care advocates from across the nation to meet with legislators and push for important end-of-life care legislation.

Becki met with staff members from the offices of Colorado Representatives Joe Neguse and Brittany Pettersen, and Senators John Hickenlooper, and Michael Bennet to advocate for two key pieces of legislation:

1. Gerald’s Law Act: This bill would extend full burial and funeral benefits to survivors of veterans who choose to receive hospice care and die outside of a VA facility. Currently, veterans lose these benefits if they choose to spend their final days at home with family. The act aims to ensure veterans can make end-of-life decisions based on comfort, not cost.
2. Hospice Recertification Flexibility Act: This legislation would extend current telehealth flexibilities for face-to-face encounters required for hospice recertification. This change would particularly benefit rural and frontier areas, allowing for more efficient use of staff time and resources.

As part of the Level 5 We Honor Veterans program, Becki also toured various veteran memorials in D.C. She was particularly moved by the American Veterans Disabled for Life Memorial, which honors living veterans who carry both visible and invisible wounds from their service.

“These are the veterans we may have the opportunity to serve at their end-of-life,” Becki reflected. “The people we need to be intentional with, creating safe spaces for their stories to be held, offering veteran-specific care.”

TRU is proud of our commitment to serving veterans and advocating for improved end-of-life care for all. By participating in events like Hospice Action Week, we continue to work towards a future where all individuals can make end-of-life decisions based on comfort and personal wishes, rather than financial concerns.

To learn more about the full range of issues discussed during Hospice Action Week, please visit Hospice Action Network’s online summary and resources page.

Pictured above (from left to right) are Sasha Benner from Intermountain Health Hospice, Don Knox from Home Care & Hospice Association of Colorado, Brian Young of I Street Advocates, and Becki Parr from TRU Community Care.

On Tuesday, April 16th, in honor of National Healthcare Decisions Day, The Conversation Project in Boulder County, a TRU program, hosted an event that featured Cello, a short film about a renowned musician facing a terminal diagnosis and navigating important end-of-life conversations. The film showing was followed by a discussion with a panel that included the film’s producers and others working in end-of-life care. The event, which took place at The Dairy Arts Center’s Boedecker Theatre, sold out quickly, necessitating a second showing and panel discussion that evening.

TRU and The Conversation Project in Boulder County (a program of TRU) hosted this event to encourage people to think about and communicate their end-of-life healthcare values and wishes with those most important to them. We hope the program motivated our guests to consider their choices and start the conversation.

We reached 130 attendees who engaged actively with our carefully selected panel which, in addition to Cello producers, Helen Nightengale and Alex Craven, included:

Jean Abbott, a retired physician, co-founder of The Conversation Project in Boulder County, and member of TRU Community Care’s Ethics Committee.

Kim Mooney, an internationally-recognized thanatologist and educator and co-founder of The Conversation Project in Boulder County.

Claire Riley, RN, MS, a former member of TRU’s Ethics Committee and a coach and advisory board member for The Conversation Project. Claire is also on the governing Board at TRU.

Linda Wallace, who helped start Bristlecone Hospice serving Summit and Eagle counties and shas since served as a hospice volunteer and companion to individuals navigating end-of-life choices.

Susan Wilhoit, MD, a hospice and palliative medicine physician and a death doula and a National Medical Director at Compassion and Choices. This summer, she will launch a full-spectrum end-of-life practice, Rocky Mountain Compassionate Care.

Please see our panelists’ full bios here.

Sometimes it is hard to know where to start when considering your end-of-life choices; you may struggle with identifying a healthcare agent or knowing what advance care planning forms to fill out. The Conversation Project in Boulder County (TCPBC) offers free advance care planning coaching.

Learn more at theconversationprojectinboulder.org or by contacting Becki Parr at beckiparr@truecare.org.

Cello is available to watch on Vimeo for $2.99.

 

 

by Rachel Stackhouse, TRU Clinical Educator

There is only one area of healthcare where governing body regulations require every organization to have volunteers who cover at least 5% of the total clinical care hours; and that one specialty is hospice. TRU Community Care has been blessed with an incredible volunteer services department. From our faithful administrative support volunteers who are in the office every week, to the companion volunteers who travel far and wide to our patients in their homes, and the volunteers who run the TRU Thrift Shop. Altogether TRU is currently bolstered by 365 volunteers, providing 11.7% of the total hours of care given, which is double the required amount. Countless stories could be told of this generous crew, but one is too good to go untold. Often, we tend to think of the impact volunteers have on a patient, but this story is not that. This story is about how one of our patients rocked the volunteer’s world and a salute to the various stories our volunteers carry with them.  

 Meet Drew, a gentle and powerful young woman, who is also currently a nursing student completing her senior practicum here, at TRU Community Care. Drew’s journey with TRU began in the fall of 2020 as a volunteer. Earlier that year Drew had become a trained end-of-life doula. This specialty practices non-medical, holistic death care that assists the dying person and their family in navigating through the physical, emotional, spiritual, and practical aspects of the dying journey.   

 When Drew completed her doula training, she says, the next natural step was volunteering at TRU. She recalls, ” I knew about TRU since I grew up in Boulder, but I didn’t have much familiarity at the time. I just knew that it was our community’s main organization for end-of-life care, and I was excited to get involved.”  

 Drew’s first, and only companion assignment as a TRU volunteer was with a woman that, for the sake of confidentiality, we will call Grace. It was her only companion assignment simply because Grace’s life moved Drew to pursue a degree in nursing. Drew says, ” Nursing was not on my radar at all before this, but as I witnessed her terminal illness, I felt my own limitations and wanted to be able to do more for her. As her illness progressed, sometimes she would jokingly ask me to help with hands-on medical care, and I told her I would pursue a nursing career to gain those skills.“ 

 During the pandemic, Drew began her assignment with Grace strictly over Zoom for about six months, and eventually as regulations allowed in the spring of 2021, was able to visit Grace in person, albeit masked and at a distance. Drew supported Grace by helping her with tasks such as getting water from Natural Grocers, a basic need that Drew was happy to meet. Drew defines this assignment as a “gorgeous friendship that was so life changing.” expressing gratitude for how incredibly lucky she was in this match. Grace became her friend and teacher, and Drew states, “Even though she’s gone, she’s always with me. She has been with me so much through all of nursing school.”  

 During her time with Grace, the two of them wrote out Grace’s last words of wisdom to share with the world. Drew keeps these bits of wisdom at her fingertips, and still treasures them today. Through Grace, Drew connected with others she would not have crossed paths with otherwise. Grace had been involved with an organization called Live By Living, and as Grace attended, Drew got to meet the organization’s director, Stephanie.  Drew and Stephanie are good friends still, and they get together to honor Grace’s memory each year on the anniversary of her death.  

  As I listen to Drew recount these beginnings of her blooming career, I am humbled. What an incredible view into humanity; the beauty of one human life breathing its final breaths of inspiration into a younger life. At times, hospice work feels clinical, technical, and logistical, and we can miss these beautiful moments. When we notice them, they remind us of the power at hand. When one life ends, others can carry that person’s story forward into the world. Like rings rippling out from a drop in a lake, these volunteers ripple the deceased’s impact through the world each day. 

 This week we are honoring the volunteers, past and present, who offer themselves to this work. We recognize that you are the ones who carry these lives in your heart, and we are reminded that this journey is never about us. The patients that we encounter are a powerful invitation to slow down, hear their wisdom, and witness their legacy.  

 This May, Drew will graduate, a BSN, RN fully equipped to provide deeper support to those placed in her care. She will fulfill her word to Grace and meet the calling that usurped her own plans back in 2021. Drew, who is also a TRU nurse extern, has made a profound impact at TRU, and with plans for her to join our New Graduate Nurse Residency, her impact is certain to multiply.  

 I mentioned earlier that Drew treasures Grace’s final words of wisdom. So, let’s end with that – with words that ripple from Grace, through Drew, and now to you. Here are a few of the pieces of wisdom that Grace left with Drew, titled The Things I learned Sometimes Too Late. 

• “Speak like you want to be heard.”
• “You have much more success in finding joy today than tomorrow.”
• “Consider your legacy of love – the greatest gift you leave behind.”

Thank you, Grace, for leaving the gift of your love with Drew, and thank you volunteers who faithfully support our patients and staff daily. This story highlights that you witness sacred moments with those to whom you’ve been assigned, and your commitment to them has the potential to touch more lives than you ever thought possible.  

 

This week is National Volunteer Week (April 21-27), and we’d like to take a moment to celebrate the amazing individuals who give so selflessly of their time and talents to support TRU Community Care’s mission.

Our robust volunteer force of over 360 dedicated volunteers play an invaluable role for TRU. In 2023 alone, these incredible people collectively donated an astounding 30,000 hours of service across our hospice, palliative care, grief services, thrift shop, and other programs.

The impact of our volunteers’ work cannot be overstated. They provide vital personalized support to our hospice patients and families – offering companionship, respite care, specialized therapies, and so much more. Our grief services would not be possible without volunteers facilitating support groups and managing the lending library. And of course, the TRU Thrift Shop simply couldn’t operate without our army of retail volunteers.

Volunteerism is woven into the fabric of who we are as an organization. Medicare actually requires that 5% of all hospice patient care hours come from trained volunteers. But at TRU, we go above and beyond, with volunteers providing double the required number of hours. This speaks to how invaluable they are to delivering the highest quality care.

“Our volunteers are an essential part of our organization. They enable us to provide the best care possible to our patients and their families,” said Jen Thomas, Director of Communications and Volunteer Services. “We could not fulfill our mission of affirming life without their compassionate service.”

From providing a reassuring presence at a patient’s bedside, to carefully sorting donations at the thrift shop, to lending an empathetic ear during grief counseling – our volunteers display unwavering commitment to easing life’s most difficult journeys.

Their selflessness truly makes our community a better, more compassionate place. While National Volunteer Week is a designated time to honor their service, we celebrate our volunteers every single day at TRU Community Care. Thank you, from the bottom of our hearts, for everything you do!

 

 

 

 

 

 

 

On Friday, March 29th, gratitude and recognition filled the air at Carbon Valley Community Center in Firestone, Colorado as we honored those who served in the Vietnam War, yet whose sacrifice often went unrecognized upon their return home.

“As time goes on you want to realize that your sacrifice meant something to somebody,” said Dave Appel, who served in the Marines in Vietnam.

Thanks to the efforts of TRU Community Care, Carbon Valley Community Center, and American Legion Post 1985, along with the community’s support, Friday’s Welcome Home Vietnam Veterans Day event was a resounding success.

The event, which TRU has organized for three years, coincides with Colorado’s establishment of March 30th as Welcome Home Vietnam Veterans Day, a day designed to pay tribute to the service and sacrifice of Vietnam veterans. “Our community failed them almost 50 years ago when they came home, and we are striving to rectify that,” said Becki Parr, TRU Volunteer Coordinator and a key organizer of this event.

A highlight of the day was the Healing Warriors Pop-up, which offered veterans of all eras and their partners the chance to receive acupuncture, craniosacral, and healing touch therapy at no cost. The Healing Warriors Program aims to provide integrative, non-narcotic treatments for a range of issues including PTSD, TBI, chronic pain, and more.

The day culminated with a Welcome Home Vietnam Veterans commemoration that included a presentation and posting of the colors by American Legion Post 1985’s Color Guard, a presentation of handmade quilts by members of Quilts of Valor, and a moving pinning ceremony in which the Vietnam veterans present were individually welcomed home by the community.

Firestone Mayor Drew Peterson was in attendance to offer a heartfelt ‘thank you’ to the veterans for their service and sacrifice, closing out a day of recognition and appreciation that was long overdue.

Thank you to Tone Images for photographing the event.

As the warmth of spring blooms around us, so has TRU Community Care’s latest Spring Newsletter. Learn about TRU’s newest board members, the enduring legacy of Leo Hill, and our unwavering commitment to bridging healthcare disparities in rural communities. Plus, meet TINA: TRU Immediate Nurse Access, the new face of hospice care.

Download the latest issue of TRU Talk here.