RU2849697C2 - Xr-nurses - simulation platform for training middle-level medical personnel - Google Patents

Abstract

FIELD: medicine; computer technology.

SUBSTANCE: method for practical training of medical personnel is proposed, including stages in which: an animated interactive patient located in a dynamic virtual environment is displayed in real time on a display device to the trainee user, generated by a computer system using a virtual patient model, which is implemented on the basis of a library of nursing scenarios, in turn, the trainee user, in the course of practical training in professional medical skills, interacts with the animated interactive patient by means of at least one input device connected to the computer system, while the learner interacts with the animated interactive patient, the computer system analyses the learner's actions and, in response to all their actions, reproduces an audio and video stream in the form of motor, speech and facial reactions of the animated interactive patient with the ability to visualise pathological changes in their condition, whereby all actions of the trainee user are recorded and stored in a local database, and at the end of the training session, based on the previously stored data, the computer system evaluates the correctness of the actions performed by the trainee user, comparing the stored actions and manipulations of the user with the corresponding pre-established correct actions and manipulations stored in the nursing scenario library.

EFFECT: high-quality, safe practical training for nursing staff.

5 cl, 11 dwg, 1 tbl

Description

AREA OF TECHNOLOGY

This technical solution relates to the field of medicine and computing, in particular to methods of safe practical training of mid-level medical personnel in professional medical skills.

LEVEL OF TECHNOLOGY

A prior art solution, selected as the closest analog, is known: RU 2715148 C1, February 25, 2020. This solution pertains to computing technology, specifically to simulators using virtual reality. The simulator includes a PC with a machine-readable storage medium. It consists of a logical part of the simulator and a 3D graphical shell, which are connected to the computer. It also includes peripheral devices for navigation in the virtual environment. The logical part, in the form of a software package, includes a switching module and an evaluation module, interconnected via a local software interface. The switching VR simulator is designed such that the operator is connected via two-way communication with the instructor and virtual reality goggles. The virtual reality goggles include a helmet, headphones, a microphone, a manipulator-controller, position trackers, and a movement platform. The virtual reality goggles have a two-way connection to the software system. It consists of a scenario set module, a scenario editor module, and a basic software core module. The engine module consists of a simulator module, a switching module, an evaluation module and a voice module.

The proposed solution is aimed at eliminating the shortcomings of the current state of technology and differs from known solutions in that the proposed solution ensures high-quality and safe practical training of mid-level medical personnel in professional medical skills.

ESSENCE OF THE INVENTION

The technical problem addressed by the claimed solution is the creation of a method for practical training of mid-level medical personnel in professional medical skills. Additional embodiments of the present invention are presented in the dependent claims.

The technical result consists in providing high-quality, safe practical training for mid-level medical personnel.

The claimed technical result is achieved by implementing a method for practical training of nursing staff, which includes the following stages: an animated interactive patient is broadcast to the training user in real time on a display device, located in a dynamic virtual environment, which is generated by a computing system using a virtual model of the patient, which is implemented on the basis of a library of scenarios on nursing, in turn, the training user during the practical training of professional medical skills interacts with the animated interactive patient by means of at least one input device associated with the computing system, wherein during the interaction of the training user with the animated interactive patient, the computing system analyzes the actions of the training user and, in response to all of his actions, reproduces an audio and video stream in the form of motor, speech and facial reactions of the animated interactive patient with the ability to visualize pathological changes in his condition, and all actions of the training user are recorded and written to a local database, and at the end of the training session, based on previously saved data, the computing system evaluates the correctness of the actions performed the trained user, comparing the saved actions and manipulations of the user with the corresponding pre-established correct actions and manipulations stored in the library of nursing scenarios.

In a particular embodiment of the described method, the display device is virtual reality glasses.

In another particular embodiment of the described method, the computing system is a virtual reality system.

In another particular embodiment of the described method, the virtual reality system tracks the user's glasses in space and tracks the user's controllers in space.

In another particular embodiment of the described method, the user interacts with an animated interactive patient via sensors with optical finger tracking.

In another particular embodiment of the described method, the computing system evaluates the correctness of the user's actions based on an algorithm, where each user action for each training scenario has a predetermined weight, which is characterized by a number.

In another particular embodiment of the described method, the computing system evaluates the correctness of the user's actions performed additionally taking into account the speed of the actions performed, based on time ranges that cannot be exceeded during the session.

DESCRIPTION OF DRAWINGS

The invention will be further described in accordance with the accompanying drawings, which are provided to illustrate the invention and in no way limit its scope. The following drawings are attached to the application:

Fig. 1 illustrates an example of a dynamic virtual environment (location "Emergency Department").

Fig. 2 illustrates the skeleton of an animated interactive patient.

Fig. 3 illustrates a virtual model of an animated interactive patient.

Fig. 4 illustrates an animated interactive patient ("Obese Middle-Aged Man").

Fig. 5 illustrates an animated interactive patient ("Young Man").

Fig. 6 illustrates an animated interactive patient ("Middle-aged man").

Fig. 7 illustrates an animated interactive patient ("Middle-aged woman").

Fig. 8 illustrates a virtual implementation of a defibrillator.

Fig. 9 illustrates virtual instruments laid out on a medical table.

Fig. 10 illustrates the general scheme of the algorithm of the user action evaluation system.

Fig. 11 illustrates the logical diagram of the algorithm for evaluating user actions.

DETAILED DESCRIPTION OF THE INVENTION

The following detailed description of the invention includes numerous implementation details intended to provide a clear understanding of the present invention. However, one skilled in the art will readily understand how the present invention may be used with or without these implementation details. In other instances, well-known methods, procedures, and components have not been described in detail in order to avoid unnecessarily obscuring the features of the present invention.

Furthermore, it will be clear from the foregoing description that the invention is not limited to the embodiment described. Numerous possible modifications, changes, variations, and substitutions, while preserving the spirit and form of the present invention, will be apparent to those skilled in the art.

Terms and definitions.

Virtual reality is a technically generated world conveyed to the user through their senses: sight, hearing, touch, and others. Virtual reality simulates both impact and reaction to impact.

A controller is a control device in electronics and computing.

Nursing is a part of the health care system that includes activities to promote public health, prevent diseases, provide psychosocial assistance and care to people with physical and mental illnesses, as well as disabled people of all groups.

Simulation is the imitation of a physical process using an artificial (e.g. mechanical or computer) system.

Tracking is the process of determining the location of moving objects over time using a camera.

A paramedic is a specialist with secondary specialized medical education who has the right to conduct diagnostics and establish a diagnosis, conduct independent treatment, or refer a patient to a specialist doctor.

Computer technologies are actively used in the educational process practically throughout the world. The creation of educational computer simulations is one of the key areas in the computerization of education. Full immersion in virtual reality and interaction with its objects is achieved only with the use of specialized devices. Such devices that provide full immersion in virtual reality and simulate user interaction with it through the senses are called virtual reality (VR) systems. An important factor in increasing the level of immersion in a virtual environment is the ability for the user to interact with environmental elements and characters in the virtual reality.

The use of simulation techniques is driven by the need to ensure patient safety, provide planned practice, and provide sufficient repetitions to develop practical skills.

Demonstrating symptoms and practicing examination skills on real patients is difficult because it's impossible to schedule patients with all the necessary symptoms during the trainees' clinical rotation. Furthermore, most patients refuse to interact with trainees because they experience discomfort and pain during examinations by students. In addition to pain, repeated examinations by students can lead to complications and delays in providing necessary emergency care for patients with acute conditions. At the same time, acquiring stable skills requires repeated exposure and the opportunity to observe symptoms in a variety of patients.

Thus, the acquisition of skills for examination and recognition of pathologies is significantly hampered, which subsequently leads to an incorrect interpretation of the information obtained during the examination of patients.

The proposed technical solution allows the learning user to see the environment, interactive objects, and an animated interactive patient, and to safely and practically interact with them. This approach increases immersion, expands interaction capabilities, and enables the implementation of automated, comprehensive, and objective user assessment systems.

This technical solution is designed for safe, practical training and assessment of the skills of mid-level medical personnel, without risk to patients and trainees, in a realistic simulation environment, with a comprehensive automated assessment system based on the principles of national guidelines.

More specifically, the solution is designed for safe and practical training of nurses and paramedics. It enables them to learn basic patient care skills, clinical reasoning, communication skills, and action algorithms in various simulated clinical cases, emergency situations, and abnormal situations with a wide range of virtual patients.

Fig. 1 illustrates an example of a dynamic virtual environment (the "Emergency Department" location). This virtual location is used to practice nursing skills during an emergency and can be displayed to the training user. In a specific embodiment, the solution allows the user to visually assess the general condition of the virtual patient, including skin (color, moisture or dryness, presence of rash); monitor vital signs of the cardiovascular and respiratory systems; and establish verbal contact with the patient.

To implement this technical solution, seven different virtual patient models were developed. A character skeleton was created for each patient for subsequent animation of actions and interaction with interactive objects (Fig. 2). All models are capable of lip sync technology (synchronizing the character's lip movements with sound) for realistic training and practice of patient communication skills, clinical reasoning, emergency procedures, and more.

Depending on the clinical case, additional pathologies and external manifestations (cyanosis, sweating, redness, etc.) are developed for the patient. Patient models are designed to realistically demonstrate and practice the correct sequence of actions for performing manipulations, as well as adherence to sanitary and epidemiological regulations and safety rules.

To implement this technical solution, the following virtual patient models were developed:

1. Middle-aged man with obesity (Fig. 4);

2. Young man (Fig. 5);

3. Middle-aged man (Fig. 6);

4. Middle-aged woman (Fig. 7);

5. An elderly man;

6. Child;

7. Young girl.

Virtual tools have been developed for specific locations and patients, based on clinical scenarios. Beginners can practice basic skills such as administering injections, taking ECGs, correctly placing and connecting various sensors to patients, inserting catheters, caring for postoperative wounds, and much more.

Virtual tools are adapted to each existing patient model and have logic with rules for their use and application to the patient.

To implement this technical solution, the following virtual instruments have been developed:

1. Infusomat.

2. Oxygen humidifier.

3. Defibrillator.

4. Nasal cannula.

5. Peripheral venous catheter.

6. Full-face oxygen mask.

7. ECG electrodes.

8. Flashlight to check pupil reaction to light.

9. Urinary catheter.

10. Pulse oximeter connected to a bedside monitor.

11. Central venous catheter.

The Infusomat is a device designed for the prolonged, dosed, controlled administration of solutions, highly active medications, and nutrients to patients. It has been designed with mechanisms for drug selection, dosage, and administration rate.

The mechanics of operating the device and applying it to the patient have been implemented for the defibrillator (Fig. 8).

All tools are necessary to implement the mechanics embedded in the scenarios. Each virtual tool is linked to the simulator's evaluation system for further verification of its correct use depending on the scenario.

A nasal cannula is a virtual device used in place of an oxygen mask for patients. It consists of plastic tubes inserted 1-2 cm into each nostril, delivering oxygen to the nasal cavity. At the other end, the tubes are connected to an oxygen system, which can be a portable oxygen tank or a central oxygen distribution system. A connection mechanism is implemented for the nasal cannula.

A central venous catheter is used in medicine for catheterization of central veins (internal jugular vein, subclavian vein, femoral vein). A central venous catheter is used for faster administration of infusion solutions and medications, parenteral nutrition, blood sampling, and other purposes compared to a needle.

All instruments that contain flexible tubes are animated under the idle animation of the virtual patient.

Fig. 9 illustrates virtual instruments laid out on a medical table, where 4 is a nasal cannula, 5 is a peripheral venous catheter, 6 is a full-face oxygen mask, 7 is ECG electrodes, 8 is a flashlight for checking pupillary response to light, 9 is a urinary catheter, 10 is a pulse oximeter connected to a bedside monitor, 11 is a central venous catheter.

To implement this technical solution, scenarios were developed in the following categories:

1. Patient care;

2. Diagnostic procedures;

3. Treatment measures;

4. Providing emergency care;

5. Preventive measures;

6. Ensuring infection safety.

The scenarios were developed with the help of medical experts based on medical data, a list of manipulations in the specialty of "Nursing", as well as educational and methodological manuals on nursing.

List of scenarios on the basis of which the proposed method can be implemented:

1. Washing a newborn

2. Changing the diaper

3. Preparing a hygienic bath

4. Swaddling in the maternity hospital

5. Wide open swaddling

6. Wide closed swaddling

7. Treatment of skin folds

8. Bottle feeding

9. Primary toilet of a newborn

10. Technique for transferring to a stable lateral position

11. Sanitation of the tracheobronchial tree during mechanical ventilation

12. Tube feeding of a newborn

13. Drainage maintenance

14. Assessment of pain intensity

15. Caring for a urinary catheter

16. Colostomy care

17. Care of bedsores

18. Care of an indwelling urinary Foley catheter

19. Gastrostomy manual

20. Carrying out toilet of postoperative and purulent wounds

21. Carrying out toilet of a burn wound

22. Carrying out toilet of the wound surface in case of frostbite

23. Treatment of colostomy after surgery (before using a colostomy bag)

24. Technique for pulse examination

25. Technique for measuring blood pressure

26. Technique for determining respiratory rate

27. Technique for thermometry

28. Technique for measuring blood glucose with a glucometer

29. Pulse examination technique for children

30. Techniques for measuring blood pressure for children

31. Technique for determining respiratory rate for children

32. Technique for taking thermometry for children

33. Technique for examining the pulse in the ward

34. Technique for measuring blood pressure in the ward

35. Technique for determining respiratory rate in the ward

36. Pulse oximetry technique

37. Technique for working with the vital functions monitor

38. Algorithm for performing electrocardiography

39. Taking blood from a peripheral vein using a vacuum system (Vacutainer, Monovet)

40. Preparation and collection of sputum for testing (for general analysis, atypical cells, Mycobacterium tuberculosis, microflora culture and antibiotic sensitivity)

41. Preparation and collection of urine for testing in children and adults (for general analysis, according to Zimnitsky, Nechiporenko, for sugar from the daily amount, culture for microflora and sensitivity to antibiotics)

42. Preparation and collection of feces for testing (for coprogram, helminth eggs, occult blood, microflora culture and antibiotic sensitivity)

43. Taking a smear for enterobiasis

44. Taking a swab from the throat and nose for microflora and sensitivity to antibiotics

45. Measuring blood pressure with a mechanical tonometer. Evaluation of study results

46. Pulse counting. Evaluation of study results

47. Calculating the respiratory rate. Evaluating the results of the study

48. Anthropometry

49. Determination of BMI. Evaluation of study results

50. Algorithms for performing injections (s.c., i.m., i.v.)

51. Algorithm for setting up a system for intravenous drip infusions

52. Algorithm for inserting an intravenous peripheral catheter

53. Technique for delivering oxygen through a mask or nasal cannula

54. Algorithms for performing injections (s.c., i.m., i.v.) for children

55. Algorithm for setting up an intravenous drip system for children

56. Algorithm for placing an intravenous peripheral catheter for children

57. Technique for applying an aseptic dressing

58. Technique for preparing and using an ice pack and heating pad

59. Gastric lavage technique

60. Algorithm for catheterization of the urinary bladder with Nelaton and Foley catheters

61. Algorithm for providing assistance in case of vomiting

62. Algorithm for providing assistance in case of generalized seizures

63. Subcutaneous administration of a medicinal product to persons of different ages

64. Subcutaneous administration of insulin (with a syringe, syringe pen)

65. Intramuscular administration of a drug to individuals of different ages

66. Intravenous jet injection of a medicinal product to persons of different ages

67. Catheterization of a woman's bladder with a soft catheter

68. Catheterization of a man's bladder with a soft catheter

69. Insertion of a permanent Foley urinary catheter into a woman

70. Insertion of a permanent Foley urinary catheter into a man

71. Performing anterior nasal tamponade

72. Removing skin sutures

73. Intradermal administration of drugs

74. Introduction of serum using the Bezredko method

75. Vaccination (Tetanus toxoid administration)

76. Providing emergency care

77. Technique for performing Safar's triple technique

78. Technique of artificial ventilation with an Ambu bag

79. Algorithm for basic cardiopulmonary resuscitation using an automated external defibrillator

80. Algorithm of basic cardiopulmonary resuscitation for adults

81. Algorithm for preparing a manipulation table and assisting with tracheal intubation

82. Technique for applying an arterial tourniquet

83. Technique for applying a pressure bandage

84. Technique for applying a sling bandage to the upper limb

85. Application of immobilization splints

86. Application of an occlusive dressing

87. Algorithm for providing assistance in case of complete obstruction of the upper respiratory tract in adults

88. Algorithm for basic cardiopulmonary resuscitation of a newborn in the delivery room

89. Algorithm of basic cardiopulmonary resuscitation for children under 1 year of age

90. Algorithm of basic cardiopulmonary resuscitation for children from one to eight years old

91. Methods of administration of various vaccines (intradermal, subcutaneous, intramuscular injections)

92. Filling out the medical examination route map

93. Registration of voluntary informed consent for preventive vaccinations

94. Completing the vaccination certificate

95. Filling out the vaccination card

96. Ensuring infection safety

97. Algorithm for processing artificial lung ventilation systems

98. Algorithm for donning PPE

99. Preparation of a general surgical instrument kit

100. Preparation of a set of instruments for primary surgical treatment of wounds (PSW), opening of abscesses/phlegmon, tracheostomy, pleural puncture, laparocentesis (abdominal puncture).

To implement scenarios and simulate real-life user-patient interactions, manipulation mechanics required in the scenarios of this technical solution were developed. A list of some of these mechanics is provided in Table 1.

Table 1 - Developed mechanics and their description.

Mechanics Description Administration of drugs with a syringe (intramuscularly, subcutaneously, intradermally) 1. Open the cabinet, select the required drug by name;
2. Open the ampoule, take the syringe, draw the required volume of the drug into the syringe;
3. Discard the ampoule in the correct container;
4. The patient should be sitting or lying down. Wipe the puncture site with an alcohol wipe, bring the syringe to the patient's puncture site, and administer the injection using the appropriate route (intramuscular, subcutaneous, or intradermal).
5. Discard the syringe and needle in the correct container. Measuring heart rate by hand 1. Bring your hand to the patient’s wrist;
2. Feel the pulse and count for 10 seconds. Taking an ECG 1. We greet and warn about the upcoming procedure;
2. Undress the patient (if dressed), expose the chest, legs and arms, in a supine position;
3. Apply the electrodes according to the diagram to their points, having previously moistened them with gel;
4. Record the ECG on film;
5. Remove the electrodes and wipe the areas where they were located with a dry cloth. Measuring blood pressure 1. Warn about the upcoming procedure;
2. Place the patient in a sitting position or lying on his back if in a hospital or intensive care unit;
3. Place the blood pressure monitor cuff on the middle of the arm;
4. Measure blood pressure;
5. Inform the patient of the result and record it in the card. Calculating the respiratory rate 1. Sit or lay the patient in a comfortable position;
2. Bring your hand to the patient’s wrist, observe the patient’s chest movements and count them for 1 minute. Thermometry 1. Prepare a thermometer, with the patient in a sitting position or lying on his back;
2. Insert the thermometer into the patient’s armpit, wait for the sound signal (the thermometer is electronic);
3. Take out the thermometer, read the readings, and tell the patient;
4. Record the temperature on the card and wipe the thermometer. Subcutaneous insulin injection with a syringe pen 1. Take the syringe pen and select the required amount of insulin using the rotating knob at the end of the pen;
2. With the patient in a sitting or supine position, wipe the injection site with an alcohol wipe.
3. Put on a disposable needle;
4. Bring your hand with the syringe pen to the injection site and inject;
5. Press the plunger (the button on the top of the syringe pen);
6. Remove the syringe pen and wipe the injection site again;
7. Remove the disposable needle and discard it in the needle container. Intravenous drip administration of the drug 1. Take the bag with the drug and hang it on the dropper stand;
2. Open the system and discard the packaging into container A;
3. Insert one end of the IV system into the bag with the solution, make sure that the liquid level in the system reaches the syringe, and close it;
4. Place the patient on the couch (if outpatient, if in a ward, make sure he lies on his back);
5. Apply a tourniquet;
6. Wipe the injection site with an alcohol wipe;
7. Insert the needle into the vein, remove the tourniquet, open the system, select the injection rate;
8. After finishing, remove the needle, press the injection site with a napkin, ask the patient to bend the arm or apply a pressure bandage;
9. Remove the needle and discard it in the needle container, discard the system and bag in container B;
10. Remove PPE and gloves;
11. Make a mark about completion. Taking blood from a peripheral vein using a vacuum system 1. Put on PPE and gloves;
2. Seat the patient, place his hand on the table (if outpatient, if inpatient, then in a supine position);
3. Take the components of the vacuum system, the test tube, sign the test tube (or stick on the barcode);
4. Apply a tourniquet, select the injection site, wipe the injection site with an alcohol wipe;
5. Screw the needle into the system, remove the cap, inject into the vein, attach the test tube, wait until the blood is collected, remove the test tube;
6. Remove from the vein, press the injection site with an alcohol swab, ask the patient to bend the arm or apply a pressure bandage;
7. Remove and discard the needle in a needle container;
8. Send the patient out, explaining that the bandage can be removed in 10 minutes (if outpatient);
9. Remove PPE and gloves and throw them away. Determination of glucose by rapid method 1. Put on gloves and PPE;
2. Call the patient and seat him (if outpatient), warn him about the upcoming procedure;
3. Wipe the fingertip with an alcohol wipe and wait for a minute;
4. Open the test strip and insert it into the glucometer;
5. Prick the patient’s finger with a scarifier, obtain a drop of blood, and place the finger on the test strip;
6. See the indications, inform the patient;
7. Wipe your finger with an alcohol wipe;
8. Remove the strip and discard in container B;
9. Remove gloves and send the patient away. Taking swabs (from the throat, nose) 1. Call the patient and seat him (if outpatient), explain the essence and methodology of the procedure;
2. Sign the test tube (stick on the barcode), take a smear stick from the test tube;
3. Ask the patient to open his mouth (if from the pharynx);
4. Run the stick through your nose/along the back of your throat, then lower the stick into the test tube. Taking a smear/scraping from the rectum for enterobiasis 1. Call the patient (if outpatient), explain the essence of the procedure;
2. Lay the person on their side with their back to you and ask them to bend their knees;
3. Take the swab from the test tube, bring it to the rectum, and take a smear;
4. Place the stick into the test tube;
5. Release the patient. Conducting pulse oximetry 1. Seat the patient (if outpatient);
2. take a pulse oximeter and place it on your finger with the desired side;
3. Look at the result, tell the patient, record the result in the card. Placement of a peripheral venous catheter 1. Call the patient and seat them, ask them to place their hand on the table (if it is an outpatient clinic), and explain the procedure;
2. Examine the patient’s hands, select the placement site, apply a tourniquet;
3. Wipe the catheter insertion site with an alcohol wipe;
4. Bring the catheter to the insertion site, insert it 1/3 of the way, pull out the needle and insert the catheter to the end
Close the catheter with a cap and secure with a bandage. Oxygen supply via mask/cannula 1. Take a mask or cannula and connect it to the oxygen outlet;
2. Place a mask or cannula on the patient;
3. Turn on the supply by turning the tap, select the required speed. Application of an aseptic dressing 1. Prepare dressing material;
2. Treat the edges of the wound with an antiseptic;
3. Take the bandage, peel off the protective film from the bottom, and place the sterile bandage on the wound. Catheterization of the bladder with a Foley catheter 1. Prepare a catheter, syringe, urine bag, and petroleum jelly;
2. Put on gloves;
3. Wipe the patient’s perineum with an antiseptic wipe;
4. Open the package with the catheter and urine bag (discard the packages in container A), connect them;
5. Lubricate the tip of the catheter with petroleum jelly, insert the catheter into the urethra, make sure that urine flows into the urine bag, and insert the catheter all the way;
6. Fill the syringe with air, connect it to the second channel of the catheter and inject air (inflate the balloon);
7 Pull the catheter towards you until it stops;
8. Look at the amount of urine and mark it on the chart. Catheterization of the bladder with a Nelaton catheter 1. Prepare a catheter, syringe, urine bag, and petroleum jelly;
2. Put on gloves;
3. Wipe the patient’s perineum with an antiseptic wipe;
4. Open the package with the catheter and urine bag (discard the packages in container A), connect them;
5. Lubricate the tip of the catheter with petroleum jelly, insert the catheter into the urethra, make sure that urine flows into the urine bag, and insert the catheter all the way;
6. Wait until the urine stops flowing, remove the catheter and urine bag, note the amount of urine in the urine bag, and throw them into container B;
7. Note the amount of evacuated urine on the chart. Sanitation of the tracheobronchial tree 1. Prepare a suction device, a catheter, and a syringe with saline solution;
2. Connect the catheter to the suction device, turn on the suction device;
3. Open the valve for inserting the sanitizing catheter, insert it, and make several back-and-forth movements;
4. Remove the catheter, close the valve. Carrying out cardiopulmonary resuscitation 1. Record circulatory arrest (no pulse) on the monitor or absence of pulse in the neck;
2. Place the patient in a supine position, lower the head of the bed if it is raised, place a cushion under the shoulder blades, and tilt the head back slightly (Safar's triple maneuver);
3. Start indirect cardiac massage and ventilation of the lungs with a mask and an Ambu bag;
4. If you have an automatic defibrillator, apply the defibrillator electrodes to the appropriate places on the chest wall, wait for the device signal and, if necessary, discharge;
5. Continue CPR until the pulse is restored. Drainage maintenance 1. Prepare a dressing, pour antiseptic into a jar, and place the patient in a supine position;
2. Remove the dressing from around the drain and discard it in container B;
3. Assess the condition of the skin around the drainage (that there is no redness or swelling);
4. Treat the skin around the drainage with an antiseptic - dip a cotton swab in the antiseptic solution and run it over the skin area around the drainage;
5. Take a self-adhesive bandage, peel off the protective layer, and place it on the drainage. Care for bedsores 1. Prepare the dressing, pour the antiseptic into an open jar;
2. Turn the patient into a position on his side with his back towards you;
3. Remove the old bandage and assess the condition of the bedsore;
4. Treat the surrounding skin with an antiseptic. Depending on the depth and severity of the bedsore, call a doctor (if the bedsore has pus, bleeding, or severe redness around it) or apply a new bandage. Caring for a urinary catheter 1. Prepare everything you need;
2. Place the patient in a supine position with knees bent and a napkin placed underneath;
3. Wipe the area where the catheter is located and the catheter itself with a sterile cloth (if there is one, make a mark and call the doctor);
4. Assess for signs of inflammation around the urethra and ensure that the tubes are not pinched. Colostomy care 1. Prepare everything you need;
2. Inspect the ostomy bag for leaks. If everything is leak-proof, then the case is finished;
3. If it is not airtight, peel it off;
4. Wipe the skin around with a chlorhexidine wipe, then with a dry wipe, then with an alcohol wipe;
5. Visually assess the condition of the skin and intestines, call a doctor if necessary;
6. Glue the new ostomy bag on and close it. Carrying out wound toilet 1. Put on PPE, prepare everything necessary;
2. Inspect the old dressing, remove it, visually assess the condition of the wound, call a doctor if necessary (redness and swelling of the postoperative wound, pus from the wound, the dressing is soaked with pus);
3. Treat the edges of the wound with an antiseptic, apply a new bandage;
4. Mark the task as completed with a description. Cleansing enema 1. Prepare Esmarch’s mug (hang and fill with water), put on gloves and an apron;
2. Take the tip, lubricate it with Vaseline, connect it to the system, and bleed the air from the system;
3. Place the patient in a lying position on his side (lying on his back with his knees bent is acceptable);
4. Insert the enema tip into the anal canal, open the system, make sure the water starts to flow, wait until all the water is gone;
5. Ask the patient to lie down for 10 minutes, remove the tip and soak it in a container with disinfectant solution, dispose of the system and Esmarch's mug in container B, remove gloves and apron. Preparing tool kits 1. Take a special tray and put the necessary contents (depending on the set) from the list or from what is lying on the table: sets of napkins, tools, etc.
2. After you have put everything you need, place it in a sterilization bag and seal it. Application of immobilizing splints 1. Select a splint of the required length depending on the injured limb, the patient in a sitting position (if the arm is broken) or lying down (if the leg);
2. Place the limb on a splint and secure with bandages.

The above and similar mechanics and interactions with patients and instruments can be implemented, for example, using the Oculus Quest 2 controllers. In each scenario, the mechanics are implemented to achieve maximum fidelity to real-world human movements. User manipulations and interactions involving grasping objects or other controls different from those typically used in reality are replaced by button presses on the Oculus Quest 2 controller's input device. The overall solution can be implemented using standalone VR systems (OS: Android, CPU: Qualcomm Snapdragon XR2, RAM: from 6 GB, ROM: 64 GB).

The user action evaluation mechanics are designed taking into account the key stages of the scenario and the expected actions at each stage.

The key stages that can be identified in each scenario are:

• Dialogue with the patient.

• Carrying out manipulations with the patient.

• Reaction to the patient's responses and condition.

• Prescribing correct/incorrect (unnecessary) drugs/treatments/tests.

Evaluation criteria also include the speed of completed actions, their accuracy, and the parameter ranges that must not be exceeded during the simulation run in each case. After completing a scenario or stage, the user is provided with feedback on its results.

The basic diagram of the algorithm for the user action evaluation system is shown in Figure 10.

Moreover, the evaluation criteria and tracked user actions may vary across scenarios. The "Comparison with Expected Actions" and "Recording Errors and Deviations" blocks have different appearances depending on the scenario and set of initial parameters. As a result, the evaluation scenario and the set of metrics and expected user actions that influence the outcome for each case may be unique. Logical diagrams have been developed for the assessment system for various diseases, such as tonsillitis, hypoglycemia, and others. An example of a logical diagram is shown in Figure 11.

As a result of each executed scenario, the user receives:

• Rating: This could be a percentage, points, or other metric that reflects his or her performance.

• Detailed feedback: List of actions performed correctly, mistakes made.

• Statistics: Time, date of completion and other quantitative metrics

An example of the implementation of this technical solution.

An animated interactive patient (e.g., see Fig. 6) and a dynamic virtual environment are displayed to the training user in real time on a display device (e.g., virtual reality glasses). The animated interactive patient is located in the dynamic virtual environment (e.g., see Fig. 1) and is generated by a computing system (e.g., a virtual reality system) using a virtual patient model, which is implemented using a library of nursing scenarios.

During the practical training of professional medical skills (e.g., see Fig. 8), the user interacts with an animated interactive patient (practically performing manipulations on the patient, based on the mechanics and scenarios described earlier), as well as with a dynamic virtual environment and virtual instruments. The main variations of user interactions include: user dialogue with the virtual patient; manipulations with the virtual patient; user reactions to the virtual patient's responses and condition; and the user's prescription of correct/incorrect (unnecessary) medications/treatments/tests.

The learner interacts with the animated interactive patient via at least one input device (e.g., optical finger tracking sensors or other input devices). All user interactions with the animated interactive patient are transmitted from the input device to the computing system, where all actions/inactions of the learner are analyzed (the scenario is compared with the user's actions). In response to all actions/inactions of the learner, the computing system generates and plays an audio and video stream on the display device in the form of the motor, speech, and facial expressions of the animated interactive patient (with the ability to visualize pathological changes in its condition according to the scenario).

Additionally, all interactions between the training user and the animated interactive patient, within the session and scenario, are recorded and saved in a local database. Based on the recorded and saved data, at the end of the training session and/or scenario, the computing system evaluates the accuracy of the training user's actions. This stage is accomplished by comparing the saved user actions and manipulations with the corresponding predefined, correct actions and manipulations stored in the scenario library.

In these application materials, a preferred disclosure of the implementation of the claimed technical solution was presented, which should not be used as limiting other, particular embodiments of its implementation that do not go beyond the scope of the requested scope of legal protection and are obvious to specialists in the relevant field of technology.

Claims (5)

1. A method for practical training of nursing staff, comprising the following stages: an animated interactive patient is broadcast to the training user in real time on a display device, located in a dynamic virtual environment generated by a computing system using a virtual model of the patient, which is implemented on the basis of a library of nursing scenarios, in turn, the training user, during the practical training of professional medical skills, interacts with the animated interactive patient, by means of at least one input device associated with the computing system, wherein during the interaction of the training user with the animated interactive patient, the computing system analyzes the actions of the training user and, in response to all of his actions, reproduces an audio and video stream in the form of motor, speech and facial reactions of the animated interactive patient with the ability to visualize pathological changes in his condition, wherein all actions of the training user are recorded and written to a local database, and at the end of the training session, based on previously saved data, the computing system evaluates the correctness of the actions performed by the training user, by comparing the saved actions and manipulations of the user with the corresponding pre-established correct actions and manipulations embedded in the library of nursing scenarios, wherein the computing system evaluates the correctness of the performed actions of the user additionally taking into account the speed of the performed actions, based on time ranges that cannot be exceeded during the session; wherein the learning user, during the practical training of professional medical skills, interacts with an animated interactive patient by means of virtual medical instruments, wherein the virtual instruments contain logic with the rules for their use to implement the mechanics embedded in the scenarios, wherein each virtual instrument is linked to the evaluation system for further verification of its correct use depending on the scenario; wherein the result of each completed scenario is: an assessment consisting of a percentage value or points; a list of actions performed correctly and errors made; statistics characterizing the time and date of execution. 2. The method according to claim 1, wherein the display device is virtual reality glasses. 3. The method according to claim 1, wherein the computing system is a virtual reality system. 4. The method according to claim 1, in which the virtual reality system tracks the user's glasses in space and tracks the user's controllers in space. 5. The method according to claim 1, wherein the user interacts with the animated interactive patient via sensors with optical finger tracking.