{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T07:09:04Z","timestamp":1788764944961,"version":"build-2803163510"},"reference-count":47,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,6]],"date-time":"2026-09-06T00:00:00Z","timestamp":1788652800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["shmpublications.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Hospital Medicine"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Pediatric sepsis remains a major cause of mortality, with persistent emergency transfers despite standardization. Limited situation awareness may underlie prior failures, and virtual reality (VR) may improve situation awareness by enhancing team recognition and communication of impending sepsis\u2010related decompensation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The study assessed the effectiveness and implementation of a VR curriculum, MUVR_Shock, embedded in nurse orientation to improve recognition and escalation of pediatric shock in acute care settings.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      Effectiveness outcomes included changes in institutional serious safety event rates and emergency transfers during the 18 months pre\u2010 and post\u2010implementation. Self\u2010perceived comfort verbalizing concern for shock and implementation outcomes, including acceptability, appropriateness, and feasibility, were assessed via surveys. Outcomes were analyzed with descriptive statistics and paired\n                      <jats:italic>t<\/jats:italic>\n                      \u2010tests as applicable. Cost feasibility was assessed using a cost analysis of the MUVR_Shock intervention.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 463 nurses participated in MUVR\u2010Shock, with 351 nurses (75.8%) completing the post survey. Following implementation, there were no SSEs nor an increase in the rate of emergent transfers for sepsis\/shock. Participant self\u2010reported comfort with verbalizing a concern for sepsis\/shock increased following exposure to MUVR_Shock (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.001). The intervention was found highly acceptable and appropriate among participating nurses, although VR facilitators reported that 70% of sessions required technical troubleshooting. Costs were determined to be $178\/participant, primarily reflecting personnel and equipment costs.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>MUVR_Shock improved nurses' confidence in recognizing pediatric shock during onboarding. VR may offer an acceptable modality for situation awareness training, though improvements in usability and cost reduction are required.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhm.70460","type":"journal-article","created":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T06:37:54Z","timestamp":1788763074000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Implementation of nurse onboarding multi\u2010user virtual reality training on recognition of pediatric shock"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0639-8748","authenticated-orcid":false,"given":"Matthew W.","family":"Zackoff","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine Cincinnati Ohio USA"},{"name":"Division of Critical Care Medicine Cincinnati Children's Hospital Medical Center Cincinnati Ohio USA"},{"name":"Center for Simulation and 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