In the constantly changing world of health care, new ideas and ways of thinking contribute to continuous progression in serving patients and families as they encounter the stressors sourced from new people, places, and experiences. As child life specialists, psychosocial professionals, and advocates for best practice, considerations are to be made for moving beyond what has always been done and transition to opportunities for a new standard of care. Over the past several years, new audiovisual technology has allowed for alternative approaches to many educational and interventional services. Specifically, virtual reality has become an innovative tool in the health care setting for education, distraction, and play for diversion as a way for users to be immersed into a world beyond their own. However, what if a tool used to submerge a child into a world of star-gazing, marine life-viewing, and dinosaur-hunting could be used to allow children to be transported into a room that will soon become familiar for medical procedures such as MRI’s, CT scans, surgical procedures, and more, all from the comfort of their own hospital bed?

When evaluating the ways in which we as child life specialists support the psychosocial well-being of patients and families prior to procedures, the question is how to adapt to the needs of children raised in a world of technology while being fiscally mindful to one’s own institution. Through use of virtual reality goggles donated by outside organizations, cost-free applications, and coordination with hospital departments, 360-degree preparation materials were created by the child life team at Norton Children’s Hospital to allow patients a greater understanding and viewpoint of rooms they will encounter during their hospital stay. According to Bray (2019), “If children understand and can develop realistic expectations about what will happen when they come to hospital, they can become more active in healthcare encounters and more engaged in making choices” (p. 627). While this mindset is both valued and practiced in the field of child life, moving beyond photo, video, and auditory preparations by utilizing 360- degree photo preparations within and outside of virtual reality allows this perspective to be broadened.

Street View, an application by Google, allows users to view landmarks, city streets, and geographical areas by transforming multiple photo sets into a 360-degree view. Users can move their screen to view at varying vantage points while being visually integrated into the location-based photo-sets, which can be accessed later on compatible mobile, desktop, and virtual reality headset devices. By use of the Street View application at Norton Children’s Hospital, hospital-specific 360-degree preparations were created to further support patients and families prior to procedures, inpatient stays, and potential stressors related to hospitalization with no cost to the department. Coordination with various departments including risk management, security, public relations, child life, surgery, inpatient units, and radiology was necessary when publicly posting photos through this outlet. Once gaining appropriate permissions within their establishment, institutions can follow the instructions below to create individualized 360-degree preparation tools for their patients and families. The instructions are fairly intuitive but are described here to assist the specialist in the development of the tool.

Immersive Preparation Tool Creation Steps:

• Download Street View app onto Mobile device such as cell phone or tablet.
• In the lower right-and corner, select the orange camera button and then choose "Photo Sphere." 
• Point the device's camera at the room to include orange dots.  

• Stay in one spot until dot disappears and new ones appear.
• Photos will overlap; use the undo arrow in the lower left-hand corner to undo a photo if it needs to be redone.

• When the 360-degree photo is finished, the checkmark below the photo will light up green. Press the checkmark to complete the photo.
• Your photo will show up as "Ready to publish." Click select and choose the 360-degree photo you have made.

• Click on "..." in upper right-hand corner of photo, and select "Edit Location."

• Move location dot to your hospital (ex: Norton Children's Hospital).

• Click "pick a maps listing."

• Click or enter appropriate address (ex: Norton Children's Hospital).

• Click the upload arrow in upper right-hand corner of the photo and then select "Publish."

• Within a few minutes, Google will approve your photo. Once approved, you will be able to view on your VR goggles on the Street View app by searching for the institution's name or street address.

When creating these preparation materials, multiple attempts may be needed when taking 360-degree photos while using a mobile device. Child life specialists taking these photos may benefit from practicing this process prior to arriving in areas that may be time sensitive due to patient care. Practicing in a room without time constraints will allow child life specialists to practice aligning image sets and to gain familiarity with the system prior to completing preparations. Standing in one place while rotating your entire body, or sitting in a rotating chair, ensures that the photo becomes consistent and lines up evenly. Additionally, finding an area to take photos at the center of the room provides effective results in maintaining even distribution of multiple overlapped images. Child life specialists working to create these preparations should keep in mind vantage points applicable to a child and consider including potential machines, materials, and staff members that patients 

may encounter during their procedure to adequately prepare for as well as address any potential stressors or questions arising during preparation.

Child life specialists should utilize assessment skills in determining proper patient populations for virtual reality preparation using 360-degree photos. Among child life specialists at Norton Children’s Hospital, virtual reality preparation has been deemed an effective preparation tool when used with patients assessed to have an ability to regulate and connect their understanding of the virtual world to the actuality of their upcoming procedure. For children who face motion sickness or have a history of seizures, immersive preparation may not be appropriate. However, 360-degree photo preparations on a desktop or mobile device can serve an alternative for institutions without virtual reality tools and for patients who may benefit from alternative forms of preparation.

Patient using virtual reality and 360-degree preparation tools to prepare for a CT scan.

Since trialing the use of 360-degree preparation tools both inside and outside of virtual reality, patients and families have expressed that this means of preparation has effectively lessened pre-procedural and pre-admission anxiety, while also offering a unique sense of familiarity when entering rooms experienced with virtual reality. During a recent encounter, child life was called to prepare a school-age patient with no previous hospital experience for a CT scan. Prior to preparation, the patient expressed strong anxiety and fear in regard to the upcoming procedure. When presented with virtual reality as a preparation tool, the patient brightened immediately and was conversational throughout. Occasionally, the patient would ask questions about different medical equipment in the virtual reality preparation and expand the conversation about the items she already recognized. After several minutes, the patient removed the headset and simply stated “well that’s not scary at all.” While patients and families continue to verbalize positive implications of virtual reality and 360-degree preparation tools, in the future empirical research would provide an opportunity to gain greater insight into the effectiveness of these tools in contrast to traditional preparation approaches.

At Norton Children’s Hospital, conversations surrounding the use of both 360-degree preparation and virtual reality have been expanded further due to the impact of COVID-19. During the early months of the pandemic, child life staff members were limited to direct patient care with patients in non-isolation rooms. By using the patient’s room phone and available devices, preparation was able to be completed using the 360-degree photos in a non-direct capacity until our restrictions were ultimately lifted. For institutions using Zoom, screen-sharing features are an additional opportunity to expand preparing patients when face-to-face preparation is not an option. Due to changes in visitation policies, child life specialists within the pediatric intensive care unit and cardiac intensive care unit have discussed possible opportunities for sibling support through use of virtual reality. This could offer siblings a view into the patient’s life at the hospital without going directly onto an inpatient unit and provide an opportunity for sibling education and dialogue. Additional conversations have occurred when discussing department-wide alternatives for pre-operative tours. Both of these alternatives could theoretically take place in a lobby setting when siblings and outside guests are allowed. 

Within the Association of Child Life Professional’s value statements, it is emphasized that we as child life professionals value “the commitment to excellence and integrity in our professional practices [which] involves lifelong learning, adherence to our code of ethics, and the development and support of educational and training programs based upon defined clinical competencies” (ACLP, 2011). As child life professionals, we are obligated to not only provide the services with which we are familiar—but also to explore new ways of thinking to better serve our patients and families. Each day patients step into a world of health care that proves to be an intimidating reality. Through virtual reality and 360-degree preparation, child life specialists can work to transform a room that was once unfamiliar, intimidating, and distant to become simply just another room.