A VR Experience

Designing a virtual reality experience to reduce anxiety of children with CHD during the perioperative period

Context and Problem

The medical procedures faced by children with CHD

• Tricuspid atresia (TA) is a common CHD, and children with this condition will experience several invasive and complex operations from birth.
• Children will suffer traumatic stress due to surgery, which means that a series of psychological and physical reactions are likely to occur when children are faced with a medical procedure or are under treatment. These reactions will impair their daily functions and affect treatment compliance and recovery (Peterson).
• Anesthesia is one of the most stressful medical procedures that children may experience, with 40%-60% of children showing apparent stress behavior (Kain et al.).
  

Goal

Using VR to reduce the anxiety of children with CHD

• Understand how to communicate to children about heart disease and surgery.
•  Understand children's fantasy VR experience preferences to identify design elements.
• Identify the current VR technology used for heart surgery children and design innovative concepts.
• Design and evaluate a design intervention through consultations with the medical team, patients, and their families.
  

The research strategy is ‘research for design’ (Frayling) which means solving the existing research problems by collecting, interpreting, analyzing, and discussing data. Through literature research of books and academic articles, I learned how to exchange knowledge about heart surgery with children, understand the preferences of children aged 5-11, and find actual VR experience cases. The study focused on children aged 5-11. Participants were interviewed semi-structured, including children with congenital heart disease, their parents and doctors, as well as child development experts. The final design proposal included developing the story, designing the characters, and creating the illustrations for the VR experience.

Solution

Methods of Relieving Children's Anxiety in Hospital

• Try to change the patient's emotional state and environment.
• A therapeutic play intervention before surgery and interactive therapeutic play education can reduce children's anxiety caused by the environment and treatment.
• Games for handheld devices distract children and reduce anxiety.
• Through playing, children can manage their anxiety caused by surgery and prevent traumatic stress after surgery.
  
  Thus, my design will reduce preoperative anxiety in children with coronary heart disease through preoperative simulation education. The idea is to use virtual reality to help children, distract them from the anxiety of medical procedures by immersing them in a fantastical world.
  

The Design and prototype

Step1 Preoperative Preparation 

• How it will go?
  Children aged 5-11 will go to an OR visit at least five days before for preoperative preparation (MACLAREN and KAIN). At this time, children’s life experts will provide children with a storybook to familiarize themselves with the story process. The purpose is to use children's books to reduce preoperative anxiety for children and parents (Felder-Puig et al.) because children aged 5-11 fear the unknown and fear losing control (Panella).
• Why use it?
  Children will understand the story's plot based on the content in the reading book and become curious about the VR experience. The purpose of this link is to familiarize themselves with the storyline so that they will complete the VR experience in a short time. This book is also intended to alleviate children's resistance to anesthesia procedures in the early stages.

Figure 2 Storybook

The Design and prototype

Step 2 Anesthesia Education

• How it will implement?
  On an operating day, children will prepare for surgery in the induction room. During this period, children will show anxiety reactions due to the environment and medical procedures. Therefore, children will receive anti-anxiety drugs 20 minutes before surgery, doctors at this time expressed anxiolytic drugs as "happy medicine" to children.
  The storybook starts with the little boy Tommy who drank the happiness medicine and fell asleep so that this stage can be linked to the storybook's content. After drinking the medicine, the children will put on the VR headset and start the VR experience until they enter the operating room for anesthesia.
• Why implement it?
  Although the experience is the same as the storybook's content, it will give children a different experience from reading the book. Because the child will be completely immersed in another fantasy adventure world, and the VR experience will be synchronized with the real medical procedure until the children start the anesthesia procedure. In this process, children will be distracted and not pay attention to the factors that affect their anxiety. This is also the purpose and the goal of this VR experience.

Figure 3 Immersive screen

Details

This VR experience will be a game designed around the theme of adventure, challenge, and help. In order to increase children’s endorphins, which are chemicals produced by happiness. This VR game will use the green element, the forest to help children increase endorphins to get happiness in this game. The story will start with the children reading a letter. Due to the fairy’s errors, these animals have stuck by a magical spell. So, the children need to help them be rescued from the magic.

Story Research

Wearing medical clothing

When the children rescued the jungle animals, the jungle animals will wear medical clothing to consider the participation of medical staff. In the process of children rescuing animals, the children will establish an intimate relationship with the animals wearing medical clothing, not to feel unfamiliar with the medical staff after the VR experience is over. misunderstand medical procedures.

Figure 10 Animals wear the medical outfits 

Story Research

Children's thoughts

Children aged 5-11 have misunderstandings about anesthesia, and some children worry that they will not be able to wake up from anesthesia during the operation. Therefore, at this stage, the children can use another way to prove that they will be awake after anesthesia.

Figure 11 Save the stone raccoon 

The end of the experience

Personal event and story screen

When children lie on a bed with a mask and prepare to return to their world (in reality, they will be transferred from the cart to the operation bed), then they can choose among several different anesthetic gas smells. All animals will surround the children in the game, and explain that children were also imbued with magic while helping these animals, so the animals will go to their world to help the children.

After all the VR experience is finished, it will be connected to the operating area. The doctors already carried the corresponding animal tags or the related animal medical caps when the child takes off the VR glasses. It can help the children recover and not be afraid in this area.

Figure 12 The end of the experience

The program aims to reduce anxiety among children with congenital heart disease. By combining adventure stories and preoperative simulations, my designs inform children about preoperative procedures while distracting them from the immersive experience. The design I created could use further development, but the VR experience developed from this project could increase the chances of a smooth transition from the preoperative room to the operating room. The program can improve a child's experience with medical procedures, reduce anxiety, and promote a positive attitude during treatment and recovery. Although the study focused on pediatric heart surgery, it may find application in other hospitals. One possible application is for preoperative education in other specialties.

Figure 5 Works Exhibition

The motion about the VR experience can be viewed here