JMIR Publications

ABSTRACT

Background. Although helping people living with HIV to manage their antiretroviral therapy is a core competency of HIV nursing care, no educational intervention has sought to strengthen this competency. Thus, we codeveloped a simulation of a virtual patient having difficulty adhering to treatment to foster the relational skills nurses require in such situations. Objectives. This viewpoint paper describes the codevelopment process and the content of the virtual patient simulation, as well as the challenges we encountered and the strategies we used to overcome them. Methods and content. We used a collaborative and iterative approach to develop the simulation based on qualitative evidence, theoretical approaches (strength-based nursing, motivational interviewing, adult-learning theories) and expert recommendations. We carried out two main phases: (1) planning the simulation development; and (2) designing the simulation content, sequence, and format. We created the script as if we were writing a choose-your-own-adventure book. All relational skills (behaviour change counselling techniques deriving from motivational interviewing) were integrated into a nurse-patient dialogue. The logic of the simulation is as follows: if the nurse uses techniques consistent with MI (eg, open-ended questions, summarizing), dialogue is opened up with the virtual patient. If the nurse uses relational skills inconsistent with MI (eg, providing advice without asking for permission), the virtual patient will react accordingly (eg, defensively). Learners have opportunities to assess and reflect on their interventions with the help of quizzes and feedback loops. Discussion. The most saliently experienced challenges were related to the second phase of the virtual patient simulation development. Two challenges are discussed. The first was to start the project with divergent conceptions of how to approach the virtual patient simulation: the simulation company’s perspective of a procedural type approach vs the clinical team’s vision of a narrative approach. As a broad strategy, we came to mutual understanding to develop a narrative-type virtual patient simulation. It meshed with our conception of a nurse-patient relationship, the values of strength-based nursing (a collaborative nurse-patient relationship), and the motivational interviewing’s counselling style. The second challenge was the complexity in designing realistic relational skills in preprogrammed and simulated nurse-patient dialogue while preserving an immersive learning experience. As a broad strategy, we created a collaborative and work-in-progress writing template as a shared working tool. Conclusion. Our experience may be helpful to anyone looking for practical cues and guidance in developing narrative virtual patient simulations. Since relational skills are utilized by all nurses—from novices to experts—and other healthcare practitioners, focusing on this clinical behaviour is a good way to ensure the simulation’s adaptability, sustainability, and efficiency.