JMIR Publications

ABSTRACT

Background:

Violence and aggression are significant challenges faced by clinicians globally. Traditional methods of training consist of “on the job learning” and role play simulations. While both approaches can result in improved skill levels they are not without limitation. Interactive simulations using VR can complement traditional training processes as a cost-effective, engaging, easily accessible and flexible training tool.

Objective:

This exploratory study aimed to determine the feasibility of, and barriers to, verbal engagement with a virtual avatar researched in the context of the Code Black VR application. Code Black VR is a new interactive VR based verbal de-escalation trainer developed using the authors previously developed educational VR design framework.

Methods:

28 participants of varying clinical expertise from 4 local hospitals enrolled in the Western Sydney Local Health District (WSLHD) Clinical Initiative Nurse (CIN) program and Transition to Emergency Nursing Programs (TENP), participated in one of 5 workshops. They completed multiple playthroughs of the VR Code Black verbal de-escalation trainer application. In the application, users can verbally interact with a Virtual Avatar. The avatar responds to what the user says and either gets more or less agitated depending on nature of the user’s interaction. Observations were made by the authors during the playthroughs, and reflections documented. After the playthroughs, users completed the SUS – Quick and Dirty Usability Scale. A thematic analysis was conducted on the results. The application itself also records the total interactions and the successfully completed interactions, and these were also included in the results.

Results:

The VR Code Black – Verbal de-escalation training application was well received. Thematic analysis of the user feedback and facilitator observations reinforced the findings from our previous design framework and identified three new factors, motion sickness, perceived value and privacy to be considered for future application development.

Conclusions:

This study was conducted to explore the feasibility of verbal interaction with a virtual avatar to train staff in verbal de-escalation skills and we found that this is an effective medium to supplement clinician training in verbal de-escalation skills. In addition, our findings have revealed broader design considerations which will guide further developments in this area.