A Virtual Counseling Application Using Artificial Intelligence for Communication Skills Training in Nursing Education: Development Study

Abstract

BackgroundThe ability of nursing undergraduates to communicate effectively with health care providers, patients, and their family members is crucial to their nursing professions as these can affect patient outcomes. However, the traditional use of didactic lectures for communication skills training is ineffective, and the use of standardized patients is not time- or cost-effective. Given the abilities of virtual patients (VPs) to simulate interactive and authentic clinical scenarios in secured environments with unlimited training attempts, a virtual counseling application is an ideal platform for nursing students to hone their communication skills before their clinical postings.ObjectiveThe aim of this study was to develop and test the use of VPs to better prepare nursing undergraduates for communicating with real-life patients, their family members, and other health care professionals during their clinical postings.MethodsThe stages of the creation of VPs included preparation, design, and development, followed by a testing phase before the official implementation. An initial voice chatbot was trained using a natural language processing engine, Google Cloud’s Dialogflow, and was later visualized into a three-dimensional (3D) avatar form using Unity 3D.ResultsThe VPs included four case scenarios that were congruent with the nursing undergraduates’ semesters’ learning objectives: (1) assessing the pain experienced by a pregnant woman, (2) taking the history of a depressed patient, (3) escalating a bleeding episode of a postoperative patient to a physician, and (4) showing empathy to a stressed-out fellow final-year nursing student. Challenges arose in terms of content development, technological limitations, and expectations management, which can be resolved by contingency planning, open communication, constant program updates, refinement, and training.ConclusionsThe creation of VPs to assist in nursing students’ communication skills training may provide authentic learning environments that enhance students’ perceived self-efficacy and confidence in effective communication skills. However, given the infancy stage of this project, further refinement and constant enhancements are needed to train the VPs to simulate real-life conversations before the official implementation.

Rediscovering the use of chatbots in education: A systematic literature review

“…Jill Watson [18] has been evaluated by means of an alias without identifying the students or the human tutor to determine if the chatbot is able to serve as an assistant teacher by answering FAQs, obtaining very positive reactions and no negative reactions. With Virtual Patient [60], nursing students improved their communication skills and self‐efficacy. The success of educational chatbots is predominant, and students value the positive impact [16], autonomous learning, self‐organization, and self‐motivation.…”

“…A chatbot, if not properly trained to account for differences and be inclusive, may give inappropriate or inadequate responses to certain issues relating to minorities. Virtual Patient [60] highlights technological limitations that make it unable to correctly identify the context of the conversation; these limitations make it to sometimes give wrong answers. There is a summary of the problems found in the research in Table 2.…”

“…The role of educational chatbots is not limited to class assistants, they have also been tested as Virtual Patients [60], whose mission is to help train nurses to improve their effective communication skills. Schmulian and Coetzee [56] have developed chatbots visually (through the company ChatFuel) without much IT knowledge, for training in accounting.…”

Predicted Influences of Artificial Intelligence on the Domains of Nursing: Scoping Review

“…Multiple articles discussed the skills, knowledge, and expertise that nurses can contribute to the co-design of AIHTs [2,63,[85][86][87]. Nurses uniquely understand the complexities of the health care environment [63], including what works, what does not work, and what can be done to improve patient experiences and health outcomes [85].…”

Digital Health Solutions for Mental Health Disorders During COVID-19

“…Other challenges clinical AI have also been described in various specialities, including practical, technical, and sociocultural barriers to implementation ( 35 , 36 ). Particularly given the conversational nature of chatbots and linguistic variations in different populations, acculturation is needed to facilitate the implementation of chatbots in new populations, as demonstrated with AI chatbots for health professional training to address colloquialisms such as “Singlish” in Singapore ( 37 ). This is crucial to ensure emotional support or triage advice are perceived accurately by patients, and piloting messages will help ascertain effectiveness ( 38 ).…”