Designing Virtual Reality–Based Conversational Agents to Train Clinicians in Verbal De-escalation Skills: Exploratory Usability Study

Abstract

Background Violence and aggression are significant workplace challenges faced by clinicians worldwide. Traditional methods of training consist of “on-the-job learning” and role-play simulations. Although both approaches can result in improved skill levels, they are not without limitation. Interactive simulations using virtual reality (VR) can complement traditional training processes as a cost-effective, engaging, easily accessible, and flexible training tool. Objective In this exploratory study, we aimed to determine the feasibility of and barriers to verbal engagement with a virtual agent in the context of the Code Black VR application. Code Black VR is a new interactive VR-based verbal de-escalation trainer that we developed based on the Clinical Training Through VR Design Framework. Methods In total, 28 participants with varying clinical expertise from 4 local hospitals enrolled in the Western Sydney Local Health District Clinical Initiative Nurse program and Transition to Emergency Nursing Programs and participated in 1 of 5 workshops. They completed multiple playthroughs of the Code Black VR verbal de-escalation trainer application and verbally interacted with a virtual agent. We documented observations and poststudy reflection notes. After the playthroughs, the users completed the System Usability Scale and provided written comments on their experience. A thematic analysis was conducted on the results. Data were also obtained through the application itself, which also recorded the total interactions and successfully completed interactions. Results The Code Black VR verbal de-escalation training application was well received. The findings reinforced the factors in the existing design framework and identified 3 new factors—motion sickness, perceived value, and privacy—to be considered for future application development. Conclusions Verbal interaction with a virtual agent is feasible for training staff in verbal de-escalation skills. It is an effective medium to supplement clinician training in verbal de-escalation skills. We provide broader design considerations to guide further developments in this area.

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“…Opsahl et al (2021) discussed their transition from a F2F setting to an online event (via Zoom and Mentimeter 6 ) to educate employees about cyber-civility, which ultimately had equivalent outcomes to similar in-person events. Research has begun to examine novel interventions to prevent VNWB, including cyber-incivility (C. M. Clark & Dunham, 2020;Rose et al, 2020), cyber-media ethics (Permanasari et al, 2021), cyber-abuse (Seinfeld et al, 2021), bystander intervention in cyber-aggression (Rovira & Slater, 2022;Xue et al, 2021), and conflict de-escalation training for human resource employees (N. Moore et al, 2022). These include the use of online games and virtual/augmented reality simulations.…”

“…Research has begun to examine novel interventions to prevent VNWB, including cyber-incivility (C. M. Clark & Dunham, 2020; Rose et al, 2020), cyber-media ethics (Permanasari et al, 2021), cyber-abuse (Seinfeld et al, 2021), bystander intervention in cyber-aggression (Rovira & Slater, 2022; Xue et al, 2021), and conflict de-escalation training for human resource employees (N. Moore et al, 2022).…”

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“…В разных областях медицины применение технологий VR показало свои преимущества. Одной из причин, по которой VR оказывает положительное воздействие на организм, является использование принципа полимодального воздействия, основанного на принципах биологически обратной связи [63,64]. N. Ahmadpour в своем аналитическом обзоре, посвященном оценке действия VR в качестве анальгезирующего средства, отмечает, что технологии VR являются эффективным дополнением или альтернативным методом терапии боли как у детей, так и у взрослых.…”

“…Применение технологий VR в клинической практике позволяет сократить время и стоимость реабилитации пациентов, а также способно увеличивать количество пациентов, проходящих реабилитацию одновременно [67]. Одним из положительных аспектов использования систем виртуальной реальности является непосредственное и постоянное взаимодействие пациента с лечащим врачом в удаленном формате, что повышает приверженность к лечению [68].…”