Keep calm and carry on: Virtual reality helps medical and nursing students manage agitated patients with empathy

Caring for patients who are facing stress, anxiety and depression, or when physical restraint is required, is one of the several challenges that healthcare professionals face in the clinical setting.

Compounded by the effects of COVID-19, the rise in mental health issues has led to an increase in instances of agitation and violence against healthcare workers in recent years. As inadequate management of agitation can result in physical and psychological injuries, it is important for healthcare workers to be equipped with competencies in managing agitation safely, holistically, and empathically.

A blended, inter-disciplinary learning approach

To enhance education on managing incidences of agitation in the clinical setting, the NUS Yong Loo Lin School of Medicine (NUS Medicine) has developed a new virtual reality (VR) programme to teach medical and nursing students effective management of agitated patients using empathic means, in a safe, repeatable, and controlled manner. Titled “Virtual Reality in Agitation Management (VRAM)”, the programme helps students learn the skills while handling VR patients that reflect behaviour characteristics of patients often encountered by healthcare workers. The NUS IT team also provided the team with technical support and advice, while an external vendor was commissioned to help develop the programme.

Led by Assistant Professor Cyrus Ho from the Department of Psychological Medicine at NUS Medicine, the team comprises medical and nursing staff, as well as medical students, from NUS Medicine, the Alice Lee Centre for Nursing Studies (NUS Nursing) and the National University Hospital (NUH). As healthcare workers from different disciplines often work together, the team developed the programme to integrate the learning for both doctors and nurses, so as to provide holistic care for patients in the future.

“Moving forward, we will see more distressed patients, and healthcare workers need to have an empathetic response while collaboratively making decisions under pressure. With the blended learning approach, we hope to provide more holistic learning to help future generations of healthcare workers learn the skills of managing agitation, while practising empathy and compassion,” said Asst Prof Ho, who is also a consultant in the Department of Psychological Medicine, NUH.

Assistant Professor Shawn Goh from NUS Nursing, who is part of the team which developed the programme, also provided guidance from the perspective of nurses. He added, “The VR setting makes it a safe environment for students’ learning, as choosing the wrong response options will not result in harm to anyone. Instead, they learn the appropriate action to take, which will then help them manage real-life scenarios well and avoid threatening consequences for both patients and healthcare workers.”

Scenario guided by real-life experiences

Drawing on their clinically relevant experiences with patients, the two educators included many elements in the programme that are commonly encountered in the clinical setting. In the game, students play the role of a healthcare worker in charge of a ward, attending to a patient who is creating a scene while experiencing drug-induced psychosis with hallucinations and paranoia. Distractors typically seen in an on-call setting are included in the virtual environment, including requests from nurses and family members to follow up on certain tasks, noise from a television in the background, and people who gather around the scene.

Scenes from the virtual reality programme

Further development plans

The School has prepared 13 sets of the VR gear required for the programme, and students can borrow a set to practise the game at home as the software is made accessible to them without the need for connection to a desktop. The team estimates that a total of 300 medical students and 300 nursing students will go through the programme each year.

Following the launch of the VRAM programme, the team is developing a second scenario for the game, where students experience the first-person perspective of a patient interacting with healthcare workers while undergoing psychosis and while physically restrained, to help them better understand patients and increase their empathic responses. The team will also explore the possibility of a multi-player mode so that participants of different professions can learn to manage a situation together, as well as other scenarios tailored towards community settings such as nursing homes and family service centres, where agitation management skills are often needed.

In addition, the team has further plans to implement the programme as part of workshops for junior doctors and nurses to advance their learning in the area of empathy and agitation management.

Read more in the press release here: https://medicine.nus.edu.sg/wp-content/uploads/2022/05/2022-05-26-Press-Release-Virtual-Reality-in-Agitation-Management.pdf