Staff Experiences with VR Simulation in Patients with Challenging Behavior

Simulation is widely used in healthcare, with VR simulation replacing physical scenarios with virtual ones. Participants observe based on predefined learning objectives and reflect on them during debriefing sessions. De-escalation is recommended as the first-line response to potential aggression in mental healthcare. Staff in secure mental health units frequently face aggression, and training may enhance de-escalation skills. The study aimed to explore staff experiences with VR simulation as a supplement to physical simulation for de-escalation and examine differences between those with and without prior physical simulation experience. The study involved 58 frontline staff in a Norwegian high security secure mental health department. Twelve simulations were conducted, followed by a post-simulation questionnaire. Data was analyzed using thematic analysis and appropriate statistical analyses. Departmental and data protection approvals were obtained, and participation was based on informed consent. Two themes emerged: (1) enhances situational understanding, and (2) lack of training for action readiness. Participants rated the simulation highly on most questions and perceived VR simulation as a valuable supplement to physical simulation. Those without prior simulation experience were more satisfied with the VR scenario (mean difference = 0.421, 2-sided 95%CI = 0.036–0.807, t = 2.188, p = 0.033), learned more from the VR simulation (mean difference = 0.725, 2-sided 95%CI = 0.045–1.406, t = 2.136, p = 0.037), experienced VR scenario which was more applicable to clinical work (mean difference = 0.645, 2-sided 95% CI = 0.161–1.128, t = 2.674, p = 0.010), and reflected that the VR simulation increased their experienced safety (mean difference = 1.133. 95%CI = 0.478–1.788, t = 3.468, p = 0.001). Greater benefits were yielded from the VR simulation for those without prior simulation experience than those with previous experience. Further studies are recommended.