Beyond transcripts: Patterns of therapeutic communication learning gaps in virtual reality

Background: Therapeutic communication (TC) is a core nursing competency linked to patient safety and satisfaction.Traditional teaching strategies often lack standardization and individualized feedback.Virtual reality (VR) combined with artificial intelligence (AI) offers scalable, immersive solutions for TC training.Methods: A qualitative design using reflexive thematic analysis was applied to transcripts from 32 nursing students who completed a VR simulation focused on TC for a patient with renal failure.The simulation incorporated adaptive AI responses and automated feedback.Results: Eight overarching themes were identified: four effective and four ineffective communication patterns.The four effective TC themes were: Asking Open-Ended Questions, Providing Resources & Referrals, Offering Self, and Giving Hope & Encouragement .The four ineffective TC themes were: Controlling or Directive Communication, Minimizing or Invalidating Responses, Emotional Disconnection, and Premature Interpretation or Assumption.Students frequently initiated TC effectively but struggled to sustain empathetic dialogue during emotional moments, often reverting to task-oriented or assumptive behaviors.Conclusion: While TC skills emerged, students often failed to maintain them.AI-powered VR offers a way to pinpoint and address these gaps, improving communication competence and patient care.