Laker Caroline, Knight-Davidson Pamela, McVicar Andrew
Department of Nursing, School of Health & Medical Sciences, Clerkenwell Campus, City St George's, University of London, London EC1V 0HB, UK.
School of Nursing, Faculty of Health, Medicine and Social, Chelmsford Campus, Anglia Ruskin University, Chelmsford CM1 1SQ, UK.
Nurs Rep. 2025 Apr 30;15(5):157. doi: 10.3390/nursrep15050157.
Stress affects 45% of NHS staff. More research is needed to explore how to develop resilient mental health nurses who face multiple workplace stressors, including interacting with distressed clients. Higher Education Institutions are uniquely placed to introduce coping skills that help reduce anxiety and increase confidence for pre-registration nurses entering placements for the first time. A convenience sample of first year mental health student nurses (whole cohort), recruited before their first clinical placement, were invited to participate. Following a mixed methods design, we developed a 360-degree virtual reality (VR) video, depicting a distressed service user across three scenes, filmed in a real-life decommissioned in-patient ward. Participants followed the service user through the scenes, as though in real life. We used the video alongside a cognitive reappraisal/solution-focused/VERA worksheet and supportive clinical supervision technique to explore students' experiences of VR as an educative tool and to help build emotional coping skills. : N = 21 mental health student nurses were recruited to the study. Behavioural responses to the distressed patient scenario were varied. Students that had prior experience in health work were more likely to feel detached from the distress of the service user. Although for some students VR provided a meaningful learning experience in developing emotional awareness, other students felt more like a 'fly on the wall' than an active participant. Empathetic and compassionate responses were strongest in those who perceived a strong immersive effect. Overall, the supportive supervision appeared to decrease the anxiety of the small sample involved, but confidence was not affected. The use of 360-degree VR technology as an educative, classroom-based tool to moderate anxiety and build confidence in pre-placement mental health nursing students was partially supported by this study. The effectiveness of such technology appeared to be dependent on the degree to which 'immersion' and a sense of presence were experienced by students. Our cognitive reappraisal intervention proved useful in reducing anxiety caused by 'the patient in distress scenario' but only for students who achieved a deep immersive effect. Students with prior exposure to distressing events (in their personal lives and in clinical settings) might have developed other coping mechanisms (e.g., detachment). These findings support the idea that 'presence' is a subjective VR experience and can vary among users.
压力影响着45%的英国国家医疗服务体系（NHS）工作人员。需要开展更多研究，以探索如何培养能应对多种工作场所压力源的心理健康护士，这些压力源包括与情绪困扰的患者互动。高等教育机构在为首次进入实习岗位的预注册护士引入有助于减轻焦虑和增强信心的应对技能方面具有独特优势。我们邀请了在首次临床实习前招募的心理健康专业一年级学生护士（整个队列）这一便利样本参与研究。采用混合方法设计，我们制作了一个360度虚拟现实（VR）视频，描绘了一个情绪困扰的服务使用者在三个场景中的情况，拍摄地点是一个现实生活中已停用的住院病房。参与者仿佛在现实生活中一样，跟随服务使用者经历各个场景。我们将该视频与一份认知重新评估/聚焦解决方案/VERA工作表以及支持性临床督导技术相结合，以探究学生对VR作为一种教育工具的体验，并帮助培养情绪应对技能。共有来自心理健康专业的21名学生护士参与了该研究。学生们对情绪困扰患者场景的行为反应各不相同。有医疗工作经验的学生更有可能对服务使用者的痛苦感到疏离。尽管对一些学生来说，VR在培养情绪意识方面提供了有意义的学习体验，但其他学生感觉自己更像是“墙上的苍蝇”，而不是积极参与者。在那些感受到强烈沉浸效果的学生中，共情和同情反应最为强烈。总体而言，支持性督导似乎降低了所涉及的小样本学生的焦虑，但对信心没有影响。本研究部分支持了将360度VR技术作为一种基于课堂的教育工具来缓解预实习心理健康护理学生的焦虑并增强其信心的做法。此类技术的有效性似乎取决于学生体验到“沉浸感”和临场感的程度。我们的认知重新评估干预措施在减轻“情绪困扰患者场景”引起的焦虑方面被证明是有用的，但仅适用于那些实现了深度沉浸效果的学生。之前在个人生活和临床环境中接触过痛苦事件的学生可能已经形成了其他应对机制（例如，疏离）。这些发现支持了“临场感”是一种主观的VR体验且在用户之间可能存在差异这一观点。
