Virtual patient simulation to improve nurses’ relational skills in a continuing education context: A convergent mixed-methods study

Background: Some nurses may feel ill-equipped to support people living with HIV who do not optimally adhere to their antiretroviral therapy. In response, to enhance the relational skills nurses require in situations of non-adherence, we developed a virtual patient simulation that features an HIV-positive man struggling to adhere to his therapy. The simulation is informed by a strengths-based nursing approach, motivational interviewing, and adult learning theories This study aimed to assess nurses’ perception of simulation’s acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses’ learning experience.Methods: We conducted a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select Canadian registered nurses (n=49). who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. At the final stage of the study, we used a comparison strategy for integrating the quantitative and qualitative results.Results: Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research.Conclusions: The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses’ self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration: ISRCTN18243005, retrospectively registered on July 3 2020.