Abstract
Background: 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. Methods: 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. Results: 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. Conclusion: 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.