Copyright
©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
Tree: Reducing the use of restrictive practices on psychiatric wards through virtual reality immersive technology training
Peter Phiri, Laura Pemberton, Yang Liu, Xiaojie Yang, Joe Salmon, Isabel Boulter, Sana Sajid, Jackie Clarke, Andy McMillan, Jian Qing Shi, Gayathri Delanerolle
Peter Phiri, Laura Pemberton, Joe Salmon, Sana Sajid, Gayathri Delanerolle, Department of Research & Innovation, Southern Health National Health Service Foundation Trust, Southampton SO30 3JB, United Kingdom
Yang Liu, Jian Qing Shi, Department of Statistics and Data Science, Southern University of Science and Technology, Shenzhen 518055, Guangdong Province, China
Xiaojie Yang, School of Statistics and Mathematics, Yunnan University of Finance and Economics, Kunming 650221, Yunnan Province, China
Isabel Boulter, Virti Healthcare, Keynsham, Bristol BS31 1SN, United Kingdom
Jackie Clarke, Neuromodulation Centre, Southern Health National Health Service Foundation Trust, Southampton SO14 0YG, United Kingdom
Andy McMillan, National Health Service Talking Therapies, Southern Health National Health Service Foundation Trust, Southampton SO50 9FH, United Kingdom
Author contributions: Peter P innovated the project. Peter P and Delanerolle G conceptualised the project and wrote the first draft. Phiri P, Boulter I, and Delanerolle G developed the protocol and wrote the manuscript draft; Salmon J and Sajid S collected the data; Clarke J managed virtual reality administration; Phiri P, Liu Y, Yang X, Shi JQ, and Delanerolle G conducted the analysis; all authors critically appraised the manuscript; and all authors approved the final manuscript.
Institutional review board statement: The study received Health Research Authority (HRA) and Health and Care Research Wales (HCRW) approval. REC Reference: 22/HRA/3030. IRAS number: 317489.
Clinical trial registration statement: The manuscript was not applicable to apply for a clinical trial registration.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrolment.
Conflict-of-interest statement: Phiri P has received research grant from Novo Nordisk, and other, educational from Queen Mary University of London, other from John Wiley & Sons, other from Otsuka, other from Janssen, outside the submitted work. All other authors report no conflict of interest. The views expressed are those of the authors and not necessarily those of the NHS, the National Institute for Health Research, the Department of Health and Social Care or the Academic institutions.
Data sharing statement: The datasets generated during and/or analysed during the current study are not publicly available but are available from the corresponding author (Phiri P) on reasonable request.
CONSORT 2010 statement: The authors have read the CONSORT 2010 Statement, and the manuscript was prepared and revised according to the CONSORT 2010 Statement.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Peter Phiri, BSc, PhD, RN, Academic Research, Director, Research Fellow, Department of Research & Innovation, Southern Health National Health Service Foundation Trust, Botley Road, Southampton SO30 3JB, United Kingdom.
peter.phiri@southernhealth.nhs.uk
Received: March 6, 2024
Revised: July 11, 2024
Accepted: August 20, 2024
Published online: October 19, 2024
Processing time: 225 Days and 16 Hours
BACKGROUND
Restrictive practices (RPs) are defined by measures linked to physical and chemical restraints to reduce the movement or control behaviours during any emergency. Seclusion is an equal part of RPs intended to isolate and reduce the sensory stimulation to safeguard the patient and those within the vicinity. Using interventions by way of virtual reality (VR) could assist with reducing the need for RPs as it could help reduce anxiety or agitation by way of placing users into realistic and immersive environments. This could also aid staff to and change current RPs.
AIM
To assess the feasibility and effectiveness of using a VR platform to provide reduction in RP training.
METHODS
A randomised controlled feasibility study, accompanied by evaluations at 1 month and 6 months, was conducted within inpatient psychiatric wards at Southern Health National Health Service Foundation Trust, United Kingdom. Virti VR scenarios were used on VR headsets to provide training on reducing RPs in 3 inpatient psychiatric wards. Outcome measures included general self-efficacy scale, generalised anxiety disorder assessment 7 (GAD-7), Burnout Assessment Tool 12, the Everyday Discrimination Scale, and the Compassionate Engagement and Action Scale.
RESULTS
Findings revealed statistically significant differences between the VR and treatment as usual groups, in the Everyday Discrimination Scale items Q8 and Q9: P = 0.023 and P = 0.040 respectively, indicating higher levels of perceived discrimination in the VR group. There were no significant differences between groups in terms of general self-efficacy, generalised anxiety disorder assessment 9, and Burnout Assessment Tool 12 scores. A significant difference was observed within the VR group for compassionate engagement from others (P = 0.005) over time. Most respondents recorded System Usability Scale scores above 70, with an average score of 71.79. There was a significant reduction in rates of RPs in the VR group vs treatment as usual group with a fluctuating variability observed in the VR group likely due to external factors not captured in the study.
CONCLUSION
Ongoing advancement of VR technology enables the possibility of creating scenarios and simulations tailored to healthcare environments that empower staff by providing more comprehensive and effective training for handling situations.
Core Tip: This study explores the feasibility and effectiveness of a virtual reality (VR) platform for reducing restrictive practices in psychiatric care. Conducted at Southern Health National Health Service Foundation Trust, United Kingdom, the study used VR scenarios for training staff in three inpatient psychiatric wards. Various outcome measures like the general self-efficacy scale, generalised anxiety disorder assessment 7, and others were used. Results indicated high statistical significance for some variables, although some showed lower statistical power. The VR platform, evaluated using the System Usability Scale, was found to be highly usable. No significant differences in confidence levels were observed between the VR and treatment as usual groups, indicating the potential of VR as an effective tool for training in reducing restrictive practices.
