Effectiveness of a Web-Based Virtual Simulation to Train Nursing Students in Suicide Risk Assessment: Randomized Controlled Investigation.

Background: Suicide is a leading cause of preventable death worldwide. Nurses play a critical role in suicide prevention; yet, they face significant obstacles. Improving the evaluation and management of patients at risk of suicide requires innovative training techniques that safely and effectively enhance nursing students' skills, knowledge, and confidence. Virtual simulation (VS) based training can be particularly effective because it allows interaction with patients without the risk of causing harm. Objective: The purpose of this study was to evaluate the pedagogical effectiveness of a novel VS tool featuring a fully automated and emotionally reactive virtual patient by assessing its ability to assist nursing students in learning suicide risk assessment. VS also included an online group debriefing, co-run by a nurse and a medical teacher. Methods: A randomized controlled investigation was conducted with 68 first-year nursing students recruited from nursing schools offline and online. They were divided into a control group receiving teaching as usual (TAU) and an intervention group receiving TAU plus VS. The intervention was purely web-based and unblinded. Outcomes were self-assessed through questionnaires using Kirkpatrick Training Evaluation Model, which focuses on knowledge, skills, confidence, empathy, and satisfaction among students. Results: The VS group exhibited significantly higher confidence (3 points of increase after TAU vs 10.6 points of increase after VS, B=7.2; SE 2.5; t111.5=2.8; P=.006) and a marginally enhanced ability to respond appropriately to suicidal thoughts (1.6 points of improvement after TAU vs 6.4 points of improvement after VS, B=-4.5; SE 2.5; t119.5=-1.8; P=.08) compared with the control group. However, there were no significant differences in knowledge acquisition or the general level of empathy. Satisfaction with VS was high, particularly regarding the authenticity of the virtual patient. Authenticity was perceived as greater when emotional prosody was included with facial emotions. Conclusions: The use of VS demonstrated promising results in enhancing nursing students' confidence in detecting suicide risk and their skills in counseling individuals experiencing a suicide crisis, suggesting its incorporation into routine teaching methods. Further research is needed to explore its long-term benefits for students and its impact on patient outcomes.