Integrating Virtual Reality Simulation, Online Learning, and Group Reflection to Strengthen Dementia Care in Nursing Homes: Mixed Methods Pilot Study.

Background: Long-term care facilities are increasingly caring for persons living with dementia as this population grows. Frontline care workers provide most hands-on support, yet they often have limited access to formal dementia education and training. Traditional training formats frequently fail to support experiential learning or accommodate the linguistic, cultural, and demographic diversity of the long-term care workforce. Objective: This mixed methods pilot study examined the effects of the combined use of online learning, immersive virtual reality (VR) simulation, and facilitated group discussions on the training and preferred learning formats. In particular, this study tested whether training based on relationship-centered care (eg, emphasizing the importance of mutual respect, empathy, and shared humanity) in care relationships embodied in the immersive VR simulation allows staff to experience dementia-related cognitive and sensory changes from the perspective of persons living with dementia. Methods: A total of 21 certified nursing assistants from 1 US nursing home participated in a 3-month mixed methods intervention. Empathy and knowledge were measured using pre- and postintervention standardized tests; qualitative feedback was collected through open-ended surveys and group discussions. Results: Participants were predominantly female, Black certified nursing assistants with approximately 68% reporting 8 years or more of care experience. Among the 76.2% (16/21) of the participants who completed the pre- and postintervention surveys, empathy scores increased from pretest (mean 5.31, SD 0.74) to posttest (mean 5.51, SD 0.61). The mean difference of 0.20 (SD 0.43) did not reach statistical significance (t15=1.88; P=.08), but the effect size was moderate (Cohen dz=0.47, 95% CI -0.03 to 0.43). Dementia knowledge scores also increased from pretest (mean 5.50, SD 2.37) to posttest (mean 5.94, SD 2.11), with a mean difference of 0.44 (SD 1.63), which was not statistically significant (t15=1.07; P=.30), and demonstrated a small effect size (Cohen dz=0.27, 95% CI -0.43 to 1.31). Qualitative findings revealed that participants perceived the VR training as engaging and emotionally impactful. Participants described reframing their understanding of dementia, reporting reduced stigma and increased empathy toward persons living with dementia. Many noted that experiencing dementia-related symptoms through VR helped them better understand residents' behaviors and respond with greater compassion. Participants expressed a strong preference for immersive VR and facilitated group discussions over online modules, and cultural differences in the VR scenarios were not perceived as barriers to learning. Conclusions: While preliminary, these findings suggest that combining relationship-centered care with immersive VR may enhance empathy and engagement among staff, particularly when paired with facilitated discussion and plain language explanations. This multimodal model appears particularly valuable for supporting empathic learning within diverse and experienced workforces. Larger, multisite studies with sustained follow-up are needed to determine long-term effects and optimize training for linguistically and culturally diverse workforces.