{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T12:35:15Z","timestamp":1792154115865,"version":"4.4.0"},"reference-count":32,"publisher":"JMIR Publications Inc.","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JMIR Serious Games"],"abstract":"\n Background<\/jats:title>\n Violence and aggression are significant workplace challenges faced by clinicians worldwide. Traditional methods of training consist of \u201con-the-job learning\u201d and role-play simulations. Although both approaches can result in improved skill levels, they are not without limitation. Interactive simulations using virtual reality (VR) can complement traditional training processes as a cost-effective, engaging, easily accessible, and flexible training tool.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n In this exploratory study, we aimed to determine the feasibility of and barriers to verbal engagement with a virtual agent in the context of the Code Black VR application. Code Black VR is a new interactive VR-based verbal de-escalation trainer that we developed based on the Clinical Training Through VR Design Framework.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In total, 28 participants with varying clinical expertise from 4 local hospitals enrolled in the Western Sydney Local Health District Clinical Initiative Nurse program and Transition to Emergency Nursing Programs and participated in 1 of 5 workshops. They completed multiple playthroughs of the Code Black VR verbal de-escalation trainer application and verbally interacted with a virtual agent. We documented observations and poststudy reflection notes. After the playthroughs, the users completed the System Usability Scale and provided written comments on their experience. A thematic analysis was conducted on the results. Data were also obtained through the application itself, which also recorded the total interactions and successfully completed interactions.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n The Code Black VR verbal de-escalation training application was well received. The findings reinforced the factors in the existing design framework and identified 3 new factors\u2014motion sickness, perceived value, and privacy\u2014to be considered for future application development.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Verbal interaction with a virtual agent is feasible for training staff in verbal de-escalation skills. It is an effective medium to supplement clinician training in verbal de-escalation skills. We provide broader design considerations to guide further developments in this area.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/38669","type":"journal-article","created":{"date-parts":[[2022,6,12]],"date-time":"2022-06-12T10:06:27Z","timestamp":1655028387000},"page":"e38669","source":"Crossref","is-referenced-by-count":48,"title":["Designing Virtual Reality\u2013Based Conversational Agents to Train Clinicians in Verbal De-escalation Skills: Exploratory Usability Study"],"prefix":"10.2196","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2056-7955","authenticated-orcid":false,"given":"Nathan","family":"Moore","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1818-1930","authenticated-orcid":false,"given":"Naseem","family":"Ahmadpour","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6225-3770","authenticated-orcid":false,"given":"Martin","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6246-528X","authenticated-orcid":false,"given":"Philip","family":"Poronnik","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0861-9994","authenticated-orcid":false,"given":"Jennifer","family":"Davids","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2022,7,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","DOI":"10.3390\/ijerph17010299"},{"key":"ref2","author":"McKnight, S","year":"2019","journal-title":"De-Escalating Violence in Healthcare"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.ienj.2021.101017"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1097\/01.nurse.0000282706.14770.f7"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.1016\/j.colegn.2018.04.003"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.3912\/ojin.vol23no02ppt39"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.5688\/ajpe79112"},{"key":"ref8","unstructured":"E\u2010learning for health professionalsCochrane Database of Systematic Reviews20182022-05-18https:\/\/www.cochranelibrary.com\/cdsr\/doi\/10.1002\/14651858.CD011736.pub2\/full"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.2196\/29080"},{"key":"ref10","unstructured":"Behind Angry Stan, the virtual reality simulator training nursing students to deal with conflictANMJ2022-05-18https:\/\/anmj.org.au\/behind-angry-stan-the-virtual-reality-simulator-training-nursing-students-to-deal-with-conflict\/"},{"key":"ref11","doi-asserted-by":"publisher","DOI":"10.1145\/3359996.3365051"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.2196\/20797"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1016\/j.nedt.2018.08.002"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.2196\/10839"},{"key":"ref15","doi-asserted-by":"publisher","DOI":"10.2196\/12959"},{"key":"ref16","year":"2017","journal-title":"Cognitive Development in Digital Contexts"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1007\/s00268-001-0133-1"},{"key":"ref18","year":"2021","journal-title":"Emerging Technologies in Data Mining and Information Security"},{"key":"ref19","unstructured":"Soft skills training - reinventedBodySwaps2022-03-29https:\/\/bodyswaps.co\/"},{"key":"ref20","unstructured":"JohnsonMNewcastle Uni taps biofeedback in VR conflict trainingIT News2022-05-18https:\/\/www.itnews.com.au\/news\/newcastle-uni-taps-biofeedback-in-vr-conflict-training-534860"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1111\/jonm.12772"},{"key":"ref22","author":"Brooke, J","year":"1996","journal-title":"Usability Evaluation in Industry"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.1080\/10447310802205776"},{"key":"ref24","unstructured":"Oculus Quest 2Meta2022-05-18https:\/\/www.oculus.com\/quest-2\/"},{"key":"ref25","unstructured":"Unreal Engine homepageUnreal Engine2022-05-18https:\/\/www.unrealengine.com\/en-US\/"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1191\/1478088706qp063oa"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1111\/j.1937-8327.2001.tb00204.x"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.18084\/1084-7219.23.1.249"},{"key":"ref29","author":"Latif, S","year":"2020","journal-title":"arXiv"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s00221-016-4846-7"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1109\/rbme.2020.3006860"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1007\/s10055-021-00607-1"}],"container-title":["JMIR Serious Games"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/games.jmir.org\/2022\/3\/e38669","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T17:34:58Z","timestamp":1782840898000},"score":1,"resource":{"primary":{"URL":"https:\/\/games.jmir.org\/2022\/3\/e38669"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,7,6]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022]]}},"URL":"https:\/\/doi.org\/10.2196\/38669","relation":{"has-preprint":[{"id-type":"doi","id":"10.2196\/preprints.38669","asserted-by":"object"}]},"ISSN":["2291-9279"],"issn-type":[{"value":"2291-9279","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,7,6]]}}}