Högskolan i Skövde

Background: Against the backdrop of escalating global humanitarian crises, innovative didactic simulations are becoming increasingly important. A promising alternative to traditional classroom-based didactics for learning psychological first aid (PFA) prior to humanitarian crises is to use generative artificial intelligence (GenAI)-based virtual patient (VP) systems. However, there is limited research on the use of GenAI-based VP systems for crisis support teams' learning. The aim of this study was to describe crisis support teams' technological openness and learning attitudes toward the GenAI-based VP system called Crisis Support Virtual Reality (VR).

Method: This study employed an action research design, originating from the collaboration with the innovation project Crisis Support VR in the Västra Götaland region of western Sweden. A total of 32 participants completed the Technological Openness and Learning Attitudes (TOLA) survey. Quantitative data were analyzed using descriptive statistics, while qualitative responses were employed as illustrative quotes.

Results: The participants felt generally positive about practicing PFA for serious events/humanitarian crises using the Crisis support VR and believe that it is a good complement to practicing PFA. Perceived learning benefits for participants through observing the avatar´s facial and body expressions in applied GenAI-based VP system received lowest score among all items.

Discussion: Crisis Support VR represents an innovative didactic simulation tool for learning PFA, serving as a valuable complement to traditional classroom-based didactics. Future research should evaluate its effects on learning outcomes and, in doing so, contribute to preparedness and response capacity during humanitarian crises.

Introduction: Digital competence is essential in today’s digital society. Older persons often exhibit lower levels of digital competence than younger age groups, indicating a digital divide. Consequently, support to enhance digital competence is needed. Yet, little is known about the characteristics of such support. This study, conducted in Sweden, explored how one-to-one digital support was provided to older persons in their homes through a coaching service provided by a municipality.

Methods: This study employed an exploratory qualitative design. Data were collected through audio-recorded support sessions in which 12 persons aged 65 years and older received support with their digital needs in their homes from a municipally employed digital coach. The audio-recorded sessions were analysed using thematic analysis.

Results: Through the analysis, three main themes emerged, each comprising two sub-themes. The themes were direct support and memory aid, provided through hands-on support and tools for memory support; support built on relation and mutual influence, achieved by building a relationship and creating conditions for equal voices; and to place the person’s own digital needs at the centre, accomplished by listening and responding and by sharing adapted knowledge. The support was provided through the creation of an adapted and inclusive learning environment centred on the older persons’ own digital needs.

Conclusion: The study provided insights into how support was enacted in real-life interactions when older persons received coaching for digital competence in their own homes. These insights may contribute to improving the design of future interventions. They also highlight the potential for digital support to narrow the digital divide and promote equitable access to the resources of the digital society.

Digital systems, as synchronous computer-mediated communication have become a complement to traditional healthcare visits in primary care. The aim was to describe registered nurses' experiences of digital communication with patients via text-based synchronous computer-mediated communication. The study employed a qualitative design, and data were collected through a qualitative questionnaire that included open-ended questions, which were completed by 34 registered nurses working within primary care. The data were analysed using inductive qualitative content analysis. The Consolidated Criteria for Reporting Qualitative Research Elements were considered when conducting the study. The findings indicate that chat communication presents various challenges for registered nurses, particularly in assessing patients' health status and engaging in caring communication. Digital communication via chat appears most suitable for patient encounters involving uncomplicated and clearly articulatable needs. The findings highlight the need for more knowledge, clearer guidelines, and adapted work routines to ensure that this communication modality supports safe and person‑centered care. Clearer guidelines regarding when communication modality form is appropriate and when alternative modalities such as a telephone call or face‑to‑face contact should be used. Complementary communication pathways must available, and routines should enable early transition to another modality when the patient's needs exceed what written communication can accommodate.

The increasing complexity of humanitarian crises necessitates innovative, student-centered educational approaches to strengthen societal well-being (1). In alignment with the WHO’s mhGAP-HIG (2), training in Psychological First Aid (PFA) constitutes a core component of effective humanitarian response and is guided by Hobfoll et al., (3) five principles: safety, calming, self- and community efficacy, social connectedness, and hope. Traditionally, PFA training has relied on classroom based or instructor-led simulation that are resource-intensive and dependent on facilitator expertise, leading to variability in learning outcomes (4 – 6)

Generative AI-based virtual patient (genAI-VP) systems address these limitations by providing safe, repeatable, and structured learning environments in which learners can practice communication, decision-making, and crisis management skills without risk to real individuals (7,8). Grounded in Dewey’s philosophy (9,10) and further developed through Kolb’s (11) experiential learning theory, learners engage through four interconnected stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. By centering the learner in realistic, interactive simulations, communication, self-efficacy, and psychomotor skills are enhanced (4 -6), offering an innovative student-centered educational approach that facilitates learners preparedness in responding to humanitarian crises.

Learning and Enhancing Conversational Skills with AI Avatars

Against the backdrop of escalating global humanitarian crises, AI-based educational systems are reshaping the learning of conversational skills. Our system is designed to strengthen conversational skills among healthcare professionals, emergency services, humanitarian relief workers, and others caring for vulnerable populations. It provides a safe virtual learning environment with immersive, interactive scenarios, including natural disasters, terrorism, suicidality, intimate partner violence, sexual vulnerability, supporting repeated practice and personalized learning. Inclusion and cultural adaptability are emphasized through ten AI avatars representing a broad demographic spectrum and support for 21 languages. Interactions are followed by AI-driven feedback highlighting learners’ strengths and areas for improvement. As part of an umbrella project, the aim of the present study was to describe crisis support teams’ technological openness and learning attitudes toward the AI-based system, Crisis Support VR.

Action research in collaboration with the Crisis Support VR innovation project, Region Västra Götaland, Sweden. 32 participants completed the Technological Openness and Learning Attitudes survey. Quantitative data analyzed using descriptive statistics; qualitative responses used illustrative quotes. 

Conclusion

• Supports Learning in Humanitarian Crises

• AI Avatars Interactions Enhancing Conversational Skill

• Restricted Nonverbal Communication Remains a Key Limitation

Background: Globally, stroke is the second leading cause of death. About 20% of patients with acute stroke die within 30 days of onset, yet fewer than 10% receive palliative care, and only a small fraction of these receive it in specialized palliative units. Rather, they are treated in stroke units, where both knowledge of palliative care and support for bereaved family members may be inconsistent and limited.

Objectives: To describe the occurrence and design of bereavement support in the form of conversations offered to family members of patients who die from acute stroke in a stroke unit, as well as the registration in the Swedish Register of Palliative Care.

Design: This study employed a quantitative descriptive design with a cross-sectional approach.Methods:A study-specific survey consisting of three main questions and several follow-up questions was used. All 72 stroke units in Sweden were contacted in person, by phone, or by email; 71 units ultimately participated.

Results: Bereavement support in the form of conversations was provided to the family members of patients who had died from an acute stroke in 34 (48%) of the 71 stroke units. Among these, 21 units offered bereavement support to family members in all deaths, while 13 provided it when the need for support was identified. In total, 60 of the 71 stroke units (84%) register in the Swedish Register of Palliative Care, and of these, 25 units systematically use the registered data.

Conclusion: Neither bereavement support in the form of conversations nor the systematic use of the palliative care registry are fully established part of care at stroke units. To ensure good and equitable end-of-life care, support for bereaved family members needs to be strengthened. Palliative registry data from stroke units represent an underutilized resource with the potential to improve both palliative care and bereavement support.

Community-based nursing today faces significant challenges regarding the future supply of healthcare professionals, such as registered nurses. It is, therefore, essential to shed light on registered nurses' experiences of their working situation within community-based nursing to identify factors that can create a better working situation. Aim: To describe registered nurses' experiences of the work situation in Swedish community-based nursing. Method: The study employed a mixed-methods design. Data were collected through a) a quantitative sample and b) a qualitative sample of free-text answers to open-ended questions in the questionnaire. The quantitative material was analysed through descriptive statistics, and the qualitative material was analysed with deductive direct content analysis based on the Fundamental of Care framework's three dimensions. Results: The overall experience in community-based nursing was that the registered nurse's work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship, the integration of care and the context of care. Conclusion: Registered nurses' work situation within community-based nursing is influenced by factors such as lack of time and understaffing. Lack of time and understaffing affect the possibilities of creating a caring relationship with both the person being cared for and their next of kin. In comparison with continuity, good personal knowledge and presence are promoting factors to good caring relationships.  The establishment of a care relationship, satisfying basic care and creating organisational conditions take place in collaboration and are the foundations for being able to work person-centred, which also are elements described in the Fundamental of Care framework.

Background: The availability of digital technologies such as virtual patient simulation has nurtured innovation in higher healthcare education. However, the quality of validated questionnaires related to virtual patient simulation in higher healthcare education remains limited. In particular, there is a need for validated questionnaires for virtual patient simulations focusing on intimate partner violence. Thus, the aim was to cognitively validate questions in the Questionnaire Virtual Patient (QVP) among undergraduate nursing students.

Method: A think-aloud design was employed. Eleven undergraduate nursing students from a single school of nursing in western Sweden participated in an individual digital cognitive interview. Collected data were analyzed using a qualitative conventional analysis. The QVP consists of eleven background questions and additional eighteen questions, structured into two themes: (1) User friendliness virtual patient and (2) Virtual patient as an integrated part of educational module.

Result: The QVP was perceived as clear, well-constructed, and easy to understand. At the same time, some areas for refinement were emphasized. Thus, original questions and revised versions of the questions in QVP are presented in the alignment with the structure of the QVP.

Conclusion: The cognitive validation of the QVP highlights the need for methodological rigor and thoughtful planning in survey design. Ongoing refinement of questionnaires can contribute to the development of evidencebased learning didactics in an increasingly digital healthcare educational context.

While generative AI (genAI) has made significant advances, millions of people are facing humanitarian crises, resulting in the denial of their basic human rights. One humanitarian response to addressing humanitarian crises is crisis support teams with knowledge of psychological first aid (PFA). In humanitarian crises, skilled practice in PFA by crisis support teams can strengthen the mental health of affected individuals, which can be crucial to ensuring societal wellbeing. At the same time, there are major challenges in training crisis support teams in PFA. With advancements in genAI, there are opportunities to develop virtual patient systems to enhance PFA training for crisis support teams. This presentation will share preliminary data collected through the genAI-agents survey, which explores technological openness, attitudes and learning through genAI and genAI-based virtual patient systems in healthcare education as well as specifically targeted questions to the genAI-based VP system Crisis Support-VR. This survey is a part of a larger project focusing a central research question Does Crisis Support-VR enhance the skills and ability of crisis support teams to deliver effective PFA, thereby strengthening the mental health of individuals affected by humanitarian crises with two interconnected sub-goals; • to empirically explore health and medical staff within children, youth and adult services learning in Crisis Support-VR, • to develop an educational module for training and practice opportunities in PFA to support and help national and international organizations train crisis support teams in applying PFA to children, youths and adults affected by humanitarian crises.

Stroke units could improve support for bereaved family members by adopting a more systematic and intentional approach to bereavement support in the form of conversations following the death of patients from acute stroke. Offering such conversations routinely, rather than selectively based on perceived need, would be a valuable first step.

While many stroke units in Sweden use the Swedish Palliative Care Registry, it appears to be an underutilized resource for enhancing the quality of end-of-life care for patients with acute stroke. A more consistent and comprehensive use of the registry would be beneficial.

Background and Aims: Despite advances in primary prevention and acute treatments, stroke remains a leading cause of death. However, few patients who die from acute stroke receive care in dedicated palliative care units, highlighting the need for stroke unit staff to be well-versed in palliative care. Bereavement support for family members is also an important aspect of care. This study aimed to describe the provision of bereavement support, particularly in the form of conversations, to relatives of patients who die from acute stroke in stroke units, as well as the registration of this support in the palliative care registry.

Methods: A quantitative descriptive study with a cross-sectional design was conducted using a study-specific survey. All 72 stroke units in Sweden were contacted by email or telephone, with 71 responding. Data were analysed using descriptive statistics, including frequencies and percentages.

Results: Bereavement support through conversations was offered to family members of patients who died from acute stroke in 34 (48%) of the 71 stroke units. Of these, 21 units provided support to all family members, while 13 offered it only to those identified as needing it. Sixty of the 71 units (84%) were registered in the Swedish palliative care registry, but only 25 units systematically used the data, meaning 58% did not utilise the collected data.

Conclusion: Bereavement support in the form of conversations and palliative care registry use in stroke units require improvement to ensure comprehensive end-of-life care for patients and their families.