Designing Finding Home

A design story from the XReality studio: the thinking behind our adaptive XR simulation for dementia-care communication.

An Adaptive XR Simulation for Person-Centered Dementia Communication

1. Educational Rationale

Nursing students often learn general principles about dementia, therapeutic communication, and behavioral symptoms from textbooks or classroom cases. However, people living with dementia do not respond in one predictable way. Their communication, emotional reactions, behavior, and care preferences may be influenced by their life history, personality, relationships, culture, environment, illness progression, and current physical condition.

Traditional virtual patient scenarios may also rely on short, direct, or predetermined responses. A patient may answer the exact question asked but may not interrupt, repeat a concern, shift topics, tell an unrelated story, misunderstand the learner, or respond differently based on trust and emotional state. These limitations make it difficult for learners to practice the flexible communication required in dementia care.

This immersive simulation is designed to help learners recognize that behavior communicates an unmet need. Learners must interpret verbal, nonverbal, environmental, and personal-history cues; respond therapeutically; support safety; and continuously adapt their approach as the patient’s trust, anxiety, and willingness to cooperate change.

The simulation is not designed to teach one correct phrase. It is designed to help learners:

notice the person, understand the concern, select an appropriate response, observe the patient’s reaction, and adapt the next action.

Intended Learners

• Prelicensure nursing students

• Newly licensed nurses

• RN-to-BSN students

• Nurses entering long-term care, assisted living, home health, hospice, or palliative care

• Other health-profession learners in future versions

Primary Educational Goals

The scenario is designed to help learners:

1. Practice person-centered therapeutic communication with an older adult living with dementia.

2. Recognize how life history, personality, surroundings, and emotional state influence patient behavior.

3. Interpret wandering or exit-seeking as communication of an underlying concern rather than simply a behavior to stop.

4. Use validation, redirection, environmental modification, and relationship-building strategies.

5. Maintain safety while preserving the patient’s dignity and autonomy.

6. Adapt verbal, nonverbal, and spatial behavior according to the patient’s response.

7. Reflect on how the learner’s communication may increase or decrease distress.

8. Identify possible physical, environmental, or emotional contributors to a change in behavior.

The scenario can support learning related to:

• therapeutic communication;

• clinical judgment;

• person-centered care;

• dementia care;

• behavioral and psychological symptoms of dementia;

• patient safety;

• family and caregiver engagement;

• long-term and community-based care;

• palliative principles;

• comfort and quality of life;

• nonpharmacological approaches;

• cultural humility;

• de-escalation;

• environmental assessment;

• reflection and debriefing

The simulation may later be mapped to the NCSBN Clinical Judgment Measurement Model:

• Recognize Cues

• Analyze Cues

• Prioritize Hypotheses

• Generate Solutions

• Take Action

• Evaluate Outcomes

We can use CJMM as a feedback framework, not claim to be a fully validated automated CJMM scoring system.

Learning Objectives

By the end of the XR scenario, the learner should be able to:

1. Recognize verbal and nonverbal signs of anxiety, confusion, frustration, fear, loneliness, or unmet needs.

2. Identify personal-history and environmental cues that may explain the resident’s behavior.

3. Communicate using a calm tone, simple language, appropriate pacing, and respectful nonverbal behavior.

4. Validate the emotion underlying an inaccurate statement without repeatedly correcting or confronting the resident.

5. Redirect the resident toward a safe and personally relevant activity when appropriate.

6. Maintain a safe physical distance and avoid threatening, blocking, crowding, or restraining behavior.

7. Assess possible contributors to increased confusion, including pain, infection, fatigue, hunger, toileting needs, medication effects, noise, unfamiliar surroundings, and changes in routine.

8. Observe whether the selected communication approach increases or decreases the resident’s distress.

9. Modify the communication strategy when the first approach is not effective.

10. Involve family members or caregivers appropriately to understand the resident’s routines, preferences, history, and triggers.

11. Document and communicate relevant observations using person-centered and nonstigmatizing language.

XR Environment

Location

A resident’s room and nearby hallway in a long-term care or assisted-living community.

The first version could include only:

• one resident room;

• one hallway;

• one visible exit door;

• one sitting area.

This keeps technically manageable while still making spatial interaction important.

Time

Late afternoon, approximately 4:30 p.m.

The resident has become more restless as daylight changes and activity in the hallway increases.

Environmental Design

The room should not look generic. It should contain clues about the resident’s identity and life story.

Possible objects include:

• framed photographs;

• a calendar;

• a clock;

• an old radio;

• a familiar blanket;

• a family photograph;

• a former workplace photograph;

• a newspaper;

• familiar music;

• a personal keepsake;

• a chair positioned near the door;

• a television producing background noise;

• clothing or an object associated with a former occupation.

The patient could be a retired elementary school teacher. The room might contain:

• a photograph of her former classroom;

• a picture of her adult son as a child;

• children’s artwork;

• an old school bell or teaching award;

• a family photograph labeled with names;

• soft music from the period she enjoys.

These objects are not only decorative. They provide information the learner can notice and use during the interaction.

Patient Profile

Patient Name