Background Nurses must meet professional standards by attending continuing education activities. Despite the potential of virtual patient simulation in nursing education, it has rarely been used in nurses' continuing education to address relational skills. We developed an automated virtual patient simulation informed by motivational interviewing to enhance nurses' relational skills. The simulation features an HIV-positive man struggling to adhere to his medication. Quizzes and feedback loops

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... edded in the simulation allow learners to observe the consequences of their choices. This study aimed to assess nurses' perception of simulation's acceptability. Specific objectives were: to measure the simulation design elements, its role in supporting practice, its quality and technology acceptance, and the achievement of learning objectives; to explore nurses' learning experience. Methods We performed a convergent mixed methods study by combining a quantitative pre-experimental, one-group post-test design and a qualitative exploratory study. We used convenience and snowball sampling approaches to select registered nurses (n=49) working in Quebec, Canada, who self-reported as having basic computer literacy skills. Participants completed an online sociodemographic questionnaire, consulted the simulation, and filled out an online post-test survey. Descriptive statistics (mean, SD, median, interquartile range) were used to present quantitative findings. From the 27 participants who completed the simulation and post-test survey, five participated in a focus group to explore their learning experience. The discussion transcript was subjected to thematic analysis. Results Nurses perceived the simulation to be highly acceptable. They rated the global system quality and the technology acceptance with high scores. They reported having enjoyed the simulation and recommended other providers use it. Four qualitative themes were identified: motivations to engage in the simulation-based research; learning in a realistic, immersive, and non-judgmental environment; perceived utility of the simulation; and perceived difficulty in engaging in the simulation-based research. Conclusions The simulation contributed to knowledge and skills development on motivational interviewing and enhanced nurses' self-confidence in applying relational skills. Simulation holds the potential to change practice, as nurses become more self-reflective and aware of the impact of their relational skills on patient care. Relational skills are fundamental to high-quality nursing care.Trial registration:ISRCTN18243005, retrospectively registered on July 3 2020.