Delirium VR Nursing & Clinical Training with UTS

Enter the mind of a patient with delirium

Off-the-shelf Product

VR Training Simulations

Summary

Delirium is experienced by up to half the older population of hospital patients, with fatal outcomes for many, and yet it goes unnoticed all too often
The Faculty of Health at UTS has set out to develop a framework to recognise, treat and prevent delirium sooner and more effectively in cancer and palliative care patients
As part of the research study, a three-scenario 360° immersive VR training program was developed to deepen users’ understanding of how delirium affects the person experiencing it
Developed on Oncio and distributed on Pico VR headsets, the experience was trialled with more than 500 nursing students and practising clinicians at UTS
Delirium VR will roll out to cancer and palliative care nurses at POWH in 2027 in an effort to help healthcare professionals to provide more empathic care and mitigate the impacts of delirium on hospital patients

Introduction

Delirium is a medical emergency that affects over 30% of patients in intensive care^[1], and its consequences are devastating. Older adults who experience delirium are more than five times as likely to develop dementia^[2], and more than twice as likely to die after discharge^[3]. In 2016-17 alone, it affected more than 132,000 Australians and cost the nation $8.8 billion^[4]. Yet it is often missed.

Part of the problem is that under-resourced clinical teams rarely get the chance to understand what delirium feels like from the inside, while the University of Technology, Sydney (UTS) estimates that around 4,000 older Australians experience delirium on any given day in hospital.

The Challenge

How do you foster a real understanding of an experience you’ve never had? UTS asked this question in relation to improving the standard of empathy, care and treatment of persons experiencing delirium, by nursing students and clinicians.

Solution

Delirium VR was developed in partnership with the University of Technology, Sydney, and powered by Oncio, Start Beyond’s immersive learning platform. The VR experience forms part of a research project run by Dr. Amy Montgomery and her team at UTS which looks to enable clinicians to provide better support and more effective care to patients experiencing delirium.

The self-contained VR delirium training program places the learner in a hospital bed, seeing through the patient’s eyes. At first, the hospital appears normal, with everyday activity going on around you. Then reality begins to shift. Live-action footage and AI-generated effects gradually transform the scene into an otherworldly state that represents delirium. The learner is free to explore each of the 3 scenarios as they please and the whole experience takes approximately 10-15 minutes.

The goal is for learners to feel the fear, confusion, paranoia, delusions and mistrust that patients with delirium experience, so they can pick up on signals, respond appropriately with empathy, and reduce the impact of these symptoms on already vulnerable patients.

Three scenarios. One patient’s mind.

Waking up to anxiety & confusion: Familiar faces become unrecognisable, and strangers insist they are your family.
Hypervigilance around being watched: You start to question the intentions of the staff caring for you as the hospital begins to decay
Detachment from reality: The walls fall apart as vines and plants take over the room and hallucinations transform the hospital into a vivid jungle

[images]

Because delirium is such a personal experience, driven by imagination and emotion, AI was used to generate certain elements and exaggerate situations to re-create a state of mind reminiscent of delirium.

Process

Over several meetings, and a collaborative process spanning 3-4months, initial ideas were refined, final content agreed upon and the research project executed.

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01
Content Development

Co-designed with Amy Montgomery and her team at the UTS Faculty of Health, the program drew on the Delirium Clinical Care Standard to aid in the development of a capability model that defines the skills, knowledge and support required for high-quality delirium care, for both practitioners and consumers.
02
Production

Our Studio team shot 360°videos at the UTS campus, utilising their staff, equipment and facilities. Each scenario is shot from the perspective of a person sitting in a hospital bed. It begins with footage of a normal hospital setting and builds incrementally into a delirium state. Virtual reality, AI-augmented imaging and spatial sound make the fear and confusion feel real.
03
App Development

We built a video module around each of the three experiences on the Oncio platform. Each module runs approximately 3-5 minutes and is delivered on Pico VR headsets. The project used a Learning Health System (LHS) approach, in which data collection and feedback continually inform improvements to care and to the training itself.

Before and after the delirium experience, the user is presented with a short survey assessing their knowledge and confidence on the subject. This gives UTS measurable data on the impact of the training.

By combining realism, dramatic techniques and interactive instructional design, the VR program recreates complex real-world situations, evoking connection through emotions and making learners active participants. It’s this emotional connection that makes such training memorable and builds confidence and practical knowledge without real-world risk.

Benefits

For clinicians
Realistic, immersive simulations provide the user with a first-hand understanding of what delirium looks, sounds and feels like.
For educators & researchers
An increase in knowledge and understanding can translate into greater empathy towards patients experiencing delirium. In addition to being used as a teaching aid, its efficacy will also continue to be studied in clinical trials.
For hospitals, clinics and care units
A consistent and effective training program for teams of healthcare professionals practicing across various medical and care environments means better overall care and treatment for patients experiencing delirium.

The Result

Following a successful trial with more than 500 nursing students and clinicians at UTS, Delirium VR is set to be released in early 2027 to cancer and palliative care nurses at the Prince of Wales Hospital (POWH).

Data captured through the Delirium LHS will be used to support further improvements and content. The immersive delirium experiences will serve as an educational resource from which tailored care initiatives and interventions can be developed. Start Beyond has committed to two additional 360° video-based immersive learning scenarios, which will be integrated into the Delirium VR experience.

Designed for use in universities and hospitals, Delirium VR supports the ongoing professional development of clinicians, helping them better understand patients’ reactions, recognise indicators of delirium sooner and respond with empathy.

The research project

Delirium VR is part of a three-year study aiming to develop and evaluate Australia’s first LHS to improve evidence-based delirium care. It is led by UTS postdoctoral research fellow, Dr Amy Montgomery; Course Coordinator, Catherine Johnson, for the Master of Nurse Practitioner program at the UTS Faculty of Health; and Prof Gemma McErlean at the Prince of Wales Hospital, working with POWH’s cancer and palliative care clinical nursing specialists.

The research study combines a delirium lecture, simulation-based learning and an immersive delirium VR experience in a workshop for UTS nursing students & staff to improve their delirium knowledge, confidence, empathic concern and practice. It aims to create a scalable national framework to improve delirium recognition, treatment and prevention across diverse healthcare settings, and establish the infrastructure, implementation processes and partnerships needed to translate evidence into daily practical workflows.

Building on a partnership

Start Beyond previously collaborated with UTS on other immersive programs:

Minaca VR (Managing Incivility, Negativity And Customer Aggression) is an off-the-shelf immersive training product that helps nursing students practise managing confrontational patients. After reports of greater confidence and readiness for clinical practice, the program is to become part of the mandatory nursing curriculum at UTS from 2027.
Sacadi VR (Supporting Aged Care And Disability Individuals) is a plug and play immersive learning solution designed to train students and practitioners in aged, health, and disability care to balance their duty of care with an individual’s personal autonomy and desire for independent living. The UTS School of Nursing and Midwifery is also due to implement this program in 2027.

Sources:

[1] Brennan et al., Aust. Crit. Care (2023)
[2] Palmer et al., JAMA Neurol. (2026)
[3] Witlox et al., JAMA (2010)
[4] Pezzullo et al., BMJ Open (2019)

Project Gallery

A closer look at how we brought this project to life — from concept to final experience.

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Frequently Asked Questions

Delirium VR is an immersive training program that puts the learner in the place of a patient, in a hospital bed. Across three scenarios, you experience the confusion, fear and altered reality of delirium. The goal is for nurses and clinician to be able to recognise the signs sooner and respond appropriately, and with empathy.

Start Beyond worked directly with the UTS Faculty of Health and Dr Amy Montgomery’s team. Through a series of meetings to define and refine the details of the learning experience and outcomes, the Start Beyond studio team collaborated with the subject matter experts at UTS to determine the final content and the structure of the program as it is today. The program draws on the Delirium Clinical Care Standard so that it accurately represents the symptoms and stages of delirium.

The whole experience takes about 10–15 minutes, with each scenario running for 3–5 minutes. Learners can explore the scenarios in any order, and move about freely through the program.

Delirium is a deeply personal experience that varies from person to person. AI-generated elements made it possible to depict a distorted perception in ways standard footage could not, evoking the confusion, fear and mistrust that patients may feel.

Each of the three scenarios were shot in 360° video at the UTS campus, with UTS staff, equipment and facilities. AI-augmented imaging and spatial sound were added to add to the realism and visceral nature of the experience. The program runs on Pico VR headsets and is delivered through Oncio, Start Beyond’s proprietary immersive learning platform.

Following a successful trial with over 500 nursing students and clinicians at UTS, Delirium VR will be released in early 2027 for cancer and palliative care nurses at the Prince of Wales Hospital.

Delirium affects more than 30% of patients in intensive care and up to 50% of older adults in hospital. Older adults who experience delirium are also more than five times as likely to develop dementia, and more than twice as likely to die after discharge. Despite the high incidence of delirium in hospitals, it continues to go unnoticed.

Start Beyond Team

Start Beyond is Australia's leading VR & AR immersive learning studio. Helmed by CEO Angus Stevens, the platform and studio teams work closely to develop memorable, scalable, and effective XR training solutions. Clients include Woolworths, St John Ambulance, CommBank, UTS, ANSTO, and Qantas.