Scholarship - Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education

This episode of NLN podcast Nursing EDge Unscripted Scholarship explores the innovative use of virtual reality (VR) to foster empathy toward older adults in nursing education. Host Dr. Steven Palazzo interviews Miss Catherine Quay, Assistant Clinical Professor at Drexel University, about her study published in Nursing Education Perspectives. The discussion delves into the creation of immersive VR experiences, their impact on shifting students’ perceptions of aging, and the measurable increase in empathy demonstrated through the intervention. Miss Quay also shares insights on integrating VR into curriculum design and its potential as a transformative tool in nursing education. Learn more about her work, "Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education."

Quay, Catherine; Ramakrishnan, Arun. Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education. Nursing Education Perspectives 44(5):p 300-302, 9/10 2023. | DOI: 10.1097/01.NEP.0000000000001174 

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Transcript

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[Music] Welcome to this episode of NLN podcast Nursing EDge Unscripted the scholarship track. I'm your  host Dr. Steven Palazzo, a member of the editorial board of Nursing Education Perspectives. Nursing  EDge Unscripted and our track entitled Scholarship celebrates the published work of select nurse  educators from the NLN's official journal, Nursing Education Perspectives and the NLN  Nursing EDge blog. The conversations embrace the author's unique perspectives on teaching  and learning innovations and the implications for nursing program development and enhancement. This  episode we will discuss the author's article, "Innovative Use of Virtual Reality to Facilitate  Empathy Toward Older Adults in Nursing Education." The discussion will focus on the unique findings  of the authors who published the manuscript in this current September October special issue  of Nursing Education Perspectives. Our speaker today is Miss Catherine Quay who is an assistant  clinical professor in the College of Nursing and Health Professions at Drexell University.  Welcome Miss Quay. Thank you so much for having me. You're very welcome. Your article  really sparked an interest in us as co-editors of this special edition and you know once we sent  it out for review we were happy to get it back and have it in our issue. Could you please  describe briefly to the audience your study and themes that emerged from your research? Sure,  so our study was a pilot study and so we used a one group pre-test, post-test design  and we examined the effect of a virtual reality experience that we created on nursing student  empathy towards older adults. So I've lived in the gerontology space for about 10 years now in  my career and I observed just as many others I'm sure have that students really have these negative  perceptions about aging and about caring for older adults. That was where kind of this project  came out of was my desire to really change this. Great, well that is true what you just said  because you know I deal with senior students quite frequently that are going into their internship  and most of them want to go into the beginning of life not the end of life and it's  really unfortunate and as you know our population of elderly is increasing pretty dramatically and  will continue to and there's such a need for this so I think this idea of introducing empathy and  more understanding about the geriatric population can very be very helpful and also gaining  some interest and traction and students maybe pursuing this direction. So please describe the VR  development process and how the perspective taking was incorporated into that process, into the VR.  Sure, sure. So I guess just a little bit about how I kind of came to VR was when I started figuring out  trying to decide like how do I get my students engaged and interested in caring  for the older adults? The literature shows that immersive perspective taking experiences is  really what kind of moves the needle in terms of facilitating empathy and even changing attitudes.  With VR becoming more accessible to schools of nursing I thought like oh maybe this might work. I went to my colleague Dr. Ramakrishnan, Arun, and said this is what I want to do can you do it, because he had already been working with VR and and some other faculty in the College of Nursing  and Health Professions and he said of course I can. You need to go write the story, come up with  a script and come back to me. That's really the first step of this process is looking at what  are my learning objectives and how can I create a story that's going to help my  students meet those learning objectives and so that's how I started writing a story. The story  has to be authentic. It has to be relatable, has to be plausible. I knew I kind of  hit the nail on the head when after the first run of this VR I had students coming up to me  afterwards and was like, that story is something that I just experienced with my grandparent or I  just saw my mother have to have this really difficult conversation with their parent so  I knew that I was on to something with that, with the story that we presented in the VR. It needs  to be engaging it also needs to have an emotional component. If we're going to try to tap into  empathy and possibly change some perspectives there has to be some type of emotional and not  just a here's their medical background, right, there has to be a story and kind of getting to know the  character within the story. So kind of like a hook. Yeah, kind of you there needs to be a little  bit of a problem and then how are we going to address this problem and why does it matter. And then always having some other subject matter experts review the  story. I actually had some older adults in my own family I kind of gave them the story,  so what do you think, like does this seem plausible and accurate? And then it  was all about preparing for filming much like you would create a simulation. You have  to start to prepare and think about where are we going to film it, what's the location, what's the  environment need ,what kind of props might we need, do we need to hire actors or are we going to use  nursing faculty and students, do we need SPs? So you kind of have to go through that preparation and  and I'm going to see that this whole process came together very organically for us, but now looking  back on it we've really like kind of put it this step by-step process together and then you film it  and so the filming is always plan more time than you think it's going to take because it definitely  takes a bit of time. Then we filmed third and first perspective and that's where we really  brought in that perspective-taking aspect of this virtual reality. They require a little  bit different filming methods. Third person perspective is we use an iPhone on a tripod is how  we film the scene. This can be done up to 360°. So for our VR and that we used in this study we did 180 degree just because of the environment we were in, but you can do this  as 360 and so in the third person perspective the learner is going to feel like they are in  the space with the characters. Oh great okay and so it's not computer generated it's real like  a real movie and so they feel like they're in the space. They're not interacting with the characters  they can't interact with the environment, but they're there observing and seeing things unfold. Then the first person perspective for filming we actually use a head-mounted gear that you can put  the iPhone right in and then so for our VR the older adult put this little head mount on, put  the iPhone right in it and then we refilm the same scenes from the older adult's perspective  and so in the VR when the students get they see both. They'll do the third person and then  they get to experience some of the first person person perspective and so when they're in that  first person perspective that's where they are really in the shoes of for us it was the  older adult, but for whoever your main character is that's when they are in those shoes experiencing  some of these scenes from through their eyes really and that's where that perspective taking  really comes to life for them. Sure, yeah.  And so in our VR we were then after you do  the filming you then go into your editing process and so that's where you can add in some different  effects, cut it down, make sure it's not too long. We always want to keep things kind  of short and right to the point and for us that's where we added in some of the sensory changes. So  the students are in first person perspective and they're experiencing some visual age- related changes and they're experiencing some auditory age-related changes and so that's where  again that perspective-taking really comes in. I don't know what else can I add to that? I really  appreciate you talking about the first and third perspective and the difference between the two  and how both of them can be used to really engage the student in a way that's is authentic or more  authentic. So talk a little bit about the logistics and it's a great idea, great  concept. What is the time, the cost, the training involved and also how are you using  this for clinical hours? Sure. So in regards to the logistics it's I'm going to say the way we filmed  ours and if you're using the VR for this type of of learning I think it's very manageable. I created the story. I wrote the story. We hired, we had two SPs and then we actually had two  students who volunteered because we actually have a little flashback in there and so we have them as  like their younger selves. So we had a couple of students who who volunteered, but we hired two SPs. Standardized patients. Yeah, so actors and I did some training with them.  You can do it virtually. We actually filmed this during Covid so everything was done virtually  until the actual day of filming. So a little bit again just helping them prepare the script,  what's the feeling, what's the emotions going on in the scenario, just like you would for a simulation  really when you're training standardized patient. And then the filming is probably the  most time consuming. I'm going to say it took us about eight hours to film this and this piece is  total when we're running it is about a 20 minute VR from really getting them set up with the  equipment until they're taking the headset off is about 15 to 20 minutes. So that took about  eight hours of filming. That's the logistics in terms of time to do. It in  terms of clinical or I guess like how they counted for clinical hours I think was the other part of  that question. Yes, so I think CVR is one piece of really like a holistic way to present the  curriculum or to achieve your outcomes so I have used this VR in a multi-layered  simulation and so there's other things that the students are doing as part of that simulation and  so we count that as a full clinical day. It ends up being, it's about four hours, three and a half  hours total that they're at the sim lab and that counts as a full clinical day. I've also used it  as part of class so where I've been able to have students rotate through the VR lab and then come  back to class and and we've used it just within our course content so there are options. Are you  doing a pre-brief and a debrief with them? So yes, we are now. For this study we didn't. We were  just pilot study, just let's see if this intervention does what we want it  to do, right, yes we have a pre-brief and then we do have a debrief and that's the great  thing with VR is that you can either debrief right away or you can have them if  you have a VR lab that they can go in and watch it and then they can come back to the class the  day after and you can debrief as a whole group and so I do it right away because it's  part of our our simulation day but VR kind of gives you some options in that you can do it  in the classroom a day later, you can do it right away, you have those those again that convenience  of using it. So talk about briefly about how you measured it. What you were measuring and how you  measured it? I think that's important too. Sure. So measure for this particular study we  used the Kiersma-Chen Empathy Scale so we did pre- and post-test and then we also did as  part of our demographic questionnaire we also looked at have they used VR before and so we  wanted to really see, now most of the generation we're working with now in nursing school they've  all used VR. I'm in the undergraduate space. They all have multiple experiences with VR so  we didn't really have any, we didn't see anything in results in regards to that being  having any type of confounding variable or any effect on the results. But we did see a  significant improvement in empathy after the VR intervention and so that was pretty exciting  and we do have other studies in the works so. Oh awesome! I like that you measured something  other than student satisfaction. You were measuring a very specific outcome  that's related to patient care and so that was very attractive about your research here that you  did. Tell us a little bit about what you're doing going forward with this work? Sure. So I actually am currently writing up a study that we conducted earlier this year where we  did an actual control group study. We compared the VR intervention with an actual narrative  case study. The case study was just the story presented in VR but presented in writing and so  we're currently writing up those results in terms of we looked at empathy and we looked  at agist attitudes and then we also looked at student engagement in it's called narrative  engagement is the concept and so we looked at that and yeah, I'm not going to give anything away just yet. Oh, you're gonna hold that! Well, we're going to look forward to hearing the results  of that reading, the results of that I anticipate it'll be somewhat exciting so yeah.   Yeah, so there's a lot of ways to use VR and different ways to  use it so this is just one way. Absolutely. Well, it's great. We need to be more  creative with our simulation space and as we all are very well aware it's becoming much more  difficult to get clinical experiences out there in our communities and a lot of the  research that has come out has suggested pretty strongly that simulation is  just as good to get students to the outcomes we need them at 50%, you know, is what they're  looking at, but some of the states now I know Washington state's putting a proposal forward  to their legislation about counting simulation, every simulation hours as two hours of clinical  because it's such a concentrated and intense experience and so I'm really looking forward to  this space just continuing to evolve and develop and really help us meet the needs of our students  in the clinical setting. Well, thank you so much for joining us for this conversation  Miss Quay. I really appreciate your time and expertise in sharing this work and broadening  our understanding of this work and how we can begin to introduce this in our own institutions.  I think you were very helpful in giving us some ideas there. To our listeners, if you have not had  the opportunity to read about this work you will find the manuscript published in Nursing  Education Perspectives. Again, it's "Innovative Use of Virtual Reality to Facilitate Empathy Toward  Older Adults in Nursing Education," and you'll find it in our current special issue this September  October issue of Nursing Education Perspectives. And thank you very much again Miss Quay and  thank you listeners. We appreciate you and spread this broadly and widely. Thank you again. Thank you.