At the knock on the door, the exhausted mother discards a white blanket beside her daughter. Medical team files in extract and professional.
The white count does not go down. Some epithelial coagulation. Major lung injury. Increased level of C-reactive protein (CRP). Consider ECMO. Let’s prepare it for transportation.
The mother tilts her head, trying to absorb the words, but she is unable to find the meaning in them. Quick questions about her daughter’s vaping habit leave her stunned and confused. When she starts crying, the team storms out of the room. The mother turns out to be the last one left: the nurse cheats on her daughter.
“What does it all mean? Just tell me what will happen to her, please!”
“Mrs. Kelly, I have to go check on a patient, but I’ll be back as soon as I can,” the nurse answers, and then she too goes out the door.
The scene is so heartbreaking to witness as it is commonly believed.
“Many of us have had experience with loved ones interacting with the health care system and not receiving the kind of care we felt they needed in terms of empathy,” explains Clinical Assistant Professor Laurie Sprague, who is also an assistant director. Innovative simulation and practice center at Binghamton University Decker College of Nursing and Health Sciences. And we thought, ‘Maybe we can help people understand what it’s like to have this person go through this experience. ”
A virtual reality (VR) simulation helps undergraduate nursing students do just that, by allowing them to experience an emergency care scenario from the perspective of an alerted patient. The script aims to instill empathy which, contrary to popular belief, is a skill that can be acquired and strengthened.
Decker has explored the possibilities of virtual reality before, but previous programs were very expensive and involved a full headset tethered to a computer. It is limited to one user at a time and has proven useless for a classroom setting or home use. Enter the smartphone, the YouTube app, and Google Cardboard.
“You really need to be able to reach out to the masses, so we came up with the idea of creating a virtual reality simulation that would be easy and accessible,” says Patrick Libby, Decker’s Director of Technology and Innovation. “You can get a $3 cardboard headset, put your phone in it and have 100 students all sit in a room at the same time, doing the same virtual reality simulation.”
The Collaborative Research in Simulation and Practice (CRISP), a research group that includes both Sprague and Assistant Professor Rosemary Collier, won an Innovative Education Technology grant from the State University of New York (SUNY) for the project. Collier and Sprague are also part of an interdisciplinary research group on tobacco use and have leveraged their knowledge to create a vaping scenario in partnership with nursing programs at SUNY Delhi, SUNY Broome and SUNY Brockport.
says Collier, who is also an emergency care nurse in the Binghamton area.
Unlike traditional video production, VR must be filmed in a single take; To stay out of the scene, Libby worked in a separate room, operating the camera from an iPad. The roles were played by the faculty, who rehearsed through several costume rehearsals before Libby filmed the script with an Insta360 camera.
For their roles, faculty members drew on aspects of their own experience. The day before filming, Sprague’s daughter was hospitalized for a medical emergency; Captured on video, her feelings as a distraught mother were fresh and raw. Collier, who played the chief physician, is deeply aware of the communication blind spots that can sometimes occur in emergency situations.
“If you’re ever in a critical care unit, the doctors are walking around with these teams of residents and respiratory therapists and nurses, going from room to room,” Collier says. “They have a job to do, and the job is not always therapeutic communication with the patient and family.”
Empathy in the curriculum
Until now, virtual reality simulations have been part of the introduction to the professional nursing course, with students wearing goggles watching the simulation and then discussing it together.
Empathy and emotional intelligence are part of the nursing curriculum, and are developed in a variety of ways. For example, nursing students learn how to physically move patients to a bed while practicing on each other, which imparts not only skill, but insight into what a patient is feeling: in short, empathy.
“I am comfortable in a healthcare environment; it is for me home base. But for every patient that comes through that door, it’s a terrible day, their worst day. It can be difficult to remember to put yourself in their shoes and to remember that this is not the case they Collier says. “You really have to do your best to create some connection and comfort.”
When Jenny Nigro took her glasses off, she was already feeling stressed by competing deadlines and a big test later that afternoon. As she watched the scenario unfold, she was struck by the patient’s vulnerability.
“It was an empathic meditation on how the care team’s rudeness and lack of warmth led to (the patient’s) experience of helplessness,” says Nigro, who graduated with a nursing degree in May 2022. Notice how timely it was because our VR simulation of empathy was taking place on a day when we were feeling exhausted and tired. It provided an opportunity to think about how we can manage these feelings that are likely to emerge in nursing practice, so that we don’t deprive our clients of power.”
Plans are in the works to create additional VR scenarios, such as those involving patients who do not understand English or situations that may require conflict resolution skills. Leiby has also used 360 technology on other projects, such as a virtual tour of the new Decker Motion Analysis Research Lab.
Virtual reality scenarios could play an important role for nurses in the future, allowing them to access experiences they may not have during their clinical time and share those experiences with classmates, Collier notes. In essence, sharing is the foundation of empathy.
“Patients don’t always remember the clinical intricacies going on behind the scenes, but they will remember how their nurse or provider cared for and treated them,” Sprague says. “Sometimes it’s just a matter of pulling up a chair or changing your body language and respectfully giving a few moments of your time.”