Nursing education, virtual reality and empathy?
Simulated nursing and health-care experiences are often touted as allowing students to ‘step into the shoes’ of others and thus experience, perceive, reflect and learn about what it is like to feel like that other person, even if just for a moment (Bauman, 2012).
Implicit in this achievement is that a wicked problem afflicting nursing, and nursing education has resolved –that nursing students do not, or have not, effectively empathised with ‘the other’, and this leads to patient dissatisfaction and inadequate treatments and care.
A relatively recent addition to simulated learning is virtual reality, which, depending on your point of view, offers the potential to deepen and enrich the possibility for empathic understanding or take us further down a path of self-delusion.
In learning experiences that use VR as an attempt to facilitate crossing over into the world of the patient, empathy measures are frequently used to evaluate the learning experience. Empathy may be however what empathy scales measure and may be a useful heuristic, but do they measure a tangible state of being. VR and AR technology undeniably place students in the presence of suffering but is it empathy the students experience or pity? When a (negative) snapshot of life with a disability is all that is provided, it may be pity that is all that is invoked – and neither the student, nor the subject benefits. Pity involves a feeling of tenderness for the deficiencies of the other. It is not the perspective of the other. Pity requires a distancing from the object and usually results in consideration of the other an object or an ‘it’, not a person. Michael LaCombe, writing in the persona of a senior devil to a junior colleague, recommends using pity to pervert empathy: ‘‘permit them to see their patients as simpering fools, helpless wrecks of humanity with whom they could never identify (Wilmer, 2018 ).
The implication is that there can be no equality, respect, admiration, or collaboration when pity characterises the relationship between nurse and patient.
If indeed pity is elicited in VR and other simulations, then the measures used to test change (eg. Jefferson’s empathy scale) may not be valid. Compounding this problem with measurements has been the increasing awareness of neural pathways identified in relation to empathy, yet this has not been incorporated into empathy measurements (Neumann et al 2015, Segal et al 2017).
Because VR provides a snapshot of a person’s experience it may provide that crucial entry point to emotional receptiveness but because it is time limited, often a one off experience, and not real, it cannot reveal the vicissitudes of living with a complex health-care problem over time. A person living with a chronic illness is unlikely to be consumed by the problem all the time. There may be joys as well as struggles. Only immersion in the person’s reality can illuminate these insights, and then only if the student has a humble stance allowing them to be open to new learning (Dean et al 2020).
A further concern is that while students may be emotionally more attuned to the patient (whether this be pity or empathy), their attitudes may not lead to changed behaviour (Ainley et al 2015). The value of such exercises then can only be assessed in terms of subsequent acts. Value or virtue can only be understood in terms of performance. It is not important how one thinks but rather how one acts.
VR and AR technology have merit because they place students in the presence of suffering, and emotional reactions are frequently triggered. This provides an important entry point to the next step of learning to empathise with others, which requires acknowledgment that one does not fully understand the particular perspective of the other, and this requires humility, the performance of an act of kindness and a curiosity to learn more.
All this needs to be explicit outcomes of the learning process.
It is important, then, to ask the question: How can we effectively cultivate empathy and compassionate action in learning experiences for nursing students? We suggest the following framework to support the learning for all VR and Simulation learning that involves attempts to understand the life world of another: 1. Encourage students to move to a position of unknowing, and humility prior to the experience; 2. Consider the learning experience as an entry point, not the entirety, into the life-world of the other; 3. aim to trigger the students’ curiosity to learn more about that life-world.
If you would like to access further material on these issues, the link to a recently published paper is provided:
https://protect-au.mimecast.com/s/x75kCk81oVH4QRjou2OhPt?domain=onlinelibrary.wiley.com
Written by Sue Dean
References
Ainley, V., Maister, L., Tsakiris, M. 2015. Heartfelt empathy? No association between interoceptive awareness, questionnaire measures of empathy, reading the mind in the eyes task or the director task. Frontiers in Psychology, 6:554
https://doi.org/10.3389/fpsyg.2015.00554
Bauman EB (2012) Game-based teaching and simulation in nursing and health care. New. York: Springer Publishing Company.
Dean, S., Halpern, J., McAllister, M., Lazenby, M. 2020. Nursing education, virtual reality and empathy? Nursing Open. 00: 1-4. https://doi.org/10.1002/nop2.551
Neumann, D., Chan, R., Boyle, G., Wan, Y., Westbury, R. 2015. Measures of empathy: Self-report, behavioural, and neuroscientific approaches. In Boyle, G., Saklofske, D., Mathews, G (eds). Measures of Personality and Social Psychology Constructs. Academic Press, pp 257-289
Segal EA, Gerdes KE, Lietz CA, Wagaman MA and Geiger JM (2017) Assessing Empathy. New York: Columbia University Press.
Wijma EM, Veerbeek MA, Prins ML, Pot AM and Willemse BM (2018) A virtual reality intervention to improve the understanding and empathy for people with dementia in informal caregivers: results of a pilot study Journal of Aging and Mental Health, 22 (9):1121 -1129. https://doi.org/10.1080/13607863.2017.1348470