When the door clicked, a tired mother took a white blanket from her daughter’s side. A medical team filed, brief and professional.
The white count will not decrease. Some epithelial sloughing. A significant pulmonary injury. His CRP is elevated. Consider ECMO. Let’s get him ready for transportation.
The mother tilted her head, trying to catch the words but not finding their meaning. The rapid-fire questions about her daughter’s vaping habit were shocking and confusing. As she begins to cry, the group exits the room. The mother turned to the last person left: the nurse who was calming her daughter down.
“What does all that mean? Just tell me what will happen to him, please!”
“Mrs. said Kelly, I have to go check on a patient, but I’ll be right back when I can,” the nurse replied, then she too, headed out the door.
The scene was as heartbreaking to witness as usual.
“Many of us have had the experience of loved ones interacting with the health care system and not receiving the kind of care that we feel they need in terms of empathy,” reflects Clinical Assistant Professor Lori Sprague, also assistant director of the Innovative Simulation and Practice Center at the University’s Binghamton Decker College of Nursing and Health Sciences. “And we thought, ‘Maybe we can help people understand what it’s like to be that person who’s having the experience.'”
A virtual reality (VR) simulation can help undergraduate nursing students do just that, by allowing them to experience an emergency-care scenario from the perspective of an intubated patient. The scenario is intended to instill empathy which, contrary to popular belief, is a skill that can be acquired and strengthened.
A new solution
Decker has explored the possibilities of VR before, but early software was expensive and involved a full headset attached to a computer. Limited to one user at a time, it proved impractical for a classroom setting or home use. Enter the smartphone, the YouTube app and Google Cardboard.
“You really need to reach the masses, so we came up with this idea of creating a virtual reality simulation that’s easy and accessible,” said Patrick Leiby, Decker’s director of technology and innovation. “You get a $3 cardboard headset, put your phone in it and have 100 students sitting 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 Sprague and Assistant Professor Rosemary Collier, won a SUNY Innovative Instruction Technology grant for the project. Collier and Sprague are also part of an interdisciplinary research group on tobacco use and took their knowledge to create the vaping scenario in collaboration with the nursing programs at SUNY Delhi, SUNY Broome and SUNY Brockport.
“This is when we see some of these cases of lung damage, like young people getting ‘popcorn lung’ and ending up in the ICU after using vaping products,” said Collier, also a emergency care nurse in places called Binghamton in the United States.
Unlike traditional video production, VR must be shot in one take; to avoid the scene, Leiby works in a separate room, operating the camera from an iPad. The parts were played by faculty members, who practiced several dress rehearsals before Leiby filmed the scenario with an Insta360 camera.
For their roles, faculty members draw on aspects of their own experience. The day before filming, Sprague’s daughter was admitted to the hospital for a medical emergency; captured on video, her feelings as a worried mother are fresh and raw. Collier, who plays the lead doctor, is all too familiar with the communication blind spots that can sometimes occur in an emergency situation.
“When you’re in a critical care unit, the doctors walk around with these teams of residents, respiratory therapists and a nurse, going from room to room,” Collier recounted. “They have a job to do, and the job is not always therapeutic communication with the patient and family.”
Currently, the VR simulation forms part of the Introduction to Professional Nursing course, where students wearing goggles watch and then discuss the simulation.
Empathy and emotional intelligence are part of the nursing curriculum, and they are developed in a variety of ways. For example, nursing students learn how to physically transfer patients to a bed while practicing one-on-one, which not only provides skills, but gives them insight into what a patient feels: in in short, empathy.
“I’m comfortable with the health care setting; it MY home base. But for every patient who walks through the door, it’s a terrible day, their worst day. It can be hard to remember to put yourself in their shoes and remember not to wilderness home base,” Collier said. “You really have to go out of your way to create a connection and comfort.”
When Jenny Nigro lifted the goggles over her eyes, she was already feeling the pressure due to competition deadlines and a big test later that afternoon. As he watched the scenario unfold, he was amazed at the patient’s vulnerability.
“It was a reflection of empathy to see how the care team’s cruelty and lack of warmth resulted in (the patient’s) experience of helplessness,” said Nigro, who will graduate with her nursing degree in May 2022. . “In the post-brief, I noticed how timely our empathy VR simulation took place on a day when we felt overworked and tired. It offered an opportunity to reflect on how we manage these feelings that tend to come into nursing practice, so that we don’t disempower our clients.
Plans are in the works to create more VR scenarios, such as those involving patients who don’t understand English or situations that require conflict resolution skills. Leiby has also used 360 technology in other projects, such as a virtual tour of Decker’s new Motion Analysis Research Laboratory.
Virtual reality scenarios can play an important role for future nurses, allowing them to access experiences that they would not encounter during their clinical time and share experiences with classmates, pointed out said Collier. At its heart, sharing is the foundation of empathy.
“Patients don’t always remember the clinical complexities that go on behind the scenes, but they do remember how their nurse or provider cared for them and treated them,” Sprague said. “Sometimes it’s just a matter of pulling up a chair or changing your body language and politely giving up a few moments of your time.”