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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.