Laura Hollinshead, Learning Technologist-Curriculum Development
Recently the Mental Health Nursing team looked at the use of immersive video to help enhance students understanding and empathy for the lived experience of their patients. The idea came from a presentation at the Association for Learning Technology conference in 2017 from the University of Lincoln looking at using 360° video to show a ward round and how this was seen from the patient’s point of view. They also got students to use their own devices to view the videos which aided the scalability of the approach, so equipment numbers would not restrict numbers within a teaching group.
The Mental Health nursing team saw the potential for this approach to be used to help gain understanding and empathy for patients in students. It also linked into their simulated practice teaching which tries to give the students an opportunity to replicate the nursing practices they need to develop but on campus. This is a challenge for the Mental Health team as unlike other nursing programmes, many of the scenarios used in simulation are hard to replicate from a patient perspective. They would provide the opportunity for the students to discuss how they felt as the patient and the practices they saw by other health care professionals with each other and academic staff.
We started by discussing the different scenarios patients experience and which of these would be suitable for the video case study. We also looked at the value in the different types of video, and where 360° could add a level of agency for the students, helping them to control, to an extent, their view of the environment they were in. This was not used in all the 5 scenarios as it was felt unnecessary in the context of 3 of the scenes and point of view shots with a Go Pro were used for these instead.
The 5 scenarios covered during the patient journey were:
- Admission with the nurse from home
- Arriving for the first time on the ward
- Experiencing a communal dining area (360°)
- Outside in a corridor waiting for a meeting
- Within a multi-disciplinary meeting where several staff are discussing your care (360°)
Subject matter experts including health care practitioners, Experts by Experience (ex-patients) and academic staff created the video scripts, played parts in the video and helped to shape the delivery of this to students, ensuring an authentic patient case study. The videos were designed to contain several layers of learning, allowing students to identify how the person would feel in the situation, the practices that were good and bad as well as the nuances, which might be small but could, have a significant effect on the patient’s experience. Sustainability was built into the video design by recommending the patient was generic. Referring to them as ‘Sam’ could mean they were either male or female and from a variety of ethnicities and as no details were included of the reason Sam was entering the health care system, this meant different scenarios could be applied to the videos helping to change the way students analysed, evaluated and applied the practice seen. The staff took a while to put together scripts drawing on their different experiences and produced it in a format needed by the media team members to help support the filming. The filming itself took place in a day at an empty ward using a couple of the media team members to help with producing and editing the video.
Once the videos were ready, we worked together to develop a plan for how the videos would be delivered in the simulated practice session. The videos were delivered within a simulated practice whole day workshop where the focus was for the students to think how this experience felt for the patient. It became apparent during the pilot run through that the original session plan which had the students watch the video twice, once thinking about how the patient felt and then thinking about the practice, they had seen didn’t work well. For the second run we changed this, first the students watched each video in turn and discussed how this felt as the patient and then in the afternoon in groups, each were given a video to review where they considered the practice they had seen, identifying elements which were good and bad. Excluding the pilot, the finalised session was delivered to 54 students in total.
There were a few technical problems, and these were often related to the use of the Virtual Reality goggles and the student’s own devices. It could be difficult for them to align their devices correctly in the goggles and some students found getting the sound to work using headphones difficult. Although there were a few areas where I found more support was needed, the technology itself was easy for the students to use. They either accessed the videos using QR codes or through shortened URLs.
At the start of the session we asked students to complete a short questionnaire and it started with asking their agreement to the following statements:
- I am confident that I understand the lived experience of the service users
- I am confident that I can empathise with the lived experience of service users
- I am confident that I can critically reflect on the nuances within my practice which contribute to the positive and negative experiences of care.
They were asked to answer these questions again after watching the videos and it was interesting to see their responses to these statements. We found that although their overall agreement to these statements did not differ there was a difference with their level of agreement with more students strongly agreeing (rather than just agreeing). This has helped us to understand the impact this activity had on their learning, helping to reinforce empathy, understanding and critical reflection on their own practice. We also found it interesting that although only 74% of students said they would make changes to their practice, 94% of the students felt the session helped them to consider aspects of patient care and treatment they had previously not considered.
The further evaluation questions explored the use of the videos and how students interacted with them. 72% of the students used the headset at least once to watch a 360 video, however, we noted that during the session most of the students stopped using them and preferred viewing the video in a non-immersive way. They often cited that the goggles made them disorientated, the video looked blurry or they could not get the alignment right with their device. Both the first-person videos and 360 videos were effective approaches with 70% of the students saying they would watch the videos again.
The process of getting the script written and produced by the academic staff was the longest part of the process and working around other work commitments was also challenging. However, we saw real value in seeing this through and it was really pleasing to see the result, especially when the questionnaire clearly showed the videos had some impact on the students. It would be good to extend the use of this approach and pull in other areas of health care perhaps making the creation of the videos an interprofessional experience and helping students from different subject areas to work more closely together on discussing the patient experience from their different perspectives.