Does an immersion in a so called sTimul care ethics lab provide nursing students with insights into dimensions of empathy? Trees Coucke, participant of the research group Critical Ethics of Care, gives insight into her PhD research.
“After a career in health care of more than 30 years and being a teacher of nursing, it became clear to me that students know very well what good ethical care is. They are able to articulate theoretically what good care means to them. They know – theoretically – which fundamentals should be part of good care. However, in practice on an internship it is often not possible to realize their ideals because of various forces of pressure in institutional care. The students try, as interns, very hard to meet both the requirements of the school and the needs of the care recipients in their successive internships. Their performance and care giving is being evaluated and they need to get a positive appraisal. But at the same time students should be in a free position to evaluate critically the institutions (school and hospital) and to stand up for the individual questions and needs of care recipients, which they come across.
It is the quest for the possibilities to train or strengthen students in their caring attitude on the one hand and critical attitude on the other hand which are motivating me for my research project.”
In a first article (in review), a literature study was done based on the question whether empathy is a motive to encourage people to provide ‘good care’.
A second article (work in progress) will investigate whether and to what extent moral imagination among students can play a role in forming a possible motive to adopt an attentive caring attitude.
An attempt to let students and care providers experience how a care recipient might feel, was set up in 2007 in the form of sTimul – a care ethics lab.
sTimul care ethics lab
This care ethics lab in Flanders was set up initiated by the researcher and two of her colleagues. Students and experienced care providers (further: simulants) were exposed (for ‘exposure’ see Baart 2014) to different aspects of care dependency in a simulated situation. The aim of the researcher was to make the students and care providers reflect on lifelike experiences of real care receivers. Some research was done among simulants (Vanlaere et al. 2012), but not yet about the possible effect of such an immersion among students.
The researcher wants to understand what an experience of being dependant does with nursing students in the light of acquiring a caring and attentive attitude. The idea is that if students personally experience (a bit of) dependency, they might get a better insight into the effect or the influence of their own care actions on care receivers. The lab experience clarifies that being convinced of meeting the standard of “good care” (caregivers) might be in conflict with the care receivers’ perception of care. In sTimul this has been a real eye-opener: sometimes for the first time, a care receiver gives feedback directly to the caregiver about his or her experiences of care receiving.
“The aim of experiencing a sTimul lab is that nursing students will strive for humanitarian care for those who depend on it. They come to realize that respect and attention can make a major difference for care receivers. A better understanding of and connecting with the true needs and expectations of vulnerable, care dependent people, improves ‘good care’.
sTimul is located in a building that has been converted into a kind of department of a hospital or nursing home. The rooms are furnished as if real needy people could be admitted and taken care of. There are hoists, high beds and several kinds of materials are helpfull to simulate limitations. People are fed, washed, lifted, cared for et cetera as if they were temporarily limited.
In a sTimul lab students experience three hours of care receiving in a care-dependent position. They are also caregivers for three hours to a classmate. Afterwards they give each other feedback about the given and received care. Secondly they reflect on the learning aspects of their own experiences and the feedback from ‘the other side’. They reflect on the relevance of it for their further development to become a trained nurse.”
This care ethics lab is a care project that involves both the professional and educational field. There are two-day sessions with both experienced caregivers and students, but also one-day sessions with only student participants. The latter is called the Nurse Ethics Lab sessions (N.E.L.). Besides nursing students and simulants, the lab offers immersion sessions, allowing employees and healthcare students to experience what it is to be dependent on care. One or two day sessions have been developed specifically for this target group, supervised by experienced sTimul trainers.
Change of perspective
“The ultimate goal of all immersion sessions is the change of perspective. Participants experience from a first person perspective what it is like when needs are met or not met. They get new insights, learn to show empathy and learn ‘deep listening’ and understanding the needs, questions and anxieties of the care receiver. Reflection on experience is an essential part of the immersion sessions. All participants are invited to reflect on their own performance, either in acting or undergoing and maybe as a result of it they will act differently from then on. They are given tools to apply their findings to their professional daily care practices or their next education related internships.”
Aim of the study
“This PhD project covers the written report of the nursing students after an immersion session in sTimul, a NEL session. During the immersion, the students opt for a certain degree of dependence through the application of restrictive measures (spectacles, immobilization, deaf, paralyzed …). They thereby suffer the physical and psychological concerns that occur in these forms of dependence.”
Subject of the research
“Does the concept of empathy comprise enough elements to provoke an attentive and caring attitude among students and professional care givers? Does empathy itself motivate them to act as such? That question is the subject of my research.
In my view, more is needed than just the concept of empathy. During the process of analyzing the reports, we will be attentive to other concepts that might prove to be necessary for a good caring attitude.”
Design of the research.
During a period from June 2016 to December 2017, a total sum of 226 student reports was collected. The students wrote these reports after going through a NEL session. They were asked to describe their experiences. The assignment was:
“You probably told someone you would go to sTimul?
Would you like to tell this person now what experiences you had and what you have learned about … how it can be to be a patient, how you think about nursing, what your image of care is now, what have been good and less good experiences …
(please note, this is not an evaluation of sTimul itself)”
The research is a qualitative, phenomenological empirical research. The student reports were entered into Atlas.ti data management software version 8.1.3 and were coded and analyzed by content analysis.
The 226 reports were collected in two sTimul houses among different ‘types’ of students. All students followed a nursing course, either bachelor or undergraduate nursing. It concerned first year students (117 letters), second year students (62 letters) and third year students (47 letters). The first-year students wrote the report just after their immersion session. The second-year students were asked to write down their experiences one year after their immersion session, while the third-year students had attended a two-day session in which they had taken on the role of caregiver (exceptionally, some of them were care receiver as well). The reports were collected by teachers from the various schools (8) and were all written during a school hour. They were physically delivered, collected or delivered to the researcher via mail or by email. The written letters were literally typed out and tagged, the digitally delivered letters were placed in a format without making any text changes. All material was anonymized and coded.
In addition to the written reports, 15 in-depth interviews were conducted. Of which 8 with students right after writing their report in order to find out more about the meaning of their written words. Sometimes a student can give more explanation in spoken words than in writing. 7 former students were also interviewed. They had attended a sTimul session 6 to 8 years ago and were invited to collaborate via email (adresses collected at the schools). The main questions were: 1. Please tell us about what you remember of your sTimul experience. 2. What do you actually do with the experiences from a long time ago in your professional life? These interviews are fully transcribed verbatim and they will be included in the analysis in the same way (with the same code) as the reports and other interviews.
The researcher is currently working on the coding and analyzing of the reports and interviews. That process will last until (possibly) saturation occurs. She hopes to generate a first overview of the results by the end of 2019. In the meantime, an article is being prepared about empathy in health care: “Is empathy sufficient to encourage a healthcare provider to provide good care?”
This study is conducted under the supervision of Prof. Dr. A. Baart, founder of the Theory of Presence and Prof. Dr. Em. M. Grypdonck.
The researcher was admitted as a PhD student to the Graduate School of the University of Humanistic Studies in Utrecht in 2015. She is a bachelor nurse and master in nursing science. She is a lecturer at the University of Applied Sciences Vives Bruges (bachelor degree) and at the school for nursing RHIZO HBO5 (graduate degree) at Bruges.
The researcher is very grateful to the management of the RHIZO school which, by supporting this PhD, is enabling this research project.
Baart A. (2004) Een theorie van de presentie. Uitgeverij Lemma, Den Haag
Vanlaere L., Timmermann M., Stevens M., Gastmans C. (2012) An explorative study of experiences of healthcare providers posing assimulated care receivers in a ‘care-ethical’ lab. Nursing Ethics 19 (1): 68–79.