Development of an Innovative Digital Environments in Kosovo for learning, eHealth, and eRehabilitation

In healthcare, professional interaction skills are needed not only in patient contacts but also when working in interprofessional teams. Team members have different backgrounds, and they might have different understanding of how to work together. This underlines the importance of clear communication and teamwork. (Schmutz, Meier & Manser 2019.) Communication plays an important part in developing collaboration in teams and in the development of interprofessional empathetic relationships (Adamson et al. 2018). Already from the beginning of the studies, Metropolia UAS`s Degree Programme in Nursing Curricula (Metropolia UAS 2022) requires the student to grow their understanding about the significance of ethics and professional interaction, and consider patient’s needs for psychosocial support. The students also need to practice working methods considering patient safety and the significance of professional interaction. As a Metropolia master`s student in the Creativity and Arts in Social and Health Fields degree programme, I had an opportunity to instruct a teamwork and communication workshop using drama-based exercises. Drama-based exercises and games may be used to warm up, introduce and practice new skills, improve concentration and have fun. A recent literature review by Jeffries et al. (2021) brings out the ways how drama can support student learning and professional development. Drama-based working methods can enhance empathy, emotional engagement, and empowerment, also increase understanding of one’s own professional identity, self-awareness, self-reflection and improve communication skills. In addition, using drama can develop reflective skills. There is strong evidence of the positive role of the arts in improving health and wellbeing. A review conducted by the World Health Organization summarizes evidence from more than 900 such studies (Fancourt & Finn 2019). Drama-based workshop The three-hour drama-based workshop was conducted with international students in the advanced phase of the Degree program in Nursing, with two Metropolia nursing lecturers observing. The workshop consisted of exercises and reflective discussions. The discussion topics included teamwork interaction, communication skills and presence as key factors related to patient safety behaviour and empathy in healthcare. Students experienced the workshop as very important and useful, fun, stress relieving and they got their minds rested. They felt the atmosphere was safe and it was meaningful to hear others` thoughts, have good discussions and to connect with fellow classmates. As they expressed it, the workshop gave them: “Awareness of yourself and others”, “What wasn`t said with words was felt”, “Thank you for making me feel better”, “I feel relieved and fresh”, “The workshop was really great and it is one way to connect with our fellow classmate and hopefully it will be the same in the future”, “It helped me get comfortable with my classmates”, “Engagement between teacher and other classmates”. As take-home messages, elements taken into studies and work, the students mentioned the need for practicing good listening and acknowledgement skills in conversations with colleagues and patients: “Closed-loop-conversations with colleagues & patients”, “Communication is a key to have on successful outcome of the situation”, “It`s about how I focus”, “Repeating messages & hearing to confirm”, “Importance of communication (effective), importance of listening to self and others, trust”. The importance of eye contact and touch in human connection were mentioned several times as very meaningful techniques in communication: “The importance of human connection and touch”, “Eye to eye contact seems so simple but gives connection to someone”, “That human contact holds more importance than I thought originally”. In addition, the students found tips for releasing stress and better concentration. As they expressed it: “There is a touch that makes us feel that today is gonna be okay so just breathe and relax”, “Staying calm and staying focused”. Based on feedback this workshop was well accepted and beneficial. The exercises seemed to foster teamwork and communication skills and evoked thoughts about empathy. The students wished the workshop to be regular. However, it is important to keep in mind, that this kind of activity may not be comfortable for everyone. Interaction and teamwork exercises are beneficial Two Metropolia nursing lecturers were observing the workshop. “During the workshop, the students threw themselves into the exercises and learning seemed to be both fun and relaxing, but at the same time thought-provoking and insightful. We see the importance of interaction and teamwork exercises when studying to become a nurse. Our students are in the graduation phase, so the timing was suitable for this kind of exercise. The workshop sparked a lot of discussion among the students and based on the feedback given to us, they found the exercises very useful. Minna-Maria had a calm but at the same time inspiring and encouraging way of guiding the workshop, and the students clearly liked the experiential learning method.” The workshop also became a significant learning experience for the organizers, and they were glad that their activity was well received and appreciated. It made a milestone also for them as future professionals.  References & interesting readings Adamson, K., Loomis, C., Cadell, S., & Verweel, L.C. 2018. Interprofessional empathy: A four-stage model for a new understanding of teamwork. Journal of Interprofessional Care. 2018 Nov; 32(6), 752-761 Metropolia UAS 2022. Degree Programme in Nursing, Curricula 2022-2013. Study guide. https://opinto-opas.metropolia.fi/88094/en/108/70308?lang=en Dehnavi, M., Estebsari, F., Kandi, Z.R.K., Milani, A.S., Hemmati, M., Nasab, A.F., & Mostafaie, D. 2022. The correlation between emotional intelligence and clinical competence in nurses working in special care units: A cross-sectional study. Nurse education today 2022, Vol.116, p.105453-105453 Fancourt, D. & Finn, S. 2019. What is the evidence on the role of the arts in improving health and well-being? A scoping review. Health Evidence Network synthesis report 67, WHO. https://www.euro.who.int/en/publications/abstracts/what-is-the-evidence-on-the-role-of-the-arts-in-improving-health-and-well-being-a-scoping-review-2019 Jefferies, D., Glew, P. Karhani, Z., McNally, S. & Ramjan, L.M. 2021. The educational benefits of drama in nursing education: A critical literature review. Nurse Education Today Volume 98, March 2021, 104669 Raatikainen, E., Rauhala, L. A., & Mäenpää, S. 2017. Qualified Empathy. A key element for an empowerment professional. Sosiaalipedagoginen aikakauskirja, 18, 113–21 Schmutz, J.B., Meier, L.L. & Manser, T. 2019. How effective is teamwork really? The relationship between teamwork and performance in healthcare teams: a systematic review and meta-analysis. BMJ Open.  https://bmjopen.bmj.com/content/9/9/e028280   Writer Minna-Maria Mattila, Metropolia master`s degree student I work at medical students` skill lab at University of Helsinki Faculty of Medicine. I also work as part-time entrepreneur in arts-based workshops. I have a degree in nursing (RN, BN) and I have studied drama education to support arts-based activities. I have a long experience and studies in the field of performing arts.     Students and lecturers have given permission to use comments and quotes. The Master's degree in Creativity and Arts in Social and Health Fields (CRASH) provides strong competences to act as a developer, innovator, expert, and leader in using creativity and arts in various operating environments in social and health fields. It also gives competences to work in expert positions in the social and health sector. Creativity and different ways to express it, as well as cultural activities and arts related experiences, belong to all people as part of a good and meaningful life. The aim of CRASH is to strengthen the professional competences needed when promoting health, well-being, inclusion, and a sense of community in society through creativity and arts. You can read more about the programme here

Empathy has traditionally been taught through: Informal learning opportunities, like Service Learning projects (Engaged scholarship) (Trad 2013). Movie review reflections (Briggs, Fox & Abell 2012). Literature and poetry readings (Shapiro, Morrison & Boker 2004) Learning communication skills (Winefield & Chur-Hansen 2000) Self-assessments: different types of empathy self-evaluation measures (e.g. The Empathy Scale for Social Workers, ESSW) (King, S. & Holosko, MJ 2011). What if, instead of focusing on the verbal, oral or written reflection of learning, holistic experiences would be emphasized when teaching critically important empathy skills? In this blog text, we introduce a way of teaching empathy through aesthetic learning by using creative, multisensory methods. Austring and Sørensen (2012) have shown that aesthetic methods are particularly efficient for expressing and interpreting emotions.  When working with our first year Bachelor’s students, we gave them a series of versatile and inspiring visualization and visual art tasks through which they could develop an experiential understanding of empathy. How did we practically implement the Teaching and Learning of Empathy in the Social Services Degree Programme at Metropolia UAS? The idea behind our project on qualified empathy was to facilitate students in taking their learning from a cognitive and discursive level to an experiential understanding, as if they were the client, in order to develop a better understanding of the client’s ”experiential” world. ‘Qualified Empathy’ is defined as the ability to reflectively and emotionally separate oneself from the other and to understand the context; then in an intentional process, focus on understanding the other person’s viewpoint both cognitively and emotionally (Raatikainen, Rauhala & Mäenpää, 2017).  The following are key phrases used to express our movement through the process of developing our qualified empathy skill: The qualified empathy learning process took place in a sixteen-calendar week timeframe during the first-year studies.  The participants were students (n=47) from the Social Services degree programme (2015- 2017*). Two study modules were included: 1) Individual and Community Counselling (5 cu) and 2) Supporting Daily Lives through Social Pedagogical Work and the first internship (15 cu) (Metropolia Degree Programme Curriculum, 2016). Figure: Three ways of Learning During the Individual and Community Counselling course, the students were guided through the three ways of learning and introduced to the theoretical underpinnings of empathy as well sensory activation exercises such as visualization and reflection (discursive and aesthetic learning).  Students took part in a storytelling/visualization exercise focusing on refugees fleeing to Europe.  As this topic has been very prominent in the media and public discussion, we wanted to help the students get in touch with the emotional dimension that the refugees themselves might be experiencing. Images and sounds were used in the background as students were instructed to close their eyes and listen to the story while visualizing in their heads the thoughts and emotions a young refugee boy travelling with his younger siblings might be experiencing while crossing a storm-tossed sea in an overloaded boat. Afterwards, students were asked to ponder on their experience and then share and reflect with the group what emotions and thoughts they had.  We then discussed the different understandings they had from reading and learning the factual information about the refugee crisis (discursive learning) and the more experiential understanding after the visualization and reflection exercise (aesthetic learning).  This was then reflected back onto the previously explored theoretical framework of empathy as discussed by Gerdes and Segal (2009) regarding the components of empathy (cognitive processing, affective response and conscious decision-making). ‘How do I feel, when I feel empathy?’ During the Supporting Daily Lives and Internship module, students used visual arts as the method of exploration. They used gouache paints as a medium to express their understanding of how they ‘feel’ when they feel empathy, and then expressed it through color choices and use of paint. Some groups decided not to communicate verbally while they were working. Giving meanings to different colors, brush movements and simultaneously mirroring other group members’ body gestures and reactions helped them when trying to describe and express their own understanding of their feelings of empathy towards others and other’s perspectives on the matter. The core questions in teaching empathy by using aesthetic methods were: ‘How do I feel, when I feel empathy?’, ‘How do I understand another person’s experience’ and later ‘How do I refine the feeling of empathy to qualified empathy towards the client and what does it mean?’. So…how did the students experience the process? During the one-semester long process, starting from the counselling course and ending with the internship, the students moved from defining the concept as “the skill of stepping into another’s shoes” and were verbalizing it in more “qualified” terminology such as “Qualified Empathy means supportive rather than reactive actions to client situations”. By this, they meant to say that the social services provider is not solely reacting according to their own feelings but is rather reflecting on and transforming their own feelings into actions that support the clients. The quotes and pictures below show how students reflected verbally and through art on their own learning.  This process helped them to concretize their learning because they had to explain it to someone else.   ”Using the concept of ”qualified empathy”, it was way easier to understand the kids and  deal with the problems they were facing…I stopped judging misbehaving kids and came to understand the reasons behind their behavior.” (DR)     The ”qualified empathy” part was the most difficult for me.  I didn’t quite grasp the difference between ”normal” empathy and ”qualified” empathy during the lectures and I had to re-read some of the material. Now I think I understand the concept better, but it is still hard to connect it to practice.” (HP)   ”Qualified empathy” helped me to get into his shoes and to feel his concerns and worries in order to prevent situation(s) where he would feel insecure.” (AP) Where do we go from here? Although the process of teaching empathy skills has traditionally focused on the verbal, oral or written reflection of learning, research has not systematically reviewed holistic ways of learning empathy in the literature.  We feel that it is vital to raise awareness about how important aesthetic methods can be in helping students to understand and experience the development of their empathy skills in a safe and creative environment.  If we expect the people we serve to engage with us in an authentic manner, is it not important that we teach our students to engage authentically in the learning process themselves?  Aesthetic methods give us an efficient method to access the often-unexplored territory of the individual’s perceived experience. For social and healthcare providers, we think it is also essential to raise the student’s awareness of their own emotional capacity and ability to use their empathy skills so that they can protect themselves from compassion fatigue and burnout. We would like to leave the reader with the following thought: while the social and healthcare fields have a great need for practitioners to be able to access and ethically use their empathy skills when working with vulnerable populations there is the larger question of the importance of people working humanely and empathically in other fields which have human interaction as part of their process. Those readers living their adventure in other contexts such as business, engineering, IT, and education we would love to hear your thoughts and ideas in the comments section. How could your field benefit from learning empathy skills? *NORDPLUS PROJECT QUALIFIED EMPATHY (2015-2017) Writers Writers are lecturers in the Social Services Degree Programme at Metropolia UAS. Leigh Anne Rauhala (MSW, LCSW) teaches social work/pedagogy courses in the English Language Degree Programme in Social Services (Sosionomi AMK) and works internationally in the Social Work in Urban Areas joint programme. Eija Raatikainen, PhD, is Senior lecturer in University of Applied Sciences of Metropolia in Social Service programme. Her academic focus in “Trust” as a phenomena in different field, as like in social work and educational practice. She also worked as the Vocational teacher educator in University of Applied of Sciences of HAAGA-HELIA in the teacher education programme. In addition, she has a five years’ experience as an academic coordinator in  multicultural and multiprofessional Erasmus Intensive Programme(Poverty and Social Exclusion (2011-2013) and Combating Risk behavior Among Youngster (2014-2015). She has also worked in other projects (Matti, MOTIIVI, Tutu, SOCRE). Seija Mäenpää has a Master’s Degree in Art Education and currently works for Metropolia University of Applied Sciences in the Social Wellbeing Unit. She specializes in combining a social pedagogical approach with visual arts in working with different people in social work sector. Visual arts education is one focus of her collaboration projects in early childhood education. She is a founding member of the INECS network (International Network for Creative Professionals in Education of Social Pedagogical Work http://blog.han.nl/inecs). Her vocation is to make visual arts activities and visual culture accessible for everyone. Sources Austring, B. D & Sørensen, C. M. 2012. A Scandinavian View on the Aesthetics as Learning Media. Journal of Modern Education Review 2 (2) 90–101. Briggs, C. L., Fox, L. & Abell, C.H. 2012. The Influence of Film on the Empathy Rating of Nursing students. International Journal for Human Caring. Vol.16, 2. 59-63. Gerdes, Karen & Segal, Elizabeth. 2011. Importance of Empathy for Social Work Practice: Integrating New Science. Social Work 56 (2), 141-147. King, S. & Holosko, M.J. 2011. The Development and Initial Validation of the Empathy Scale for Social Workers. Research on Social Work Practice 22(2) 174-185. Metropolia Curriculum (2016). http://opinto-opas-ops.metropolia.fi/index.php/en/88094/en/70321/SXG16S1/year/2016 Raatikainen E., Rauhala L., Mäenpää S.2017.Qualified Empathy- a Key Element for an Empowerment Professional.Sosiaalipedagoginen aikakausikirja, vuosikirja 2017,vol18. Shapiro, J.,  Morrison, E.H. & Boker, J.R. 2004. Teaching Empathy to First Year Medical Students: Evaluation of an Elective Literature and Medicine Course.  Educational for Health, Volume 17, 1. 73-84. Trad, M. 2013. Teaching Communication Skill and Empathy through Engaged Sholarship. Radiation therapist, Volume 22, 1. 21-31. Winefield, H.R. & Chur-Hansen, A. 2000. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increases? Medical Education, 34: 90-94 Article picture: www.pixabay.com, Gordon Johnson (CC0)  

Originally published on the blog Hiiltä ja timanttia: Qualified Empathy – the new superpower! Can using aesthetic methods help you flourish? Empathy has traditionally been taught through: Informal learning opportunities, like Service Learning projects (Engaged scholarship) (Trad 2013). Movie review reflections (Briggs, Fox & Abell 2012). Literature and poetry readings (Shapiro, Morrison & Boker 2004) Learning communication skills (Winefield & Chur-Hansen 2000) Self-assessments: different types of empathy self-evaluation measures (e.g. The Empathy Scale for Social Workers, ESSW) (King, S. & Holosko, MJ 2011). What if, instead of focusing on the verbal, oral or written reflection of learning, holistic experiences would be emphasized when teaching critically important empathy skills? In this blog text, we introduce a way of teaching empathy through aesthetic learning by using creative, multisensory methods. Austring and Sørensen (2012) have shown that aesthetic methods are particularly efficient for expressing and interpreting emotions.  When working with our first year Bachelor’s students, we gave them a series of versatile and inspiring visualization and visual art tasks through which they could develop an experiential understanding of empathy. How did we practically implement the Teaching and Learning of Empathy in the Social Services Degree Programme at Metropolia UAS? The idea behind our project on qualified empathy was to facilitate students in taking their learning from a cognitive and discursive level to an experiential understanding, as if they were the client, in order to develop a better understanding of the client’s ”experiential” world. ‘Qualified Empathy’ is defined as the ability to reflectively and emotionally separate oneself from the other and to understand the context; then in an intentional process, focus on understanding the other person’s viewpoint both cognitively and emotionally (Raatikainen, Rauhala & Mäenpää, 2017).  The following are key phrases used to express our movement through the process of developing our qualified empathy skill: The qualified empathy learning process took place in a sixteen-calendar week timeframe during the first-year studies.  The participants were students (n=47) from the Social Services degree programme (2015- 2017*). Two study modules were included: 1) Individual and Community Counselling (5 cu) and 2) Supporting Daily Lives through Social Pedagogical Work and the first internship (15 cu) (Metropolia Degree Programme Curriculum, 2016). [caption id="attachment_1415" align="alignnone" width="480"] Figure: Three ways of Learning[/caption] During the Individual and Community Counselling course, the students were guided through the three ways of learning and introduced to the theoretical underpinnings of empathy as well sensory activation exercises such as visualization and reflection (discursive and aesthetic learning).  Students took part in a storytelling/visualization exercise focusing on refugees fleeing to Europe.  As this topic has been very prominent in the media and public discussion, we wanted to help the students get in touch with the emotional dimension that the refugees themselves might be experiencing. Images and sounds were used in the background as students were instructed to close their eyes and listen to the story while visualizing in their heads the thoughts and emotions a young refugee boy travelling with his younger siblings might be experiencing while crossing a storm-tossed sea in an overloaded boat. Afterwards, students were asked to ponder on their experience and then share and reflect with the group what emotions and thoughts they had.  We then discussed the different understandings they had from reading and learning the factual information about the refugee crisis (discursive learning) and the more experiential understanding after the visualization and reflection exercise (aesthetic learning).  This was then reflected back onto the previously explored theoretical framework of empathy as discussed by Gerdes and Segal (2009) regarding the components of empathy (cognitive processing, affective response and conscious decision-making). ‘How do I feel, when I feel empathy?’ During the Supporting Daily Lives and Internship module, students used visual arts as the method of exploration. They used gouache paints as a medium to express their understanding of how they ‘feel’ when they feel empathy, and then expressed it through color choices and use of paint. Some groups decided not to communicate verbally while they were working. Giving meanings to different colors, brush movements and simultaneously mirroring other group members’ body gestures and reactions helped them when trying to describe and express their own understanding of their feelings of empathy towards others and other’s perspectives on the matter. The core questions in teaching empathy by using aesthetic methods were: ‘How do I feel, when I feel empathy?’, ‘How do I understand another person’s experience’ and later ‘How do I refine the feeling of empathy to qualified empathy towards the client and what does it mean?’. So…how did the students experience the process? During the one-semester long process, starting from the counselling course and ending with the internship, the students moved from defining the concept as “the skill of stepping into another’s shoes” and were verbalizing it in more “qualified” terminology such as “Qualified Empathy means supportive rather than reactive actions to client situations”. By this, they meant to say that the social services provider is not solely reacting according to their own feelings but is rather reflecting on and transforming their own feelings into actions that support the clients. The quotes and pictures below show how students reflected verbally and through art on their own learning.  This process helped them to concretize their learning because they had to explain it to someone else. ”Using the concept of ”qualified empathy”, it was way easier to understand the kids and  deal with the problems they were facing…I stopped judging misbehaving kids and came to understand the reasons behind their behavior.” (DR) The ”qualified empathy” part was the most difficult for me.  I didn’t quite grasp the difference between ”normal” empathy and ”qualified” empathy during the lectures and I had to re-read some of the material. Now I think I understand the concept better, but it is still hard to connect it to practice.” (HP) ”Qualified empathy” helped me to get into his shoes and to feel his concerns and worries in order to prevent situation(s) where he would feel insecure.” (AP) Where do we go from here? Although the process of teaching empathy skills has traditionally focused on the verbal, oral or written reflection of learning, research has not systematically reviewed holistic ways of learning empathy in the literature.  We feel that it is vital to raise awareness about how important aesthetic methods can be in helping students to understand and experience the development of their empathy skills in a safe and creative environment.  If we expect the people we serve to engage with us in an authentic manner, is it not important that we teach our students to engage authentically in the learning process themselves?  Aesthetic methods give us an efficient method to access the often-unexplored territory of the individual’s perceived experience. For social and healthcare providers, we think it is also essential to raise the student’s awareness of their own emotional capacity and ability to use their empathy skills so that they can protect themselves from compassion fatigue and burnout. We would like to leave the reader with the following thought: while the social and healthcare fields have a great need for practitioners to be able to access and ethically use their empathy skills when working with vulnerable populations there is the larger question of the importance of people working humanely and empathically in other fields which have human interaction as part of their process. Those readers living their adventure in other contexts such as business, engineering, IT, and education we would love to hear your thoughts and ideas in the comments section. How could your field benefit from learning empathy skills? *NORDPLUS PROJECT QUALIFIED EMPATHY (2015-2017) Writers Writers are lecturers in the Social Services Degree Programme at Metropolia UAS. Leigh Anne Rauhala (MSW, LCSW) teaches social work/pedagogy courses in the English Language Degree Programme in Social Services (Sosionomi AMK) and works internationally in the Social Work in Urban Areas joint programme. Eija Raatikainen, PhD, is Senior lecturer in University of Applied Sciences of Metropolia in Social Service programme. Her academic focus in “Trust” as a phenomena in different field, as like in social work and educational practice. She also worked as the Vocational teacher educator in University of Applied of Sciences of HAAGA-HELIA in the teacher education programme. In addition, she has a five years’ experience as an academic coordinator in  multicultural and multiprofessional Erasmus Intensive Programme(Poverty and Social Exclusion (2011-2013) and Combating Risk behavior Among Youngster (2014-2015). She has also worked in other projects (Matti, MOTIIVI, Tutu, SOCRE). Seija Mäenpää has a Master’s Degree in Art Education and currently works for Metropolia University of Applied Sciences in the Social Wellbeing Unit. She specializes in combining a social pedagogical approach with visual arts in working with different people in social work sector. Visual arts education is one focus of her collaboration projects in early childhood education. She is a founding member of the INECS network (International Network for Creative Professionals in Education of Social Pedagogical Work http://blog.han.nl/inecs). Her vocation is to make visual arts activities and visual culture accessible for everyone. Sources Austring, B. D & Sørensen, C. M. 2012. A Scandinavian View on the Aesthetics as Learning Media. Journal of Modern Education Review 2 (2) 90–101. Briggs, C. L., Fox, L. & Abell, C.H. 2012. The Influence of Film on the Empathy Rating of Nursing students. International Journal for Human Caring. Vol.16, 2. 59-63. Gerdes, Karen & Segal, Elizabeth. 2011. Importance of Empathy for Social Work Practice: Integrating New Science. Social Work 56 (2), 141-147. King, S. & Holosko, M.J. 2011. The Development and Initial Validation of the Empathy Scale for Social Workers. Research on Social Work Practice 22(2) 174-185. Metropolia Curriculum (2016). http://opinto-opas-ops.metropolia.fi/index.php/en/88094/en/70321/SXG16S1/year/2016 Raatikainen E., Rauhala L., Mäenpää S.2017.Qualified Empathy- a Key Element for an Empowerment Professional.Sosiaalipedagoginen aikakausikirja, vuosikirja 2017,vol18. Shapiro, J.,  Morrison, E.H. & Boker, J.R. 2004. Teaching Empathy to First Year Medical Students: Evaluation of an Elective Literature and Medicine Course.  Educational for Health, Volume 17, 1. 73-84. Trad, M. 2013. Teaching Communication Skill and Empathy through Engaged Sholarship. Radiation therapist, Volume 22, 1. 21-31. Winefield, H.R. & Chur-Hansen, A. 2000. Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increases? Medical Education, 34: 90-94 Article picture: www.pixabay.com, Gordon Johnson (CC0)