A virtual reality intervention to increase interracial empathy and upstander behaviors in nursing leaders

Efforts to improve diversity, equity, and inclusion (DEI) in healthcare have increased, targeting healthcare worker biases with the goal of increasing inclusion of employees from racial and ethnic minoritized groups and improving care for patients from these groups. Virtual reality (VR) remains an underutilized mechanism for effecting behavior and attitude change. VR educational interventions work through two primary pathways, behavior rehearsal and embodiment. Rehearsal of communication in VR has been shown to improve self-efficacy, including preparedness, comfort, and confidence in speaking up and comforting a patient with anxiety. Embodiment involves users stepping into the point-of-view of an avatar and experiencing a virtual world through the eyes of that avatar. Users can thus experience things through the eyes of someone from a racial/ethnic group different than their own. In this study, we examined the efficacy of a VR intervention with both rehearsal and embodiment components on intergroup attitudes and behaviors in nursing leaders from a large, multi-site health care network with locations in four states of United States. Results showed significant increases, relative to a control group, in empathic feeling and expression, empathic perspective taking, theory of planned behavior-based predictors of increasing upstander behavior, and likelihood of taking action in response to a hypothetical situation where a coworker was treated in a racially biased way. Six to eight months after the intervention, significant increases in each of these measures remained. Empathy and upstander behavioral intention rates were demonstrably improved among nursing leaders towards colleagues facing race-based discrimination. This quantifiable impact reaffirms the program's effectiveness in addressing a critical issue: systemic racism in healthcare settings.