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Empathy is vital in the work of NHS staff, but it's not always part of their professional development. Persis Jadé Maravala is collaborating on a project to improve healthcare training using touch.

Within Touching Distance by ZU-UK, 2023

Sharron Wallace

“Touch comes before sight, before speech. It is the first language and the last, and it always tells the truth.” Margaret Atwood, The Blind Assassin.

There is plenty of evidence that compassion, empathy and the use of affective touch in nursing and care improve patient wellbeing - especially for mental health patients who are most affected by lack of empathy. But academic and education colleagues from the healthcare training sector consistently speak of the lack of focus on empathy skills in undergraduate nursing courses. 

Within Touching Distance is an immersive artwork from ZU-UK - part of a larger project in partnership with health researchers at the University of Greenwich – that explores the potential of extended reality (XR) arts-led experiences to develop the use of touch and empathy in mental health care. We aim to use our work in training for nurses and carers, in co-designing with mental health patients, as well as exploring its potential in therapy settings. 

I am co-founder and Artistic Director of ZU-UK - a disabled-led, global majority-led, female-led theatre and digital arts company. In a world in which loneliness has reached epidemic levels, we at ZU-UK believe in the need for shared rituals, new narratives and experiences that empower the most vulnerable to experience culture and to make excellent art.

Creating imaginative frameworks to shift perspectives

Within Touching Distance is a one-to-one mixed reality experience that combines human touch and virtual reality. Exploring the fragile nature of life and the comfort of human connection, the audience is taken from childhood through to old age, exposed to the nature of touch as it is experienced by an infant and a person in palliative care. 

A live performer, embodying an amma (mother-figure), greets each participant and guides them silently, with light application of touch as a means of instruction, through the process of getting ready for and into bed, including helping them into a VR headset. The VR experience, combined with a soothing touch choreography from the performer, takes participants through human life cycles, highlighting how our experiences change the way we interact, at a sensory level, with the world.

When we talk of empathy in this project, it is about creating imaginative frameworks within which trainee carers can shift perspectives and experience what it’s like to see, hear, think and feel from the point of view of a patient. However, the empathy we foreground is bound up with skin-to-skin human touch. We are talking about the embodied experience physically expressing and receiving care in the company of another human. 

A touch-starved society

Touch is important in human development; it unlocks the automatic response system within the parasympathetic nervous system of the body to recognise safety. As such, it is an important tool in the treatment of mental illness and trauma. As a patient in recovery myself, it helps with the lingering effects of depersonalisation and derealisation. 

In a touch-starved society, the act of touching activates the vagus nerve, which calms the nervous system, releasing oxytocin and generating emotional connection and wellbeing in ways we’re often deprived of in a Western context.  As trauma recovery practitioner, Carmen Spagnola says, we need cyclic patterns to deal with grief and destabilisation. She writes that people need to feel “safe, seen, secure and soothed” to be able to “yield” to emotion. 

The use of touch in Within Touching Distance is a way of practising yielding and holding relationships, to create spaces in which participants feel held and soothed. Performers are trained to touch people with both hands always so that, on an instinctual level, participants never have to worry about what the second hand is doing, thereby closing the circuit, creating a touch-field that can contain a person. Performers are trained to take responsibility for the participant, to enable them to yield.

Putting care at the forefront

Through our collaboration with researchers and nursing educators, we’ve begun paving the way for the application of the techniques and principles we’ve learned. We are hoping to develop a range of new creative XR training experiences to supplement and contextualise existing clinical skills training with patient perspective. 

We’re not just transposing the bare bones of a new technology; our USP is our expertise in interactive storytelling, gently cultivating buy-in to role play situations and sculpting empathy as our core artistic medium. 

Professor of Healthcare Simulation & Workforce Development at the University of Greenwich, Professor Sharon Weldon endorses our work: “Within Touching Distance is a perfect example of the power art has to push the limits of healthcare simulation and make healthcare professionals think beyond their own reality. ZU-UK's use of technology and touch is a powerful way of bringing the essence of what care is back to the forefront of what we do.”

I don’t want anyone to live a life in which they are not touched enough. Something so common should not be experienced so little. For various reasons - some very important - guidance to doctors, nurses, teachers and all in the caring professions is to guard against being too hands on. But we are losing something fundamental as there is no cure and there is no care without touch. 

Persis Jadé Maravala is co-founder and Artistic Director of ZU-UK.
With thanks to project collaborators Professor Jorge Lopes Ramos, co-founder and Executive Director of ZU-UK and Professor at the University of Greenwich and Kesia Guillery, Research Associate at ZU-UK and Research Fellow at the University of Greenwich.
 zu-uk.com/ | gre.ac.uk/research/centres/creative-futures/research

Headshot of Persis Jade Maravala
Headshot of Prof Jorge Lopes Ramos
Headshot of Kesia Guillery