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Role of a Lifetime

Theater Training Helps Students Prepare for World Stage

This exercise was for all the marbles, the culmination of a semester’s worth of study. But senior Kelly Evangelista was prepared and practiced. And she had a plan.

Get straight to the point. Be professional, but be empathetic. Show some warmth.

“I have this,” she thought.

With her professor watching through a one-way window, Evangelista opened the door and stepped inside a lab that looked like a hospital room. On the bed lay a young woman portraying an old woman whose health was failing. With her was a young man who didn’t know she was likely facing the end.

It was up to Evangelista to tell him.

Paul, a 20-something grandson, was the only family member with whom the patient was close. The nursing brief told Evangelista he’d been visiting his grandmother weekly. 

After Evangelista greeted them, her anxiety set in, and the plan to which she had been clinging vaporized. But she had to keep going.

She invited the young man to sit. “So, the last I saw your grandmother, she was doing really well,” she said. “However, in the last couple of days, her condition has deteriorated a little bit. So, we discussed this with her and the doctor, and we haven’t been able to get a whole review, but it looks like she has opted for hospice care.”

“What’s hospice?” he asked.

“Well, whenever a patient decides to go with hospice, that means that they are deciding to refuse any lifesaving measures and are going for comfort—comfort care,” she explained.

“Oh, so she’s getting better because you’re not doing treatment anymore? Right?” he asked.

“Well, typically with hospice, it’s whenever a patient has six months or less to live,” she said.

Paul’s eyes widened in disbelief. “Six months,” he said, his head dropping.

Evangelista looked him in the eye. “I’m sure this is very, very hard for you,” she said calmly and with concern. “Is there anything I can do for you?”

In this simulation for the Performance of Caring class, food and nutrition major Jasmin Sonnet, right, had to ask a colleague, portrayed by Hannah Brennan, to cover a weekend shift for her. Brennan is a criminology major and theater minor. Photo by Keith Boyer

In this simulation for the Performance of Caring class, food and nutrition major Jasmin Sonnet, right, had to ask a colleague, portrayed by Hannah Brennan, to cover a weekend shift for her. Brennan is a criminology major and theater minor. Photo by Keith Boyer

She answered more of his questions about hospice. Then he asked for some time alone with his grandmother. She explained how to reach her if they needed her.

And that was it. Done in under two-and-a-half minutes. But a lesson for a lifetime. She walked out of the room and sighed. Deeply.

“Oh my God, I thought I was going to cry!” she told her professor, Rachel DeSoto-Jackson.

“And you might cry. And that’s okay,” DeSoto-Jackson said. “It’s all right to be in that environment.” 

Really, that was the whole point. To put her in that room at that moment, so she, so her classmates, can understand what it’s like to tell someone that a loved one is probably going to die. Or perhaps has died. Or any other myriad unpleasant things that could arise in a hospital.

For any medical practitioner, these are never easy conversations to have. They’re all the more difficult for practitioners who have no experience with them. IUP, however, wants to change that.

To that end, the university is looking to refine—and expand—a fledgling course originally designed to teach nursing students communication skills through simulated workday encounters. 

Called the Performance of Caring, the class combines traditional classroom work with simulations staged by student actors portraying patients, family members, and coworkers. Started three years ago by former faculty member April Daras, the class has been surging in popularity as word spreads among students who find it well worth the effort.

After a home-care simulation, faculty member Rachel DeSoto-Jackson led a discussion about what went well and what could be improved. From left: Cheyenne Olexa, Kayla Maxwell, DeSoto-Jackson, Joe Sample, Basil Ferguson, and Ali Walker. Photo by Keith Boyer

After a home-care simulation, faculty member Rachel DeSoto-Jackson led a discussion about what went well and what could be improved. From left: Cheyenne Olexa, Kayla Maxwell, DeSoto-Jackson, Joe Sample, Basil Ferguson, and Ali Walker. Photo by Keith Boyer

“The response has been phenomenal,” said DeSoto-Jackson, an assistant professor of applied theater, who teaches the course. “Every single evaluation I received at the end of the semester spoke to the difference the course had made in the students’ practice. To varying degrees and with varying results, it changed them as practitioners.”

The class’s overall goal is to teach students to communicate empathetically. The techniques they’re taught are derived from the theater arts, which is why the class technically is part of the theater curriculum, even though it is for students in other majors. 

In the class, students learn about concepts that are part of any basic acting curriculum—essentially, how to put yourself in someone else’s shoes, how to see the world from that perspective, and how to have some sense of what that person is feeling.

For Evangelista, it has been an invaluable experience.

“By having feedback provided, I learned so much about my natural mannerisms, such as how I tend to fidget when I’m in an uncomfortable situation,” she said.

Recalling her final exercise, she said if she had encountered that situation in real life without having taken the class first, she would have awkwardly stumbled through it. But reviewing concepts such as warmth and empathy showed her that simply being there for patients and their families is just good care.

“It made me much more comfortable in a potential end-of-life situation as well as gave me the skills to approach situations such as this,” she said.

Brian Jones, chair of the Theater and Dance Department, said these sorts of skills are essential, especially nowadays.

“In the field, there is an awful lot of reliance on technology and systems and protocols,” he said. “One of the things in the health care industry that we’re understanding is the need for providers to maximize time with patients. Yet at the same time, their training is pulling them away from that.”

Performance of Caring is one aspect of a broader initiative that eventually could make IUP the regional go-to place to learn the skills these sorts of situations demand. At the same time, it could uniquely enhance IUP’s programs in nursing, allied health, and a number of others, such as criminology and business.

DeSoto-Jackson is spearheading the initiative. In fact, the faculty position she took last fall was created specifically for that purpose.

The initiative centers on the discipline of applied theater, the application of theatrical skills and concepts to things other than traditional theater. Aside from the Performance of Caring class, nursing faculty members Riah Hoffman M’06, D’12 and Shannon Dusack M’09 recently organized a mass shooting simulation to provide lessons to their students about thinking on their feet. Theater students played the wounded, and makeup artists even affixed simulated bullet wounds to the patients.

During a mass shooting simulation in March, nursing students Danielle Gasperi and Cory Haag helped one of the victims, portrayed by Basil Ferguson, into a wheelchair. Graduate assistant Audrey Botsford ’14 is at right. Photo by Keith Boyer

During a mass shooting simulation in March, nursing students Danielle Gasperi and Cory Haag helped one of the victims, portrayed by Basil Ferguson, into a wheelchair. Graduate assistant Audrey Botsford ’14 is at right. Photo by Keith Boyer

The applications for these sorts of simulations stretch well beyond nursing. They could, for instance, help teach business students how to negotiate a deal or show criminology students effective ways to de-escalate a situation.

Already, that expansion has begun. This spring, for the first time, Performance of Caring was open to students from any major. So, alongside the nursing and allied health students are food and nutrition, hospitality management, psychology, and criminology majors. To keep up with the changes, the Theater Department is adapting a room in Waller Hall to support a broader range of simulations.

As far as nursing goes, the use of actors and simulations in medical education isn’t novel. In fact, medical institutions commonly use simulations as an evaluative tool. IUP, however, is a pioneer in using applied theater simulations as a way to teach empathy and embodiment.

Nursing faculty member Roseanne Anderson has been working with DeSoto-Jackson and her student actors to incorporate home-care simulations into her Community Public Health Clinical class. She said she often hears from her students, “Wow—what a difference from talking to a mannequin.”

There are many technical aspects to nursing, Anderson said, “but really, what it’s about is the compassion and caring that nurses provide to make patients feel comfortable and cared for and to help them through difficult situations.” It’s exactly the kind of practice the simulations provide.

For theater students interested in this type of acting, DeSoto-Jackson directs a specialized group called the Simulated Patient/Applied Theater Ensemble. It coaches students and supplies talent for Performance of Caring and other simulations.

Among the ensemble’s members is Alexis Reisinger, a senior musical theater major who joined this year.

“I love learning about new ways that theater can be used in different situations,” she said. “I feel like I’ve seen theater used in a much broader context than ever before.”

Through ensemble work in nursing simulations, Reisinger has portrayed a cancer patient, a caregiver to a cancer patient, a distressed colleague, a teen recovering from surgery, a gunshot victim, a victim suffering from post-traumatic stress disorder, and a family member of a gunshot victim. In and of themselves, the roles would have been challenging enough. But Reisinger said the difficulty is amplified by the fact that her stage partners, the nursing students, have no script to follow.

“Usually you prepare a character and do all of this research and then get up on stage with other actors who have done their research and built a character, and you recreate an exchange between these characters. In SPATE, the other person in the room with me is just trying to do a job, which is really neat. You have no idea what is going to happen when you walk into that room,” she said.

“Sometimes it’s really uplifting. Sometimes it’s awkward. Sometimes the other people don’t know what to do and let their nervousness get the best of them, or they don’t quite take it seriously. It creates a sort of platform where absolutely anything can happen, and I need to be on my toes all the time. It’s a lot like improv, really—there’s only so much preparation you can do.”