Date of Award

Spring 2023

Degree Type

Open Access Dissertation

Degree Name

Education PhD, Joint with San Diego State University


School of Educational Studies

Advisor/Supervisor/Committee Chair

Cristina Alfaro

Dissertation or Thesis Committee Member

Paul J. Zak

Dissertation or Thesis Committee Member

Emilie Reagan

Terms of Use & License Information

Terms of Use for work posted in Scholarship@Claremont.

Rights Information

© 2023 Maria H Keckler


Empathy, Immersive learning, Story, Transdisciplinary research, Transformational learning, Wicked problems

Subject Categories

Education | Neurosciences | Nursing


Background: Empathy Unfolding is a conceptual framework grounded in complexity theory and neuroeducation principles that emerged during the research process and was used to trace the impact of immersive storytelling and transformational learning on nursing education through multiple lenses and measures. The study addressed the complex and multidimensional problem of declining empathetic concern among nursing students and professionals that disproportionately impacts low-income and culturally/linguistically diverse patient communities. Methods: The mixed-methods design centered around a patient story based on actual events, produced in two-dimensional (2D) video and 180° virtual reality (VR) formats. Second-year nursing students (N=70) were randomly assigned to two groups based on modality (2D and VR). The study employed a real-time neurophysiologic immersion measurement (data collected via athletic sensors to capture brain responses while participants experienced the story), the Interpersonal Reactivity Index (IRI) subscales for empathic concern, a behavioral choice to assess post-immersion empathetic concern, and focus groups to assess reflective and critical consciousness as measures of transformational learning. Results: The results indicated that immersive story interventions, regardless of modality, can strengthen empathy-based competence alongside core technical/clinical skills of nursing programs when coupled with reflective learning activities. The findings aligned with neuroscience research showing strong correlations between compelling storytelling, neurological immersion, and empathetic behaviors. Qualitative data from focus group reflections identified that patient advocates and self-advocacy are crucial to improving patient care and outcomes. However, nurse burnout, implicit biases, and healthcare systems that interpret empathy as tantamount to inefficiency contribute to this healthcare problem. Implications: The study suggests that identifying effective interventions that address the complexity of declining empathetic concern among nursing students is critical. Immersive storytelling micro-interventions, coupled with reflective activities, provide a mode to expose nursing students and professionals to a whole-person care model and invite them to co-create it. The Empathy Unfolding framework offers a pathway to conduct future research that addresses the gaps in nursing education identified in this study and to inform future studies focused on holistic approaches to address the multidimensional “wicked” problem.



Available for download on Thursday, July 24, 2025