Visual Thinking Strategies as a Means of Mobilizing Theory of Mind in Nursing Education: A Qualitative Analysis of a Pedagogical Approach
This qualitative study demonstrates that Visual Thinking Strategies effectively mobilize Theory of Mind in nursing education by fostering diverse social cognition inferences, particularly regarding uncertainty and multiperspectivity, through the co-construction of meaning.
Original paper licensed under CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). This is an AI-generated explanation of the paper below. It is not written or endorsed by the authors. For technical accuracy, refer to the original paper. Read full disclaimer
In the daily life of a nurse, the most critical information is often the hardest to see. A patient's chart might list a fever and a cough, but it cannot capture the fear in their eyes, the hesitation in their voice, or the unspoken worry about a family member waiting at home. To provide true care, healthcare professionals must do more than memorize facts; they must learn to read the invisible. This ability to guess what another person is thinking or feeling, based on limited clues, is known as the "theory of mind." It is the mental skill that allows us to understand that someone else has a different perspective, a different set of beliefs, or a different emotional state than our own. In the high-stakes, often ambiguous world of medicine, this skill is essential for making good decisions and building trust. Yet, teaching students how to practice this kind of deep, empathetic interpretation is notoriously difficult, especially when the situations they face are messy and do not have a single correct answer.
A new study explores a surprising classroom tool designed to sharpen this very skill: the use of art. Researchers Pedro Mendonça and his team investigated whether a teaching method called Visual Thinking Strategies could help nursing students practice the mental gymnastics required to understand others. This approach, originally developed for museum education, involves gathering a group to look at a complex, ambiguous image and asking three simple questions: "What is going on in this picture?", "What do you see that makes you say that?", and "What more can we find?" There are no right or wrong answers. Instead, the goal is to encourage students to make guesses, back them up with evidence from the image, and listen to how their peers see the same scene differently. The researchers wanted to know if this open-ended discussion would actually trigger the specific mental processes nurses need to understand patients.
To find out, the team observed twenty-five nursing students in Quebec as they participated in thirteen different sessions of this art-based discussion. The researchers recorded the conversations and then carefully analyzed every statement the students made. They were looking for specific types of thinking: guesses about what a person in the photo was feeling, what they intended to do, what they were thinking, or how they related to others in the image. They also looked for signs that the students were comfortable with not knowing the answer, using words like "maybe" or "it seems" to show they understood their interpretation was just a hypothesis.
The analysis of the transcripts revealed a rich and active mental landscape. The students did not just describe what was physically present; they constantly built stories about the invisible minds of the people in the photographs. In total, the researchers identified 239 distinct moments where students made these kinds of inferences. The most common type of thinking was not about specific emotions or intentions, but rather about uncertainty. The students frequently used language that acknowledged they were guessing, showing a willingness to sit with the unknown rather than rushing to a conclusion. This was followed closely by guesses about what the people in the images intended to do and what emotions they were feeling.
What made the findings particularly striking was how the thinking evolved during the conversation. The students did not work in isolation; they built on each other's ideas. One student might suggest a person looks sad, and another might add that perhaps the sadness comes from a specific relationship with someone else in the photo. The discussion allowed them to test different ideas against one another, creating a shared understanding that was more complex than any single student could have reached alone. The type of thinking shifted depending on the image. Some pictures, which were very emotional, sparked more talk about feelings. Others, which showed complex social interactions, led to more discussion about relationships and power dynamics. The level of ambiguity in the picture seemed to drive the conversation; when an image was very unclear, the students leaned heavily into their uncertainty, using phrases like "it seems" or "I have the impression" to navigate the lack of clear facts.
The study suggests that this method of looking at art does more than just improve observation skills; it creates a safe space for practicing the difficult work of understanding other people's minds without the pressure of being right. In a traditional classroom, students might fear giving a wrong answer, which can shut down the kind of open exploration needed to develop empathy. Here, the absence of a single correct answer encouraged them to propose multiple possibilities and to listen to different viewpoints. The researchers found that the students were not just guessing at random; they were carefully justifying their ideas with visual evidence and then refining those ideas as they heard from others. This process of co-constructing meaning—where the group builds a shared interpretation together—appears to be a powerful way to exercise the brain's social reasoning muscles.
While the study does not prove that these skills automatically transfer to a hospital ward, it offers strong evidence that this pedagogical approach can activate the specific cognitive processes nurses need. The students demonstrated an ability to move beyond simple observation to infer intentions, emotions, and relationships, all while maintaining a healthy tolerance for uncertainty. They learned to hold multiple perspectives in their minds at once, recognizing that a situation can be understood in several valid ways. By using ambiguous images as a training ground, the approach allows future healthcare providers to practice the art of interpretation in a low-stakes environment. The findings suggest that when students are invited to explore the unknown together, they develop a more nuanced, flexible, and human way of thinking that is essential for the complex, often unclear reality of patient care.
Drowning in papers in your field?
Get daily digests of the most novel papers matching your research keywords — with technical summaries, in your language.