Creating Caring and Empathic Nurses: A Simulated Ostomate

Empathic Care Culture in Intensive Care Unit Nurses: A Focused Ethnographic Study

Empathy is one of the important components in the patient-nurse relationship. The aim of the study was to explain the culture of empathic care in intensive care unit (ICU) nurses. The present focused ethnographic study was conducted in the cardiac surgery ICU in Tehran. Three methods of observation, interview, and review of existing documents were used to collect data. From data analysis, three cultural models, "Predominance of task-based care over emotion-based care," "Empathy and lack of empathy, two ends of the spectrum of the nurse-patient relationship," and "Empathy, an interactive and reciprocal process," were extracted. The results showed that empathy creates a caring environment where nurses not only understand their patients but also relate to them, and both are affected by it. Policymakers should consider removing barriers as a means of empowering nurses to provide empathic care.

Avoiding controversy: Considerations for point-of-view nursing simulations

Point-of-view simulations involve participants engaging in simulation to experience what it might be like to live with a health condition or disability. These types of simulations have been used frequently in nurse education as a valuable pedagogical tool, as research has shown that student engagement with point-of-view simulations increases student empathy. However, point-of-view simulations have also been problematised by disability community members and scholars researching in the disability space, as ableist and culturally unsafe. This manuscript explores recommendations for, and criticisms of, point-of-view simulations and offers considerations to address these concerns.

Empathy in Nursing Students: A Scoping Review

Purpose: Empathy is essential for nursing students as they progress through their education. To date, few review studies explored empathy in nursing students. This review examined empathy in nursing students, including how to promote empathy, factors contributing to empathy, and the evaluation of empathy. Design: The eligible population included undergraduate nursing students. The concept of interest was empathy related to nursing students. The context was undergraduate nursing programs. Eligible studies included quantitative, qualitative, and mixed-method studies. The protocol was registered in Open Science Framework (OSF). Review Methods: Joanna Briggs Institute Reviewers' Manual guided this scoping review protocol. MEDLINE with Full text (EBSCO), Scopus, ScienceDirect (Elsevier), and PubMed were used for the electronic database search. The findings were analyzed with descriptive statistics and thematic analysis. Findings: A total of 94 articles were included for analysis. Three main themes emerged: (1) approaches to promoting empathy, (2) contributing factors to empathy, and (3) evaluation of empathy. Conclusions: Empathy is cultivated in nursing in numerous ways, highlighting the need to incorporate it into the nursing curriculum. There is also controversy regarding the relationship between empathy and individual characteristics. This finding highlights the need for more effective empathy-promoting educational training that considers these personal characteristics.

Shepherding parents to prepare for end-of-life decision-making: a critical phenomenological study of the communication approach of paediatricians caring for children with life-limiting conditions in Australia

BACKGROUND/OBJECTIVES

Shared decision-making is widely accepted as the best approach for end-of-life decision-making for children with life-limiting conditions. Both paediatricians and parents find benefit in preparing for such decisions. However, little detail is known about this preparatory process. This study aims to explore how paediatricians prepare parents for end-of-life decision-making for a child with a life-limiting condition using clinical simulation.

DESIGN

Individual, semistructured, post-simulation qualitative interviews of paediatricians and parent-actors.

SETTING

Acute intensive and long-term outpatient paediatric care in Victoria, Australia.

PARTICIPANTS

18 purposively sampled paediatricians who treat children with life-limiting conditions and the two parent-actors involved in all simulations. Paediatricians were excluded if they assisted in the study design, worked within specialist palliative care teams or did not provide clinical care outside the neonatal period.

RESULTS

Three key themes in a preparatory process (termed 'shepherding') were identified: (1) paediatricians aim to lead parents along a pathway to future end-of-life decisions, (2) paediatricians prefer to control the pace of these discussions and (3) paediatricians recognise they need to have courage to face risk with this preparation. Paediatricians use a variety of shepherding strategies to influence the pace, content and framing of discussions, which may help prepare parents to make the best end-of-life treatment decisions when the time comes.

CONCLUSIONS

Shepherding is a newly identified, subtle process intended to influence parents by guiding their understanding of their child's health and potential suffering in advance of decision-making. Shepherding does not fit within current descriptions of physicians' decision-making influence. Paced reflection, thinking and provision of information are shepherding strategies preferred by paediatricians, and these appear the same regardless of whether paediatricians intend to steer parents towards particular treatment decisions or simply prepare them for the process of decision-making. Further study about the intention of this influence and parental perception of this communication is needed.

Experiences of empathy training in healthcare: A systematic review of qualitative studies

OBJECTIVE

To synthesise qualitative studies reporting student, practitioner, or patient experiences of empathy-training in healthcare.

METHODS

We included qualitative studies exploring (i) student or practitioner experiences of empathy training, or (ii) patient experiences of being treated by someone who has undergone empathy training. We used the Critical Appraisal Skills Programme (CASP) tool to assess study quality. Thematic synthesis was used to integrate findings from studies and to generate new insights.

RESULTS

Our search yielded 2768 citations, of which 23 (1487 participants) met inclusion criteria. Two clusters of themes were identified from included studies. Firstly, themes related to practitioner/trainee professionalism and wellbeing, where the main finding was that participants experienced benefit from therapeutic empathy training. Secondly, themes related to the understanding and treatment of patients, where the main finding was practitioners' deeper recognition of the positive impact of empathic care.

CONCLUSIONS

This review found that taking part in empathy-focused training can benefit practitioner/student personal growth and professional development, and benefits patient care. This review is limited by the difficulty in defining empathy and heterogeneity amongst included studies.

PRACTICE IMPLICATIONS

These results support a rationale for empathy training and the development of a framework to ensure training is having the desired effect.

Students' perceptions of interventions designed to foster empathy: An integrative review

OBJECTIVE

Empathy is assumed to be an important element of nursing care, and nursing educators are attempting to find ways to effectively foster empathy in their students. The purpose of this review is to gain a deeper grasp of what undergraduate nursing students are learning from interventions educators have designed to cultivate empathy by synthesizing qualitative data.

REVIEW METHODS

Utilizing the review methodology proposed by Whittemore and Knafl, a survey of the CINAHL, Web of Science, PubMed, and PsychINFO databases was undertaken to answer the question: What are undergraduate nursing students' perceptions of interventions designed to foster empathy?

RESULTS

A thematic synthesis of the students' perceptions from the 17 articles meeting inclusion criteria revealed five themes: Understanding the other's experience, embodying the other's experience, becoming aware of self, informing the role of the nurse, and learning or transforming.

CONCLUSIONS

Although additional conceptual work remains to create a coherent, complete, and parsimonious definition of empathy, the results indicate that the students are gaining many of the facets assumed to be part of the concept of empathy through these educational interventions. Immersive simulations that put students in the role of the "other" were particularly impactful, especially if they created a disorienting dilemma followed by guided reflection. These findings can help nursing educators tailor their interventions for their specific intended learning outcomes.

The value of simulation-based learning in pre-licensure nurse education: A state-of-the-art review and meta-analysis

Simulation modalities are numerous in nursing education, with a need to reveal their range and impact. We reviewed current evidence for effectiveness of medium to high fidelity simulation as an education mode in pre-licensure/pre-registration nurse education. A state-of-the-art review and meta-analyses was conducted based on a systematic search of publications in English between 2010 and 2015. Of 72 included studies, 43 were quantitative primary studies (mainly quasi-experimental designs), 13 were qualitative studies and 16 were reviews of literature. Forty of 43 primary studies reported benefits to student learning, and student satisfaction was high. Simulation programs provided multi-modal ways of learning. A meta-analysis (8 studies, n = 652 participants) identified that simulation programs significantly improved clinical knowledge from baseline. The weighted mean increase was 5.0 points (CI: 3.25-6.82) on a knowledge measure. Other objectively rated measures (eg, trained observers with checklists) were few. Reported subjective measures such as confidence and satisfaction when used alone have a strong potential for results bias. Studies presented valid empirical evidence, but larger studies are required. Simulation programs in pre-licensure nursing curricula demonstrate innovation and excellence. The programs should be shared across the discipline to facilitate development of multimodal learning for both pre-licensure and postgraduate nurses.

Using simulation to address care of the transgender patient in nursing curricula

This descriptive study explored the use of simulation as a means to increase cognitive and reflective practice as well as determining if simulation can alter perceptions and attitudes related to the lesbian, gay, bisexual and transgender (LGBT) community. This manuscript describes how student nurses perceive their role when providing care to and, more specifically, the care of transgender patients. The research question asks: How does a transgender simulation impact the attitudes and beliefs of nursing students related to the LGBT community? One-hundred and fifty-nine students, with a subset of 120 students attending a school in central Florida and 50 students attending a Connecticut programme, participated in the completion of the instruments. The Gender Affirmative Practice (GAP) scale was used to evaluate their attitudes and practice concerning LGBT issues. Findings suggest that the majority of the students rarely or never discuss pertinent sexual orientation issues. Students are not comfortable creating a climate that allows for self-identification by gay/ lesbians, despite admitting to being open and accepting the LGBT community with their faculty. Limitations were based on multisite location and the use of the GAP. It is important for nursing students, and healthcare providers, to acknowledge and recognise the unique vulnerabilities of transgender persons who are seeking healthcare. The exposure to transgender individuals in a clinical setting may be limited; therefore, the use of simulation will offer the opportunity to examine their beliefs and reflect on their attitudes towards this population. Simulation incorporating mental health issues is a newer training technique in which psychosocial aspects of healthcare are addressed.