Communication and Empathy in the Patient-Centered Care Model—Why Simulation-Based Training Is Not Optional

Empathy in Nutrition and Dietetics: A Scoping Review

BACKGROUND

Empathy is fundamental to the provision of efficacious patient-centered health care. Currently, there is no comprehensive synthesis of peer-reviewed empirical research related to empathy in the nutrition and dietetics profession. Understanding empathy in the context of nutrition and dietetics care may lead to improved teaching practices that support nutrition and dietetics students and practitioners to provide high-quality, empathic, patient-centered care.

OBJECTIVE

This scoping review aimed to understand the approaches through which empathy is conceptualized, measured, and taught in the field of nutrition and dietetics.

METHODS

Using the Preferred Reporting Items for Systematic reviews and Meta-Analyses-Scoping Reviews Statement and Checklist, a scoping review process was undertaken. Five databases were searched in February 2023: Cumulative Index to Nursing and Allied Health, Embase, Medline, PsycInfo, and Scopus, with no date limits. Eligible studies were English language-based, peer-reviewed, empirical research exploring or measuring empathy as an outcome in primary data stratified to nutrition and dietetics. Extracted qualitative data were synthesized and analyzed thematically with an inductive, interpretivist approach applied to conceptualize the interrelationship between empathy and dietetic practice. Quantitative data were extracted and summarized in a table.

RESULTS

Twenty-six studies were included in the scoping review. Analysis identified 2 overarching themes underpinning the current literature on empathy in nutrition and dietetics that described empathy as a key skill in the application of patient-centered care, which was supported by approaches to lifelong cultivation of empathy in the nutrition and dietetics profession. A range of tools has measured empathy in nutrition and dietetics students and practitioners with no clear consensus in findings across studies.

CONCLUSIONS

This review identified the extent and nature of empathy within nutrition and dietetics, from both practitioner and patient perspectives, and the vast array of approaches used to teach and quantify empathy in students and practitioners. Insights from this review inform the need for future studies. The results of this review suggest that future research include exploring implications of empathic dietetics care on patient outcomes and identification of best practice, evidence-based curricula and strategies to support sustainable cultivation and maintenance of empathic care across the career span of nutrition and dietetics practitioners.

Examining nurses' humanistic behaviour ability and empathy levels in clinical practice: A descriptive and exploratory study

BACKGROUND

It is critical for nurses to provide healthcare services to healthy/sick individuals with a humanistic approach and with empathy.

AIMS

This research aimed to determine nurses' humanistic behaviour ability, empathy levels and related factors in clinical practice.

DESIGN

A descriptive cross-sectional and exploratory study.

METHODS

Probability sampling method was used, and 337 nurses working in two public hospitals were included in the study. Data was collected using the Humanistic Practice Ability of Nursing Scale and the Empathy Level Determination Scale. Structural equation model analysis and descriptive statistics were used to evaluate the hypothesised model. This study adhered to the STROBE checklist for reporting.

RESULTS

Nurses' humanistic ability and empathy level in nursing practices were found to be above average. Both the ability to act humanely in nursing practices and their empathy levels were found to be significantly higher in nurses who were married and had children. A significant relationship was found between empathy levels and humanistic behaviours. Accordingly, nurses' empathy levels positively affected their humanistic care behaviours, and the model established between the two concepts was found to be statistically appropriate.

CONCLUSIONS

Nurses' empathy levels positively affect their ability to act humanistically. The result of the model established between the two concepts also supports this. Care strategies should be developed that consider factors that will improve empathetic and humanistic behaviours in nurses and maximise individualised care practices.

IMPLICATIONS FOR THE PROFESSION

Increasing the awareness of nurses about the factors affecting humanistic behaviours and empathic attitudes while caring for individuals in clinical practice, will contribute to improving the quality of nursing care.

Photovoice: An active learning tool with community nursing students

OBJECTIVE

To assess nursing students' experiences of using photovoice as a pedagogical approach to active learning in the community.

METHODS

A descriptive design with a cross-sectional mixed-method questionnaire was used with 108 students following an educational activity, in which their communities were photographed and the impact of the pandemic on vulnerable populations was reflected. Descriptive statistics and thematic analysis were used to analyze the data.

RESULTS

Seventy eight percent of the students felt that photovoice was an interesting and useful tool for nurses, 89% affirmed it helped stimulate reflection on social and health inequities in times of pandemic, 82% described that it developed many emotions and feelings and 86% would like to disseminate their photographs directly to stakeholders, citizens, and politicians. Three themes were identified in the data: "stimulate critical reflection", "develop emotional skills", and "encourage action".

CONCLUSIONS

Photovoice is a successful active learning pedagogical approach that engages nursing students to develop critical awareness while connecting with their communities, with the real world. It fosters students' sensitivity and motivation and encourages them to take action. Teachers need to introduce new scaffolds for active learning, such as photovoice, to provide innovative academic support that nurtures and develops the next generation of nurses appropriately.

Resilience and empathy in pharmacy interns: Insights from a three-year cohort study

Background

Resilience and empathy are important attributes for healthcare professionals to navigate challenging work environments and providing patient-centred care. Knowledge about pharmacists' levels of resilience and empathy, particularly during the early stages of their careers, is limited.

Objectives

To explore pharmacy interns' levels of resilience and empathy using the Connor-Davidson-Resilience-Scale-25 (CD-RISC-25) and the Kiersma-Chen-Empathy-Scale (KCES), examine potential associations with demographic characteristics and ascertain what challenges interns' resilience and which support mechanisms they identify.

Methods

Hard copies of the surveys were distributed to three cohorts during face-to-face intern pharmacy workshops from 2020 to 2022. Additionally, a qualitative questionnaire explored interns' experiences while completing an accredited internship program during the COVID-19 pandemic. Data were analysed using descriptive and inferential statistics, open-ended questions were analysed through qualitative and quantitative content analysis.

Results

Among 134 completed surveys, most respondents were female, aged 18-22, and worked in hospitals. The CD-RISC-25 mean score was 66.6 (SD 11.7) and the KCES mean was 84.3 (SD 9.23) indicative of intermediate levels of resilience and empathy. Resilience and empathy scores did not significantly differ between the three cohorts (p-value > 0.05), and both were not consistently correlated with each other (p-value > 0.05). No significant associations were found between demographic characteristics and resilience scores. However, age and pre-internship employment history showed a statistically significant association with empathy scores (p-value < 0.05), with younger age groups and those who worked part-time during undergraduate studies demonstrating higher levels of empathy. Challenges undermining interns' resilience included the COVID-19 pandemic, internship requirements, and feelings of inadequacy and inexperience.

Conclusions

This study showed that resilience and empathy scores among interns were at what can be regarded as intermediate levels, largely unaffected by the COVID-19 pandemic or cohort demographics. It highlights professional aspects and strategies which are professionally sustaining and may assist interns in navigating challenges to their resilience and empathy.

Postgraduate nursing students' experiences with simulation-based learning in palliative care education: A qualitative study

AIM

The aim of this study was to explore postgraduate palliative care nursing students' experiences with simulation-based learning focusing on communication skills, as a learning method in palliative care education.

BACKGROUND

Communication is one of several important competencies in palliative care and found to be challenging. Developing appropriate communication skills in palliative care requires education and practice. To provide postgraduate palliative care nursing students with the required knowledge and experience, practical and active learning approaches, such as simulation-based learning, can be applied. Several studies have explored undergraduate nursing students' experiences with simulation-based learning in palliative care. However, to our knowledge no studies have explored postgraduate palliative care nursing students` experiences with simulation-based learning focusing on communication skills in palliative care education.

DESIGN

An exploratory descriptive design.

METHODS

A qualitative method was employed. Three focus group interviews were conducted in May 2022 using videoconferencing (Zoom) with 11 postgraduate palliative care nursing students, eight of whom wrote reflective notes. Data were analysed using systematic text condensation.

RESULTS

Three categories were identified in the data analysis: 1) from uncertain expectations to the real experience of simulation-based learning; 2) being a skilled professional in everyday life versus being observed in the scenarios; and 3) the balance between self-confidence and challenges in experiencing professional development and mastery.

CONCLUSIONS

Postgraduate palliative care nursing students seemed to experience anxiety towards simulation-based learning in palliative care education, as well as variable expectations for the approach. This could be due to their unfamiliarity with the learning method. The need for repetition was underlined and the students indicated that they would like to be able to participate in several simulation sessions to familiarise themselves with the approach. The contrast between being a skilled professional in everyday life and the pressure of being observed and judged in the scenarios was an important finding. Students outlined the desire to feel safe, but also highlighted the importance of being challenged to experience professional development and enhanced mastery. Generally, the findings indicate that academic and psychological safety should be a focus during simulation-based learning and instructors should understand that students may have varied learning strategies, divergent learning experiences and shifting beliefs in their own competencies.

The Effects of Low-Fidelity Simulation on Students' Perceived Abilities to Build Therapeutic Relationships

BACKGROUND

The combination of nursing student anxiety toward patients with mental health conditions, along with their unpreparedness for exercising active listening, empathy, and self-awareness in clinical situations, creates a barrier to achieving therapeutic nurse- patient relationships.

METHOD

A quantitative quasiexperimental study with a one-group pretest-posttest design was used to determine whether a low-fidelity communication simulation laboratory would decrease nursing students' perceived anxiety levels toward mental health patients and increase students' perceived empathy, self-awareness, and active listening levels.

RESULTS

After completing the communication simulation laboratory, students' anxiety decreased significantly (p < .001) and active listening increased significantly (p < .001); empathy and self-awareness levels were relatively unchanged.

CONCLUSION

Using a communication simulation laboratory effectively decreased nursing students' perceived anxiety levels toward patients and improved their perceived active listening skills. The findings of the study support the use of low-fidelity simulations to prepare students for psychiatric nursing clinical practice. [J Nurs Educ. 2023;62(10):575-579.].

Perception of care from the perspective of nursing students: A study using photovoice, storytelling and poetry

BACKGROUND

The Higher Education in Nursing requires providing students with skills such as critical and reflective thinking about the actions to be carried out so that they are capable of providing humanised and quality care in an increasingly complex and technified society. Participatory teaching methodologies promote the development of these skills.

OBJECTIVES

to explore the potential of photovoice, storytelling and poetry as instruments capable of encouraging reflection. To identify through images (photovoice) and poetic narratives (storytelling and poetry) the perception that students of the nursing degree express about nursing care.

DESIGN

qualitative study in the framework of the socio-critical paradigm, using photovoice, storytelling and poetry in the field of care.

PARTICIPANTS

first-year undergraduate nursing students at two Spanish universities in the academic year 2021-2022.

METHODOLOGY

48 images were shown and students were asked to select one, write a narrative and generate a short poem connected to the image. Subsequently, a content analysis was conducted of those poems evoked by the five photographs most chosen by the students. The analysis was supported by qualitative data analysis software. A total of 67 contributions from 67 students were analysed.

RESULTS

the concepts addressed in the poems and the compositions generated reveal how critical humanist thinking and reflection on the subject of care developed. The topics identified were care, accompaniment throughout the life cycle, working on the basis of values and caring for small details as subcategories of nursing care.

CONCLUSION

The combination of different tools in university education has encouraged reflection and enabled students to identify for themselves the importance of humanised care. Working on the theoretical foundation in an active way can reduce the gap between theory and practice and foster the empowerment of the nursing identity.

Effect of Storytelling and Empathy Training to Support Affective Learning in Undergraduate Nursing Students

BACKGROUND

Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation.

PURPOSE

This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning.

METHODS

A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed.

RESULTS

Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed.

CONCLUSIONS

Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students.

Self-awareness, empathy, and patient-centered care among critical care nurses in Jordan

Self-awareness, empathy, and patient-centered care are essential components for nurses for improving nurse-patient relationship and providing high-quality care for the patients. There is limited research regarding these components among critical care nurses in Arab countries, including Jordan. Thus, this study purposed to evaluate the self-awareness, empathy, and patient-centered care among critical care nurses in Jordan. A cross-sectional, descriptive correlational design was applied. Data were collected from 140 registered nurses from six hospitals in different health sectors. Findings showed that the mean scores for self-awareness, empathy and patient-centered care were as follows: 1.92 (SD = 0.27), 4.87 (SD = 0.88), and 3.71 (SD = 0.80), respectively. These results indicate that nurses had a high level of self-awareness and empathy and a low level of patient-centered care. There was no relationship between self-awareness and socio-demographic variables, perceived stress, and social support. Also, there was a positive relationship between empathy and social support (r = 0.310, p < 0.001). Patient-centered care had a positive relationship with social support (r = 0.202, p < 0.05) and perceived stress (r = 0.175, p < 0.05), also, male nurses had higher patient-centered care than female encounters. Social support was a predictor of empathy, while social support and perceived stress were the main predictors for patient-centered care. The results of the study reflect the need for educational programs to promote self-awareness and empathy to enhance patient-centered care and achieve high-quality patient care. Additionally, correlating factors with PCC (social support and perceived stress) should be taken into consideration upon implementing any interventional programs.

Moral courage of master's students of nursing during COVID-19

BACKGROUND

Moral courage is a recognized virtue. In the context of the COVID-19 pandemic, the master's students of nursing (MSNs) in China have shown tenacious moral courage.

OBJECTIVE

This study elaborates on the moral courage of Chinese MSNs through their experiences of volunteering during the pandemic.

RESEARCH DESIGN

Descriptive qualitative, interview-based.

PARTICIPANTS AND RESEARCH CONTEXT

Participants were nursing postgraduate students who participated in the prevention and control of the COVID-19 pandemic selected by purposeful sampling. The sample size was determined by data saturation, which was reached with 10 participants. Data were analyzed using a deductive method of content analysis. Because of the isolation policy, telephone interviews were adopted.

ETHICAL CONSIDERATIONS

After obtaining the approval of the ethical institution of the author's school (No. 138, 30 August 2021), verbal consent was obtained before the interview with the participants. All data were processed anonymously and confidentially. In addition, we recruited participants through MSNs' counselors, and obtained their phone numbers with their permission.

RESULTS

Data analysis resulted in 15 subcategories that were subsequently grouped into 3 major categories including proceed without hesitation, the outcome of practicing moral courage, and develop and maintain moral courage.

CONCLUSION

This qualitative study is based on the special background of the COVID-19 pandemic, and the MSNs in China have shown tenacious moral courage in the work of epidemic prevention and control. Five factors led them to take action without hesitation, and six possible outcomes followed. Lastly, this study provides some suggestions for nurses and nursing students to enhance their moral courage. To better develop and support moral courage in the future, it is necessary to use different methods and multidisciplinary approaches to study moral courage.

Effect of empathy training on the empathy level of healthcare providers in Ethiopia: a cluster randomized controlled trial

Objective

Empathy has deteriorated throughout clinical training and medical practice, and little is known about the effect of empathy training on the empathy level of healthcare providers. To address this gap, we assessed the effect of empathy training on the empathy level of healthcare providers in Ethiopia.

Design

A cluster randomized controlled trial study design was conducted from 20 December 2021 to 20 March 2022. The empathy training intervention was conducted for three consecutive days.

Setting

The study was conducted in five fistula treatment centers in Ethiopia.

Participants

The participants were all randomly selected healthcare providers.

Main outcome measures

Total mean score, percentage changes, and Cohen's effect size were computed. A linear mixed effects model and independent t-test were used for data analysis.

Results

A majority of the study participants were nurses in the profession, married, and first-degree holders. There was no statistically significant difference in the baseline empathy score of the intervention arm across their socio-demographic features. At the baseline, the mean empathy scores of the control and intervention arms were 102.10 ± 15.38 and 101.13 ± 17.67, respectively. The effect of empathy training on the total mean score changes of empathy of the intervention arm compared to the control arm at each follow-up time had a statistically significant difference. After a week, a month, and three months of post-intervention, the total mean empathy scores between the intervention and control arms were as follows: (intervention 112.65 ± 18.99, control 102.85 ± 15.65, d = 0.55, p = 0.03); (intervention 109.01 ± 17.79, control 100.52 ± 12.57, d = 0.53, p = 0.034); and (intervention 106.28 ± 16.24, control 96.58 ± 14.69, d = 0.60, p = 0.016) with the overall percentage changes of 11, 8, and 5% from the baseline scores, respectively.

Conclusion

In this trial, the empathy training intervention was found to have more than a medium effect size. However, over the follow-up intervals, there was a decreasing trend in the total mean empathy scores of healthcare providers; suggesting that there should be continued empathy training and integration of it into educational and training curriculums to enhance and sustain the empathy of healthcare providers.Clinical Trial Registration: Pan African Clinical Trial Registry: http://www.edctp.org/panafrican-clinical-trials-registry or https://pactr.samrc.ac.za, PACTR202112564898934.

The impact of artificial intelligence on the person-centred, doctor-patient relationship: some problems and solutions

Artificial intelligence (AI) is often cited as a possible solution to current issues faced by healthcare systems. This includes the freeing up of time for doctors and facilitating person-centred doctor-patient relationships. However, given the novelty of artificial intelligence tools, there is very little concrete evidence on their impact on the doctor-patient relationship or on how to ensure that they are implemented in a way which is beneficial for person-centred care.Given the importance of empathy and compassion in the practice of person-centred care, we conducted a literature review to explore how AI impacts these two values. Besides empathy and compassion, shared decision-making, and trust relationships emerged as key values in the reviewed papers. We identified two concrete ways which can help ensure that the use of AI tools have a positive impact on person-centred doctor-patient relationships. These are (1) using AI tools in an assistive role and (2) adapting medical education. The study suggests that we need to take intentional steps in order to ensure that the deployment of AI tools in healthcare has a positive impact on person-centred doctor-patient relationships. We argue that the proposed solutions are contingent upon clarifying the values underlying future healthcare systems.

Experiences of simulation-based learning among undergraduate nursing students: A systematic review and meta-synthesis

OBJECTIVES

We aimed to examine the experiences of simulation-based learning (SBL) among undergraduate nursing students.

DESIGN

We conducted a systematic review and meta-synthesis on the experiences among undergraduate nursing studies who received SBL.

DATA SOURCES

We searched through six databases namely PubMed, CINAHL, Scopus, Web of Science, Embase, ProQuest, for qualitative studies published from January 2011 to January 2022.

REVIEW METHODS

A meta-synthesis was conducted according to the three-stage framework outlined by Thomas and Harden (2008). Critical appraisal was performed using the Critical Appraisal Skills Program (CASP) checklist. A standardised data extraction form was developed with reference from JBI Qualitative Assessment and Review Instrument Data Extraction Tools for Qualitative Research (JBI-QARI) checklist for data extraction.

RESULTS

Fifteen studies were included, and four themes emerged from the synthesis: (1) acquiring knowledge and skills through SBL; (2) positive experiences of using high-fidelity simulation (HFS) and virtual reality simulation (VRS) methods; (3) challenges encountered while using SBL methods and (4) drawing parallels between simulation and real clinical settings.

CONCLUSION

SBL allowed undergraduate nursing students to gain knowledge, acquire skills and have a positive SBL experiences. However, the provision of innovative strategies and resources for nursing students to overcome SBL-based challenges are still needed.

The Impact of a Nursing Emotional Intelligence Program to Improve Patient Satisfaction

Nurses often encounter stressful situations with patients. Inadequate nursing emotional intelligence (EI) can negatively impact patient satisfaction. EI can be utilized in challenging circumstances. A nursing EI program included virtual training, online modules, and journal clubs. A pre-post design utilized the Press Ganey survey to measure patient satisfaction. The Emotional Intelligence Appraisal measured nursing EI scores. Patient satisfaction and nursing EI scores increased, highlighting the significance of providing EI education to nurses.

Empathy and Attitude upon An Aged Body: Aged Simulation Suit Among Undergraduate Physiotherapy Students

Background and Purpose: When empathy and attitude levels of health professionals are high, patient compliance and satisfaction are increased. The purpose of this study was to assess the empathy and attitude levels of undergraduate physiotherapy students towards older people before and after wearing the aged simulation suit by performing pre-defined related scenarios. Methods: The aged simulation suit was put on 63 students to complete the pre-defined scenarios, which included reading, eating, walking, and sitting to determine the experiences and emotions of students via semi-structured questions and interviews. The empathy and attitude levels were evaluated using the Jefferson Scale of Empathy-Health Professions Students (JSE-HPS) version and Kogan's Attitudes Towards Old People (KAOP) scales at baseline and immediately after performed scenarios. Results: The scores of the JSE-HPS and its sub-scales, including "perspective-taking" (p=0.000) and "compassionate care" (p=0.008), were significantly improved, while "standing in patient's shoes" was significantly decreased after the intervention (p=0.005). KAOP positive items were found to be higher compared to the baseline results (p=0.040). Besides, 87.1% of the students stated that their behavior towards older people would change positively. Conclusion: Using aged simulation suits may be an effective educational technique that positively contributes to undergraduate physiotherapy students' attitudes and empathy.

Narrative photography with an expert patient as a method to improve empathy: a satisfaction study with health sciences students

OBJECTIVES

To assess health sciences students' satisfaction with narrative photography with an expert patient as an empathy-fostering teaching method.

METHODS

Nineteen students from a public medical sciences university in Barcelona (Spain) voluntarily completed six online training sessions using narrative photography and expert patient. Data were collected using an anonymous online satisfaction questionnaire verified by experts, including 29 quantitative and qualitative questions that were analyzed descriptively.

RESULTS

Eighteen valid questionnaires were obtained (90% response rate). All students evaluated the teaching method as highly satisfactory. The main positive aspects of the teaching method were being able to express one's emotions and reflections. Students felt the activity enhanced their empathy and helped them minimize their prejudices, specifically to patients living with HIV. Students also evaluated the online format as less optimal than if it were delivered in person.

CONCLUSION

The students found the teaching method to have a personal and professional impact, which facilitated the integration of empathy in their daily practice when caring for people living with HIV.

Empathy education in post-graduate nurses: An integrative review

AIM

This study reviews the outcomes of programmes teaching empathy to post-graduate nurses.

BACKGROUND

Nurses who are able to empathise with their patients, place themselves within a preferred position to deliver better patient outcomes. There have been substantial efforts to improve the empathy skill level of undergraduate nursing students, with success but understanding this skill level at the post graduate level is limited.

DESIGN

An integrated literature review of the qualitative and quantitative literature on nurse post graduate education programmes over the last 10 years was conducted.

DATA SOURCES

CINAHL, Medline, Psych-Info, Google Scholar and hand searching of reference lists of relevant papers were used.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

RESULTS

The review includes nine quantitative non randomised studies and one qualitative study. The findings suggest that empathy skills in post graduate nurses can be improved, but given the variation in the operational definition of empathy used, range in frequency and length of training and speciality specific requirements further work is needed to understand the use of 'empathy' in the post graduate nurse.

CONCLUSION

Future non university based or 'in house' empathy education in nursing should focus on the post graduate nurse and the needs of their clinical specialties.

The Use of Simulation Based Learning: With Bachelor of Science Pharmaceutical Science and PharmD Students

BACKGROUND AND PURPOSE

Interprofessional education between bachelor of science pharmaceutical science (BSPS) students and Doctor of Pharmacy (PharmD) students is rare. According to the Association of American Medical Colleges, more than 80% of medical schools incorporate simulation based teaching within all four years of the curriculum.

EDUCATIONAL ACTIVITY AND SETTING

The University of Rhode Island College of Pharmacy healthcare simulation lab has developed integrated educational opportunities for both groups of students by offering independent study opportunities that allow BSPS students to collaborate with PharmD students. A recent example of this model includes BSPS student development of patient cases which are integrated into high-fidelity human patient simulators with faculty assistance. A senior BSPS student researched and designed four clinical patient cases which were presented to P3 pharmacy students.

FINDINGS

In all four cases, there was an increase in knowledge and attitudes following the simulation. Qualitative comments from students noted the importance of patient education and an enhanced ability to manage disease and side effects.

SUMMARY

The nature of the simulation lab at the University of Rhode Island is a platform that can be modeled by other institutions with both PharmD and BSPS programs.

The Diabetes Simulation Challenge: Enhancing Patient Perspective-Taking for Medical Students

The Diabetes Simulation Challenge is a unique training tool to foster empathy, a key facet of patient-centered care, for medical students. Thirty-two medical students participated in a 24-hour perspective-taking activity as part of their curriculum, during which they simulated some common experiences of living with a chronic health condition, specifically type 1 diabetes. Students' written reflections were analyzed using a phenomenological qualitative approach to provide a composite description of the experience. An exhaustive, iterative method of thematic analysis that included manual coding was used to determine whether this activity led to expressions of empathy or thoughts and beliefs consistent with patient-centered health care. Nine unique themes emerged, six of which indicated that students adopted the perspective of an individual with a chronic illness. Most of the students' reflections illustrated an understanding of the behavioral, social, and emotional challenges related to living with type 1 diabetes, as well as increased empathy toward individuals with the disease. Medical students who aim to provide patient-centered care benefited from this perspective-taking exercise, and training programs should consider using such methods to extend learning beyond traditional didactic education.

Advancing communication skills in intensive care: Caring for relatives of critically ill patients

OBJECTIVE

The aim of this study was to explore critical care nursing students' experiences with simulation-based communication skills training focusing on relatives.

METHODS

Two complex scenarios were developed using professional actors in the role as relatives. A survey was conducted with critical care nursing students from 2017 to 2020. We performed descriptive and correlational analysis of the quantitative data and thematic analysis of the open-ended questions.

RESULTS

The total learning outcome was 4.10 (SD = 0.79, N = 98) on a Likert scale from 1 to 5. The learning outcome with the use of a professional actor was 4.65 (SD = 0.6, N = 118), and the experience of realism was 4.16 (SD = 0.85, N = 67). The students rated the debriefing as 4.38 (SD = 0.73, N = 118), and they experienced more positive emotions than negative during the simulation.

CONCLUSION

High learning outcomes were reported. The use of professional actors with fine-tuned improvisational skills enhanced the sense of realism in the scenarios. However, the impact of emotions on learning outcomes should be further investigated.

PRACTICE IMPLICATIONS

By obtaining advanced communication skills focusing on relatives during their nursing education, critical care nursing students can improve the care they give.

Patients' Perceptions Toward Human-Artificial Intelligence Interaction in Health Care: Experimental Study

Background

It is believed that artificial intelligence (AI) will be an integral part of health care services in the near future and will be incorporated into several aspects of clinical care such as prognosis, diagnostics, and care planning. Thus, many technology companies have invested in producing AI clinical applications. Patients are one of the most important beneficiaries who potentially interact with these technologies and applications; thus, patients’ perceptions may affect the widespread use of clinical AI. Patients should be ensured that AI clinical applications will not harm them, and that they will instead benefit from using AI technology for health care purposes. Although human-AI interaction can enhance health care outcomes, possible dimensions of concerns and risks should be addressed before its integration with routine clinical care.

Objective

The main objective of this study was to examine how potential users (patients) perceive the benefits, risks, and use of AI clinical applications for their health care purposes and how their perceptions may be different if faced with three health care service encounter scenarios.

Methods

We designed a 2×3 experiment that crossed a type of health condition (ie, acute or chronic) with three different types of clinical encounters between patients and physicians (ie, AI clinical applications as substituting technology, AI clinical applications as augmenting technology, and no AI as a traditional in-person visit). We used an online survey to collect data from 634 individuals in the United States.

Results

The interactions between the types of health care service encounters and health conditions significantly influenced individuals’ perceptions of privacy concerns, trust issues, communication barriers, concerns about transparency in regulatory standards, liability risks, benefits, and intention to use across the six scenarios. We found no significant differences among scenarios regarding perceptions of performance risk and social biases.

Conclusions

The results imply that incompatibility with instrumental, technical, ethical, or regulatory values can be a reason for rejecting AI applications in health care. Thus, there are still various risks associated with implementing AI applications in diagnostics and treatment recommendations for patients with both acute and chronic illnesses. The concerns are also evident if the AI applications are used as a recommendation system under physician experience, wisdom, and control. Prior to the widespread rollout of AI, more studies are needed to identify the challenges that may raise concerns for implementing and using AI applications. This study could provide researchers and managers with critical insights into the determinants of individuals’ intention to use AI clinical applications. Regulatory agencies should establish normative standards and evaluation guidelines for implementing AI in health care in cooperation with health care institutions. Regular audits and ongoing monitoring and reporting systems can be used to continuously evaluate the safety, quality, transparency, and ethical factors of AI clinical applications.

Improving nursing students' perspective taking, perceptions of humanness, and attitudes toward older adults

Whereas prior work has examined the role of nursing courses in improving empathic skills and reducing dehumanization of older adults, little research has explored how perspective taking and perceptions of humanness of older adults acquired through nursing curricula predict attitudes toward this age group. Nursing students (N = 43) completed surveys at the beginning (Time 1) and end of gerontological coursework (Time 2). Perspective taking and perceived human nature and human uniqueness of older adults increased from Time 1 to Time 2. Perceived human nature of older adults was associated with more positive attitudes at the end of the semester, compared to the beginning. Improved perceptions of the human nature of older adults also predicted lower ageism at the end of the semester. Strategies for improving perspective taking and perceptions of humanness of older adults in nursing courses are discussed.

Development of student simulated patient training and evaluation indicators in a high-fidelity nursing simulation: a Delphi consensus study†

Objective

This study is aimed to develop student simulated patient (SSP) training content and evaluation indicators, and further explores their validity and reliabilities.

Methods

Delphi consultations with 20 nursing experts were conducted. The weights of indicators were calculated through the analytic hierarchy process. SSP training was conducted with a high-fidelity nursing simulation.

Results

The expert positive coefficients were 0.952 in the first round consultation and 1.00 in the second round consultation. The expert authority coefficient was reported as 0.87. The training included role and responsibility of simulated patient (SP), script interpretation, plot performance, and training for a rater, with a total of 17 indicators. SSP evaluation consisted of disease knowledge, role portrayal, and performance fidelity and since being a rater, it consists of 20 indicators in total. The coordination coefficients of two rounds of consultation ranged from 0.530 to 0.918. The content validity of SSP evaluation indicators was 0.95. The inter-rater reliability was reported as 0.866, and the internal consistency established using Cronbach’s α was 0.727.

Conclusions

Students as SPs should have first-hand knowledge and experience within the simulated scenarios. SSP training content and evaluation indicators were determined through the Delphi consensus combined with analytic hierarchy process. The evaluation indicators were valid and reliable, and provided the objective and quantifiable measurements for SSP training in nursing.

Unwanted isolation: An obstacle to constructive interaction between oncology nurses and their patients

Aim

The current study was carried out to investigate the obstacles faced by oncology nurses in their interactions with their patients.

Design

This research is a descriptive qualitative study.

Methods

In this study, conventional content analysis was used for analysing the data collected from 26 oncology nurses. The participants were selected through purposive sampling. Semi‐structured interviews were used for collecting data. Data analysis was conducted with Elo and Kyngäs's approach.

Results

The results included three categories: “role conflict,” “role overload” and “inefficient interaction,” and 10 subcategories.

The need for empathetic healthcare systems

Medicine is not merely a job that requires technical expertise, but a profession concerned with making the best decisions and recommendations with reference to, and in consultation with, the patient. This means that the skill set required for healthcare professionals in order to provide good care is a combination of scientific knowledge, technical aptitude, and affective qualities or virtues such as compassion and empathy.

Nursing students' perspectives on the inclusion of course content on lesbian, gay, bisexual, and transgender health in the nursing curriculum: A descriptive qualitative study

The aim of the study was to examine nursing students' perspectives on why and how course contents on lesbian, gay, bisexual, and transgender health should be included in the nursing curriculum. This was a descriptive qualitative study. A purposive sample was used, and 17 students participated. Thematic analyses revealed four themes: "The need for knowledge and awareness"; "Communication"; "The need for practice-based learning"; and "Inclusion of course contents on lesbian, gay, bisexual and transgender health in the nursing curriculum". Almost all the students reported that the proportion of the course content that had been allocated to lesbian, gay, bisexual, and transgender health was inadequate and emphasized that it is necessary to improve both the theoretical and practical components of the nursing curriculum.

Clinical simulation in teaching Pediatric Nursing: students' perception

OBJECTIVES

to comprehend the perception of undergraduate nursing students about learning to care for the child and family through clinical simulation.

METHODS

this is a qualitative research conducted with ten nursing students through semi-structured interviews. Data were analyzed through content analysis.

RESULTS

data were organized into two categories: "learning a new way to learn," in which students describe their experiences during the simulation, and "learning a new way to care," in which they reflect on learning through simulation.

FINAL CONSIDERATIONS

we believe that clinical simulation practice in teaching should be encouraged because of the benefits it can offer to the students, faculty, patients and their families. However, we recommend further studies to validate scenarios of child and family healthcare.

Artificial intelligence and the ongoing need for empathy, compassion and trust in healthcare

Empathy, compassion and trust are fundamental values of a patient-centred, relational model of health care. In recent years, the quest for greater efficiency in health care, including economic efficiency, has often resulted in the side-lining of these values, making it difficult for health-care professionals to incorporate them in practice. Artificial intelligence is increasingly being used in health care. This technology promises greater efficiency and more free time for health-care professionals to focus on the human side of care, including fostering trust relationships and engaging with patients with empathy and compassion. This article considers the vision of efficient, empathetic and trustworthy health care put forward by the proponents of artificial intelligence. The paper suggests that artificial intelligence has the potential to fundamentally alter the way in which empathy, compassion and trust are currently regarded and practised in health care. Moving forward, it is important to re-evaluate whether and how these values could be incorporated and practised within a health-care system where artificial intelligence is increasingly used. Most importantly, society needs to re-examine what kind of health care it ought to promote.

Employing newly qualified nurses to work in hospices: A qualitative interview study

AIM

To establish an understanding of the experiences of newly qualified nurses' working in hospices from the perspective of both newly qualified and senior nurses.

DESIGN

A qualitative interview study.

METHODS

Semi-structured interviews with six newly qualified nurses and five senior nurses from four UK hospices were conducted between March - July 2017.

RESULTS

The hospices involved in this study were among the first to recruit newly qualified nurses. Participants believed that newly qualified nurses coped well with hospice working and received unique opportunities for professional development. Participants identified the value of formal and informal support, however, newly qualified nurses faced negative attitudes from some established staff. Newly qualified nurses expressed concerns about a perceived lack of technical clinical skills training, however, they highlighted gaining end-of-life care and communication skills that would be transferrable to other settings. Participants highlighted the need to allocate more time for education and formal support including preceptorship. Senior staff did not necessarily expect newly qualified nurses to remain in long-term hospice employment suggesting that they could disseminate their hospice learning to future workplaces.

CONCLUSION

This study supports recruitment strategies that increasingly target newly qualified nurses to work in hospices with findings suggesting that hospices can be a suitable environment for recent graduates to work in. The senior nurses in this study viewed the employment of newly qualified nurses in a positive light but shared the concerns of newly qualified nurses regarding skills training.

IMPACT

At a time when hospices need to expand if they are going to meet demand for their services, they along with most areas of healthcare face difficulties recruiting and retaining registered nurses. To increase the appeal of hospice employment, recruitment campaigns aimed at newly qualified nurses should emphasize the transferability of skills gained in hospice settings.

Empathy and Efficiency in Healthcare at Times of Austerity

Efficiency is an important value for all publicly funded healthcare systems. Limited resources need to be used prudently and wisely in order to ensure best possible outcomes and waste avoidance. Since 2010, the drive for efficiency, in the UK, has acquired a new impetus, as the country embarked on an ‘age of austerity’ purportedly to balance its books and reduce national deficit. Although the NHS did not suffer any direct budget cuts, the austerity policies imposed on the welfare system, including social and mental healthcare, have had a direct and detrimental impact on the healthcare service. This paper draws from a qualitative study conducted in three A&E Departments in England to explore the effects of austerity policies on the everyday experiences of doctors and nurses working in Emergency Departments. It discusses the operationalisation of efficiency in A&E, in a climate of austerity, and its effects on the experiences and practices of healthcare professionals. It uses the empirical data as a springboard to highlight the role of structures and regulations, in this case targets and protocols, in how core healthcare ethical values, such as empathy, are exercised in practice. It provides an analysis of the normative role structures and regulations can play on the perception and practice of professional duties and obligations in healthcare.

Investigation of empathy amongst dietetic interns at selected primary and tertiary health-care facilities

AIM

Empathy is an essential aspect in the delivery of quality nutrition care and promoting better outcomes in patients. With an increased emphasis of patient-centred care in dietetic practice, empathy should underpin the construct of the curriculum in dietetic education. The present study investigated the empathy level of dietetic interns through self-reporting measures and patients' perception.

METHODS

This cross-sectional study was conducted on a total of 57 dietetic interns and 99 patients from primary and tertiary health care settings. The dietetic interns completed the Toronto Empathy Questionnaire (TEQ) while the Consultation and Relational Empathy (CARE) measure was self-administered by patients. Socio-demographic information of participants was collected.

RESULTS

The dietetic interns' mean (standard deviation [SD]) TEQ scores were 46.90 ± 5.28 and 47.78 ± 5.34 in primary and tertiary care, respectively. CARE measure scores rated by patients in the primary care were 38.61 ± 8.38 and for tertiary setting, the scores were slightly higher (39.47 ± 7.65). The settings, gender, ethnicity and period of internship did not affect dietetic interns' empathy level. In primary care, CARE scores were significantly different between patients' age grouping (P = 0.007).

CONCLUSIONS

Findings from the present study showed that patients' age significantly affected their perception of dietetic interns' empathy in primary health care. These preliminary findings could facilitate an understanding of the level of empathy amongst interns for consideration in the future design of dietetic training.

Using Standardized Actors to Promote Family-centered Care

PURPOSE

The purpose of this study was to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation. This study was considered an innovative approach within our undergraduate program because the use of standardized actors (SAs) was new to the program and had only previously been used in our graduate program.

METHOD

This study used a mixed method design of descriptive comparative data and content analysis to examine nursing students' performance in providing family-centered care and empathic communication in a pediatric simulation.

RESULTS

There were 146 students who participated in this study. Thematic analysis indicated that empathy needs to extend beyond the patient to the family. A comparison of the standardize actors' and peer assessment of student empathy was significant.

CONCLUSIONS

Nurse educators can use standardized actors as caregivers in simulation as an effective teaching strategy to connect theory and the philosophy of family-centered care to its application in pediatric nursing practice.

PRACTICE IMPLICATIONS

Family-centered care is a key philosophy in pediatric nursing. Students report that there is a significant gap between family-centered care theory and its application to practice. Few baccalaureate nursing students receive experience in family interactions during their clinical time. Therefore, this research supports the need for incorporating family-centered care simulation practices in nursing education to increase student nurses' readiness to practice in specialty settings such as pediatrics.

Three-dimensional needs of standardized patients in nursing simulations and collaboration strategies: A qualitative analysis

Simulation-based education using standardized patients is recognized as an effective education method from which students can learn in a safe and controlled environment, and instructors can provide consistent education. It has been reported that the level of standardized patients' satisfaction in the simulation experience positively affects to their case mastery and providing feedback to learners. This study aimed to explore standardized patients' lived experiences on nursing simulation using qualitative research to provide empirical resources to facilitate collaboration with standardized patients for efficacious nursing simulation. Study participants were recruited from simulation centers and had experience with nursing simulation education as standardized patients within the last 3 years. Focus group interviews were conducted to explore experiences of the 12 standardized patients in nursing simulations. The focus group interviews were conducted with structured four steps of opening, transition, key, and ending questions, from which additional questions and discussions followed. They were recorded electronically and transcribed for analysis. Qualitative content analysis was used to analyze the data. Two researchers read the interview transcripts several times to become familiar with the content, and then interpreted them systematically. From the qualitative analysis of standardized patients' experiences on nursing simulation, 23 codes, 10 sub-categories, 4 categories, and a theme were derived. It would be concluded that standardized patients have serving, learning, and interpersonal needs on their simulation, which may be related to their experiences in the simulation that affects learning outcomes of the students' as well. By facilitating positive experiences of standardized patients, quality of nursing simulation could be increased to provide more active and effective learning opportunities for students.

The effects of empathy skills training on nursing students' empathy and attitudes toward elderly people

BACKGROUND

Nursing students' empathy and positive attitudes toward elderly people could help provide improved elderly care in their future practice. This study aimed to investigate the effects of empathy skills training on nursing students' empathy and attitudes toward elderly people.

METHODS

This quasi-experimental study was conducted in Yasuj, Iran in 2014. The sample consisted of 63 students at Hazrat Zeinab Nursing and Midwifery School who were randomly divided into a control (n = 31) and an intervention group (n = 32). The intervention group attended an eight-hour workshop on empathy skills that was presented through lectures, demonstration, group discussions, scenarios, and questioning. The data were collected using the Persian versions of Kogan's Attitudes towards Old People Scale and Jefferson Scale of Physician Empathy-Health Professionals Version. Then, the data were entered into the SPSS software, version 19 and were analyzed using descriptive statistics, chi-square test, t-test, and repeated measures analysis of variance.

RESULTS

The results showed that the empathy skills training program had a significant impact on the students' mean scores of empathy and attitudes toward elderly people (p < 0.001). The intervention group's mean score of empathy increased from 77.8 (SD = 10.7) before the intervention to 86 (SD = 7.3) immediately after that and 85.2 (SD = 8.9) 2 months later. Their mean score of attitude also increased from 110.8 (SD = 10.9) before the intervention to 155.2 (SD = 23.4) immediately after the intervention and 158.6 (SD = 23.2) 2 months later. Additionally, the empathy and attitude scores of the intervention group were significantly higher than those for control group immediately and 2 months after the intervention.

CONCLUSIONS

Empathy skills training improved the nursing students' empathy and attitudes towards elderly people. Therefore, empathy training is recommended to be incorporated into the undergraduate nursing curriculum.

The academic-practice gap: Strategies for an enduring problem

The academic-practice gap in nursing is well documented. Academe is criticized for producing nurses insufficiently prepared to fully participate in patient care. Practice settings are criticized for having unrealistic expectations of new graduates. This article is based on a review of the literature and an exploration of contemporary practices used to bridge academic and practice partnerships. Differences in outcome expectations for new graduates between academe and practice are outlined and consequences of the gap for new graduates, patients, and employers are discussed. Five specific strategies to address the gap are discussed, with the primary realm and responsibility for two falling to education, one to practice, and two to both. Strategies discussed include increased use of simulated learning in nursing education; disruptive innovations in education that promote learner-centered active learning; extended orientation/Transition to Practice Programs for new graduates; dedicated education units; and academic service partnerships. Current literature suggests the viewpoints of academic and practice leaders continue to appear divergent. Closing the gap will require a dedicated and coordinated response from both academe and clinical practice.

Ensuring relational competency in critical care: Importance of nursing students' communication skills

OBJECTIVES

The aim of this study was to analyse the communication skills of students in interactions with simulated critically-ill patients using a new assessment tool to study the relationships between communication skills, teamwork and clinical skills and to analyse the psychometric properties of the tool.

METHODS

A cross-sectional study was conducted to assess the communications skills of 52 students with critically-ill patients through the use of a new measurement tool to score video recordings of simulated clinical scenarios.

RESULTS

The 52 students obtained low scores on their skills in communicating with patients. The reliability of the measuring instrument showed good inter-observer agreement (ICC between 0.71 and 0.90) and the validity yielded a positive correlation (p<0.01).

CONCLUSIONS

The results provide evidence that nursing students lack skills when communicating with critically ill patients in simulated scenarios. The measuring instrument used is therefore deemed valid and reliable for assessing nursing students through a clinical simulation.