Simulation-Based Empathy Training Improves the Communication Skills of Neonatal Nurses

Using Simulation to Improve Communication Skills

Ineffective communication is implicated in 80% of medical errors, costing the United States approximately $12 billion annually. Teaching communication skills is a component of nursing curricula linked to improved patient outcomes. Simulation-based experience (SBE) is a strategy for healthcare professionals to learn communication skills. Providing nurses with the ability to practice nurse-nurse, nurse-physician, nurse-patient, and team communication skills in a psychologically safe learning environment provides an opportunity for skill development and meaningful self-reflection. The multiple modalities for SBE support needed communication techniques for skill development and acquisition to improve patient outcomes.

Supporting Disclosure of Unmet Mental Health Needs among Parents of Critically Ill Infants

OBJECTIVE

To characterize (1) the prevalence of mental health discussion and (2) facilitators of and barriers to parent disclosure of mental health needs to clinicians.

STUDY DESIGN

Parents of infants with neurologic conditions in neonatal and pediatric intensive care units participated in a longitudinal decision-making study from 2018 through 2020. Parents completed semi-structured interviews upon enrollment, within 1 week after a conference with providers, at discharge, and 6 months post-discharge. We used a conventional content analysis approach and NVIVO 12 to analyze data related to mental health.

RESULTS

We enrolled 61 parents (n = 40 mothers, n = 21 fathers) of 40 infants with neurologic conditions in the intensive care unit. In total, 123 interviews were conducted with 52 of these parents (n = 37 mothers, n = 15 fathers). Over two-thirds of parents (n = 35/52, 67%) discussed their mental health in a total of 61 interviews. We identified two key domains when approaching the data through the lens of mental health: (1) self-reported barriers to communicating mental health needs: parents shared uncertainty about the presence or benefit of support, a perceived lack of mental health resources and emotional support, and concerns about trust; (2) self-reported facilitators and benefits of communicating mental health needs: parents described the value of supportive team members, connecting to peer support, and speaking to a mental health professional or neutral third party.

CONCLUSIONS

Parents of critically ill infants are at high risk of unmet mental health needs. Our results highlight modifiable barriers and actionable facilitators to inform interventions to improve mental health support for parents of critically ill infants.

Strategies to improve interpersonal communication along the continuum of maternal and newborn care: A scoping review and narrative synthesis

Effective interpersonal communication is essential to provide respectful and quality maternal and newborn care (MNC). This scoping review mapped, categorized, and analysed strategies implemented to improve interpersonal communication within MNC up to 42 days after birth. Twelve bibliographic databases were searched for quantitative and qualitative studies that evaluated interventions to improve interpersonal communication between health workers and women, their partners or newborns' families. Eligible studies were published in English between January 1st 2000 and July 1st 2020. In addition, communication studies in reproduction related domains in sexual and reproductive health and rights were included. Data extracted included study design, study population, and details of the communication intervention. Communication strategies were analysed and categorized based on existing conceptualizations of communication goals and interpersonal communication processes. A total of 138 articles were included. These reported on 128 strategies to improve interpersonal communication and were conducted in Europe and North America (n = 85), Sub-Saharan Africa (n = 12), Australia and New Zealand (n = 10), Central and Southern Asia (n = 9), Latin America and the Caribbean (n = 6), Northern Africa and Western Asia (n = 4) and Eastern and South-Eastern Asia (n = 2). Strategies addressed three communication goals: facilitating exchange of information (n = 97), creating a good interpersonal relationship (n = 57), and/or enabling the inclusion of women and partners in the decision making (n = 41). Two main approaches to strengthen interpersonal communication were identified: training health workers (n = 74) and using tools (n = 63). Narrative analysis of these interventions led to an update of an existing communication framework. The categorization of different forms of interpersonal communication strategy can inform the design, implementation and evaluation of communication improvement strategies. While most interventions focused on information provision, incorporating other communication goals (building a relationship, inclusion of women and partners in decision making) could further improve the experience of care for women, their partners and the families of newborns.

Empathy training for service employees: A mixed-methods systematic review

Following the surge for empathy training in service literature and its increasing demand in service industries, this study systematically reviews empirical papers implementing and testing empathy training programs in various service domains. A mixed-methods systematic review was performed to identify and describe empathy training programs and discuss their effectiveness in service quality, service employees' well-being, and service users' satisfaction. Included papers met those eligibility criteria: qualitative, quantitative, or mixed-methods study; one training in empathy is identifiable; described training(s) developed for or tested with service employees dealing with service users. We searched health, business, education, and psychology databases, such as CINAHL, Medline ABI/Inform Global, Business Source Premier, PsycINFO, and ERIC. We used the Mixed-Method Assessment Tool to appraise the quality of included papers. A data-based convergent synthesis design allowed for the analysis of the data. A total of 44 studies published between 2009 to 2022 were included. The narrative presentation of findings was regrouped into these six dimensions of empathy training programs: 1) why, 2) who, 3) what, 4) how, 5) where, and 6) when and how much. Close to 50% of studies did not include a definition of empathy. Four main empathic competencies developed through the training programs were identified: communication, relationship building, emotional resilience, and counseling skills. Face-to-face and group-setting interventions are widespread. Our systematic review shows that the 44 papers identified come only from health services with a predominant population of physicians and nurses. However, we show that the four empathic skills identified could be trained and developed in other sectors, such as business. This is the first mixed-methods, multi-disciplinary systematic review of empathy training programs in service research. The review integrates insights from health services, identifies research limitations and gaps in existing empirical research, and outlines a research agenda for future research and implications for service research.

A study of empathy levels among nursing interns: a cross-sectional study

BACKGROUND

Empathy is one of the therapeutic communication techniques used to help the client feel better. However, there are a few studies have investigated level of empathy among enrollers at nursing colleges. The aim was to examine the level of self-reported empathy among nursing interns.

METHODS

The study was a descriptive, cross-sectional in nature. A total of 135 nursing interns fill in the Interpersonal Reactivity Index from August to October 2022. Data was analyzed through the SPSS program. An independent -sample t-test and one way- ANOVA was used to explore differences in the degree of empathy with respect to academic and sociodemographic factors.

RESULTS

The results of this study showed that nursing interns showed a mean level of empathy of 67.46 (SD = 18.86). This result indicated that the nursing interns have moderate levels of empathy overall. There was statistical significant difference in the mean level of subscales of perspective-taking and empathic concern between males and females. Additionally, nursing interns who are less than 23 years old scored high in the subscale of perspective-taking. Married nursing interns and who preferred nursing as a profession scored higher in the subscale of empathic concern than unmarried ones and who did not preferred nursing as a profession.

CONCLUSION

Perspective taking incresed with younger male nursing interns, this reflects high cognitive flexibility with younger age nursing interns. Morover, the empathic concern incresed with male married nuring interns who preferred nursing as a profession. This implies that they should engage in continuous reflection and educational activities as part of their clinical training as nursing interns in order to improve their empathic attitudes.

Construction and validation of simulated scenarios in the emergency care of patients with chest pain

OBJECTIVE

To construct and validate clinical simulation scenarios for emergency care for patients with chest pain.

METHODS

A methodological study carried out in two stages: construction and validity. The construction took place through the survey of evidence from national and international literature. The validity stage took place through instrument assessment by judges, according to the Content Validity Index and application of a pilot test with the target audience. Fifteen judges with expertise in simulation, teaching and/or care participated in the research, in addition to 18 nursing students, in the pilot test.

RESULTS

Two scenarios of clinical simulation were constructed, and all the assessed items obtained a value above 0.80, showing evidence of validity, being considered instruments suitable for application.

CONCLUSION

The research contributed to the development and validity of instruments that can be applied for teaching, assessment and training in clinical simulation in emergency care for patients with chest pain.

Understanding of empathetic communication in acute hospital settings: a scoping review

OBJECTIVE

Empathy and empathy education have been reviewed a number of times through systematic reviews and meta-analyses; however, the topic of 'empathetic communication' remains poorly understood when considering engaging in hospital-based research. Therefore, this scoping review aimed to explore the existing literature concerning empathetic communication in hospital settings and to evaluate the definitions presented.

DESIGN

Scoping review.

DATA SOURCES

Systematic searches of the PubMed, CINAHL, Cochrane, PsycINFO, and PsycArticles databases were conducted.

STUDY SELECTION

All English studies in which empathetic communication in hospital settings were explored. The search terms used included empathy, communication, hospital settings, providers, and consumers.

DATA EXTRACTION

Data were assessed through the use of a pre-set analysis tool.

RESULTS

After conducting the searches, 419 articles were identified, of which 26 were included in this review. No single article specifically defined the term 'empathetic communication'; however, 33 unique definitions of 'empathy' were identified, of which 23 considered communication to be a component of empathy. There was a considerable lack of consistency between the empathy definitions, with some classifying communication in empathy as an ability and others classifying it as a dynamic process.

CONCLUSION

Future and contextually focused research is needed to develop a consistent and clear definition of empathetic communication and empathy within a hospital setting to better build positive healthcare cultures.

PRACTICE IMPLICATIONS

Inconsistencies between definitions of empathy in empathetic communication research could reduce the efficacy of future research gains and impact the translation of research findings into clinical practice.

Views of Hospital Nurses and Nursing Students on Nursing Engagement-Bridging the Gap Through Communication Courses

Background

Communicative engagement plays a significant role for effective nurse-patient communication. In the existing college nursing communication training within and outside China, there is a difference between what students are taught and what they can apply in their clinical placements.

Aims

Using needs analysis, this mixed-methods study explored potential gaps between frontline hospital nurses' and college nursing students' perceptions of nurse-patient communicative engagement, and collated a list of effective engagement strategies for pedagogy.

Methods

Surveys and interviews were conducted with key stakeholders, including 16 hospital nurses and 60 nursing students. A new scale named Nursing Engagement with Patients Scale (NEPS) was developed and validated to explore stakeholders' views on nursing engagement.

Results

Differences between the views of nurses and students on engagement were identified. While frontline nurses affirmed the importance of engaging with patients while providing nursing care, nursing students were unsure about the concept and role of engagement, and how to enact it. A list of communication strategies that promote engagement was culled from the interviews with the experienced nurses.

Implications

These can be used to inform nursing communication courses to bridge the gap between what nursing students are currently taught and what they will need in the workplace.

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.

Evaluation of the Effectiveness of an Empathy Training on Empathy Skills, Life Satisfaction, and Relationship Quality for Chinese Adolescents and Their Mothers: A Mixed Methods Study

Using a pre- and post-test design, this study examined the changes in empathy skills, life satisfaction, and relationship quality among mainland Chinese adolescents (ages 13–15 years) and their mothers ( N = 108 dyads) following an empathy training intervention. Participants completed a 20-day empathy training, including two in-person group training sessions and daily journals on assigned topics. Participants’ mother-child relationship quality, mother-child conflict, life satisfaction, and empathy skills were measured three times, and selected participants were interviewed to explore their experience of the training. The research procedure followed protocols that were approved by an Institutional Review Board. ANOVAs were used to examine quantitative data and inductive analysis was used for qualitative data. The findings suggest that after the training, both adolescents and mothers reported significant benefits in mother-child relationship quality and life satisfaction. However, participants’ empathy skills (i.e., perspective taking and empathic concern skills) did not change. Possible mechanisms of the observed changes included the empathy skills (e.g., perspective taking skills) learned through the training and the reciprocal nature of positive changes within the mother-child dyad. The current study suggests that empathy training may benefit adolescents and their mothers, both within the relationship and in their general life satisfaction.

Communication Styles Inventory-Brief: Adaptation and validation for Spanish nursing

Healthcare attention is sometimes considered purely technical, but communication has proven to be closely related to clinical results and patient satisfaction. Therefore, evaluation of communication in the scope of healthcare is a priority. The purpose of this study was to validate and adapt the Spanish version of the Communication Styles Inventory in a sample of nursing professionals. The sample was made up of 2313 nursing professionals selected at random from various medical centres in Spain, and is therefore a sample actively employed at the time data were acquired. We started out from the Communication Style Inventory, a questionnaire for evaluating the predominance of certain individual communication behaviours on six scales (expressiveness, preciseness, verbal aggressiveness, questioningness, emotionality and impression manipulativeness). Confirmatory Factor Analysis of the model proposed showed god fit indices. The reliability of the model shown by the Cronbach's alpha of α = 0.81 was adequate, and so was single-level and aggregate consistency. Finally, in the analysis of variance by type of contract, configural, metric and scalar invariance was acceptable, but not strict invariance. This instrument progresses in measuring non-technical attributes, such as communication styles, in nursing personnel.

Cross-cultural Adaptation, Reliability, and Validity of the Turkish Version of the Health Professionals Communication Skills Scale

PURPOSE

The aim of this study is to evaluate the psychometric properties of the Turkish version of the Health Professionals Communication Skills Scale (HP-CSS).

METHODS

The HP-CSS was translated into Turkish following an international instrument translation guideline. A convenience sample of 394 health professionals participated in this study. Internal consistency reliability, content validity, test-retest reliability, and convergent validity were assessed. A confirmatory factor analysis was conducted to evaluate the construct validity.

RESULTS

The Turkish version of HP-CSS comprised four factors (empathy, informative communication, respect, and social skill). The HP-CSS-TR demonstrated adequate internal consistency (Cronbach's α values .72-.79). In terms of the content validity, the scale-level content validity index (CVI) was .94, and the item-level CVI ranged from .83 to 1.00. The HP-CSS-TR showed good test-retest reliability (intraclass correlation coefficients were above .82). No statistically significant difference was found between the applications. There was a good agreement between the HP-CSS-TR and communication skills inventory (CSI) scales. Confirmatory factor analysis results (χ2/df, GFI, AGFI, IFI, TLI, CFI, RMSEA, and SRMR) showed a good fit for the original four-factor model.

CONCLUSION

Results showed that the Turkish version of the HP-CSS is a valid and reliable tool for the assessment of communication skills of health professionals in Turkey. The use of the HP-CSS-TR measure in clinical settings could be useful in enhancing the quality of care by identifying inadequacies and improving communication skills.

The mediating role of cognitive and affective empathy in the relationship of mindfulness with engagement in nursing

BACKGROUND

The work of health professionals is characterized by a high demand for psychological and emotional resources and high levels of stress. Therefore, the promotion of commitment and job well-being through strategies such as increased mindfulness, is important among nursing workers. Although mindfulness has shown positive effects in the health field, few studies have explored the mechanisms and processes underlying these results. We investigated the mediating role of empathy (cognitive/affective) in the effect of mindfulness on the dimensions of engagement in nursing professionals.

METHODS

Sample was comprised of 1268 Spanish nurses between 22 and 62 years old, that completed the Utrecht Labor Engagement Scale and the adapted versions of Mindful Attention Awareness Scale and Basic Empathy Scale. The relationship between variables to be included in the regression analyses, bivariate correlations were carried out, and the descriptive statistics of these variables were also found. To estimate the mediation model was used, in this case for multiple mediation effects.

RESULTS

Mindfulness is found to affect the Vigor and Dedication factors of engagement through cognitive empathy. While for the Absorption factor, the affective component of empathy also exerts a mediating role, although weaker than cognitive empathy. Cognitive empathy, as an individual factor, was shown to have a mediating effect between mindfulness and the factors of engagement in healthcare workers.

CONCLUSIONS

The level of mindfulness influences engagement of nursing professionals positively, and this result is mediated mainly by cognitive empathy. Both mindfulness and empathy are modifiable individual factors, so their intervention by designing and implementing specific programs, can increase the commitment and wellbeing of professionals generating benefits to workers and to their patients.

Use and impact of virtual reality simulation in dementia care education: A scoping review

BACKGROUND

Communication and empathy are considered as key competences in the care of persons with dementia. Virtual reality might be an effective intervention to train informal and professional caregivers of persons with dementia in order to improve their communication skills and empathy.

OBJECTIVES

The aim of this study was to map the use and impact of virtual reality simulation in dementia care education.

METHOD

A scoping review was performed. Studies with all types of qualitative or quantitative design published since 2007 in English, French or German were included if a virtual reality intervention was examined in a dementia care education setting (e.g. nursing school, caregiver training). The literature search was conducted in six databases (MEDLINE, CINAHL, PsycINFO, Web of Science Core Collection, ERIC, and Inspec), including an additional hand search as well as backward and forward citation tracking of included studies. Charted data was narratively reported by clustering results according to study characteristics and impact of virtual reality.

RESULTS

The review process resulted in the inclusion of six studies published between 2012 and 2017. Two of them are ongoing studies. Three studies had a one group pre-post-test design and in one study a post-test only design was applied. The samples consisted of caregivers of people with dementia as well as students and varied in size between seven and 126. Eight different outcomes were measured, e.g. empathy, competence, and stress. Interventions resulted in improvements of caregivers' and students' empathy and competences among other outcomes.

CONCLUSIONS

No studies with controlled design and group comparisons are available yet. There are some indications that virtual reality might be an effective intervention to train caregivers of persons with dementia. Little is known about the use and impact of virtual reality in dementia-related education. Since studies are rare and do not address effectiveness, the findings of this review can substantially contribute to guide further research on this topic.

Supporting Empathy Training Through Virtual Patients

For the training of interpersonal skills, such as those required in the medical field, virtual agents can provide a safe environment for practice. However, many agent systems are not developed with the ability to understand non-verbal input. Being able to automatically parse such input is essential for the practice of interpersonal skills such as empathy. Currently, it is still an open question which prosodic or visual features would aid automatic classification of empathy and how this knowledge can be used to support the practice of these skills. As a first step towards this goal, we report on 42 second-year nursing students practicing their empathy skills with a virtual patient or through collaborative role playing. We found that across both the role playing and simulation, students assessed their empathy as increasing over time but as higher during the role playing. This work contributes to the continued development of virtual agents for the training of interpersonal skills.

Emotional Intelligence, Self-Efficacy and Empathy as Predictors of Overall Self-Esteem in Nursing by Years of Experience

Empirical research on self-esteem has a special interest in nursing professionals, because they work in a challenging environment that requires, in order to continue working during their working age, a strong physical, social and emotional involvement. The objective was to determine the explanatory value of individual variables such as Self-efficacy, Empathy and Emotional Intelligence on Self-esteem in a sample of nursing professionals, to identify which variables have the most explanatory value for overall self-esteem with years of experience. The study sample consisted of a total of 1,601 Spanish nurses aged 22–60, with a mean age of 31.19 (SD = 6.59) years. The emotional intelligence factors in all cases were observed to have positive correlations with overall self-esteem. Mood was still the predictor with the most explanatory weight in all the groups. General Self-Efficacy disappeared in the model of professionals with the most experience. Organizations and management nursing should implement intervention programs that promote wellbeing and satisfaction in workers during their working age. It would be of interest to train nursing professionals in such necessary competences as Empathy, Emotional Intelligence and Self-Efficacy.

Explanatory Value of General Self-Efficacy, Empathy and Emotional Intelligence in Overall Self-Esteem of Healthcare Professionals

We analyze the explanatory value of individual variables such as self-efficacy, empathy and Emotional Intelligence for self-esteem in a sample of healthcare workers, and identicare the variables with the most explanatory value for overall self-esteem. A total of 386 healthcare professionals participated in this study (nursing, Certified Nursing Assistants, physicians and physiotherapists). In all the healthcare professionals, Mood, a dimension of Emotional Intelligence, and Self-Efficacy are predictors of self-esteem. This study showed that Self-Efficacy, Empathy and Emotional Intelligence have a significant positive relationship with Self-Esteem. The results have important practical implications for to promote the worker's wellbeing and health.