A systematic review of the effectiveness of empathy education for undergraduate nursing students

Impact of interprofessional education on empathy of pre-licensure healthcare students: A mixed-studies systematic review

BACKGROUND

In the age of automation and technology, incorporating empathy in pre-licensure healthcare education is essential in providing empathic care to patients and co-workers. This can be achieved through interprofessional education (IPE).

OBJECTIVE

To consolidate evidence to evaluate interprofessional education's impact on pre-licensure healthcare students' empathy levels.

DESIGN

A mixed-studies systematic review following a convergent segregated approach.

METHODS

Ten electronic databases were searched from their inception until 30 November 2023. Quantitative, qualitative, and mixed-method studies that explored the impact of IPE on the change in empathy level in pre-licensure healthcare students were reviewed. The methodological quality of the included studies was assessed using the Mixed-Method Appraisal Tool. Findings from the qualitative and quantitative aspects were analysed and synthesized separately using thematic and narrative synthesis. The findings were integrated by convergent synthesis.

RESULTS

A total of 36 studies involving 3887 participants were included in this review, consisting of five quantitative, 14 qualitative and 17 mixed-methods studies. This review found that IPE enhanced the empathy level of students by improving their understanding of empathy and various empathic responses. Through IPE activities, students demonstrated empathy towards both patients and interprofessional peers. Three themes were generated through the synthesis of qualitative and quantitative results: (1) Empathy Awareness, (2) Internal Empathic Processes, and (3) Intentional Actions. The results showed that healthcare students exhibited empathic care behaviours towards patients and their interprofessional peers.

CONCLUSION

The findings of this review suggested that IPE was effective in improving awareness and knowledge of empathy and in providing empathy care to patients and interprofessional peers. This review encourages educators to implement IPE to pre-licensure healthcare students to increase their knowledge of the importance of providing empathic patient care and interprofessional empathy. Future research could explore more on the processes of interprofessional empathy in students.

The Relationship Between the Attitudes of Nursing Students Towards Providing Care for a Dying Patient and Their Empathic Tendencies

This study was planned to determine the relationship between the attitudes of nursing students towards death and dying patients and their empathic tendencies. This study was conducted with a descriptive and correlational design. The research was completed with 176 students. Positive significant relationship found between between the FATCOD and ETS scores. It was observed that a 1-point increase in the Empathic Tendency Scale score caused an increase of 0.502 points in the FATCOD score. İt is recommended providing training sessions with simulation applications for nursing students to prepare them for end-of-life care experiences.

Clinical Simulation Program for the Training of Health Profession Residents in Confidentiality and the Use of Social Networks

BACKGROUND

In the transition to a professional learning environment, healthcare professionals in their first year of specialized postgraduate clinical training (known as residents in Spain) are suddenly required to handle confidential information with little or no prior training in the safe and appropriate use of digital media with respect to confidentiality issues. The aims of this study were: (1) to explore the usefulness of an advanced clinical simulation program for educating residents from different healthcare disciplines about confidentiality and the dissemination of clinical data or patient images; (2) to explore the use of social networks in healthcare settings; and (3) to explore participants' knowledge and attitudes on current regulations regarding confidentiality, image dissemination, and the use of social networks; Methods: This was a cross-sectional study. Data were collected from all 49 first-year residents of different health professions at a Spanish hospital between June and August 2022. High-fidelity clinical simulation sessions designed to address confidentiality and health information dissemination issues in hospital settings, including the use of social networks, were developed and implemented. Data were assessed using a 12-item ad hoc questionnaire on confidentiality and the use of social media in the healthcare setting. Descriptive of general data and chi-square test or Fisher's exact test were performed using the SPSS 25.0 software; Results: All the participants reported using the messaging application WhatsApp regularly during their working day. A total of 20.4% of the participants stated that they had taken photos of clinical data (radiographs, analyses, etc.) without permission, with 40.8% claiming that they were unaware of the legal consequences of improper access to clinical records. After the course, the participants reported intending to modify their behavior when sharing patient data without their consent and with respect to how patients are informed; Conclusions: The use of advanced simulation in the training of interprofessional teams of residents is as an effective tool for initiating attitudinal change and increasing knowledge related to patient privacy and confidentiality. Further follow-up studies are needed to see how these attitudes are incorporated into clinical practice.

Experiences of internationally educated nurses working with older adults: A scoping review protocol

BACKGROUND

Canada, like many other jurisdictions worldwide, is facing a nursing shortage. At the same time, high-income countries are facing a rapidly ageing and more complex older adult population. Demands for more responsive health care services are driving systems of care to meet the evolving needs of the ageing population. Internationally-educated nurses (IENs) can help fill gaps in the care of older adults, but may need considerable support to work in new social and health care environments. However, the experiences of IENs within the geriatric care literature have not been comprehensively reviewed. This protocol will outline a scoping review to determine: (1) what is known about the experiences and support needs of IENs in geriatric healthcare settings within high income countries? (2) what are current supportive-pathways for IENs in geriatric practice settings? And (3) what are the research gaps in the existing literature on the experiences and support needs of IENs within the context of geriatrics?

METHODS

A scoping review will be conducted guided by the methodological framework set out by Arksey and O'Malley (2005) and later advanced by Levac, Colquhoun and O'Brien (2010). The search strategy will be applied to seven databases (MEDLINE, PubMed (non-MEDLINE records), PsycINFO, PsychArticles, CINAHL, Scopus, Web of Science). Grey literature will be searched using Google search engines, targeted websites and consultation with content experts. Articles of any publication date will be included. A two-stage screening process will be conducted in duplicate (i.e., two reviewers per stage) to determine eligible articles. Data from eligible articles will be extracted using a piloted charting form. Extracted data will be analyzed using thematic and descriptive analyses.

DISCUSSION

The findings of the upcoming will highlight opportunities and recommendations to inform future research and support training to support IENs working with older adults within high income countries. Publication, presentations and stakeholder meetings will disseminate our findings.

Rehearsing empathy: exploring the role of poetry in supporting learning

Empathy is an important aspect of therapeutic relationships in health and social care settings. Health educators can foster empathy development in learners through creative writing activities. Drawing on the humanities, specifically poetry, this paper offers strategies for educators to support empathy development in learners, with a focus on service user poetry and associated creative writing activities. We discuss how poetry can enable alternative perspectives about care to emerge thereby challenging previously held assumptions about mental and physical states. Using poetry can enable a rehearsal of empathy by bringing experiences to the learner in a safe and facilitated environment. Through creative writing activities, we believe that students can learn to better understand and empathise with others, as well as explore their own feelings and experiences related to caregiving, to support self-care.

Validity and reliability evaluation of the Turkish version of the Clinical Interpersonal Reactivity Index

AIM

This study was conducted to evaluate the validity and reliability of the Turkish version of the Clinical Interpersonal Reactivity Index, an instrument to assess nurses' empathy.

BACKGROUND

A practical empathic approach is valuable for planning nursing interventions suitable for the patient's conditions and needs and increasing patient satisfaction.

DESIGN

This is a methodological study.

METHODS

The study was carried out at Muğla Sıtkı Koçman University Training and Research Hospital, recruiting a total of 358 nurses between January and February 2023. Exploratory and confirmatory factor analyses were used to determine and validate the factor structure of the Clinical Interpersonal Reactivity Index.

RESULTS

The exploratory factor analysis extracted three factors. According to the confirmatory factor analysis, all goodness of fit measures were within acceptable limits. Cronbach's α values were 0.89 for the total scale with 17 items and between 0.73 and 0.81 for the factors. In test-retest analyses, all intra-class correlation coefficients were higher than 0.7, and the correlations between the first and second applications of the scale were between 0.61 and 0.73.

CONCLUSION

The Turkish version of the Clinical Interpersonal Reactivity Index can be applied as a valid and reliable measurement tool to evaluate empathy in Turkish nurses.

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.

Insomnia mediates the relation between empathy and anxiety among nursing students: a latent moderated mediation model of self-compassion

BACKGROUND

Nursing students are faced with multiple challenges and have a higher probability of suffering from anxiety. The current study aims to explore the relation between empathy and anxiety, examining the mediation and moderation effects of insomnia and self-compassion, respectively.

METHODS

This study employed a convenient sampling method, recruiting 1,161 nursing students (female = 923, male = 238, Meanage = 18.37, SDage = 2.38) from three universities in China. These students completed the questionnaires online, including General Anxiety Disorder -7 (GAD-7), Jefferson Scale of Physician Empathy-Nursing student (JSPE-NS), Youth Self-rating Insomnia Scale -8 (YSIS-8), and Self-Compassion Scale (SCS). The study employed latent variable structural equation models to analyze the relation and mechanisms between empathy and anxiety. Then, the mediated role of insomnia and the moderated role of self-compassion were examined.

RESULTS

The prevalence rates of anxiety and insomnia in the current sample are 18.24% and 26.76%, respectively. The results showed that empathy could negatively predict anxiety, with a significant mediating effect of insomnia between them (B = -0.081, p < 0.05, 95% CI [-0.197, -0.063]). Additionally, it was proven that self-compassion moderated the positive relation between insomnia and anxiety. With a higher level of self-compassion, the indirect effect of empathy on anxiety through insomnia was weaker (B = -0.053, p < 0.01, 95% CI [-0.095, -0.019]). When individuals showed a lower level of self-compassion, the indirect effect of empathy on anxiety through insomnia was stronger (B = -0.144, p < 0.01, 95% CI [-0.255, -0.059]).

CONCLUSION

The analysis of this research proved that empathy was negatively related to anxiety, and insomnia served as a mediator between empathy and anxiety. Besides, the protective role of self-compassion on individuals' mental health was identified. The findings of the study suggest that the education of nursing students should highlight the significance of fostering empathy and self-compassion. The intervention on insomnia may be helpful in reducing the levels of anxiety since insomnia is a risky factor for anxiety.

Cultural adaptation and psychometric evaluation of the Italian version of the active-empathic listening scale among undergraduate nursing students: A three phase validation study

AIM

To translate, culturally adapt and evaluate the psychometric properties of an Italian version of the Active Empathic Listening Scale (AELS-It) for first year students on a Bachelor degree in nursing.

BACKGROUND

Active and empathic listening is characterised by the active and emotional involvement of the listener and is particularly important for nurses to understand and address patients' needs. When nurses demonstrate to patients that they are active and empathic listeners, it leads to deeper engagement and trust, strengthens the nurse-patient relationship and enhances the quality of care. Consequently, it is essential to incorporate active and empathic listening into nursing education, as it equips future nurses to communicate and respond to patients' needs effectively. AELS is a tool that measures active and empathic listening styles. To the best of our knowledge, no study has validated and psychometrically tested AELS among nursing students and no studies have examined the application of the AELS scale within the Italian context.

DESIGN

A three-phase validation study.

METHODS

The tool was first translated and adapted into Italian. A panel of 12 experts in nursing education evaluated the face and content validity. The psychometric properties of the Italian AELS (AELS-It) were assessed in a sample of nursing students. The dimensionality and construct validity of the tool were tested through exploratory and confirmatory factor analyses. Reliability was estimated using both traditional and composite methods.

RESULTS

A total of 207 students were included. The overall content validity index was 0.9. The exploratory factor analysis confirmed a three factor structure. Confirmatory factor analysis showed a second-order factor structure with adequate fit indices. The reliability of the second-order factor analysis for the scale was adequate, with Cronbach's α (0.877) and Composite-ω (0.875).

CONCLUSIONS

The Italian version of AELS-It proved to be a reliable tool to test active empathic listening in Italian nursing students and it could be a useful instrument in nursing education.

Nursing Students' Experiences of Empathy in a Virtual Reality Simulation Game: A Descriptive Qualitative Study

Empathy is significant in nursing, and showing empathy toward a patient positively impacts a patient's health. Learning empathy through immersive simulations is effective. Immersion is an essential factor in virtual reality. This study aimed to describe nursing students' experiences of empathy in a virtual reality simulation game. Data were collected from nursing students (n = 20) from May 2021 to January 2022. Data collection included individual semistructured interviews; before the interviews, the virtual reality gaming procedure was conducted. Inductive content analysis was used. Nursing students experienced compassion and a feeling of concern in the virtual reality simulation game. Students were willing to help the virtual patient, and they recognized the virtual patient's emotions using methods such as listening and imagining. Students felt the need to improve the patient's condition, and they responded to the virtual patient's emotions with the help of nonverbal and verbal communication and helping methods. Empathy is possible to experience by playing virtual reality simulation games, but it demands technique practicing before entering the virtual reality simulation game.

Use and effectiveness of the arts for enhancing healthcare students' empathy skills: A mixed methods systematic review

OBJECTIVE

To identify, critically appraise and synthesise evidence of the use and effectiveness of the arts for enhancing pre-registration/prelicensure healthcare students' empathy skills.

DESIGN

A systematic review of mixed methods literature.

DATA SOURCES

A search of six electronic databases was conducted.

REVIEW METHODS

Articles describing English language, peer-reviewed, primary research studies reporting empathy as an outcome of an arts-based intervention with pre-registration/prelicensure healthcare students (years 1-7) and published between 2000 and 2024 were eligible for inclusion. The JBI Manual for Evidence Synthesis guided the review and a convergent segregated methodology was used to synthesise the results. Methodological rigour of included studies was examined using the Mixed Methods Appraisal Tool.

RESULTS

Twenty studies from 12 countries described the use of the arts to develop empathy, with visual arts being the most common approach (n = 8). Other modalities included film, drama, digital stories, literature, creative writing, music, poetry, photography and dance. Studies included nursing, medicine and dental, pharmacy and/or health sciences students. Ten studies used quantitative methods, three qualitative, and seven used mixed methods designs. Of the studies that presented pre-post outcome measures, nine reported significant gains in empathy scores at post-test and two reported non-significant gains in empathy. In eight studies, empathy scores demonstrated a significant intervention effect with effect sizes ranging from moderate (d = 0.52) to large (d = 1.19). Findings from qualitative studies revealed that arts pedagogies support students to better understand the perspectives of people with a lived experience of suffering but that these approaches are sometimes perceived negatively by students.

CONCLUSIONS

Arts interventions generally have a positive effect on healthcare students' empathy levels and enable a nuanced conceptual understanding of empathy. Arts modalities used as a stimulus for active learning and supported with facilitated group-based discussion and/or reflection, tend to be most effective.

Technology-based interactive communication simulation addressing challenging communication situations for nursing students

BACKGROUND

Simulation-based interventions for nursing students addressing challenging communication situations involving geriatric patients and end-of-life care are limited.

PURPOSE

This study evaluated the effects of technology-based interactive communication simulations on nursing students' communication knowledge, self-efficacy, skills, compassion, and program satisfaction.

METHOD

A randomized controlled repeated-measures design was used with third- and fourth-year nursing students enrolled in five nursing colleges located in five regions in Korea as participants. Participants were randomly assigned to either a technology-based interactive communication simulation or an attention control group. Changes in communication knowledge, self-efficacy, skills, compassion, and program satisfaction were assessed using three self-reported measures and communication skills were measured by the raters. Statistical analyses included descriptive analyses, chi-square tests, t-tests, and a generalized estimating equation model.

RESULTS

Eighty students participated in one of the two programs, and 77 in the four-week follow-up test. The intervention group indicated significant improvements in communication knowledge, self-efficacy, skills, and compassion, as well as higher program satisfaction compared with the attention control group. Communication skills as assessed by raters also showed significant change at all assessment time points.

CONCLUSION

The technology-based interactive communication simulation program is effective in improving communication skills among nursing students managing geriatric patients and end-of-life care.

Nursing students' empathic communication: Role in recognizing and treating chronic pain patients

OBJECTIVE

A substantial body of research supports what many nurses know from experience: empathy is at the heart of providing quality care. The major objective of this study was to identify unique mechanisms through which higher empathy translates into greater intentions to treat patients in pain employing novel methodology.

METHODS

Using an ecologically-valid scenario methodology, student nurses (N = 156) reviewed the narrative of a patient in chronic pain. They completed standard, valid measures of empathy toward the patient, perception of the patient's pain, and intention to provide pain-relieving treatment. Nursing student's personality traits were assessed and perception of patients' age and sex were experimentally manipulated.

RESULTS

Empathy was associated with higher intention to treat the patient in chronic pain irrespective of patients' age or sex. A moderated-mediation analysis confirmed that nursing students with higher empathy perceived the patient in the scenario as being in greater pain. This was correspondingly associated with higher intention to provide treatment. Nursing students' trait Extraversion was a moderator.

CONCLUSION

Empathy not only improves rapport between patients and providers but is related to intentions to provide pain-relieving treatment.

PRACTICE IMPLICATIONS

The clinical and educational importance of empathy in patient-provider relationships are discussed.

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.

Evaluating the Effectiveness of Empathy-Based Education in Undergraduate Nursing: A Scoping Review

BACKGROUND

Empathy is an essential trait in nursing practice that improves the quality of patient care. Nursing curricula that incorporate empathy-based experiential learning (i.e., hands-on educational experiences and reflections designed to foster and develop emotional intelligence) promote students' self-awareness and confidence when providing care to patients. This scoping review examined studies that explored the effects of educational interventions on the development of empathy in undergraduate nursing students.

METHOD

Searches were conducted in MEDLINE using keywords related to nursing education and translated into CINAHL, EMBASE, and ERIC databases.

RESULTS

A total of 6,238 studies were identified. After duplicate and unrelated articles were excluded, 18 publications were considered for this review. Sixteen studies concluded empathy interventions were effective, five indicated the need for further research, and two implicated a need for standardization in empathy-evaluation tools.

CONCLUSION

This review endorses the effectiveness of educational interventions and supports their implementation to promote empathy in undergraduate nursing students. [J Nurs Educ. 2024;63(6):367-371.].

The role of evidence-based practice and empathy in shared decision-making attitudes among newly graduated nurses: A cross-sectional study

AIM

Examine the levels of variables and explore drivers associated with shared decision-making attitudes among newly graduated nurses.

DESIGN

This was a descriptive and cross-sectional study.

METHODS

From August 2022 to October 2022, a cross-section of 216 newly graduated nurses from four comprehensive A-level hospitals in northern China was recruited using convenience sampling. Newly graduated nurses are generally defined as nurses with a service period of six months to one year. Data were collected using an online questionnaire support platform, including the Nursing Shared Decision-Making Attitude scale, Jefferson scale of Empathy-Health profession students and the Health Sciences Evidence-Based Practice questionnaire. All data were analysed descriptively, and correlational analysis and hierarchical regression were used to make identical connections between variables.

RESULTS

Newly graduated nurses supported shared decision-making. Perceptions of shared decision-making were correlated with the experiences of empathy and evidence-based practice. Additionally, perspective-taking of empathy and beliefs, and the ability to search for and apply existing scientific findings of evidence-based practice had a significant impact on more positive attitudes.

CONCLUSION

The survey showed that acceptance of shared decision-making was positive among newly graduated nurses. Clinical nursing managers and teachers should pay attention to cultivating the evidence-based practice and empathy of newly graduated nurses to adopt an optimistic attitude towards shared decision-making in the long term.

IMPACT

The survey addresses attitudes of shared decision-making among newly graduated nurses and determines whether empathy and evidence-based practice has an impact on it. The main finding is that newly graduated nurses have an optimistic outlook on the implementation of shared decision-making. This survey showed that empathy and evidence-based practice competencies are associated with shared decision-making attitudes among newly graduated nurses. The results of this survey have an impact on educational institutions and hospitals in the form of recommendations. Several training programmes on empathy and evidence-based practice can help adopt the shared decision-making attitudes of newly graduated nurses.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

Effectiveness of simulation-based interventions on empathy enhancement among nursing students: a systematic literature review and meta-analysis

BACKGROUND

This study aimed to secure and analyze evidence regarding the enhancement of nursing students' empathy through simulation-based interventions. It comprehensively analyzed self-reported emotions and reactions as primary outcomes, along with the results reported by nursing students who experienced simulation-based interventions, including empathy.

METHODS

This systematic literature review and meta-analysis investigated the effects of simulation-based interventions on enhancing empathy among nursing students. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for the systematic review and meta-analysis. The following details were considered: population, nursing students; intervention, simulation-based interventions targeting empathy enhancement; comparators, control groups without intervention or those undergoing general non-simulation-based classes; and outcomes, self-reported empathy.

RESULTS

In the systematic review of 28 studies, it was found that the use of simulation-based interventions among nursing students led to an increase in empathy, albeit with a small effect size. This was demonstrated through a pooled, random-effects meta-analysis, yielding an effect size (Hedge's g) of 0.35 (95% CI: 0.14, 0.57, p = 0.001). The results of meta-regression and subgroup analysis significantly increased in empathy for studies published after 2019 (Hedge's g = 0.52, 95% CI: 0.31 to 0.73, p < 0.001), quasi-experimental research design (Hedge's g = 0.51, 95% CI: 0.27 to 0.74, p < 0.001), more than 60 participants (Hedge's g = 0.31, 95% CI: 0.02 to 0.59, p = 0.034), and simulation-based interventions in nursing education (Hedge's g = 0.43, 95% CI: 0.22 to 0.65, p < 0.001).

CONCLUSIONS

Considering factors such as variations in sample size, research approaches, and the effects of independent studies on empathy, this systematic literature review and meta-analysis suggests that simulation-based education can significantly improve nursing students' overall empathy skills.

Effectiveness of the aged simulation suit on undergraduate nursing students' attitudes and empathy toward older adults: A systematic review and meta-analysis

AIM

This study aims to investigate the efficacy of the aged simulation suit on undergraduate nursing students' attitudes and empathy toward older adults.

BACKGROUND

A new approach to teaching to enhance nursing students' attitudes toward and empathy for older adults involves the use of an aging simulation suit.

DESIGN

This systematic review and meta-analysis seeks to determine the efficacy of the aged simulation suit on the attitudes and empathy of undergraduate nursing students toward older adults. This protocol for a systematic review and meta-analysis was registered as CRD 42023393879 on the PROSPERO database.

METHODS

In February-March 2023, a systematic review with meta-analysis of randomized controlled and quasi-experimental studies was conducted in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Population, Intervention, Control, Outcomes, Study Design (PICOS) structure was used for search strategy. Databases CINAHL, Cochrane Library, PubMed, PsycINFO, and Web of Science, as well as ULAKBIM, Turkish Medline, Turkiye Klinikleri, and YOK National Thesis Center, were searched for the articles. The Joanna Briggs Institute Critical Appraisal Tools were used to evaluate the methodological quality of a study and the extent to which its design, conduct, and analysis addressed the possibility of bias.

RESULTS

The meta-analyses of attitudes toward older adults included six studies (including 535 nursing students). The intervention group's attitudes toward older adults were found to be similar to those of the control group (SMD: 15.84, Z= 1.98, p= 0.05). The subgroup analyses revealed similarities between intervention group's and the control group's mean score on attitudes toward older adults (SMD: 4.85, Z=0.70, p=0.48, for RCT; SMD: 23.05, Z= 2.02, p=0.04, for quasi-experimental). Three studies (involving 207 nursing students) revealed significantly higher mean empathy score for the control group compared with the intervention group following the intervention (SMD: 7.08, Z=4.82, p=0.00001). The subgroup analyses revealed statistically significantly higher mean level of empathy for the control group compared with the intervention group was after the intervention (SMD: 7.49, Z=3.15, p=0.002, for RCT; SMD: 6.83, Z= 3.65, p=0.0003, for quasi-experimental).

CONCLUSIONS

Nursing students should be aware of older adults' feelings and experiences aging-related changes and aged simulation interventions can be a useful intervention to allow students to empathize with an older adult.

'It's very values driven': A qualitative systematic review of the meaning of compassion according to healthcare professionals

AIMS AND OBJECTIVES

To explore the meaning ascribed to the concept of compassion by healthcare professionals.

BACKGROUND

Compassion is universally regarded as the foundation of healthcare, a core value of healthcare organisations, and essential to the provision of quality care. Despite increasing research on compassion in healthcare, how healthcare professionals understand compassion remains unclear.

DESIGN

A systematic review of qualitative studies was conducted and is reported following PRISMA guidelines.

METHOD

Medline, Emcare, PsychINFO and CINAHL were searched to November 2021 for qualitative studies in English that explored healthcare professionals' understandings of compassion. Included studies were appraised for quality before data were extracted and thematically analysed.

FINDINGS

Seventeen papers met the inclusion criteria. An overarching theme, 'It's very values driven' underpins the four main themes identified: (1) 'It's about people and working with them': Compassion as being human, (2) 'There is this feeling': Compassion as being present, (3) 'If I don't understand them, I won't be able to help': Compassion as understanding, (4) 'Wanting to help in some way': Compassion as action.

CONCLUSIONS

Healthcare professional participants reported compassion as motivated by values and inherent to humanistic healthcare practice. The meanings healthcare professions described were varied and contextual. Qualitative research should further explore healthcare practitioners' experiences of compassion as part of their practice to inform health professions education, policy, and practice.

RELEVANCE TO CLINICAL PRACTICE

To practice with compassion, healthcare professionals require supportive and humanistic organisations that honour each person's humanity and encourage people to be human and compassionate to each other as well as to patients, their families and/or carers. Healthcare professionals need to reflect on what compassion means to them, how it is situated within their unique practice context, and how compassion can enhance clinical practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review had no patient or public contribution.

Experiencing COVID-19 Through the Patient Lens to Promote Empathy: Pilot Testing a Virtual Reality Learning Opportunity

Understanding the patient's experience with COVID-19 was essential to providing high-quality, person-centered care during the pandemic. Having empathy or being able to understand and respond to the patient's experience may lead to improved outcomes for both patients and clinicians. There is mixed evidence about how best to teach empathy, particularly related to promoting empathy during COVID-19. Literature suggests that virtual reality may be effective in empathy-related education. In collaboration with four patient partners with lived experience, a 360° VR video was developed reflecting their stories and interactions with the healthcare system. The aim of this study was to pilot test the video with interprofessional healthcare providers (HPs) to explore acceptability and utility, while also seeking input on opportunities for improvement. Eleven HPs reviewed the video and participated in one of three focus groups. Focus group data were analyzed using thematic analysis. Data suggest that video content is acceptable and useful in promoting a better understanding of the patient's experience. Building on these encouraging findings, additional iterations of videos to promote empathy will be developed and tested.

Attitudes Toward People With Schizophrenia Among Undergraduate Nursing Students

BACKGROUND

Negative attitudes toward mental disorders are not only an interpersonal issue but also a concern of mental health care. Given that nursing students are future health care providers, it is pivotal to improve their attitudes toward individuals with mental disorders prior to their transition into clinical practice. However, research on nursing students' attitudes in relation to schizophrenia in Taiwan remains unexplored.

AIM

The aim of this article is to examine the correlates of attitudes toward individuals with schizophrenia among Taiwanese undergraduate nursing students.

METHOD

A descriptive, correlational, and cross-sectional study was adopted. Self-reported questionnaires were conducted with a convenience sample of 306 Taiwanese undergraduate nursing students. Descriptive statistics, independent t tests, one-way analysis of variance, Pearson's correlations, and a stepwise regression analysis were performed.

RESULTS

Nursing students expressed negative attitudes toward individuals with schizophrenia. Nursing students, who were female, had contact with individuals with mental disorders, and expressed greater empathy and personality traits held more favorable attitudes toward individuals with schizophrenia. The study found that empathy, personality traits, and academic year were the most crucial attributes contributing to attitudes of nursing students toward individuals with schizophrenia.

CONCLUSION

Findings suggest that nursing education programs with empathy- and personality-tailored modules in mental health are pivotal to provide humanistic approaches with supportive attitudes regarding schizophrenia.

Empathy in family medicine postgraduate education: A mixed studies systematic review

PURPOSE

Empathy is an important construct in patient-physician relationships, particularly critical in family physicians' daily practice. We aimed to understand how empathy has been conceived and integrated into family medicine postgraduate training.

MATERIALS AND METHODS

Medline, PsyINFO, and Embase were searched in this systematic mixed studies systematic review. Two independent reviewers screened abstracts and full texts. Disagreements were solved through research team consensus-based discussion. Included studies were synthesized thematically.

RESULTS

A total of 18 studies were included. Four themes were identified. (1) Empathy definition. Included studies stressed the cognitive component of empathy, paired either with a behavioural or an affective response. (2) Empathy modifiers. Starting residency right after medical school, having a role model, having high empathy levels before residency, having children, being married, and being exposed to patient involvement in education were found to have a positive impact on empathy. (3) Empathy-burnout relationship. Whereas greater burnout was related to lower empathy levels, excess empathy seems to favour burnout through 'compassion fatigue.' (4) Educational programs for empathy development. Five programs were identified: a communication workshop, a patient-led program, a mindfulness program, a family-oriented intervention, and an arts-based program.

CONCLUSIONS

Studies mostly measured the cognitive component of empathy. The moral component of empathy was underrepresented in the conceptualization of empathy and the development of educational interventions. Conflicting evidence exists regarding the decline of empathy levels during the family medicine residency. Longitudinal designs should be privileged when exploring the evolution of empathy levels across the continuum of medical education.

Communication and empathy of nursing students in patient care through telenursing: A comparative cross-sectional study

BACKGROUND

Phone calls and videoconferences are the most widely used systems to interact with patients in real time. Patient care through phone calls or videoconferences is different from an in-person meeting. Interpersonal communication skills, self-confidence communication skills and empathy with the patient may be affected during phone calls or videoconferences.

AIM

The objective of this study was to describe the interpersonal communication skills, self-confidence communication skills and empathy of nursing students during patient care through phone calls or videoconferences.

DESIGN

A cross-sectional study.

PARTICIPANTS

A total of 170 nursing students participated from the University of Almeria. The subjects were randomly assigned to the phone call group or videoconference group.

METHODS

The students contacted standardised patients through phone calls or videoconferences. Questionnaires were used to assess interpersonal communication skills with patient, empathy, and self-confidence in communication skills. Data collection was carried out between March and May 2022.

RESULTS

No statistically significant differences were found between self-confidence in communication skills with the patient and the type of consultation, nor were statistically significant differences found between the empathy of the nursing students and the type of consultation. The students who used videoconference reported higher patient interpersonal communication skills than the students who made phone calls. Finally, the participants who made videoconferences obtained a higher score in dimension therapeutic use of self than those who made phone calls.

CONCLUSIONS

Nursing students have shown a high level of empathy and interpersonal communication skills with patients and a moderate level of self-confidence in communication skills, both when interacting with patients through phone calls and videoconferences. Finally, differences were found in interpersonal communication skills with patient and type of consultation. In particular, interpersonal communication skills with the patient are greater when the nursing students make a videoconference.

The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review

OBJECTIVES

This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness.

METHODS

We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis.

RESULTS

Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations.

CONCLUSIONS

For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.

A Systematic Review of the Application of Simulation to Promote Empathy in Nursing Education

SUMMARY STATEMENT

This systematic review aimed to identify, appraise, and synthesize evidence for the effectiveness of simulation modalities in promoting nursing students' empathy. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was followed with 20 studies included. The Medical Education Research Study Quality Instrument (MERSQI) was used to evaluate the quality of the publications. The mean MERSQI score was 10.95 with an SD of 1.62, which was above the average in the literature.Five simulation modalities were identified: standardized patient, simulated suit, manikin, virtual simulation, and virtual reality simulation. Most of the studies (n = 15) reported significant differences in the measured outcomes after their simulation activities, including all 5 simulation modalities, but the most effective modality was the simulation suit. The simulation suit replicates the lived experiences of others, which enhances perspective taking by "turning the student into the patient" through the physical and sensory effects of simulated suits. However, outcome measures were limited to self-report instruments in the studies.

Measures of empathy and compassion: A scoping review

Evidence to date indicates that compassion and empathy are health-enhancing qualities. Research points to interventions and practices involving compassion and empathy being beneficial, as well as being salient outcomes of contemplative practices such as mindfulness. Advancing the science of compassion and empathy requires that we select measures best suited to evaluating effectiveness of training and answering research questions. The objective of this scoping review was to 1) determine what instruments are currently available for measuring empathy and compassion, 2) assess how and to what extent they have been validated, and 3) provide an online tool to assist researchers and program evaluators in selecting appropriate measures for their settings and populations. A scoping review and broad evidence map were employed to systematically search and present an overview of the large and diverse body of literature pertaining to measuring compassion and empathy. A search string yielded 19,446 articles, and screening resulted in 559 measure development or validation articles reporting on 503 measures focusing on or containing subscales designed to measure empathy and/or compassion. For each measure, we identified the type of measure, construct being measured, in what context or population it was validated, response set, sample items, and how many different types of psychometrics had been assessed for that measure. We provide tables summarizing these data, as well as an open-source online interactive data visualization allowing viewers to search for measures of empathy and compassion, review their basic qualities, and access original citations containing more detail. Finally, we provide a rubric to help readers determine which measure(s) might best fit their context.

The impact of moulage on learners' experience in simulation-based education and training: systematic review

BACKGROUND

Moulage is a technique used to simulate injury, disease, aging and other physical characteristics specific to a scenario, often used in health and emergency worker training, predominantly for simulation-based learning activities. Its use in allied health fields is unclear. Previous work has explored moulage as an adjunct for authentic simulations, however there is opportunity for broadening its scope.

AIM

To explore the effects of moulage interventions in simulation-based education and training, for learner experience. A secondary aim was to understand which pedagogical frameworks were embedded in moulage interventions.

METHOD

Four electronic databases (PubMed, CINAHL, EmBase, Proquest Central) were systematically searched to December 2022 for studies utilising moulage in simulation-based education experiences. Outcomes were focused on learner satisfaction, confidence, immersion, engagement, performance, or knowledge. Study quality was assessed using the Mixed Methods Appraisal Tool.

RESULTS

Twenty studies (n = 11,470) were included. Studies were primarily conducted in medicine (n = 9 studies) and nursing (n = 5 studies) and less frequently across other health disciplines. The findings demonstrated greater learner satisfaction, confidence, and immersion when moulage was used against a comparator group. Minimal improvements in knowledge and performance were identified. One study underpinned the intervention with a pedagogical theory.

CONCLUSION

Moulage improves learner experience in simulation-based education or training, but not knowledge or clinical performance. Further research utilising moulage across a broader range of professions is needed. Interventions using moulage should be underpinned by pedagogical theories.

Patient's views of empathic and compassionate healthcare interactions: A scoping review

BACKGROUND

Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients.

OBJECTIVE

The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions.

METHOD

This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion.

RESULTS

Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare.

CONCLUSION

Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.

How to maximise asynchronous video resources that have been co-produced with patient partners

Ensuring that health professional education is person centred is vital in the pursuit of person-centred clinical care. However, the volume of person-centred care content varies broadly in health professional education. One acknowledged approach to designing curriculum that is person-centred is to embed resources that have been co-produced by patients with lived and living experience. In this article, we aim to provide a guideline for the inclusion of asynchronous interdisciplinary video resources that have been co-produced by patients with lived and living experience.

Effect of moral sensitivity on professional values of undergraduate nursing students: Mediating effect of empathic tendency

BACKGROUND

The development of professional values in nursing students is an important issue for the nursing profession. However, the research on nursing students' professional values and its related factors is very limited.

PURPOSE

This cross-sectional and correlational study aimed to examine the mediating effect of empathy between moral sensitivity and professional values.

METHODS

This study was conducted with 328 second, third and fourth-year students. The participants completed an online survey consisting of the student information form, Modified Moral Sensitivity Questionnaire for Student Nurses, Empathic Tendency Scale and Nursing Professional Values Scale.

RESULTS

The results showed that moral sensitivity affected undergraduate nursing students' professional values not only directly but also indirectly through empathic tendency.

CONCLUSIONS

The results of the study show that moral sensitivity and empathic tendency support the acquisition of professional values in undergraduate nursing students. Nurse educators needs to realize that can be improved professional values by integrating moral sensitivity and empathic tendency in their curriculum.

Activities to promote empathy for patients among pharmacy learners: A scoping review

BACKGROUND

Provider empathy has been shown to be directly linked to improved patient outcomes. The objective of this scoping review of the literature was to identify and describe learning activities that promote empathy for patients among pharmacy learners.

METHODS

This scoping review was conducted using the following inclusion criteria: publication in English, activities conducted in any academic pharmacy training program (professional degree program, experiential, residency, or fellowship), description of the learning activity(ies) provided, and focus on the experience of empathy/caring/compassion for patients, either human or animal. Articles were excluded if they focused only on skills such as empathic responding or if they did not describe the learning experience. All study designs other than reviews were included.

RESULTS

The scoping review revealed 89 full-text articles that met the inclusion criteria. Included studies demonstrated a wide variety of approaches to the design of learning experiences as well as methods of measurement of empathy. Various types of learning modalities have been used to develop empathy in pharmacy learners, with reflection being the most common. A large proportion of studies that assessed empathy development used quasi-experimental or qualitative designs and did not report tests of statistical significance, which would make it difficult to compare the effectiveness of the different learning activities.

IMPLICATIONS

A variety of approaches have been used among pharmacy learners to develop empathy for patients. Due to the high level of variability in approaches, more rigorous studies are needed to assess the effectiveness of these learning activities.

Empathic nurses with sufficient job resources are work-engaged professionals who deliver more individualized care

AIMS

This study examined whether nurse work engagement mediated the associations of job resources (collegial support and autonomy) and a personal resource (empathy) with individualized care delivery, in both hospital and long-term care settings. We also explored potential setting-specific differences in how strongly the resources were associated with work engagement and individualized care delivery among nurses.

DESIGN

We conducted a cross-sectional study in three hospitals and two long-term care facilities.

METHODS

In total, 454 nurses completed a web-based survey including validated measures on resources (collegial support, autonomy, empathy), work engagement and individualized care delivery. Data were analysed using mediation and moderated mediation analyses.

RESULTS

In both settings, all resources were indirectly associated with individualized care delivery via work engagement. Empathy was also directly associated with individualized care delivery, and a stronger association was found in the long-term care setting than in the hospital setting.

CONCLUSION

The present study showed work engagement to mediate the associations of job resources and empathy with individualized care delivery in both hospital and long-term care settings. Individualized care delivery was furthermore directly facilitated by high levels of empathy, especially among nurses working in long-term care settings.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Patients may benefit from better individualized care delivery by empathic nurses who are more work-engaged in the face of sufficient job resources in their practice environment.

IMPACT

Nurses are better able to deliver individualized care when provided with sufficient job resources (collegial support and autonomy) that support their being work-engaged professionals. Furthermore, empathic nurses also reported being able to better support patient individuality. These findings can be translated to policies of hospitals and long-term care facilities, to optimize job resources and enhance empathy and thus facilitate the support of patient individuality by nurses.

REPORTING METHOD

This study adhered to the STROBE guidelines.

PATIENT OR PUBLIC CONTRIBUTION

Nurses were involved in the design and data collection of the study.

Beyond scientific and technical training: Assessing the relevance of empathy and assertiveness in future physiotherapists: A cross-sectional study

Background and Aims

Empathy and assertiveness are two essential social skills for a health professional such as a physiotherapist and are necessary for developing moral thinking. Previous studies show that the development of empathy and other social skills improves as students progress in their studies. However, other authors show deterioration of empathy as students progress in their studies and acquire clinical experience. Training in soft skills, such as assertiveness, among health science students will have an impact on the quality of patient care. Effective communication, conflict resolution and the ability to work as part of a team are competencies that have been put to one side as a result of the recent COVID-19 pandemic and it is important to resume training students in soft skills. The objective of this study is to investigate to determine the empathic and assertive state of physiotherapy university students.

Methods

A descriptive cross-sectional study of physiotherapy university students was conducted in the 2022/2023 academic year. The Interpersonal Reactivity Index (IRI) scales for empathy and the Rathus test for assertiveness (RAS) were used as study tools. Finally, 127 students participated in the study, 52.91% of the total population of physiotherapy students. The questionnaire was available for 4 weeks in November and December 2022.

Results

The empathetic and assertive development of the students was found to be acceptable. Significant differences were also observed according to the gender variable in the students, with female students presenting better results (p = 0.01). Students who are working or have clinical experience in other professions score lower on the empathy personal distress subscale (p < 0.001).

Conclusion

Future research should be considered to help improve clinical and professional expertise in physiotherapy students about empathic and assertive development. The findings provide new evidence on the levels of empathy and assertiveness in physiotherapy students.

The Development and Feasibility of an Empathy Virtual Reality Scenario in Healthcare Education

Technology-enhanced simulations such as virtual reality and computer-based experiences allow students to improve their understanding of patient perspectives and increase empathy for patients. These technologies can be daunting to nursing faculty without robust technology and video development resources. The purpose of this project was to share a guide for creating and implementing a patient-centered immersive virtual reality scenario within a nursing program. The research team developed, filmed, and produced a cost-effective virtual reality simulation scenario for use with smartphones and inexpensive virtual reality headsets, which could be widely disseminated for students to watch in class or online. The virtual reality simulation allowed an immersive first-person view and was well received by both faculty and students. The virtual reality scenario was implemented with ease in classroom, virtual, and laboratory settings. These virtual reality simulations work in the live setting or remotely, and synchronously or asynchronously with minimal equipment, which reduces barriers to access.

A phenomenological study of compassion satisfaction among social work educators in higher education

Background

Compassion satisfaction (CS) is a phenomenon that has been studied among the helping professions, such as nursing and social work and has been linked to stress, burnout, compassion fatigue, and vicarious trauma. Social work educators may also experience these same issues, yet more research is needed on how they might counter the negative impacts associated with this type of work by utilizing their experiences of CS.

Objectives

A phenomenological study was carried out to explore and describe how social work educators in higher education experiences CS.

Methods

Eleven in-depth interviews with social work educators were conducted, and constructivist grounded theory techniques were utilized to analyze the data.

Results

Social work educators experienced CS within the education and personal realms, which encompassed four different elements: achievement, support, balance, and empathy.

Discussion

The four elements of CS were utilized by social work educators in this study as coping strategies to enhance their experience of CS, thus encountering threats to CS, such as institutional barriers, interaction with administrators and colleagues, and work overload.

Conclusion

Interventions fostering compassion satisfaction and reducing compassion fatigue, burnout, and stress should be considered, including interventions that increase the sense of accomplishment, promote holistic self-care, encourage administrative and collegial support, and improve work-life balance.

Innovative Use of Virtual Reality to Facilitate Empathy Toward Older Adults in Nursing Education

ABSTRACT

Innovative educational interventions that dispel aging myths and promote empathy toward older adults can be used to reduce age bias and health care disparities. Virtual reality (VR) is one intervention that has shown promise in this area. This one-group, pretest-posttest design pilot study examined the effect of a VR experience on empathy with a sample of 121 second-degree, prelicensure nursing students. A significant improvement in empathy was observed. This study adds to the limited evidence that examines the use of VR for immersive storytelling and facilitation of empathy toward older adults in nursing students.

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.

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.

An undergraduate course on pain: Its impact on students' empathy

INTRODUCTION

Empathy towards patients in pain involves an internal process in which both affective and cognitive processes in the observer are responsible for a final behavioral reaction. This study investigated the impact of an undergraduate elective course on pain on students' empathy in a mixed-method design.

METHODS

Undergraduate students of the elective course on pain (intervention group) as well as undergraduate students of a compulsory course on neuropharmacology (control group) completed the Dutch version of the Interpersonal Reactivity Index (IRI) questionnaire at the beginning and the end of the course. In addition, students' empathy in the intervention group was explored by content analysis of students' reflective writing assignments related to documentary films that were part of the course activities.

RESULTS

Twenty students (intervention group) and seven students (control group) completed both IRI questionnaires. IRI scores for subscales perspective taking, fantasy, and personal distress significantly increased over time more in the intervention group than in the control group (intervention x time interaction). Effect sizes (generalized eta squared) for these effects were 0.084, 0.041, and 0.139 for perspective taking, fantasy, and personal distress, respectively. The qualitative data revealed information on cognitive and affective responses, and to some extent behavioral responses.

CONCLUSIONS

Both IRI outcomes and analysis of the reflective assignments demonstrate that students' empathy increased during the course on pain. Further research should explore in-depth the effects of different documentaries in the course on students' empathy development and the long-term effect of the course on students' empathy.

The effect of drama-supported, patient role-play experience on empathy and altruism levels in nursing students: A randomized controlled study

AIM

This study aims to determine the effect of drama-supported, patient role-play experiences on the empathy and altruism levels of nursing students.

BACKGROUND

Empathy, one of the most important skills of the nursing profession, has an important place in the patient-nurse relationship. To be empathetic, which is acknowledged as the most basic motivation of altruistic behavior, requires recognizing emotional states and understanding the needs of others.

DESIGN

The format of this study was a pre-test-post-test, regular parallel-group, randomized, controlled experiment.

METHODS

The study data were collected between October 2021 and February 2022. The research was carried out with second-year students at Necmettin Erbakan University, Faculty of Nursing, who did not have any history of hospitalization or any chronic diseases. All subjects agreed to participate in the study (n = 52, intervention group=26, control group 26). Data were collected using a Descriptive Characteristics Form, the Altruism Scale and the Jefferson Scale of Empathy for Nursing Students (JSENS). After a three-hour drama workshop, participants in the intervention group acted out the role of a bed-bound patient in the laboratory environment and no intervention was applied to the control group. A series of Mixed ANOVAs were conducted for the analysis of the data.

RESULTS

The mean age of participants was 19.94 years (SD = ± 1.31) and 83.7 % of the participants were women. The intervention group showed a significant increase in altruism compared with the control group, as evidenced by higher scores in the Altruism Scale Total Score and a significant group*time interaction effect. However, in the JSENS Total Score, including the perspective taking and standing in patient's shoes sub-dimensions, no differences were observed based on group, time and group * time interactions.

CONCLUSION

The patient role-play experience increased the empathy and altruism levels of nursing students, but the effect was not evident at the three-month follow-up.

Original Research: Nurses' Self-Assessed Knowledge, Attitudes, and Educational Needs Regarding Patients with Substance Use Disorder

BACKGROUND

Substance use disorder (SUD) is a chronic illness, but it's often seen as an intentional choice rather than as a disease. People with SUD are frequently stigmatized, leading to disparate care. Findings from previous studies have indicated that nurses feel inadequately prepared to care for, and tend to have negative attitudes toward, patients with SUD. But it's unknown what kind of education would better prepare nurses caring for this patient population, or whether these negative attitudes vary across practice settings.

PURPOSE AND DESIGN

This observational, cross-sectional, mixed-methods study sought to explore nurses' self-assessed knowledge of and attitudes toward caring for patients with SUD (whether formally diagnosed or not) in hospital settings across the United States. A secondary aim was to determine nurses' educational preferences and needs in this area.

METHODS

Data were collected over a three-month period in early 2020, using the online social networking platform Facebook. All participants were nurses working in hospital settings throughout the United States. Participants were surveyed using two tools: the Drug and Drug Problems Perceptions Questionnaire, and another questionnaire that included open-ended questions regarding nurses' SUD-related education and their experiences and perceived needs in caring for patients with SUD. Quantitative data were analyzed using analysis of variance and post hoc Tukey tests. Qualitative data were analyzed using thematic analysis.

RESULTS

A total of 691 nurses participated. Nurses reported having been educated in SUD but wanted additional face-to-face education from mental health specialists. The nurses working on mental health units had significantly more positive attitudes toward caring for patients with SUD than nurses on other units. Older nurses had significantly more positive attitudes toward patients with SUD than younger nurses. Qualitative analysis uncovered four themes: unmet needs, personal experiences inform care, personal beliefs inform perceptions, and judgmental attitudes.

CONCLUSIONS

Study findings indicate that, in general, hospital nurses have negative attitudes toward patients with SUD. The results further reaffirm the need for empathy-based nursing education for nurses who care for these patients. Participants expressed a preference for face-to-face training by mental health specialists experienced in SUD. Given the increasing prevalence of SUD and the expected retirement of older nurses, it is urgent that we prioritize empathy-based nursing education, particularly for newer-to-practice nurses, in order to improve nurses' attitudes and ensure best care for patients with SUD.

Influence of Emotional Skills on Attitudes towards Communication: Nursing Students vs. Nurses

Communication in nursing is essential to the quality of care and patients' satisfaction, and personal variables such as empathy and emotional intelligence (EI) can improve it; however, no studies have to date analyzed these competencies and their relations among nursing students compared with nurses. The aims of this study are, therefore, to analyze the differences between nursing students and nurses in the means for empathy, EI and attitudes towards communication in order to assess the impact of empathy and EI on nurses' and nursing students' attitudes towards communication, and their influence on the behavioral dimension of attitude. A cross-sectional descriptive study was performed on a convenience sample of 961 nursing students and 460 nurses from the Valencian Community, Spain. T-test and hierarchical regression models (HRM) were used. The data was collected in the selected universities in the 2018/2019 academic year. The results showed high levels in all the variables analyzed (i.e., empathy, EI, and attitudes towards communication) in both samples. The HRM results suggested that empathy was a better predictor than EI of the attitudes towards patient communication among both the nursing students and nurses. In the behavioral dimension of the attitude, the cognitive and affective dimensions had greater weight than the emotional component (i.e., empathy and EI). Developing empathy and the cognitive dimension of the attitude in nursing students and nurses could, therefore, help improve EI and attitudes towards communication. These findings are important for developing intervention programs adjusted to real needs.

Effects of a Comprehensive Person-Centered Care Education Program for Nursing Students

Background and Objectives: The aim of this study is to develop and implement a comprehensive person-centered care (PCC) education program for nursing students and assess its effects on individualized care, empathy, communication competence, and clinical practice stress. Materials and Methods: A non-equivalent control group non-synchronized design was used. Participants were 60 third-year nursing students undergoing clinical practicum in a nursing school. They were assigned either to the control group (29 students) or experimental group (31 students). The experimental group participated in a comprehensive PCC education program, while the control group did not. Four 65-min sessions were conducted over two weeks; each session comprised 5 min of introduction, 50 min of education, and 10 min of sharing of thoughts and training. Individualized care, empathy, communication competence, and clinical practice stress were measured. Data were collected immediately before the education program and two weeks after program completion. Results: After the education program, the experimental group showed significant improvements in individualized care, empathy, and communication competence and significantly reduced clinical practice stress compared to the control group. Conclusions: The comprehensive PCC education program is a potentially beneficial intervention for nursing students to help them practice person-centered care with confidence. Longitudinal randomized controlled trials are needed to substantiate these findings.

Factors that affect levels of alexithymia, empathy and communication skills of nursing students in northern Iran

AIM

The inability of nurses to express their own emotions, understand others' emotions and show empathy could result in communication gaps that could affect patient care outcomes. This study investigates the factors associated with the levels of alexithymia, empathy and communication skills among nursing students.

DESIGN

A survey was conducted among 365 nursing students, and data were collected using an online questionnaire.

METHODS

Data analyses were done using SPSS software version 22.

RESULTS

There was a significant positive association between age and empathy and a negative association between the number of times a nurse took the entrance exam. The level of education and interest in nursing correlate with communication skills. All the predictor variables of alexithymia in this current study were not significant. Emphasis should be placed on improving nursing students' empathy and communication skills. Student nurses should be taught how to recognize and express their emotions. To assess their mental health, they must be screened regularly.

Physiotherapy students' empathy towards Australians living in rural settings: A pre-test post-test evaluation of a stand-alone rural simulation activity

OBJECTIVE

To investigate how a rural simulation activity influenced physiotherapy students' rural empathy, and to explore students' perception of the activity.

SETTING

A metropolitan university in Queensland, Australia.

PARTICIPANTS

Second year undergraduate physiotherapy students.

DESIGN

A single cohort pre-test post-test evaluation was undertaken to evaluate a rural simulation activity. Participants received the rural simulation activity, featuring an immersive video and telehealth simulation with a standardised patient portrayed by an actor. Participants undertook a structured debrief and guided reflection following the simulation. Outcome measures included the Rural Comprehensive State Empathy Scale (R-CSES) and the Satisfaction with Simulation Experience Scale. Group interviews were undertaken regarding participant perceptions of the activity. Wilcoxon Rank-Sum tests were used to analyse survey data, and group interview data were subject to thematic analyses.

RESULTS

A total of 102 students undertook the activity, with an outcome measure response rate of 92.2% (94/102). Intra-personal rural empathy increased following the activity as demonstrated by the overall R-CSES score [pre-test: 101.5 (90-110.75) vs post-test 107 (100-120); p = <0.001; r = 0.39]. There was high satisfaction with the experience [mean SSES score = 18/21]. Two themes were generated from the group interview data: (1) effect on perceptions of rural practice and (2) feedback regarding the simulation.

CONCLUSION

A rural simulation activity using an immersive video, standardised patient, and a structured debrief increased physiotherapy students' empathy towards Australians living in rural settings. Students were satisfied with the activity and felt that it improved their understanding of the challenges of rural healthcare.

Relationship between self-consciousness and empathy for cancer patients among nursing students: The moderating effects of clinical practice satisfaction

BACKGROUND

Patients with cancer experience physical and mental difficulties that can be relieved with the support and empathy of healthcare professionals. Empathy can be affected by self-consciousness. The clinical performance and interpersonal competence of nursing students are related to their satisfaction with clinical practice.

OBJECTIVE

This study explored the moderating effect of clinical practice satisfaction of nursing students on the relationship between self-consciousness and empathy for patients with cancer.

DESIGN

Cross-sectional descriptive study.

SETTING

Three colleges of nursing in South Korea.

PARTICIPANTS

A total of 136 senior nursing students across three universities.

METHODS

The participants completed an online questionnaire on demographic and education-related characteristics, self-consciousness, and empathy competency. We used the Korean versions of the Self-Consciousness Scale and Empathy Construct Rating Scale. The overall response rate was 42.5 %. SPSS PROCESS macro was used to test the moderating role of satisfaction with clinical practice.

RESULTS

Private self-consciousness was significantly associated with clinical practice satisfaction and empathy. The relationship between practice satisfaction and empathy was significantly positive. In addition, the satisfaction of the nursing students with clinical practice moderated the association between private self-consciousness and empathy for patients with cancer. Empathy was more affected by private self-consciousness among senior nursing students who were less satisfied with clinical practice than among those who were more satisfied with clinical practice.

CONCLUSION

To improve empathy for patients with cancer, educational strategies must be created to improve the private self-consciousness and satisfaction with the clinical practice of nursing students.

Effects of video-recorded role-play and guided reflection on nursing student empathy, caring behavior and competence: A two-group pretest-posttest study

AIM

The study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies.

BACKGROUND

Educating nursing students in empathy and caring behaviors before entering clinical practice is challenging.

DESIGN

We used a two-group pretest and post-test quasi-experimental design.

METHODS

First-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale.

RESULT

A total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η² effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (β = 0.81, 95% CI:0.66-0.97).

CONCLUSIONS

Education based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.