Effectiveness of simulation-based interventions at improving empathy among healthcare students: A systematic review and meta-analysis

Advancing empathy and emotional intelligence among pharmacy students: A comparative mixed-methods study with peer role-play simulation intervention

INTRODUCTION

Due to the significance of interpersonal empathy and emotional intelligence in pharmaceutical practices, it has become essential to emphasize its importance in pharmacy education. The aim of this study is to provide pharmacy students, who require proper communication skills throughout their professional careers, with a simulation-based intervention focusing on empathy and emotional intelligence, and to evaluate the influence of this educational intervention on emotional intelligence and empathy levels.

METHODS

The methodological approach adopted in this study aims to integrate both qualitative and quantitative data for a comprehensive analysis, that is, the mixed method, and to provide in-depth answers to the research questions.

RESULTS

There was a difference observed in the change in empathy and emotional intelligence scores between the control and intervention groups. When the pre-test and mid-test results with the intervention group were analyzed, there was a difference in the values for emotional intelligence when only education was offered. Conversely, no difference was found in empathy scores under the same conditions. In the intervention group, after the implementation of both training and simulation practice resulted in a difference in the scores for emotional intelligence and empathy when comparing the results before and after the test. Gender and the interaction between gender and group had small effect sizes on both empathy and emotional intelligence. The comprehensive data collected from these interviews enabled a rigorous thematic analysis, culminating in the identification of three primary themes accompanied by respective categories: the contribution of theoretical education to simulation, perceptions of simulation practice, the significance of debriefing sessions. Students highlighted the development of various communication skills, such as improving patient-provider relationships, conveying empathy to patients, being aware of and managing their emotions, and building self-confidence through simulated encounters and debriefing sessions.

CONCLUSION

Based on these findings, it is recommended that simulation methods be made mandatory in pharmacy school curricula and be disseminated nationwide.

Effects of empathy training on psychological concerns and empathy in caregivers of older people: A randomized, double-blind, crossover, clinical trial with follow-up

OBJECTIVES

To investigate the effects of empathy training on psychological concerns and empathy in caregivers of older people.

METHODS

A randomized, double-blind, crossover, clinical trial with follow-up was conducted online. Thirty paid and unpaid caregivers of older people from different regions of Brazil participated in an empathy training program. The caregivers answered a sociodemographic questionnaire and measures for the evaluation of empathy (affective and cognitive domains), burden, the impact of providing care as well as depressive symptoms and psychiatric symptoms before and immediately after training. Empathy and its domains were also assessed at three post-intervention follow-ups.

RESULTS

Empathy training diminished levels of psychological concerns. Moreover, an increase was found in levels of cognitive empathy 15, 30 and 60 days after the intervention.

CONCLUSIONS

Empathy training with a focus on cognitive empathy diminished psychological concerns in caregivers of older people and increased the levels of this ability over time. This intervention can be considered a coping strategy for negative impacts related to providing care.

CLINICA LTRIAL REGISTRATION

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A Comparison of Virtual Reality and Traditional Audio-Recorded Hearing Voices Simulations: Their Impact on Empathy in Health Care Students

ABSTRACT

Empathy is essential to the development of communication skills. Simulating psychosis to develop empathy for mental health patients is complex; we hypothesized that virtual reality (VR) would be effective in increasing empathy in health care students. This experimental study compared the effectiveness of a VR simulation with a traditional hearing voices simulation as measured by the Kiersma-Chen Empathy Scale-Revised. Twenty-five health care students were randomized into two groups. The results indicated that both simulated experiences increased empathy levels, supporting the study's hypothesis. A 10-minute VR simulation is an effective teaching strategy for developing empathy in health care students.

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum

Objectives

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases.

Methods

Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs.

Results

Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83).

Conclusions

The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

Virtual reality-based simulation intervention for enhancing the empathy of informal caregivers of people with dementia: A mixed-methods systematic review

Dementia is a long-term and progressive syndrome that not only influences the person with dementia (PWD) but also the caregiver. However, informal caregivers are not always empathic and understand the symptoms of dementia, leading to destructive caregiving relationships and poor quality of caregiving. VR-based simulation interventions can provide a more realistic and memorable learning experience for caregivers to walk in PWDs' shoes. This review aimed to provide practitioners and researchers with insights on developing and/or adopting an effective VR-based simulation intervention for enhancing the empathy of informal caregivers of PWD. A mixed-methods systematic review was conducted. Quantitative, qualitative, and mixed-methods studies were searched from MEDLINE, PsycINFO, CINAHL, Scopus, Embase, and Cochrane Library updating. Standard JBI critical appraisal instruments were used for the quality appraisal. A convergent segregated approach was used to synthesize and integrate the data. A total of seven studies were included. Inconsistent quantitative results were reported on the effects of VR-based simulation on empathy enhancement. Significant effects were reported on knowledge of dementia and emotion-focused coping strategies. Two themes were generated from the qualitative studies, including "Informal caregivers gained better insight into problems encountered by older people with dementia" and "Thinking from the perspective of older people with dementia, leading to changes in attitudes and behaviours towards dementia". The qualitative synthesized evidence showed that informal caregivers gained better insight into problems encountered by PWD, but the quantitative synthesized results are inconsistent. Yet, informal caregivers experienced a change in attitude by thinking from the perspective of PWD.

Applying narrative medicine to prepare empathetic healthcare providers in undergraduate pharmacy education in Singapore: a mixed methods study

BACKGROUND

Narrative medicine demonstrated positive impact on empathy in medicine and nursing students. However, this pedagogical approach had not been evaluated in pharmacy education. This study sought to apply and evaluate the narrative medicine approach in extending empathy in Asian undergraduate pharmacy students.

METHODS

Narrative medicine was applied through workshops which used narratives of people with different experiences and perspectives. First-year undergraduate pharmacy students who volunteered and attended these workshops formed the intervention group (N = 31) and the remaining first-year cohort formed the control group (N = 112). A sequential explanatory mixed methods approach was adopted in which quantitative methods were first used to measure impact on pharmacy students' empathy using the Jefferson Scale of Empathy- Health Professions Student (JSE-HPS), and qualitative methods (i.e. group interviews) were then used to assess pharmacy students' emotional responses to narratives, and the perspectives of pharmacy students and faculty of this pedagogical approach.

RESULTS

There was no difference in JSE-HPS scores between intervention and control groups across baseline (i.e. upon matriculation), pre-intervention, and post-intervention timepoints. Pharmacy students in the intervention group had lower scores in Factor 3 ("Standing in People's Shoes") following the intervention. Five themes, guided by internal and external factors in cognition, emerged from the Group Interviews: (1) incongruence between students' motivation and faculty's perception, (2) learning context, (3) academic context, (4) cognitive system, and (5) affective system. Themes 1, 4 and 5 referred to internal factors such as students' motivation, perceived learnings, and feelings. Themes 2 and 3 referred to external factors including workshop materials, activities, content, and facilitation.

CONCLUSION

This study is the first to demonstrate that pharmacy students engaged with the narrative medicine approach as narratives elicited emotional responses, exposed them to diverse perspectives, and deepened their appreciation of the importance of empathy and complexities of understanding patients' perspectives. Scaffolded educational interventions using narratives and real-life patient encounters, alongside longitudinal measurements of empathy, are necessary to bring about meaningful and sustained improvements in empathy.

Taxonomy of teaching methods and their use in health professions education: a scoping review protocol

INTRODUCTION

Applying the lens of social constructivist theory, teaching methods facilitate the process of learning and may be used differently across settings to align learning goals. Teaching methods are used across disciplines, occupations and learning settings, yet terminology, descriptions and application for use vary widely. This scoping review will identify eligible literature of reported teaching methods with documented descriptions across disciplines with a focus of how teaching methods are applied to health professions education. A literary description of a teaching method was used as a basis from which to select eligible articles based on two criteria, a specified method and delivery of that teaching by a teacher figure.

METHODS AND ANALYSIS

Using the extension of the Joanna Briggs Institute methodology aligned to Arksey and O'Malley's six-stage framework and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines, this scoping review will systematically search ERIC, Embase, Web of Science and PubMed databases. The search strategy was supported by an information specialist. Eligible studies will be identified in a two-stage screening process with four researchers. To complement eligible peer-reviewed literature, we will also search out relevant grey literature including University Websites, Conference Programmes and handsearched reference lists. Data extraction will be performed using a developed data extraction tool. A narrative summary will accompany charted results and describe the results aligned to the study objectives.

ETHICS AND DISSEMINATION

As no intervention or patient recruitment is required for this research, ethics board approval is not required. Results will be disseminated via publication in a peer-reviewed journal, conference presentations and where feasible reaching out to those organisations and universities with published glossaries of terms for teaching.

Student empathy in standardized patient experiences: Applying concepts from a critical thinking emulation model

INTRODUCTION

Clinician empathy can improve patient outcomes, but the literature is scant on patient-based, student-led experiences to demonstrate the projection of empathy in patient interactions.

PURPOSE/OBJECTIVES

(1) Develop a learning guide for observable behaviors communicating emotional and cognitive empathy and (2) determine whether the learning guide can be used as a rubric for assessing empathy in a standardized patient experience.

METHODS

Eleven standardized patients assessed 80 D3 students using a 4-point interval scale on 19 behavioral criteria in four domains: Initiation (four criteria); Health History and Caries Risk (four criteria); Treatment Planning (six criteria); and Communication Skills (five criteria). Standardized patients also provided qualitative feedback.

RESULTS

Standardized patients completed all 1520 interval scales on the rubric and 94% of 320 open-ended entries. Students performed well. Of the 1520 criterion interval scales, 1242 (81.7%) were rated "excellent." Wilcoxon signed-rank tests revealed Initiation scores (Mean [M] = 3.82, Standard deviation [SD] = 0.28) and Treatment Planning scores (M = 3.82, SD = 0.36) were significantly higher than Health History Scores (M = 3.75, SD = 0.34; p < 0.05). Qualitative feedback also was overwhelmingly positive for Treatment Planning and more equivocal for Health History.

CONCLUSIONS

The emulation model for students to demonstrate observable aspects of empathy is viable as both a learning guide and evaluation rubric in a standardized patient format. The next steps include the development of a succinct skillset for reinforcement in the patient setting and continued discussion on what best captures core observable aspects of empathy.

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.

TeamSTEPPS®-based clinical simulation training program for critical care professionals: A mixed-methodology study

INTRODUCTION

The Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS®) programme has been shown to improve interprofessional work among healthcare professionals by enhancing teamwork. Intensive care professionals were trained in this methodology through the course "Simulation Trainer: Improving Teamwork through TeamSTEPPS®".

OBJECTIVES

To analyse the teamwork performance and good practice in simulation of the intensive care professionals attending the course and to explore their perceptions of the training experience carried out during the course.

METHODS

A cross-sectional descriptive and phenomenological study was carried out using a mixed methodology. The 18 course participants were administered the questionnaires "TeamSTEPPS™ 2.0 Team Performance Observation Tool" to evaluate teamwork performance and "Educational Practices Questionnaire" for good practices in simulation after the simulated scenarios. Subsequently, a group interview was conducted through a focus group with 8 attendees using the Zoom™ videoconferencing platform. A thematic and content analysis of the discourses was carried out using the interpretative paradigm. Quantitative and qualitative data were analysed using IBM SPSS Statistics™ 27.0 and MAXQDA Analytics Pro™ respectively.

RESULTS

Both the level of teamwork performance (mean = 96.25; SD = 8.257) and good practice in simulation (mean = 75; SD = 1.632) following the simulated scenarios were adequate. The following main themes were identified: satisfaction with the TeamSTEPPS® methodology, usefulness of the methodology, barriers to methodology implementation and non-technical skills improved through TeamSTEPPS®.

CONCLUSIONS

TeamSTEPPS® methodology can be a good interprofessional education strategy for the improvement of communication and teamwork in intensive care professionals, both at the care level (through on-site simulation strategies) and at the teaching level (through its inclusion in the students' curriculum).

The effect of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy: A randomised controlled trial

BACKGROUND

Although improvements in burn care have increased the probability of survival in recent years, major complications are still common in burn patients. Nursing students should be competent to evaluate and intervene in the burn.

OBJECTIVE

To examine the effects of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy.

DESIGN

In this study, a randomised experimental design was used.

PARTICIPANTS

This study was conducted on third-year undergraduate nursing students.

METHODS

Students in this study were randomly assigned to one of two groups: the Hybrid Simulated Group (N = 26) and the Control Group (N = 30). Standard Education training was completed by all participants. Only the hybrid simulation group students received training on the standardised patient with wearable burn plasters. Students' knowledge of burn care was assessed using an information questionnaire immediately following the theoretical training and after training for three weeks. An Objective Structured Clinical Exam was used to assess students' abilities. The Objective Structured Clinical Exam was convened three weeks after the theoretical training. The Multidimensional Emotional Empathy Scale was used to assess the students' empathy ability level immediately following the theoretical training and three weeks later.

RESULTS

After the intervention, nursing students in the Hybrid Simulated group had improved empathy, knowledge, skills of physical assessment, and implementation of interventions and referral criteria on burn care (p < 0.05).

CONCLUSION

Simulated burn training could be utilised to improve nursing students' empathy, knowledge, and skills of physical assessment evaluation of interventions and referral criteria on burn care.

Great geriatric syndromes: Acquisition of nursing competencies and undergraduate nursing students' perceptions through high-fidelity simulation training

BACKGROUND

The constant increase in the aging population will lead to a greater demand for high-quality nursing care for this population over the coming years. Early detection and proper treatment of great geriatric syndromes are essential and, consequently, geriatric nurses must acquire the necessary competencies for their adequate management.

OBJECTIVES

To evaluate the acquisition of the necessary nursing competencies for adequate management of great geriatric syndromes through high-fidelity simulation training and to explore undergraduate nursing students' perceptions about this training.

METHODS

80 undergraduate nursing students participated in a mixed methods study. The simulated scenarios recreated older patients with diagnoses of great geriatric syndromes using standardized patients. Nursing competencies were evaluated using a verification list. 10 focus groups were interviewed to explore their perceptions, conducting a qualitative study with an interpretative approach.

RESULTS

Most of the students (86.55 %) acquired the necessary nursing competencies for adequate management of great geriatric syndromes. The nursing students stated that they improved their communication skills (provide solutions to older patients; facilitate and redirect the clinical interview; contrast the information given to the patient), psychological resources (psychological support; physical contact and accompaniment; empathy and persuasion), and geriatric knowledge (identify their lack of knowledge; recognize their limits in terms of healthcare and refer to other health professionals; know the patient's conditions) to provide quality care for older people diagnosed with great geriatric syndromes.

CONCLUSIONS

The use of high-fidelity simulation training including standardized patients makes it easier for nursing students to acquire the necessary nursing competencies for adequate management of great geriatric syndromes and improve their clinical skills. Geriatric nursing education should focus on equipping nursing students with the necessary clinical skills, integrating high-fidelity simulation training in geriatric study plans to train students in the nursing care to be provided to older patients, and preparing them for real clinical practice.

Effects of weight bias training on student nurse empathy: A quasiexperimental study

AIM

This study aimed to identify the efficacy of weight bias training on the empathy skills of student nurses when working with a person with obesity.

BACKGROUND

Weight bias with nurses harboring negative attitudes towards patients with obesity results in inferior care and patients' reluctance to seek medical care. Empathy is a communication skill used in nursing to build trust and rapport with patients to provide optimal patient-centered care.

METHODS

This study used a quasi-experimental design with 121 undergraduate nursing students in their first semester of the nursing program. The students completed learning activities on weight bias, including reading an article on weight bias, watching a video showing an individual with obesity's experiences in the healthcare setting and participating in a group discussion and reflection on the article and video. In addition, students completed the Jefferson Scale of Empathy-Health Professions Students' version before and after the learning activities. Following the learning activities, students participated in a simulation activity with a standardized patient wearing an obesity suit. The standardized patient completed the Jefferson Scale of Patient Perceptions of Nurse Empathy to rate the patient's perception of the nursing student's level of empathy based on their interactions in the simulation scenario.

RESULTS

A comparison of the scores on the Jefferson Scale of Empathy-HPS showed there was not a significant difference in the scores before learning activities (M = 15.45, SD = 12.7) and post-learning activities (M = 15.94, SD = 11.5); t(120) = 0.476, p = .635. Data analysis identified significant changes in empathy scores on the Jefferson Scale of Empathy-HPS in the accelerated second-degree cohort with differences in scores before learning activities (M = 113.7, SD = 10.5) and post-learning activities (M = 116.5, SD = 13.4); t(50) = 2.02, p = .049. The traditional cohort did not have a significant change in empathy scores. Empathy scores and the patient's perception of empathy scores showed no relationship. Most (79 %) of the patient's perception of empathy scores was moderate. Student comments in this study support the findings that some nursing students harbor weight bias towards individuals with obesity.

CONCLUSION

There is a need to identify learning activities that eliminate weight bias in the nursing student population and result in the student's ability to demonstrate appropriate communication skills and nursing behaviors in a nondiscriminatory manner to the patient with obesity. To improve empathy behaviors, students should practice communication skills throughout the nursing curriculum.

Experiences of Mental Health Practitioners With Empathy Computer Games

Several learning games designed for nursing training exist. Yet, there is a gap in understanding what makes learning games efficacious. The current study examined the reactions of 12 mental health nurses, therapists, social workers, and counselors during and after playing four computer games designed to induce empathy for persons with mental health disorders. Thematic analysis revealed that games accurately embodied emotional and cognitive experiences of the intended disorders. Analysis also indicated shortcomings, including games falling short in their usefulness for understanding depicted disorders. Participants indicated that the games changed their attitudes and beliefs. Findings suggest that learning games can be useful for nursing students and trainees, as well as patients' friends and family members. [Journal of Psychosocial Nursing and Mental Health Services, 61(1), 25-31.].

Evaluation of therapeutic communication education for nursing students based on constructivist learning environments: A systematic review

OBJECTIVES

Education on therapeutic communication has been emphasized in nursing education. However, few studies have used an educational framework to develop educational interventions, such as the instructional design model for Jonassen's Constructivist Learning Environments. Based on the model of Constructivist Learning Environments, this study aimed to analyze educational interventions on therapeutic communication for nursing students and propose a model for therapeutic communication education for nurse educators.

DESIGN

A systematic review.

DATA SOURCES

The terms "nursing," "students," "therapeutic," and "communication" were used to search for studies in English conducted between 2000 and 2022 in four databases (PubMed, Embase, Cumulative Index of Nursing and Allied Health Plus with Full Text, and Cochrane Library CENTRAL).

REVIEW METHODS

Two researchers independently screened the titles and abstracts of the original studies, followed by the full texts. The Cochrane Risk of Bias Tool 2.0 for randomized controlled trials and Risk of Bias Assessment Tool for Non-Randomized Studies for quasi-experimental studies were used to evaluate the eligible studies. This review adopted the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

RESULTS

Twelve studies were included in this review. Among the six instructional components of the model for Constructivist Learning Environments, the most commonly used were question/case/problem, cognitive tool, and conversational/collaboration tool. Among the three instructional methods of the model, coaching was the most frequently used. Therefore, an instructional design model for effective therapeutic communication education for nursing students was proposed based on Constructivist Learning Environments.

CONCLUSIONS

Employing an instructional design, such as Constructivist Learning Environments, can effectively promote the therapeutic communication education of nursing students.

The effects of high-fidelity simulation training on empathy and attitudes toward older people among undergraduate nursing students: A quasi-experimental study

AIM

To evaluate the effects of high-fidelity simulation training on attitudes towards older people and empathy among undergraduate nursing students.

BACKGROUND

People worldwide are living longer and, consequently, the number of older people is increasing globally. Geriatric syndromes are highly prevalent and associated with increased morbidity and mortality in this population. Positive attitudes towards older people and high levels of empathy are necessary for the provision of high-quality nursing care, which will contribute towards improving the quality of life of older patients affected by these syndromes.

METHODS

A quasi-experimental study was conducted using a longitudinal design with a single group and a pre- and post-intervention evaluation. The development of attitudes towards older people and empathy skills were evaluated using high-fidelity simulation-based training, comparing the levels obtained in these skills at baseline and after the simulation experience. The simulated scenarios recreated the great geriatric syndromes in older patients: instability, immobility, intellectual impairment and incontinence.

RESULTS

After the simulation sessions, nursing students significantly improved their total scores for both attitudes toward older people and empathy, moreover, improvements were found in the three subscales of empathy. The effect size was large for the total scores of both the attitudes towards older people and the empathy scales and the 'perspective taking' subscale. The obtained effect size was small for the 'compassionate care' subscale, whereas for the 'standing in the patient's shoes' subscale, the obtained effect size was medium.

CONCLUSIONS

Our high-fidelity simulation-based training allows undergraduate nursing students to improve their empathy levels and positive attitudes toward older people. The development of these skills may provide benefits directly related to high-quality care for older patients. Therefore, the inclusion of simulation training programs in geriatric nursing study plans is necessary to train nursing students in the care of older people and to prepare them for real clinical practice.

The impact of ageing simulation education on qualified acute care nurses' empathy towards older people: A mixed-methods study

AIMS AND OBJECTIVES

To evaluate the influence of an ageing simulation intervention on qualified acute care nurses' empathy towards older people.

BACKGROUND

Life expectancy is increasing globally with an increased incidence of older people accessing healthcare services. As such, it is essential for qualified nurses within hospital settings to connect with older people by establishing healthful relationships. Empathy is an essential component of healthful nurse-patient relationships. Fortunately, empathy can be taught through education.

DESIGN

A convergent mixed-methods design was utilised.

METHODS

Nurses (N = 95) undertook an 8-hour ageing simulation intervention. Data were collected from April 2019 to May 2020 across three time points: before the intervention (T0); immediately after (T1) and at three months follow-up (T2). A mix of convenience (intervention) and purposeful (follow-up) sampling techniques were utilised. Quantitative data were collected via the Interpersonal Reactivity Index survey (n = 86) and analysed using repeat measures ANOVA to compare mean scores across time points. Qualitative data were collected via debriefing discussions (N = 95) and focus groups (n = 38), and analysed using a systematic thematic analysis method. Data convergence occurred during the interpretation phase. Study reported with the TREND checklist.

RESULTS

Primarily, when quantitative and qualitative findings were merged they confirmed each others' empathy outcomes. Quantitative results showed a statistically significant increase in affective and cognitive empathy levels among nurses post-intervention. Qualitative findings expanded on quantitative results and revealed an increase in nurses' affective, cognitive and behavioural empathy represented in themes 'enhancing my empathy', 'impact of ageing', 'from self to others' and 'person-centred moments'.

CONCLUSIONS

This study adds empirical evidence how a mixed-methods design can be used to evaluate the influence of an ageing simulation intervention on nurses' empathy levels.

RELEVANCE TO CLINICAL PRACTICE

Ageing simulation interventions are a suitable experiential educational approach to improve acute care nurses' affective, cognitive and behavioural empathy towards older people.