Effects of Simulation on Nursing Students' Dementia Knowledge and Empathy: A Mixed Method Study

Curricular initiatives for dementia education

Dementia education can be an effective pedagogical tool to improve student perceptions of dementia and dementia care. In this article, we describe four evidence-based educational initiatives implemented in an undergraduate and graduate level social work course. Students participated in an informational presentation on dementia, a dementia simulation, and a virtual discussion board. They also conducted an interview with a person living with dementia and their caregiver. Twenty-nine students completed a pre- and postsurvey on their (a) prior contact with individual(s) living with dementia, (b) dementia-related knowledge, attitudes, and self-efficacy, and (c) willingness to support individuals living with dementia, and 43 students participated in a focus group. Comparison of pre- and post-participation scores indicated improvements in knowledge, attitude, and self-efficacy. Content analyses of focus group responses and discussion posts generated themes that shed light on students' (a) knowledge gains at cognitive and affective levels, (b) attitudes toward future practice in dementia care, (c) perceived value of interprofessional practice, and (d) perceptions of dementia related learning activities. Despite limitations in implementation and evaluation, the curricular initiatives provide a template to train future health professionals in dementia care, a vital area of practice.

Is elderspeak communication in simulated hospital dementia care congruent to communication in actual patient care? A mixed-methods pilot study

AIMS

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. The purpose of this mixed-methods study was to determine if simulation accurately captures elderspeak communication by nursing staff in hospital dementia care.

DESIGN

A 3-part mixed-methods design in which (1) three dementia care simulations were designed and validated by a panel of experts, (2) communication by nursing staff completing each simulation was quantitatively compared to communication during actual patient care, and (3) views on the realism were explored using within- and across-case coding.

METHODS

Three simulations using different modalities (manikin, role-play, and standardised patient) were designed and validated with eight experts using the Lynn Method. Ten nursing staff were audio-recorded and their communication was coded for elderspeak communication. Results for each simulation were compared using Wilcoxon signed-rank test to recordings taken during actual dementia care encounters. Debriefings were coded for realism and results were converged.

RESULTS

The average time using elderspeak during naturalistic care was 29.9% (SD = 20.9%) which did not differ from the average amount of elderspeak used across the three simulations modalities which ranged from 29.1% to 30.4%. Qualitative results suggested a lack of realism with the manikin condition and the nursing staff indicated preference for the simulation with the standardised patient.

CONCLUSIONS

Communication elicited in the dementia care simulations was congruent to communication produced in actual dementia care but preference was for the standardised patient.

IMPLICATIONS FOR PATIENT CARE

Elderspeak communication can be accurately produced in the simulated environment which indicates that simulation is a valid method for person-centred communication training in nursing staff.

IMPACT

Simulation offers a feasible modality to prepare nurses for challenges communicating with patients with dementia. Elderspeak communication is speech that sounds like baby talk and can lead to rejection of care by patients with dementia. However, it is unknown if simulation can be used to capture elderspeak communication in dementia care. Elderspeak communication captured in the simulated environment was congruent to communication nursing staff use during actual patient care to hospitalised persons living with dementia. This study empirically identifies that communication is elicited in similar patterns by nursing staff in the simulated environment compared to the naturalistic care environment which demonstrates that simulation can be used as a valid tool for education and research on person-centred communication.

REPORTING METHODS

STROBE.

PATIENT OR PUBLIC CONTRIBUTION

No Patient or Public Contribution.

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.

Nursing undergraduates' ageism and attitudes toward dementia: Serial multiple mediating effects of person-centered care and compassion - A cross-sectional survey

Background

Although ageism has a strong relationship with attitudes toward dementia, no study has confirmed how person-centered care and compassion mediate the relationship between nursing students' ageism and attitudes toward dementia.

Objectives

This study aimed to examine the mediating effects of person-centered care competency and compassion competency on ageism and attitudes toward dementia among nursing undergraduates.

Participants

Participants were 295 undergraduate nursing students from four universities.

Methods

A descriptive cross-sectional electronic survey was conducted, involving the selection of four Korean nursing schools for the study. Data was obtained via an online survey conducted from March to July 2022. Data were analyzed with Pearson's correlations, and multi-mediating effects using the PROCESS Macro for software, utilizing bootstrap techniques.

Results

Attitudes toward dementia was correlated with ageism (r = -0.386, p < 0.001), person-centered care (r = 0.422, p < 0.001), and compassion competency (r = 0.457, p < 0.001). The total effect (β = -0.326, p < 0.001) and direct effect (β = -0.243, p < 0.001) of ageism on attitudes toward dementia were significant. Ageism does not have a direct effect on compassion competency (Std. estimate = -0.0213, CI: -0.0518∼0.0048). However, person-centered care and compassion competency had multiple serial mediating effects on the relationship between ageism and attitudes toward dementia (Std. estimate = -0.0357, CI: -0.0624∼-0.0145).

Conclusions

Person-centered care and compassion competency may mediate the association between ageism and attitudes toward dementia. Ageism was negatively associated with person-centered care and compassion competency, which in turn positively contributed to attitudes toward dementia. Therefore, an educational program that considers the interaction between generations and the context of older people must be applied to increase person-centered care and compassion competency.

Effects of a Clinical Simulation-Based Training Program for Nursing Students to Address Social Isolation and Loneliness in the Elderly: A Quasi-Experimental Study

INTRODUCTION

The population of older adults is rapidly increasing worldwide, presenting both prospects and complexities for society and healthcare professionals to maximize the functional capacity of this age group. Social isolation and loneliness significantly affect this population. The objective was to determine the effectiveness, satisfaction, and perceptions of the simulation-based education practices of a training program for nursing students, which was created to palliate the social isolation and loneliness of older adults.

METHOD

A quasi-experimental study was conducted with nursing students who participated in an online training program using teleservice based on high-fidelity clinical simulation. The program included asynchronous theoretical training and synchronous practical training using an online platform. Five scenarios were designed using simulated phone calls to address the social isolation and loneliness of older adults.

RESULTS

Twenty-five nursing students participated in the program, and they had a mean age of 27.44, with 76% of them being women. After the training program, the participants showed statistically significant improvements (p < 0.05) with respect to their knowledge and attitudes towards older adults, and the program was adapted to the best educational practices in simulations.

CONCLUSIONS

Simulation-based online training efficiently improved the knowledge and attitudes of nursing students towards older adults, improving their ability to address social isolation and loneliness. The high satisfaction and adhesion to the best educational practices underline the usefulness of high-fidelity online simulations, especially in situations in which face-to-face training is not feasible, and accessibility and equilibrium could be guaranteed between work and personal life.

Identifying undergraduate nurses´ learning requirements and teaching strategies in dementia care education: A nominal group technique

AIM

Identify priorities and reach a consensus on student nurses´ learning requirements and the best-suited teaching strategies in dementia care.

BACKGROUND

Dementia has become a global health priority. Nurses are primary service providers for people with dementia, but they may fall short on professional training. Nursing curricula still lacks a clear educational framework for dementia, meaning that nurse educators must make decisions amidst uncertainty.

DESIGN

Nominal group technique based on the conceptual framework proposed by Van de Ven and Delbecq (1972).

METHODS

A structured face-to-face meeting convened in November 2021 involved nine participants who were directly involved in dementia care. The steps in the technique were (a) idea generation, (b) round-robin recording, (c) discussion, (d) voting and ranking, (e) discussion on the vote and (f) re-ranking. Participants answered two nominal questions. Consent, anonymity, feedback and iteration were guaranteed throughout the process.

RESULTS

The nominal group prioritized theoretical understanding of dementia, communication, caregivers´ needs, comprehensive assessment and ethical practice as learning requirements for nursing students. The outstanding teaching strategy discussed included various approaches to experiential learning.

CONCLUSIONS

The nominal group technique process explored learning requirement priorities for student nurses within a specific context. Participants discussed experiential learning as the best-suited teaching strategy. Findings could support nurse educators to design and deliver better dementia education.

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.

A Systematic Review of the Effectiveness of Educational Interventions in Promoting Person-Centred Care in Dementia Services

OBJECTIVES

To review evidence about the effectiveness of educational programmes in promoting the delivery of person-centered care by staff in dementia services.

METHODS

Several databases were searched, and the methodological quality of identified studies systematically evaluated. A summary mean effect size was calculated for several types of outcome (direct knowledge, applied knowledge, attitudes, self-reported and observed working practices).

RESULTS

Eighteen studies were identified. Results were mixed, with findings of no change, significant improvement, and (in attitude) significant deterioration. Effect size was modest for direct knowledge (standardized mean difference = 0.6), but small or negligible for applied knowledge (0.29) and self-reported (0.06) and observed (0.25) working practices. There was a negative effect for attitudes (-0.17).

CONCLUSIONS

The quality of evidence was poor. Apart from attitudes, the effect sizes are likely to be overestimates. There was little evidence that education programmes can reliably produce substantial improvements in working practices.

CLINICAL IMPLICATIONS

Education alone is unlikely to be sufficient for establishing high standards of person-centered care in services. It needs to be supplemented by steps to ensure that staff develop skills in delivering such care in practice, and by organizational support to ensure staff have sufficient motivation, cues and opportunities for implementation.

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.

Use of virtual and augmented reality-based interventions in health education to improve dementia knowledge and attitudes: an integrative review

OBJECTIVES

Immersive technologies such as virtual (VR) and augmented reality (AR) can potentially help health professionals and trainees understand psychological symptoms and responsive behaviours associated with dementia within a safe and supportive learning environment. This integrative review sought to ascertain the types of VR and AR-based interventions used in dementia education and training and its efficacy to improve knowledge and attitudes of health professionals or trainees.

DESIGN

The protocol was submitted to PROSPERO and literature published from 2000 onwards was searched in eight databases: CINAHL, MEDLINE, Web of Science, Cochrane, Embase, PsycINFO, ERIC and Scopus. A total of 19 articles were included and assessed with the Mixed Methods Appraisal Tool. Methodological quality varied across studies.

RESULTS

VR rather than AR-based intervention are used in dementia education and training for health professional and trainees. Immersive virtual learning potentially enhance knowledge, attitudes, empathy and sensitivity of health professionals and trainees.

CONCLUSIONS

While promising, there remains a lack of conclusive and robust evidence to fully recommend the introduction and inclusion of immersive virtual learning in dementia education and training. Additional rigorously designed research studies with larger sample sizes are needed to confirm the benefits on attitudes, empathy, sensitivity and knowledge.

PROSPERO REGISTRATION NUMBER

CRD42020182083.