Effectiveness and experience of arts-based pedagogy among undergraduate nursing students: a mixed methods systematic review

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.

Generative AI Backstories for Simulation Preparation

BACKGROUND

Developing engaging presimulation learning materials that provide contextualized patient information is needed to best prepare students for nursing simulation. One emerging strategy that can be used by educators to create visual images for storytelling is generative artificial intelligence (AI).

PURPOSE

The purpose of this pilot study was to determine how the use of generative AI-created patient backstories as a presimulation strategy might affect student engagement and learning in nursing simulation.

METHODS

A qualitative cross-sectional survey with content analysis was completed with undergraduate nursing students following an acute care simulation.

RESULTS

Student surveys point to positive pedagogical outcomes of using AI image generation as a strategy to prepare for simulation such as decreased anxiety in simulation, increased preparatory knowledge, and increased emotional connection with the patient's story.

CONCLUSIONS

Images created with generative AI hold promise for future research and transforming nursing education.

Verbatim theatre as a creative approach to health professions education research translation

CONTEXT

Traditionally, the impact and outcomes from health professions education research (HPER) have focused on academic outputs, whereas in the humanities, research translation is conceptualised more broadly and creatively, including research-based performances like verbatim theatre. Translating HPER findings through the emotive and embodied nature of a verbatim theatre performance provides a unique opportunity to translate research data and create alternative learning spaces for rich and valuable insights that aligns with transformative pedagogy.

APPROACH

In this paper, we describe the background of verbatim theatre, a form of performance, which draws on a research participants' testimony and lived experience and how we used this creative approach to translate HPER findings. We discuss the experiential process of bringing an interdisciplinary team together, health professions academics and an academic playwright to craft a verbatim theatre script that provided space to honour the breadth, depth and diversity of participant voices from a large (n = 100) qualitative research study exploring professionalism and sociocultural factors in health professions education (HPE). Furthermore, we discuss the powerful potential of drawing on research-based performance to create alternative, safe and non-threatening learning spaces to resonate with and experience HPER in new and transformative ways. Finally, we offer reflexive insights on the key opportunities and challenges we encountered in translating HPER into a verbatim theatre performance.

CONCLUSIONS

Verbatim theatre presents an innovative and creative way to communicate and translate HPER. This paper offers research and pedagogical insights in translating research into verbatim theatre to support transformative pedagogy and practice in HPE. In conclusion, we encourage other health professions researchers to consider this dynamic and creative approach to transforming HPE.

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.].

Effects of Arts-Based Pedagogy on Competence Development in Nursing: A Critical Systematic Review

The integration of arts-based methods into nursing education is a topic of growing interest in nursing practice. While there is an emerging body of research on this subject, evidence on competence development remains vague, largely due to methodological weaknesses. The purpose of this review is to evaluate the effectiveness of arts-based pedagogy in nursing, specifically in terms of students' changes in knowledge, skills, and attitudes. It explores which arts-based approaches to nursing education qualify as evidence-based practice in terms of nursing competence. A systematic critical review of research on arts-based pedagogy in nursing was conducted, identifying 43 relevant studies. These studies were assessed for methodological quality based on the CEC Standards for evidence-based practice, and 13 high-quality comparative studies representing a variety of arts-based approaches were selected. Creative drama was identified as the only evidence-based practice in the field, positively affecting empathy. The findings highlight a research gap in nursing education and emphasize the need for measurement and appraisal tools suitable for the peculiarities of arts-based pedagogy.

Examining arts-based practice in midwifery education: An integrative review

AIMS

The aim of this integrative review is to synthesise the literature on creative teaching methods in midwifery education. The review question seeks to investigate the experiences of student midwives and midwifery educators of using creative methods as a learning approach.

BACKGROUND

The benefits of creative teaching methods are widely acknowledged but the ways in which this may impact midwifery students' learning processes, or how this relates to their developing professional development, is not well understood. Research focused specifically on student midwives is yet to be synthesised.

DESIGN

An integrative review was undertaken using data comparison with reflexive thematic analysis to identify common themes.

METHODS

Eight electronic databases were searched with key terms in June 2022. English language studies from qualitative, quantitative, mixed-methods and wider literature were included.

RESULTS

Twenty-two texts were included in the synthesis. Four themes were generated from the data; 1) What is the offering - More than a lecture; exploring the educator and student exchange and environment for learning; 2) Working in parallel - examining the change in teaching dynamic and collaborative partnerships; 3) Journeying towards holism - focused on student's integration of learning processes; and 4) Stepping into the professional - engaging with how using creativity can aid students' growing sense of themselves as professionals. This highlights improvements in levels of confidence, professional development and emotional intelligence in midwifery students.

CONCLUSION

Creative teaching and learning methods enable student midwives to make meaningful connections between theoretical and practice learning environments, assisting knowledge and skills acquisition.

An integrative review of humanities-based activities in baccalaureate nursing education

PURPOSE

The American Association of the Colleges of Nursing has stressed the importance of the liberal arts as a foundation of nursing education that supports the development of clinical reasoning and judgments in their recently updated essentials for professional nursing education. The purpose of this research was to conduct an integrative review of the literature to explore the use of the humanities in baccalaureate nursing programs.

RESEARCH QUESTION

Among undergraduate nursing programs, what types of humanities interventions were used in nursing courses and what were the outcomes of these interventions?

THEORETICAL FRAMEWORK

This research was guided by the Aesthetic Knowing and Knowledge conceptual model by Chinn and Kramer, which is based on the Fundamental Patterns of Knowing in Nursing by Carper.

METHODS

An integrative review method, as outlined by Whittemore and Knafl, was used for this research.

RESULTS

After analysis of 227 titles, 19 studies were selected. Studies used art, literature, music and dance-based interventions. A key theme in examining the use of humanities in nursing education is its connection to aesthetic knowing in nursing. This included moral/ethical comportment, therapeutic use of self and scientific competence, as outlined in the Aesthetic Knowing and Knowledge conceptual model by Chinn and Kramer. Additionally, several other common themes emerged across the studies as nursing students reflected on the impact of the inclusion of humanities in their nursing curricula. Nursing student-recognized benefits included enhanced learning, emotional development, communication and new insights into best nursing practices.

CONCLUSIONS

Humanities-based interventions are a useful addition to undergraduate nursing education. Future research should use randomized controlled designs to strengthen the body of literature regarding this topic.

Teaching strategies of clinical reasoning in advanced nursing clinical practice: A scoping review

AIM/OBJECTIVE

To report and synthesize the main strategies for teaching clinical reasoning described in the literature in the context of advanced clinical practice and promote new areas of research to improve the pedagogical approach to clinical reasoning in Advanced Practice Nursing.

BACKGROUND

Clinical reasoning and clinical thinking are essential elements in the advanced nursing clinical practice decision-making process. The quality improvement of care is related to the development of those skills. Therefore, it is crucial to optimize teaching strategies that can enhance the role of clinical reasoning in advanced clinical practice.

DESIGN

A scoping review was conducted using the framework developed by Arksey and O'Malley as a research strategy. Consistent with the nature of scoping reviews, a study protocol has been established.

METHODS

The studies included and analyzed in this scoping review cover from January 2016 to June 2022. Primary studies and secondary revision studies, published in biomedical databases, were selected, including qualitative ones. Electronic databases used were: CINAHL, PubMed, Cochrane Library, Scopus, and OVID. Three authors independently evaluated the articles for titles, abstracts, and full text.

RESULTS

1433 articles were examined, applying the eligibility and exclusion criteria 73 studies were assessed for eligibility, and 27 were included in the scoping review. The results that emerged from the review were interpreted and grouped into three macro strategies (simulations-based education, art and visual thinking, and other learning approaches) and nineteen educational interventions.

CONCLUSIONS

Among the different strategies, the simulations are the most used. Despite this, our scoping review reveals that is necessary to use different teaching strategies to stimulate critical thinking, improve diagnostic reasoning, refine clinical judgment, and strengthen decision-making. However, it is not possible to demonstrate which methodology is more effective in obtaining the learning outcomes necessary to acquire an adequate level of judgment and critical thinking. Therefore, it will be necessary to relate teaching methodologies with the skills developed.

Engaging the creative heArts of nurse educators: a novel conceptual model

OBJECTIVES

Nurse educators are increasingly challenged in preparing future nurses to be creative thinkers. The purpose of this innovative quality improvement initiative is to share nursing students' interpretations of the value arts-based pedagogy (ABP) brings to their nursing practice.

METHODS

Braun and Clarke's approach to thematic analysis was utilized to identify and report patterns of ideas within learners' interpretations of engaging in an ABP assignment.

RESULTS

The analysis of students' interpretations led to the creation of a novel conceptual model to encourage and support nurse educators in the use of innovative ABP approaches.

CONCLUSIONS

ABP can be seamlessly integrated within teaching and learning methodologies to cultivate meaningful student learning.

IMPLICATIONS FOR INTERNATIONAL AUDIENCE

The intent of the conceptual model is to encourage and support nurse educators in the use of innovative ABP approaches designed for engaging nursing students in active, creative, and challenging learning environments.

Impact of art and reflective practice on medical education in the emergency department

OBJECTIVES

There is heightened intrigue surrounding the application of arts-based pedagogy in medical education. Art encompasses multiple forms of expression and is used to convey specific meaning and emotion, whereas provoking critical reflection. Our aim was to explore the effectiveness of art and reflective practice in medical education, in the context of the ED.

METHODS

Longitudinal methodological study design. Prior to the first, and after the final clinical practicum, medical students watched a 3-min film: 'The Art of the ED'. Written reflections focused on changing perceptions towards the film during their medical education programme. Data were thematically analysed.

RESULTS

Three themes were collected from 25 written reflections and included: 'professional growth' exploring personal and professional development across the medical programme; seeing 'patients are people'; and the purpose, structure and function of an ED exposed in 'the reality of ED'. Results highlight that arts-based pedagogy can facilitate meaningful and critical reflection in medical students, whereas also fostering professionalism. Reflecting on the film broadened their perspective into a realm of new possibilities, challenging them to identify implicit bias around ED, and promote professional identity formation.

CONCLUSIONS

The combination of art and reflection in medical education enhances reflective learning and can lead to transformative change, including the development of core doctoring values of service, empathy and respect for patient. There are clear benefits to medical education incorporating more arts-based pedagogy that promotes reflective exploration and interpretation of the psychosocial context of health and illness, delivery of more holistic models of care and their role as doctors.

Exploring nurse and nursing student experience of using an artist-produced photobook to learn about dementia

Background

Improving understanding about dementia in nursing is a priority area for educators and policymakers. This is due to poor professional understanding about dementia and suboptimal healthcare practice. While many educational interventions exist, there has been a paucity of research which has considered the use of artist-produced photobooks to improve knowledge and understanding about dementia. The aim of this study is to understand the impact of an artist-produced photobook on nurses’ attitudes and beliefs about dementia.

Results

Following a thematic analysis of four focus group interviews with 22 nurses and nursing students from Northern Ireland, three themes emerged. Theme one was about how the artist-produced photobook helped participants to humanise the person living with dementia. Theme two related to how the artist-produced photobook supported participants to actively construct their own meanings about dementia based on their previous professional and personal experiences. Theme three explored how an artist-produced photobook could be successfully used to complement existing dementia education in the future.

Conclusions

Using an artist-produced photobook was an innovative way to learn about dementia for nurses and nursing students. The photobook functioned as a tool underpinned by arts-based pedagogy (ABP), supporting nurses to understand the person behind the dementia disease. As such, an artist-produced photobook has the potential to be a useful complementary resource for supporting professional education about dementia.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-022-00991-2.

Knowledge and practices of female students at university of Kara regarding sexually transmitted infections in Togo, 2021

A good knowledge of sexually transmitted infections (STI) in female students is an important element in the prevention of STI transmission. The objective of this study is to describe the level of knowledge and practices on STI among female students at the University of Kara. A cross-sectional study was conducted at the University of Kara from July to September 2021. Data were collected using a standard, digitalised, selfadministered questionnaire. Logistic regression analysis was used to describe factors associated with the level of knowledge of STIs. A total of 1,055 female students with a median age of 21 years (interquartile range: 20-24) participated in the study. More than one-third (33.7%) of the students had good knowledge of STI. Having already been tested for HIV (aOR=3.25; 95% CI 2.36-4.52), having already had sex (aOR=1.56; 95% CI 1.10-2.24) and the level of education (AOR=3.46; 95% CI 2.10-5.85) were significantly associated with good STIs knowledge. Among the 723 female students (68.5%) who already had sex, 32.5% reported inconsistent use of condoms during sexual intercourse and 18.9% reported having multiple sexual partners. The results of this study highlight the importance of intensifying STIs prevention efforts (awareness, screening, and vaccination) among female students at the University of Kara.

A creative approach for undergraduate nursing students to learn anatomy and physiology: a qualitative exploratory study

Anatomy and Physiology (A&P) courses in undergraduate nursing programs are often considered challenging for students. Typically, a wide variety of teaching strategies, including dissection, experiments, illustrations and photographs are used to engage students. This study aimed to explore and describe the learning experiences of an open creative assessment task on undergraduate nursing students of learning A&P. A total of eight students participated in semi-structured interviews. Two major themes emerged from the data, this included 'Bringing A&P to life' which included two sub-themes of 'Learning through peer teaching' and 'An easy way to learn', with the second major theme, 'Custom made learning' which included four sub-themes, 'To grade or not to grade', 'Catering for different learning styles', 'Logistics of group work', and 'Effect of group dynamics'. This qualitative exploratory study contributes to further pedagogical insights into art and/or creative approaches to teaching.

Art and knowing in health management education

Presented is a case illustrating connections between art, learning and the mobilization of knowledge. As part of an assessment task in a postgraduate degree, a student made a painting about her experiences with workplace harassment and bullying in the surgical ward that she managed. I interviewed this student and made my own artworks to better understand her workplace and learning experiences. We then discussed our respective artworks and recorded those conversations. These data suggest that art-making can create powerful learning experiences, change attitude to health management practice, make connections and generate productive conversations within a healthcare organization, and mobilize knowledge. The paper responds to the question: Can art be 'paradigm-shifting' and therefore hold potential for creating a 'good' or better health service? It also reflects on the use of art in health service research more generally, especially in an era considered by some to be 'postparadigmatic.'

Participatory Arts-Based Pedagogy in Baccalaureate Nursing Education

ABSTRACT

Arts-based pedagogy (ABP) is an innovative teaching method combining art and learning in an existing curriculum. To understand the impact of students' perceptions of the effects of ABP on critical thinking, communication, and observational skills, 89 students completed an online survey. The results indicate that students enjoyed ABP and that it positively affected critical thinking, enhancing their future clinical practice and preparing them for increasingly complex health care environments.

Music Lessons for the Study of Affect

Some accounts of the evolution of music suggest that it emerged from emotionally expressive vocalizations and serves as a necessary counterweight to the cognitive elaboration of language. Thus, emotional expression appears to be intrinsic to the creation and perception of music, and music ought to serve as a model for affect itself. Because music exists as patterns of changes in sound over time, affect should also be seen in patterns of changing feelings. Psychologists have given relatively little attention to these patterns. Results from statistical approaches to the analysis of affect dynamics have so far been modest. Two of the most significant treatments of temporal patterns in affect-sentics and vitality affects have remained outside mainstream emotion research. Analysis of musical structure suggests three phenomena relevant to the temporal form of emotion: affect contours, volitional affects, and affect transitions. I discuss some implications for research on affect and for exploring the evolutionary origins of music and emotions.

Evaluating the impact of an arts-based multimedia knowledge translation assignment on undergraduate nursing students

BACKGROUND

Despite the expectation that nurses utilize research to provide excellent patient care, students often fail to recognize the value of learning about evidence-informed practice. Experiential, creative pedagogical approaches are needed to engage undergraduate nursing students in evidence-informed practice. In two undergraduate courses, we implemented an innovative assignment in which students created an arts-based multimedia knowledge translation presentation to communicate systematic review findings to patients.

OBJECTIVE

To evaluate how the assignment affected nursing students' satisfaction, learning, and anticipated behaviour changes regarding evidence-informed practice and to assess what factors influenced their evaluation of the assignment.

DESIGN AND METHODS

Kirkpatrick's Evaluation Model and Groff's Theory of Whole-Mindedness informed our study, incorporating an observational cross-sectional survey design. We recruited a convenience sample of nursing students (N = 242) from two baccalaureate programs. We collected data with an online survey comprised of closed- and open-ended questions. Quantitative data were analyzed with descriptive statistics, univariate analysis, and general linear models, and qualitative data with content analysis.

RESULTS

Most students were satisfied (68%) and reported learning (77%) and benefits for their future practice (75%). Age, enjoyment of and experience with the arts, type of motivation, and valuing evidence-informed practice were significant predictors (p < 0.01) and the model predicted 59% of the variance in positive student perceptions of the assignment. Students reported experiencing relational and engaged learning, translating research findings creatively and clearly, understanding complex research concepts through experiential learning, and having frustrations and pragmatic concerns.

CONCLUSION

Creative approaches that contextualize research findings hold potential to deepen students' understanding of evidence-informed practice. This study identified key factors that influenced students' evaluation and experience of the assignment. These results provide valuable insights to inform effective implementation of arts-based assignments in nursing education.

Occupational therapy interventions in child and adolescent mental health to increase participation: A mixed methods systematic review

Introduction

Mental health disorders and low levels of mental well-being can have a lasting effect on life satisfaction and contribution to society for children and adolescents, yet the effectiveness of occupational therapy interventions is unknown.

Methods

A mixed methods systematic review was conducted including studies with children and adolescents aged 5–16 years, who had mental health difficulties, that evaluated occupational therapy interventions and focused on participation in everyday occupations as an outcome.

Results

The nine included studies were generally very low quality. The results could not be pooled due to heterogeneity. For children with Asperger’s syndrome, the Cognitive Orientation to Daily Occupational Performance intervention had clinically significant improvements on occupational performance and social skills. For children with attention deficit hyperactivity disorder, the Ultimate Guide to Play, Language and Friendship intervention improved playfulness and the Cognitive–Functional intervention had a statistically significant improvement on occupational performance and behaviour.

Conclusion

One intervention used by occupational therapists with children with Asperger’s syndrome and two interventions used with children with attention deficit hyperactivity disorder had some evidence of effect. No evidence was identified for the effectiveness of occupational therapy interventions for children and adolescents with other common mental health conditions.

Educators' strategies for engaging diverse students in undergraduate nursing education programs: a scoping review protocol

OBJECTIVE

The objective of this scoping review is to identify and chart teaching strategies that educators use in classroom settings to engage diverse students in undergraduate nursing education programs.

INTRODUCTION

Student engagement is critical to facilitating academic success and significant learning experiences for undergraduate nursing students. However, students from diverse backgrounds face challenges in undergraduate nursing programs, and these challenges impact their academic engagement and sense of belonging and inclusion. Creating conditions in nursing education that foster engagement by meeting the learning needs of diverse learners could facilitate their success, which ultimately might strengthen the nursing workforce diversity.

INCLUSION CRITERIA

This review will consider papers on how educators engage undergraduate nursing students from diverse backgrounds in classroom settings, including online, face-to-face, and blended formats, irrespective of the country. Evidence obtained from all sources including qualitative, quantitative, and mixed methods studies, systematic reviews, as well as gray literature will be considered for inclusion.

METHODS

JBI methodology for scoping reviews, which includes a three-step search strategy, will be employed. First, keywords will be identified from relevant articles in CINAHL and ERIC. Second, another search using the identified keywords and index terms across select databases will be conducted. Third, the reference lists of all identified articles will be screened for additional papers. Titles and abstracts will be screened by two independent reviewers, and then followed by the full text review of included articles against the inclusion criteria by two independent reviewers. Data will be extracted from included articles and the findings will be presented in tables, figures, and narratively as appropriate.

SCOPING REVIEW PROTOCOL REGISTRATION

Open Science Framework https://osf.io/7bv5p/.

Storytelling: One arts-based learning strategy to reflect on clinical placement. An integrative review

Storytelling is one method of arts-based learning. The pedagogy of arts-based learning integrates the arts into another topic to enhance learning. Nursing students' experiences of clinical placement are often complex. Students may benefit not only from cognitive thinking, but also creative reflection. This integrative literature review explores storytelling as an arts-based approach to learning during clinical placements. A search of electronic databases focused on articles published in English during 2010-2020. The search identified thirteen international papers. The diversity of clinical environments included community mental health, overseas placement, community aged care, and acute care hospitals. The synthesis revealed four main themes: arts-based learning in nurse education, student-patient communication, student-Registered Nurse communication, and student-educator communication. Engaging in stories as a means of reflection improved students' self-knowledge, identified their preconceptions and stereotyping of patients and so improving their patient interactions. Positive relationships between students and patients were not only necessary for caring practice, but also intrinsic to learning. Positive relationships between Registered Nurses and students reduced anxiety and encouraged students to focus on quality patient care. Storytelling provided a creative approach to reflect on practice. Reflection using the affective domain assisted students to reflect more broadly about their placement experience.

Teaching and discussing mental health among university students: a pilot arts-based study

Purpose

Interdisciplinary approaches to health education are becoming increasingly common. Here, the authors describe an arts-based approach designed by academics and artists to both supplement the study of mental illness and support the individual mental health of undergraduate and postgraduate university students, by raising the visibility of mental illness in an innovative way.

Design/methodology/approach

Through workshops, university students were guided in a sensory and physical way to discuss psychological health and vulnerability. This was followed by the creation of physical representations of mental distress through art pieces.

Findings

Students were able to design their own art pieces and discuss mental health issues in an open and creative way. Students reported that the arts-based initiative was beneficial to their practice as future professionals and provided a holistic learning experience. At the same time, artists were able to generate powerful images which facilitated further discussions within the faculty.

Practical implications

This project provides an innovative model for workshops which could be employed to raise the visibility of common mental health disorders among university students while providing a safe space to discuss and support wellbeing. Additionally, variations could be implemented to enhance the teaching of affective disorders within a university curriculum.

Originality/value

This paper presents the results of collaboration between academics and artists, who together generated an innovative way to both support students' mental health and provide an alternative way to supplement experiential learning about common mental health conditions such as anxiety and depression.

Navigating creativity within arts-based pedagogy: Implications of a constructivist grounded theory study

BACKGROUND

Educators implement arts-based pedagogy with the hope that it will foster meaningful learning for students. However, nursing students have varied reactions to artistic assignments, and there is a need to further understand students' learning processes with this novel approach and the factors influencing their learning. This understanding could promote the more effective implementation of arts-based pedagogy into nursing education.

OBJECTIVE

To develop a theoretical understanding of how and when undergraduate nursing students learn through arts-based pedagogy.

DESIGN

Constructivist grounded theory.

SETTINGS

Canadian baccalaureate nursing program.

PARTICIPANTS

Thirty third-year undergraduate nursing students and eight of their nursing instructors.

METHODS

Participants who had experienced arts-based assignments were recruited with purposive and then theoretical sampling. We collected four sources of data: a socio-demographic questionnaire, semi-structured interviews, photo/art elicitation, and field notes. The socio-demographic data were analyzed with descriptive statistics and all other data with constructivist grounded theory procedures.

RESULTS

Our findings revealed that students had to navigate a creative process with arts-based assignments, which involved several iterative phases. This type of learning was unique within their program and somewhat constrained by the context of nursing education. There was notable variation in the students' experiences. Although many reported meaningful learning, approximately 20% of the students did not value the assignment. Our findings elucidated multi-level enabling and restraining factors that influenced students' engagement with and learning from this creative process.

CONCLUSIONS

These findings provide insight into modifiable factors that influenced students' engagement and learning, and have important implications for making ABP accessible and meaningful for more students.

The Effectiveness of Teaching Clinical Empathy to Medical Students: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

PURPOSE

Clinical empathy is a necessary trait to provide effective patient care, despite differences in how it is defined and constructed. The aim of this study was to examine whether empathy interventions in medical students are effective and how confounding factors potentially moderate this effect.

METHOD

The authors performed a systematic review and meta-analysis. They searched the literature published between 1948 and 2018 for randomized controlled trials that examined empathy interventions in medical students. The search (database searching, citation tracking, hand-searching relevant journals) yielded 380 studies, which they culled to 16 that met the inclusion criteria. For the meta-analysis, they used a random effects model to produce a pooled estimate of the standardized mean difference (SMD), then completed subgroup analyses.

RESULTS

The authors found evidence of the possibility of response and reporting bias. The pooled SMD was 0.68 (95% confidence interval 0.43, 0.93), indicating a moderately positive effect of students developing empathy after an intervention compared with those in the control groups. There was no evidence of publication bias, but heterogeneity was significantly high (I = 88.5%, P < .01). Subgroup analyses indicated that significant moderating factors for developing empathy were age, country, scope of empathy measurement, type of empathy intervention, and presence of rehearsal. Moderating factors with limited evidence were sex, study quality, journal impact factor, and intervention characteristics.

CONCLUSIONS

Despite heterogeneity and biases, empathy interventions in medical students are effective. These findings reinforce arguments in the literature and add considerable rigor from the meta-analysis. The authors propose a conceptual model for educators to follow when designing empathy interventions in medical students.

Reflecting Art in Nursing Practice: Developing Visual Arts Programs to Transform and Strengthen Practice

Despite evidence of its positive impact on observation, description, empathy, and self-care, few arts-related professional development opportunities exist for nurses in practice settings. This academic medical center launched a 4-part visual arts-humanities professional development workshop for RNs to enhance their clinical skills through reflective activities and guided conversations of art. Participating RNs provided written feedback of their impressions and reflections on course content and potential personal growth. Participants reported profound changes in their self-awareness in multiple areas, and 3 consistent themes emerged: 1) seeing as enhanced observation; 2) attunement, and 3) thinking shifts. The workshop also provided respite from patient care demands for professional development and opportunities to cultivate collegial relationships among nurses from different areas and units. These findings underscore the value of the Quadruple Aim, which focuses on workplace practices that promote a sense of well-being and meaning at work. Consistent support from the chief nursing officer and nursing leadership was essential to the success of the program.

Arts-Based Reflection on the End of Life: Nursing Student Narrative Analysis

Nurses play an essential role in providing compassionate evidence-based care at the end of life, yet many undergraduate students have limited opportunities to participate in end-of-life care experiences. Arts-based pedagogy has been explored as a strategy in nursing education that focuses on the affective domain of learning. The purpose of this qualitative narrative analysis was to explore the impact of an arts-based reflection assignment on student affective learning using artistic images depicting end-of-life scenarios. Student written narratives (n = 21) were analyzed using content analysis, and four themes emerged that described the components of affective learning in several areas.

Student's Experiences on Learning Therapeutic Relationship: A Narrative Inquiry

Despite the importance of the therapeutic relationship on nursing practice, the literature regarding teaching and learning therapeutic relationship is limited. This paper discussed how an undergraduate nursing student learned therapeutic relationship in an acute care setting. Narrative inquiry was applied as a research methodology. The student's reflection served as the narrative in this paper. Collaboratively, researchers conducted data analysis, common themes were drawn, and a summative narrative was presented. Based on the student's narrative, a three-dimensional model, including practical knowledge, theory, and reflection, has been created as our summative narrative. This model suggests that, to facilitate a learning process on creating therapeutic nurse-patient relationship, practical knowledge is the foundation, theory is a leading guide, and constant reflection is a learning tool which transforms learning into a reflective and meaningful experience. To promote learning on therapeutic relationship, nurse educators should emphasize the importance of both practical knowledge and theory. Constant reflection as a learning tool should be encouraged and embedded in nursing curriculum. Diverse approaches of reflection should be promoted.

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis (2012-2016)

BACKGROUND

Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.

AIM

To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.

METHODS

A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach’s alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I² statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger’s test, Begg’s test, and the trim and fill analysis.

RESULTS

Thirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis’ Interpersonal Reactivity Index. The overall reliability was 0.805 (95%CI 0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries of the studies under investigation and student types but most heterogeneity remained unexplained.

CONCLUSION

The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

Visual intelligence education as an innovative interdisciplinary approach for advancing communication and collaboration skills in nursing practice

BACKGROUND

Recognizing the relationship of keen observation to communication, critical thinking, and leadership in evidence-based literature, educators have expanded the use of art museums to augment visual intelligence skills. The purpose of this pilot intervention was to evaluate an innovative, interdisciplinary approach for integrating visual intelligence skills into an advanced communications and collaboration course.

METHOD

Collaborating with museum educators, the intervention for doctoral students was conducted at the National Gallery of Art. The aims were to explore and evaluate observation skills, use of intentional language in communication, impact of visual intelligence on perception, and role of visual intelligence with empathy.

RESULTS

Descriptive and nonparametric statistics highlighted significant differences in pre- to post-assessment scores related to the expansiveness of intentional visual observation, alternate views, perception and empathy, suggesting that visual intelligence training's impact can be identified and evaluated.

CONCLUSION

Healthcare providers' ability to communicate effectively, including observing, listening, explaining, and empathizing, significantly impacts healthcare outcomes and patient perceptions of satisfaction. All educators have access to a variety of two-dimensional art and the opportunity to implement interdisciplinary learning experiences to enhance visual intelligence. The intervention was considered a successful new learning modality for advanced communications skills and was integrated into the curriculum.

Poetry: An Innovative Teaching Strategy for Exploring Empathy With Beginning Nursing Students

BACKGROUND

Empathy is a professional value difficult to teach and challenging for beginning nursing students to grasp. This article describes how a poem was integrated in a seminar to engage students in exploring empathy and its relevance to their forming professional identities.

METHOD

Preseminar, nursing students (N = 8) read a book chapter about thinking empathetically. In seminar, they read an assigned poem and, using guiding questions, discussed it in small and large groups. Postseminar, students wrote self-reflections about their most important learning of the week.

RESULTS

Through in-seminar discussions and postseminar reflections, students crafted new meanings of empathy, contemplated new insights, and integrated them into their imagined professional identities. In written self-reflections, six of eight students indicated the seminar was their most important learning of the week.

CONCLUSION

Poetry is an engaging platform that makes accessible to beginning students the values of the profession that are difficult to articulate and grasp. [J Nurs Educ. 2018;57(5):315-318.].