Heart health whispering: A randomized, controlled pilot study to promote nursing student perspective-taking on carers' health risk behaviors

A randomized pragmatic feasibility trial to promote student perspective-taking on client physical activity level: a collaborative project

BACKGROUND

Health-care practitioners have opportunities to talk with clients about unhealthy behaviors. How practitioners approach these conversations involves skill to be effective. Thus, teaching health-care students to communicate empathetically with clients should promote effective client-practitioner conversations about health behavior change. The primary objective of this pilot trial was to assess the feasibility, acceptability, and appropriateness of a theoretically informed intervention designed to improve perspective-taking.

METHODS

For inclusion in this randomized mixed-methods parallel two-arm trial, participants needed to be a student at the investigators' Canadian university and have completed course content on behavior change communication. Using a 1:1 allocation ratio, participants in Respiratory, Physical, and Occupational Therapy; Nurse Practitioner; and Kinesiology programs were randomly assigned to full or partial intervention conditions. Full intervention participants completed a perspective-taking workshop and practiced perspective-taking prior to an in-lab dialogue with a client-actor (masked to condition) about physical activity. Partial intervention participants received the workshop after the dialogue. We assessed feasibility and appropriateness by comparing recruitment rates, protocol, and psychometric outcomes to criteria. We assessed acceptability (secondary outcome) by analyzing exit interviews.

RESULTS

We screened and randomized 163 participants (82 = full intervention; 81 = partial intervention). We fell slightly short of our recruitment success criteria (10-15 participants per program) when 2/50 Occupational Therapy students participated. We met some but not all of our protocol criteria: Some full intervention participants did not practice perspective-taking before the dialogue, because they did not see anyone during the practice period or did not have a practice opportunity. Psychometric outcomes met the criteria, except for one measure that demonstrated ceiling effects and low reliability (Cronbach's alpha < .70). There were no adverse events related to participation.

CONCLUSIONS

The intervention should be largely feasible, appropriate, and acceptable to deliver. We suggest changes that are large enough to warrant conducting another pilot study. We outline recommended improvements that are applicable to researchers and educators interested in recruitment, adherence to home practice, and online uptake of the intervention.

TRIAL REGISTRATION

This trial was registered retrospectively on November 8, 2023, at https://clinicaltrials.gov/study/NCT06123507 .

Exploring Actual and Presumed Links between Accurately Inferring Contents of Other People's Minds and Prosocial Outcomes

The term "empathic accuracy" has been applied to people's ability to infer the contents of other people's minds-that is, other people's varying feelings and/or thoughts over the course of a social interaction. However, despite the ease of intuitively linking this skill to competence in helping professions such as counseling, the "empathic" prefix in its name may have contributed to overestimating its association with prosocial traits and behaviors. Accuracy in reading others' thoughts and feelings, like many other skills, can be used toward prosocial-but also malevolent or morally neutral-ends. Prosocial intentions can direct attention towards other people's thoughts and feelings, which may, in turn, increase accuracy in inferring those thoughts and feelings, but attention to others' thoughts and feelings does not necessarily heighten prosocial intentions, let alone outcomes.

Development and Design of E_MOTIV: A Theory-Based Adaptive E-Learning Program to Support Nurses' Provision of Brief Behavior Change Counseling

Brief counseling, when provided by adequately trained nurses, can motivate and support patient health behavior change. However, numerous barriers can impede nurses' capability and motivation to provide brief counseling. Theory-based interventions, as well as information and communication technologies, can support evidence-based practice by addressing these barriers. The purpose of this study was to document the development process of the E_MOTIV asynchronous, theory-based, adaptive e-learning program aimed at supporting nurses' provision of brief counseling for smoking cessation, healthy eating, and medication adherence. Development followed French's stepwise theory- and evidence-based approach: (1) identifying who needs to do what, differently, that is, provision of brief counseling in acute care settings by nurses; (2) identifying determinants of the provision of brief counseling; (3) identifying which intervention components and mode(s) of delivery could address determinants; and (4) developing and evaluating the program. The resulting E_MOTIV program, guided by the Theory of Planned Behavior, Cognitive Load Theory, and the concept of engagement, is unique in its adaptive functionality-personalizing program content and sequence to each learners' beliefs, motivation, and learning preferences. E_MOTIV is one of the first adaptive e-learning programs developed to support nurses' practice, and this study offers key insights for future work in the field.

Usability testing of a Web-Based Empathy Training Portal: A Mixed Methods Study (Preprint)

BACKGROUND

The prepandemic period saw a rise in web-based teaching. However, web-based tools for teaching the essential clinical skill of cognitive empathy (also known as perspective taking) remain limited. More of these tools are needed and require testing for ease of use and understanding by students.

OBJECTIVE

This study aimed to evaluate the usability of the In Your Shoes web-based empathy training portal application for students using quantitative and qualitative methods.

METHODS

This 3-phase formative usability study used a mixed methods design. In mid-2021, we conducted a remote observation of student participants interacting with our portal application. Their qualitative reflections were captured, followed by data analysis and iterative design refinements of the application. Overall, 8 third- and fourth-year nursing students from an undergraduate baccalaureate program at a Canadian university, in the western province of Manitoba, were included in this study. Participants in phases 1 and 2 were remotely observed by 3 research personnel while engaged in predefined tasks. In phase 3, two student participants were asked to use the application as they liked in their own environments, after which a video-recorded exit interview with a think-aloud process was conducted as participants responded to the System Usability Scale. We calculated descriptive statistics and performed content analysis to analyze the results.

RESULTS

This small study included 8 students with a range of technology skills. Usability themes were based on participants' comments on the application's appearance, content, navigation, and functionality. The biggest issues that participants experienced were with navigating the application's "tagging" features during video analysis and the length of educational material. We also observed variations in 2 participants' system usability scores in phase 3. This may be because of their different comfort levels with technology; however, additional research is required. We made iterative refinements to our prototype application (eg, added pop-up messages and provided a narrated video on the application's "tagging" function) based on participant feedback.

CONCLUSIONS

With increasing engagement in web-based teaching, technology has become an essential medium for receiving health care education. We developed a novel prototype application as a supplemental classroom tool to foster students' self-directed learning of empathy. This study provided direction for refinements to optimize the usability of and satisfaction with this innovative application. Qualitative feedback revealed favorable input toward learning perspective taking place on the web and helpful recommendations for improving user experiences with the application. We could not fully assess the application's key functions owing to the COVID-19 protocols. Thus, our next step is to obtain feedback from a larger sample of student users, whose experiences performing "live" video capture, annotation, and analysis will be more authentic and wholesome with the refined application. We discuss our findings in relation to research on nursing education, perspective taking, and adaptive e-learning.

Remote Moderator and Observer Experiences and Decision-making During Usability Testing of a Web-Based Empathy Training Portal: Content Analysis

Background

COVID-19 restrictions severely curtailed empirical endeavors that involved in-person interaction, such as usability testing sessions for technology development. Researchers and developers found themselves using web-based moderation for usability testing. Skilled remote moderators and observers are fundamental in this approach. However, to date, more empirical work is needed that captures the perceptions and support needs of moderators and observers in testing situations.

Objective

The aim of this paper was to identify remote moderator and observer participant experiences and their use of certain tools to capture feedback of users as they interact with the web browser application.

Methods

This research is part of a broader study on an educational web browser application for nursing students to learn perspective taking and enhance their perceptual understanding of a dialogue partner’s thoughts and feelings. The broader study used a quantitative and think-aloud qualitative problem-discovery usability study design. This case study explored written accounts of the remote moderator and observer participants regarding their roles, experiences, and reactions to the testing protocol and their suggestions for improved techniques and strategies for conducting remote usability testing. Content analysis was used to analyze participants’ experiences in the usability testing sessions.

Results

We collected data from 1 remote moderator and 2 remote observers. Five themes were identified: dealing with personal stressors, dealing with user anxiety, maintaining social presence, ethical response to the study protocol, and communication during sessions. The participants offered recommendations for the design of future remote testing activities as well as evidence-informed training materials for usability project personnel.

Conclusions

This study’s findings contribute to a growing body of endeavors to understand human-computer interaction and its impact on remote moderator and observer roles. As technology rapidly advances, more remote usability testing will occur where the knowledge gleaned in this study can have an impact. Recommendations based on moderator and observer participant perspectives identify the need for more evidence-informed training materials for their roles that focus on web-based interpersonal communication skills, execution of user testing protocols, troubleshooting technology and test user issues, proficiency in web conferencing platforms, behavior analysis and feedback technologies, and time management.

Expanding the conversation: A Person-centred Communication Enhancement Model

The intricacy and impact of human communication has long captured the attention of philosophers, scholars and practitioners. Within the realm of care and service provision, efforts to maximize outcomes through optimal person-provider communication have drawn research and clinical focus to this area for several decades. With the dawning of the person-centred care movement within healthcare, and in particular long-term care home and dementia care settings, improvement in care providers' use of person-centred communication strategies and enhancement of relationships between residents, their families and care providers are desired outcomes. Thus, several person-centred care and communication theoretical perspectives have been employed to ground study in this field. However, a comprehensive theoretical position to underpin person-centred communication in dementia and older adult research does not exist to our knowledge. To offer expansion to the theoretical work in this emerging field, a Person-Centred Communication Enhancement Model for long-term care and dementia care is proposed, as well as rationale for its development. This discussion will also provide an overview and critique of the extant philosophies, theories, frameworks and models that have been utilized in the study of person-centred communication within the context of long-term care and dementia care.

Effectiveness of an online short compassion strengths course on nursing students compassion: A mixed methods non-randomised pilot study

BACKGROUND

Although student nurses are expected to demonstrate and show understanding of compassion in their learning and practice, literature suggests that this is not always the case. To address this, nursing students need to be introduced to the value and behaviours of compassion during their education.

OBJECTIVES

To evaluate the effectiveness of an online course to help nursing students develop their strengths and further validate the Bolton Compassion Strengths Indicators.

DESIGN

A pre-and post-mixed methods non-randomised pilot study.

SETTING

A university in the north west of England.

PARTICIPANTS

A sample of first year undergraduate nursing students (67), in two groups, with 33 in the online control and 34 in the on-site group.

METHODS

Both groups took part in the Short Compassion Strengths Course (SCSC). The online group took the course in their own time over a 3-week period, while the on-site group completed the course during their time at University. In both groups baseline assessments were carried out using the Bolton Compassion Strengths Indicator (BCSI). Post-test data were collected 3 weeks after in the online group and immediately after in the on-site group, for the BCSI and reflective accounts. Data were analysed using ANOVA in SPSS27.

RESULTS

The online group did not complete the course but filled out the questionnaires. The on-site group had significantly higher scores on all indicators but self-care and engagement.

CONCLUSIONS

The SCSC is an effective course for teaching and developing compassion strengths when delivered on-site. This paper adds further validity for the BCSI.

Analysis of Continuous Nursing Intervention on Aplastic Anemia Patients Based on the "Information-Motivation-Behavioral Skills Model"

Objective

To explore the effect of continuous nursing care based on the “information-motivation-behavioral skills model” (IMB) in the intervention of patients with aplastic anemia.

Methods

A total of 90 patients with aplastic anemia who were admitted to our hospital from June 2019 to January 2021 were included in the study. The patients were divided into an observation group and a control group according to the random number table, with 45 patients in each group. The control group received routine nursing care, while the observation group received continuous nursing care based on IMB on the basis of the control group. Patients were followed up for 3 months, and their health knowledge was assessed with our self-made health knowledge rating scale. Patients' medication compliance was assessed using the Morisky medication compliance questionnaire. The self-care ability was assessed with the self-made self-care ability scale in our hospital. The comprehensive quality of life assessment questionnaire (GQOLI-74) was used to assess the quality of life of patients. A self-prepared nursing satisfaction questionnaire was used to score patients' nursing satisfaction. The total effective rate of nursing was evaluated.

Results

The awareness scores of basic disease knowledge, medication knowledge, and daily self-care knowledge in the observation group were higher than those in the control group (P < 0.05). The scores of medication compliance in the observation group were higher than those in the control group (P < 0.05). The self-care abilities such as healthy diet, psychological adjustment, self-care skills, oral care, and perianal care in the observation group were higher than those in the control group (P < 0.05). The quality of life scores of patients in the two groups in the 3 months of nursing were higher than those when they were discharged from hospital (P < 0.05). The GQOLI-74 score of 3 months' nursing care in the observation group was higher than that in the control group (P < 0.05). The nursing satisfaction degree of the observation group (97.78%) was higher than that of the control group (82.23%) (P < 0.05). The total effective rate of nursing care in the observation group (97.78%) was higher than that in the control group (77.78%) (P < 0.05).

Conclusion

IMB-based continuous nursing care can significantly increase the awareness of health knowledge in patients with aplastic anemia, effectively improve medication compliance, significantly enhance self-care ability, and thus, improve the quality of life.

"Walking in Their Shoes": The effects of an immersive digital story intervention on empathy in nursing students

AIM

To evaluate the effects of a novel, immersive digital story intervention on empathy.

DESIGN

A randomized trial with three phases.

RESULTS

A total of 238 2nd year nursing students were recruited between May 2018 and December 2019. At baseline, no significant differences in empathy between the groups were found (p = .760). However, at post-test, empathy was significantly higher in the intervention group (M: 118.76, SD: 10.65) than it was in the control group (M: 114.60, SD: 15.40) (p = .012). At follow-up, there were no significant differences in empathy between the groups (p = .364).

CONCLUSION

The intervention resulted in an immediate increase in empathy in nursing students. However, further development of effective intervention delivery modes and fundamental redesign of the intervention itself would be needed to sustain this improvement over the long term.

Assessing the effect of empathy-enhancing interventions in health education and training: a systematic review of randomised controlled trials

OBJECTIVE

To estimate the effect of empathy interventions in health education and training from randomised controlled trials (RCTs).

METHODS

MEDLINE, PsycINFO, EMBASE, CINAHL and Cochrane databases were searched from inception to June 2019 for RCTs investigating the effect of empathy-enhancing interventions in medical and healthcare students and professionals. Studies measuring any aspect of 'clinical empathy' as a primary or secondary outcome were included. Two reviewers extracted data and assessed the risk of bias of eligible studies using the Cochrane Risk of Bias Tool. Random effects meta-analyses of the impact of empathy training on participants' empathy levels were performed.

RESULTS

Twenty-six trials were included, with 22 providing adequate data for meta-analysis. An overall moderate effect on participant empathy postintervention (standardised mean difference 0.52, 95% CI 0.36 to 0.67) was found. Heterogeneity across trial results was substantial (I²=63%). Data on sustainability of effect was provided by 11 trials and found a moderate effect size for improved empathy up until 12 weeks (0.69, 95% CI 0.23 to 1.15), and a small but statistically significant effect size for sustainability at 12 weeks and beyond (standardised mean difference 0.34, 95% CI 0.11 to 0.57). In total, 15 studies were considered to be either unclear or high risk of bias. The quality of evidence of included studies was low.

CONCLUSION

Findings suggest that empathy-enhancing interventions can be effective at cultivating and sustaining empathy with intervention specifics contributing to effectiveness. This review focuses on an important, growing area of medical education and provides guidance to those looking to develop effective interventions to enhance empathy in the healthcare setting. Further high-quality trials are needed that include patient-led outcome assessments and further evaluate the long-term sustainability of empathy training.

PROTOCOL REGISTRATION NUMBER

PROSPERO (CRD42019126843).

Perceptions of an evidence-based empathy mobile app in post-secondary education

Cognitive empathy (also known as perspective-taking) is an important, teachable, skill. As part of a knowledge translation project, we identified a) interest in an evidence-based cognitive empathy mobile app and b) which faculties believe that cognitive empathy is important for their profession. Students (n = 638) and instructors/professors (n = 38) completed a university-wide survey. Participants in Education, Social Work, and the Health Sciences were among those most interested in the app. The majority of participants said that they would prefer for the app to be free or less than $3 for students. Most participants preferred a one-time payment option. Across 17 faculties, all but one had 60% or more of its sampled members say that cognitive empathy is important for their profession. Results illuminate perceptions of cognitive empathy instruction and technology. Results also provide insight into issues to consider when developing and implementing an educational communication app.

Behavior change counseling training programs for nurses and nursing students: A systematic descriptive review

OBJECTIVES

(1) To systematically review the literature on behavior change counseling (BCC) training programs targeting nurses and nursing students; (2) to characterize these training programs according to their content (i.e., targeted health behavior[s], BCC approaches taught, BCC techniques taught), structure, and modes of delivery.

DESIGN

A systematic, descriptive literature review.

DATA SOURCES

PubMed, CINAHL and Embase were searched with no time limitation in August 2018.

REVIEW METHODS

A systematic, descriptive literature review structured according to Paré et al.'s methodology and the PRISMA guidelines. Primary studies were included if they evaluated a BCC training program with nurses or nursing students. Review authors screened studies, extracted data, and assessed study quality using the MERSQI. Data was synthesized through narrative synthesis, descriptive statistics, and content analysis.

RESULTS

From a pool of 267 articles, we included 25 articles published between 2003 and 2018. Two studies scored as low quality (8%), 18 as moderate quality (72%), and 5 as high quality (20%). Physical activity (n = 14; 56%) and smoking (n = 11; 44%) were the most frequently targeted health behaviors. Eleven BCC approaches were cited (e.g., motivational interviewing), and 48 BCC techniques were identified (e.g., eliciting and scaling change talk). The median number of training sessions was 3 (interquartile range [IQR] 5), the median training program duration was 3 h (IQR 6.25 h), and median training period was 24.5 days (IQR 110 days). Programs were most often delivered as seminars and workshops.

CONCLUSIONS

High-quality studies reporting the assessment of BCC training programs with nurses and nursing students are scarce. There was significant heterogeneity in terms of the BCC approaches and techniques taught. Current evidence suggests nurses and nursing students learn BCC mainly through active, realistic practice. However, computer-based training programs are rapidly gaining ground. Further research emphasizing theory-based BCC training programs is warranted.