Elsevier

Nurse Education Today

Volume 59, December 2017, Pages 75-81
Nurse Education Today

Measuring the impact of a ‘point of view’ disability simulation on nursing students' empathy using the Comprehensive State Empathy Scale

https://doi.org/10.1016/j.nedt.2017.09.007Get rights and content

Highlights

  • Too often healthcare providers fail to provide empathetic care to vulnerable patients.

  • Point-of-view simulations allow students to see the world through the eyes of another person.

  • The Comprehensive State Empathy Scale is a reliable instrument that measures changes in empathy scores pre-post.

Abstract

Background

Although empathy is an integral component of professional practice and person-centred care, a body of research has identified that vulnerable patients groups frequently experience healthcare that is less than optimal and often lacking in empathy.

Aim

The aim of this study was to examine the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury.

Setting and Participants

A convenience sample of 390 nursing students from a cohort of 488 participated in the study, giving a response rate of 80%. Students undertook the simulation in pairs and were randomly allocated to the role of either a person with Acquired Brain Injury or a rehabilitation nurse. The simulated ‘patients’ wore a hemiparesis suit that replicated the experience of dysphasia, hemianopia and hemiparesis.

Design

Characteristics of the sample were summarised using descriptive statistics. A two-group pre-test post-test design was used to investigate the impact of the simulation using the Comprehensive State Empathy Scale. t-Tests were performed to analyse changes in empathy pre post and between simulated ‘patients’ and ‘rehabilitation nurses’.

Results

On average, participants reported significantly higher mean empathy scores post simulation (3.75, SD = 0.66) compared to pre simulation (3.38 SD = 0.61); t (398) = 10.33, p < 0.001. However, this increase was higher for participants who assumed the role of a ‘rehabilitation nurse’ (mean = 3.86, SD = 0.62) than for those who took on the ‘patient’ role (mean = 3.64, SD = 0.68), p < 0.001.

Conclusion

The results from this study attest to the potential of point-of-view simulations to positively impact nursing students' empathy towards people with a disability. Research with other vulnerable patient groups, student cohorts and in other contexts would be beneficial in taking this work forward.

Introduction

In Australia 20% of the population have a disability, and 1.4 million people have severe disabilities and require help with mobility, communication and/or self-care (Australian Bureau of Statistics, 2015). Although empathy is an integral component of professional practice and person-centred care (Brunero et al., 2010), a body of research has identified that vulnerable patients groups, such as people with a disability, frequently experience healthcare that is less than optimal and lacking in empathy. This is illustrated in recent healthcare reports which highlight examples of discrimination, systemic indifference and neglect of people with a disability (Department of Health, 2012, Francis, 2013, Parliament of Victoria, 2016).

While empathic care contributes substantially to both physiological and psychosocial patient outcomes (Hojat et al., 2013, Scott, 2011), studies suggest that healthcare professionals sometimes have a limited understanding of the perspectives, concerns, needs and healthcare preferences of people with a disability (Iezzoni et al., 2003, Kitson et al., 2012). For these reasons, educational interventions designed to foster empathy are increasingly being introduced into healthcare curricula. The most effective of these initiatives are immersive point-of-view simulations which allow learners to ‘step into a patient's shoes’ and ‘see the world through their eyes’ in order to gain new insights into the feelings, perspectives and experiences of another person (Bearman et al., 2015, Everson et al., 2015).

This paper presents one component of a multi-site mixed methods study that examined the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury (ABI) using the Comprehensive State Empathy Scale (CSES) (Everson et al., under review).

Section snippets

The Meaning and Meaningfulness of Empathy

Empathy is a multidimensional construct and the literature is replete with various definitions of the term. At a broad level empathy involves the cognitive ability to intuit what another person is feeling (evaluative response), an emotional resonance with those feelings (affective response), and the intention to respond compassionately to the person's needs and concerns (behavioural response) (Hatfield et al., 2011). In the general community there have been generational shifts in empathy

Study Aim

The aim of this study was to examine the impact of an immersive point-of-view simulation on nursing students' empathy towards people with an Acquired Brain Injury (ABI).

Study Design

This study employed a two-group pre-test post-test design. Comparisons in empathy levels were made at baseline (pre-test) and after the simulation experience (post-test).

Setting

Participants were a convenience sample of second-year bachelor of nursing students from three campuses of one Australian university.

Recruitment and Ethical Considerations

An announcement and a participant information statement were posted on an electronic learning management system (Blackboard™), and potential participants were invited to email the researchers if

Participant Socio-demographic Characteristics

A total of 390 students from a cohort of 488 participated in the study, giving a response rate of 80%. The majority were female (92.5%) and their ages ranged from 19 to 67 years, with an average of 28.80 years (SD = 9.42). The majority (63%) of participants had personal or professional experiences caring for a person with a disability. See Table 1 for further details about the socio-demographic characteristics of the sample.

Psychometric Testing of the CSES

Psychometric testing of the CSES demonstrated good internal consistency

Discussion

Empathy is one of the strongest negative correlates of prejudice (Pettigrew and Tropp, 2008) and integral to safe, professional and effective nursing ‘practice’ (Brunero et al., 2010). Premised on this understanding, empathy simulations are increasingly being implemented in healthcare education. Although a range of different simulation modalities have been used, for example, standardised patients, manikins, role-plays, games, and virtual reality (Ker and Bradley, 2010); a systematic review

Conclusion

The results from this study are encouraging and attest to the potential for immersive point-of-view simulations to positively impact learners' empathy towards other vulnerable patient groups. Given the unequivocal evidence about the physiological and psychosocial impact of empathic engagement with patients, further research with other student cohorts and in other contexts would be beneficial to extend on this work. Additionally, as scale development is an iterative process further studies

Funding Sources

N/A.

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