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Napolitano F, Calzolari M, Di Pietro S, Pagnucci N, Zanini M, Catania G, Aleo G, Gomes L, Sasso L, Bagnasco A. Pedagogical strategies to improve emotional competencies in nursing students: A systematic review. NURSE EDUCATION TODAY 2024; 142:106337. [PMID: 39154590 DOI: 10.1016/j.nedt.2024.106337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 07/18/2024] [Accepted: 08/01/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVES To reveal the effectiveness of didactic architectures and pedagogical strategies to be implemented in nursing curricula to develop and improve Emotional Competencies (EC) in undergraduate nursing students. DESIGN Systematic review of effectiveness conducted according to Joanna Briggs Institute (JBI) guidelines. We followed the PRISMA statement to guarantee the transparency of the review and the GRADE to report the strength of evidence. DATA SOURCES Seven databases were searched: MEDLINE, The Cochrane Library, SCOPUS, CINAHL, EMBASE, PsycINFO and ERIC. Grey literature was also searched through the OpenGrey database. REVIEW METHODS Studies focusing on educational programmes and/or activities to develop EC in nursing curricula, published in English or Italian were included. Quality assessment of the studies was evaluated using JBI critical evaluation tools and the Mixed Methods Appraisal Tool (MAAT). Following JBI guidelines, a narrative synthesis was performed. RESULTS A total of 19 studies from 8 countries were included. The population varied from first to fourth-year students in relation to the duration of the undergraduate nursing program across the various countries. Most of the students were females. The age of the participants ranged between18 and 56 years. The most common pedagogical strategies were simulation, role playing, and face-to-face lessons. In some cases, studies combined two or three pedagogical strategies in the same intervention. The most effective strategy was simulation, which improved EC, compassion, self-awareness, self-efficacy, empathy, critical thinking, clinical practice skills, and teamwork skills. Furthermore, the combination of lessons, simulation, and literature exploration effectively developed communication skills, and improved students' satisfaction. CONCLUSIONS Investing in simulation, role-playing activities, and lessons regarding the importance of EI, empathy and compassion, and the role of an emotionally competent nurse leads to improved nursing care and wellbeing.
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Affiliation(s)
- Francesca Napolitano
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Michela Calzolari
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Sara Di Pietro
- Dipartimento Materno Infantile, Ospedale Policlinico San Martino - IRCCS, Largo R. Benzi 10, 16132 Genoa, Italy.
| | - Nicola Pagnucci
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Milko Zanini
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Gianluca Catania
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Giuseppe Aleo
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy; Faculty of Nursing and Midwifery, Royal College of Surgeons in Ireland, 123 St. Stephen's Green, Dublin, Ireland.
| | - Lisa Gomes
- Nursing School, Minho University, Campus de Gualtar - Edifício BGUM 2° Piso, 4710 - 057 Braga, Portugal.
| | - Loredana Sasso
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
| | - Annamaria Bagnasco
- Department of Health Sciences, University of Genoa, Via A. Pastore 1, 16132 Genoa, Italy.
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Zou Y, Lan Q, Chen L, Yao Z, Zhai J. Undergraduate midwifery students' experiential learning of perinatal bereavement care: A qualitative analysis. NURSE EDUCATION TODAY 2024; 141:106324. [PMID: 39116473 DOI: 10.1016/j.nedt.2024.106324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 07/09/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND It is widely acknowledged that midwives are essential in providing care for mothers experiencing perinatal death. However, midwifery students lack the knowledge and skills needed to deal with perinatal death, and. There is limited research on perinatal bereavement care training for midwifery students. AIM To investigate undergraduate midwifery students' experiential learning of perinatal bereavement care and serve as a reference for future perinatal bereavement care teaching and training. DESIGN Qualitative descriptive design. SETTING University in Guangzhou, China. PARTICIPANTS Undergraduate midwifery students at a university in Guangzhou, China. METHOD This research was conducted at a university in Guangzhou, China. The participants were recruited using purposeful sampling. Semi-structured, in-depth interviews were conducted with 11 midwifery students who participated in perinatal bereavement care training from May to June 2023. The Colalizzi 7-step data analysis method was used for data analysis. RESULTS From the data, five themes emerged: 1) immersive experience of perinatal bereavement care, 2) formation of perspectives on perinatal bereavement care, 3) clarification of the service boundaries and internalization of the professional service spirit, 4) emotional impact and coping strategies, and 5)) factors influencing practice optimization. CONCLUSIONS Experiential learning is an effective teaching strategy. However, participants continued to feel unprepared to provide perinatal bereavement care. Implementing relevant training, disseminating perinatal bereavement care knowledge and skills, and enhancing the ability of midwifery students to manage and cope with the psychological impact of perinatal death are important.
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Affiliation(s)
- Yinting Zou
- Department of Nursing, Guangdong Maoming Health Vocational College, Maoming 525400, China
| | - Qinqin Lan
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Lijin Chen
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Zheng Yao
- School of Nursing, Southern Medical University, Guangzhou 510515, China
| | - Jinguo Zhai
- School of Nursing, Southern Medical University, Guangzhou 510515, China.
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Qu Z, Sun J, Li L, Zhao L, Jiang N, Fan J, Zhang J, Liang B. The effect of simulated problem learning in nursing ethics on moral sensitivity, empathy and critical thinking of nursing students: A quasi-experimental study. Nurse Educ Pract 2024; 80:104119. [PMID: 39226852 DOI: 10.1016/j.nepr.2024.104119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Revised: 08/22/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024]
Abstract
AIM Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction. BACKGROUND Promoting nursing students' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education. DESIGN A quasi-experimental design based on a non-equivalent control group pre-test/post-test. METHODS A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students' characteristics and satisfaction with teaching post-intervention. Student's t-test was used to assess group differences in scale scores and test scores. RESULTS Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05). CONCLUSION The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.
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Affiliation(s)
- Zhifei Qu
- School of Nursing, Jilin University, Changchun, Jilin 130021, China
| | - Jingjing Sun
- Department of Otolaryngology Head and Neck Surgery, The First Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Li Li
- Nursing Department, The Second Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Lijing Zhao
- School of Nursing, Jilin University, Changchun, Jilin 130021, China
| | - Nan Jiang
- Department of Cardiovascular center, Jilin University First Hospital, Changchun 130000, Jilin, China
| | - Jia Fan
- The Second Hospital of Jilin University, Changchun, Jilin 130021, China
| | - Jiaxin Zhang
- Department of Nursing, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
| | - Bing Liang
- School of Nursing, Jilin University, Changchun, Jilin 130021, China.
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Juniarta, Eka NGA, Ferawati Sitanggang Y. Empathy in Nursing Students: A Scoping Review. J Holist Nurs 2024; 42:S59-S86. [PMID: 37039440 DOI: 10.1177/08980101231163966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
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.
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Affiliation(s)
- Juniarta
- Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia
- Biblical Seminary of the Philippines, Valenzuela, Philippines
| | - Ni Gusti Ayu Eka
- Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia
| | - Yenni Ferawati Sitanggang
- Faculty of Nursing, Universitas Pelita Harapan, Tangerang, Indonesia
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Wu JH, Lin PC, Lee KT, Liu HL, Lu PY, Lee CY. Situational simulation teaching effectively improves dental students' non-operational clinical competency and objective structured clinical examination performance. BMC MEDICAL EDUCATION 2024; 24:533. [PMID: 38745156 PMCID: PMC11092032 DOI: 10.1186/s12909-024-05546-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Appropriate communication with dental patients enhances treatment outcomes and patient satisfaction. Implementing simulated patient interviews courses can improve patient-centered care and reduce conflict during clerkship training. Therefore, this study explored the relationship among student participation in a situational simulation course (SSC), academic performance, clerkship performance, and objective structured clinical examination (OSCE) performance. METHODS This study was conducted with a sample of fifth-year dental students undergoing clerkship training. After implementing a situational simulation course to investigate the relationship among participation in SSC, academic performance, clerkship performance, and OSCE performance, a path analysis model was developed and tested. RESULTS Eighty-seven fifth-year dental students were eligible for the SSC, and most (n = 70, 80.46%) volunteered to participate. The path analysis model revealed that academic performance had a direct effect on OSCE performance (β = 0.281, P = 0.003) and clerkship performance (β = 0.441, P < 0.001). In addition, SSC teaching had a direct effect on OSCE performance (β = 0.356, P < 0.001). CONCLUSIONS SSCs can enhance dental students' non-operational clinical competency and OSCE performance effectively. Simulated patient encounters with feedback, incorporated into the dental curricula, have led to improved communication. Based on our findings, we suggest implementing SSC teaching before the OSCE to improve communication and cognitive skills.
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Affiliation(s)
- Ju-Hui Wu
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, No. 100, Shih-Chuan 1st Road, 80708
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- Center for Medical Education and Humanizing Health Professional Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Pei Chen Lin
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, No. 100, Shih-Chuan 1st Road, 80708
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Kun-Tsung Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, No. 100, Shih-Chuan 1st Road, 80708
- Department of Dentistry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Hsin-Liang Liu
- Graduate Institute of Adult Education, National Kaohsiung Normal University, Kaohsiung, Taiwan
- Department of Emergency Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Peih-Ying Lu
- Center for Medical Education and Humanizing Health Professional Education, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- College of Humanities and Social Sciences, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Chen-Yi Lee
- Department of Oral Hygiene, College of Dental Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan, No. 100, Shih-Chuan 1st Road, 80708.
- Department of Medical Research, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
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Roberts ML, Kaur T. Effect of Storytelling and Empathy Training to Support Affective Learning in Undergraduate Nursing Students. Nurse Educ 2023; 48:260-264. [PMID: 37074957 DOI: 10.1097/nne.0000000000001419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND Empathy is a desired characteristic in nurses, but its development is often overlooked in nursing simulation. PURPOSE This study evaluated the effect of a storytelling and empathy training intervention to enhance empathy development in simulation-based learning. METHODS A quasi-experimental control group design was used to evaluate differences in self-perceived and observed empathy in undergraduate nursing students (N = 71). Relationships between self-perceived and observed empathy were also assessed. RESULTS Repeated-measures analysis of variance revealed a statistically significant increase in self-perceived empathy, and higher, but nonstatistically significant differences in observed empathy for subjects in the treatment condition. No relationship between self-perceived and observed empathy was observed. CONCLUSIONS Storytelling and empathy training may augment simulation-based learning experiences to promote empathy development in undergraduate nursing students.
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Affiliation(s)
- Michele Livich Roberts
- Assistant Professor (Dr Roberts), School of Nursing, Rutgers University, Newark, New Jersey; and Endowed Assistant Professor (Dr Kaur), College of Nursing, Villanova University, Villanova, Pennsylvania
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Wu Q, Zhu P, Ji Q, Shi G, Qian M, Xu H, Gu X, Wang W, Zhang Q. The effect of death education course utilizing constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death: A mixed study design. NURSE EDUCATION TODAY 2023; 126:105809. [PMID: 37058871 DOI: 10.1016/j.nedt.2023.105809] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/26/2023] [Accepted: 03/28/2023] [Indexed: 05/25/2023]
Abstract
Inadequate clinical preparation for palliative care is often reflected in inadequate education about death. Nursing students as nurses of the future, it is necessary to make them aware of death and overcome fear of it so that they can cope with their future careers and provide qualified and warmly care service. OBJECTIVES To determine the effect of death education course using constructivist learning theory on first grade undergraduate nursing student attitudes and coping abilities towards death. DESIGN This study was designed using a mixed-methods design. SETTING Two campuses of a university school of nursing in China. PARTICIPANTS First grade Bachelor of Nursing Science students (n = 191). METHODS Data collection includes questionnaires and reflective writing as after class task. Quantitative data were analyzed using descriptive statistics, the Wilcoxon Signed Rank test, and the Mann-Whitney U test. As for reflective writing, content analysis was hired to analysis. RESULTS The intervention group's attitude towards death tended to be neutral acceptance. The intervention group's ability to deal with death (Z = -5.354, p < 0.001) and expression of thoughts about death (Z = -3.89 b, p < 0.001) greater than that of the control group. Four themes (Awareness of death before class, Knowledge, The meaning of palliative care, New cognition) were identified from reflecting writing. CONCLUSION Compared with the conventional teaching, death education course utilizing constructivist learning theory was found to be a more effective method for developing students' death coping skills and reducing fear of death.
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Affiliation(s)
- Qiwei Wu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Pingting Zhu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China; Jiangsu Key Laboratory of Zoonosis, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China.
| | - Qiaoying Ji
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Guanghui Shi
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Meiyan Qian
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - HuiWen Xu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Xinyue Gu
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Wen Wang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
| | - Qianqian Zhang
- School of Nursing, Yangzhou University, 136 Jiangyang Middle Road, Hanjing County, Yangzhou City 225009, Jiangsu Province, China
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Unal E, Ozdemir A. The effect of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy: A randomised controlled trial. NURSE EDUCATION TODAY 2023; 126:105828. [PMID: 37086499 DOI: 10.1016/j.nedt.2023.105828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Revised: 03/16/2023] [Accepted: 04/11/2023] [Indexed: 05/03/2023]
Abstract
BACKGROUND Although improvements in burn care have increased the probability of survival in recent years, major complications are still common in burn patients. Nursing students should be competent to evaluate and intervene in the burn. OBJECTIVE To examine the effects of hybrid simulated burn care training on nursing students' knowledge, skills, and empathy. DESIGN In this study, a randomised experimental design was used. PARTICIPANTS This study was conducted on third-year undergraduate nursing students. METHODS Students in this study were randomly assigned to one of two groups: the Hybrid Simulated Group (N = 26) and the Control Group (N = 30). Standard Education training was completed by all participants. Only the hybrid simulation group students received training on the standardised patient with wearable burn plasters. Students' knowledge of burn care was assessed using an information questionnaire immediately following the theoretical training and after training for three weeks. An Objective Structured Clinical Exam was used to assess students' abilities. The Objective Structured Clinical Exam was convened three weeks after the theoretical training. The Multidimensional Emotional Empathy Scale was used to assess the students' empathy ability level immediately following the theoretical training and three weeks later. RESULTS After the intervention, nursing students in the Hybrid Simulated group had improved empathy, knowledge, skills of physical assessment, and implementation of interventions and referral criteria on burn care (p < 0.05). CONCLUSION Simulated burn training could be utilised to improve nursing students' empathy, knowledge, and skills of physical assessment evaluation of interventions and referral criteria on burn care.
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Affiliation(s)
- Eda Unal
- Bursa Uludag University, Faculty of Health Sciences, Department of Public Health Nursing, Bursa, Turkey.
| | - Aysel Ozdemir
- Bursa Uludag University, Faculty of Health Sciences, Department of Public Health Nursing, Bursa, Turkey.
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Basit G, Su S, Geçkil E, Basit O, Alabay KNK. The effect of drama-supported, patient role-play experience on empathy and altruism levels in nursing students: A randomized controlled study. Nurse Educ Pract 2023; 69:103634. [PMID: 37094434 DOI: 10.1016/j.nepr.2023.103634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 03/23/2023] [Accepted: 04/05/2023] [Indexed: 04/26/2023]
Abstract
AIM This study aims to determine the effect of drama-supported, patient role-play experiences on the empathy and altruism levels of nursing students. BACKGROUND Empathy, one of the most important skills of the nursing profession, has an important place in the patient-nurse relationship. To be empathetic, which is acknowledged as the most basic motivation of altruistic behavior, requires recognizing emotional states and understanding the needs of others. DESIGN The format of this study was a pre-test-post-test, regular parallel-group, randomized, controlled experiment. METHODS The study data were collected between October 2021 and February 2022. The research was carried out with second-year students at Necmettin Erbakan University, Faculty of Nursing, who did not have any history of hospitalization or any chronic diseases. All subjects agreed to participate in the study (n = 52, intervention group=26, control group 26). Data were collected using a Descriptive Characteristics Form, the Altruism Scale and the Jefferson Scale of Empathy for Nursing Students (JSENS). After a three-hour drama workshop, participants in the intervention group acted out the role of a bed-bound patient in the laboratory environment and no intervention was applied to the control group. A series of Mixed ANOVAs were conducted for the analysis of the data. RESULTS The mean age of participants was 19.94 years (SD = ± 1.31) and 83.7 % of the participants were women. The intervention group showed a significant increase in altruism compared with the control group, as evidenced by higher scores in the Altruism Scale Total Score and a significant group*time interaction effect. However, in the JSENS Total Score, including the perspective taking and standing in patient's shoes sub-dimensions, no differences were observed based on group, time and group * time interactions. CONCLUSION The patient role-play experience increased the empathy and altruism levels of nursing students, but the effect was not evident at the three-month follow-up.
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Affiliation(s)
- Gülden Basit
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department, Konya, Turkey.
| | - Serpil Su
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department, Konya, Turkey.
| | - Emine Geçkil
- Necmettin Erbakan University, Faculty of Nursing, Department of Child Health and Diseases Nursing, Konya, Turkey.
| | - Osman Basit
- Necmettin Erbakan University, Eregli Faculty of Education, Department of Pre-school Education, Konya, Turkey.
| | - Kübra Nur Köse Alabay
- Necmettin Erbakan University, Faculty of Nursing, Fundamentals of Nursing Department, Konya, Turkey.
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Huang SM, Fang SC, Lee SY, Yu PJ, Chen CJ, Lin YS. Effects of video-recorded role-play and guided reflection on nursing student empathy, caring behavior and competence: A two-group pretest-posttest study. Nurse Educ Pract 2023; 67:103560. [PMID: 36731259 DOI: 10.1016/j.nepr.2023.103560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 12/12/2022] [Accepted: 12/20/2022] [Indexed: 01/24/2023]
Abstract
AIM The study examined the differences in nursing student empathy, caring behavior and competence between the experimental and control groups before and after educational intervention and to predict the factors affecting their core competencies. BACKGROUND Educating nursing students in empathy and caring behaviors before entering clinical practice is challenging. DESIGN We used a two-group pretest and post-test quasi-experimental design. METHODS First-year nursing students from medical schools in Taiwan participated in our study. Data were collected between March and May 2022. The learning method used with the intervention group was role-playing with videos and guided reflection. The control group was exposed to traditional curriculum. Empathy, caring behavior and competence were measured using the Jefferson Scale of Empathy- Healthcare Providers, the Caring Behaviors Scale and the Nursing Student Competence Scale. RESULT A total of 72 participants (40 in the experimental group and 32 in the control group) were included in the final statistical analysis. The response rate was 92%. Statistically significant differences in nursing student empathy, caring behavior and competence were observed between the experimental and control groups (p < .05). The η2 effect levels were 0.083, 0.223 and 0.270. Higher caring behavior scores were significantly associated with higher nursing student competence scores (β = 0.81, 95% CI:0.66-0.97). CONCLUSIONS Education based on video role-play and guided reflection improved empathy, caring behavior and nursing competence in first-year nursing students.
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Affiliation(s)
- Sheng-Miauh Huang
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Su-Chen Fang
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Szu-Ying Lee
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Pei-Jung Yu
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Chen-Jung Chen
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
| | - Yan-Si Lin
- Department of Nursing, MacKay Medical College, New Taipei City, Taiwan.
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Leyva-Moral JM, Rafael-Gutiérrez SS, Aguayo-Gonzalez M, Guevara-Vásquez G, Gómez-Ibáñez R. Effectiveness of Narrative Photography in Increasing Nursing Students' Empathy: A Pretest-Posttest Study. J Nurs Educ 2022; 61:701-705. [PMID: 36475990 DOI: 10.3928/01484834-20221003-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Narrative photography is a method that can enhance nursing students' empathy when caring for individuals with HIV. METHOD This quasiexperimental pre-test-posttest study included 28 first-year nursing students from a public university in Barcelona, Spain. Empathy was assessed using the Spanish validated version of the Interpersonal Reactivity Index. RESULTS Empathy scores were higher in the intervention group (p = .01). Women scored higher on empathy and also on the fantasy, empathic concern, and personal distress dimensions. A significant relationship was found between the perspective taking dimension and students choosing nursing as their first option at university. Having no experience in the health field was associated with higher scores on the empathic concern dimension (p = .027). CONCLUSION Narrative photography is an effective learning method to promote nursing students' empathy when caring for individuals with HIV. [J Nurs Educ. 2022;61(12):701-705.].
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Barker ME, Crowfoot G, King J. Empathy development and volunteering for undergraduate healthcare students: A scoping review. NURSE EDUCATION TODAY 2022; 116:105441. [PMID: 35751985 DOI: 10.1016/j.nedt.2022.105441] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/19/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Empathy in healthcare benefits patients and healthcare providers. However, empathy decline is a recent trend within healthcare education. There is a paucity of literature that investigates the impact of volunteering on the empathy levels of undergraduate healthcare students. This scoping review explores the literature regarding empathy and volunteering for healthcare students. DESIGN The Joanna Briggs Institute methodology for scoping reviews guided this study. DATA SOURCES The electronic databases MEDLINE, CINAHL, ProQuest, JBI, Cochrane, PubMed, PsychInfo, and PsychNurses were searched from January 2001 to August 2021. The original search was developed in MEDLINE and then adapted to the other databases. REVIEW METHODS This scoping review used the Joanna Briggs Institute scoping review methodology. The search retrieved a total of 310 articles. Following deduplication, 271 articles were reviewed by title and abstract. Thirty articles were reviewed in full text with twelve articles meeting the criteria for inclusion. Included studies were assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS Five qualitative, four quantitative and three mixed method studies were included. A variety of volunteering interventions for undergraduate healthcare students were identified from countries including the United States of America, Singapore, Australia, and Brazil. Thematic analysis identified that volunteer undergraduate healthcare students practiced and developed empathy, and experienced professional and personal development. CONCLUSIONS Volunteering interventions were primarily in a service-learning modality within community health and palliative healthcare settings. Inconsistencies exist in empathy definitions and empirical empathy measurement. There is a need for more research that explores empathy development through volunteer activities in acute care settings.
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Affiliation(s)
- Mary-Ellen Barker
- Central Coast Local Health District, Gosford, NSW 2250, Australia; School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Gary Crowfoot
- School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW 2300, Australia.
| | - Jennie King
- Central Coast Local Health District, Gosford, NSW 2250, Australia; School of Nursing and Midwifery, College of Health, Medicine and Wellbeing, University of Newcastle, Newcastle, NSW 2300, Australia.
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McMillian-Bohler J, Gedzyk-Neiman S, Hepler B, May JT, Koch A. The Power of a Story: Enhancing Students' Empathy for Transgender Pregnant Men. J Nurs Educ 2022; 61:489-492. [PMID: 35944194 DOI: 10.3928/01484834-20220602-11] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Transgender individuals continue to face stigma and discrimination within the health care system. Sharing the lived experience of transgender pregnant men can increase awareness, understanding, and empathy for this underrepresented population. METHOD A transgender man (and advocate) shared his pregnancy experiences with students enrolled in a maternity course. Students completed pre- and postpresentation surveys on their perceptions of working with transgender patients and the importance of providing transgender-affirming care. RESULTS Students reported the speaker's presentation increased their awareness of the experience of transgender patients. Many students reported increased interest and desire to provide trans-affirming care. CONCLUSION Nursing faculty can provide opportunities for students to meet and speak with transgender patients as a strategy to increase empathy and reduce discrimination toward transgender patients in health care. [J Nurs Educ. 2022;61(8):489-492.].
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Steinmair D, Zervos K, Wong G, Löffler-Stastka H. Importance of communication in medical practice and medical education: An emphasis on empathy and attitudes and their possible influences. World J Psychiatry 2022; 12:323-337. [PMID: 35317334 PMCID: PMC8900587 DOI: 10.5498/wjp.v12.i2.323] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 06/30/2021] [Accepted: 12/25/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Healthcare professionals need to be prepared to promote healthy lifestyles and care for patients. By focusing on what students should be able to perform one day as clinicians, we can bridge the gap between mere theoretical knowledge and its practical application. Gender aspects in clinical medicine also have to be considered when speaking of personalized medicine and learning curricula.
AIM To determine sets of intellectual, personal, social, and emotional abilities that comprise core qualifications in medicine for performing well in anamnesis-taking, in order to identify training needs.
METHODS An analysis of training clinicians’ conceptions with respect to optimal medical history taking was performed. The chosen study design also aimed to assess gender effects. Structured interviews with supervising clinicians were carried out in a descriptive study at the Medical University of Vienna. Results were analyzed by conducting a qualitative computer-assisted content analysis of the interviews. Inductive category formation was applied. The main questions posed to the supervisors dealt with (1) Observed competencies of students in medical history taking; and (2) The supervisor’s own conceptions of "ideal medical history taking".
RESULTS A total of 33 training clinicians (n = 33), engaged in supervising medical students according to the MedUni Vienna’s curriculum standards, agreed to be enrolled in the study and met inclusion criteria. The qualitative content analysis revealed the following themes relevant to taking an anamnesis: (1) Knowledge; (2) Soft skills (relationship-building abilities, trust, and attitude); (3) Methodical skills (structuring, precision, and completeness of information gathering); and (4) Environmental/contextual factors (language barrier, time pressure, interruptions). Overall, health care professionals consider empathy and attitude as critical features concerning the quality of medical history taking. When looking at physicians’ theoretical conceptions, more general practitioners and psychiatrists mentioned attitude and empathy in the context of "ideal medical history taking", with a higher percentage of females. With respect to observations of students’ history taking, a positive impact from attitude and empathy was mainly described by male health care professionals, whereas no predominance of specialty was found. Representatives of general medicine and internal medicine, when observing medical students, more often emphasized a negative impact on history taking when students lacked attitude or showed non-empathetic behavior; no gender-specific difference was detected for this finding.
CONCLUSION The analysis reveals that for clinicians engaged in medical student education, only a combination of skills, including adequate knowledge and methodical implementations, is supposed to guarantee acceptable performance. This study’s findings support the importance of concepts like relationship building, attitude, and empathy. However, there may be contextual factors in play as well, and transference of theoretical concepts into the clinical setting might prove challenging.
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Affiliation(s)
- Dagmar Steinmair
- Department of Psychoanalysis and Psychotherapy, Medical University of Vienna, Vienna 1090, Austria
- Karl Landsteiner University of Health Sciences, Krems 3500, Austria
- Department of Ophtalmology, University Hospital St. Pölten, St. Pölten 3100, Austria
| | - Katharina Zervos
- Department of Internal Medicine I, KRH Klinikum Robert-Koch-Gehrden, Gehrden 30989, Germany
| | - Guoruey Wong
- Faculty of Medicine, University of Montréal, Montréal 2900, Québec, Canada
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Chua JYX, Ang E, Lau STL, Shorey S. Effectiveness of simulation-based interventions at improving empathy among healthcare students: A systematic review and meta-analysis. NURSE EDUCATION TODAY 2021; 104:105000. [PMID: 34146845 DOI: 10.1016/j.nedt.2021.105000] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 04/13/2021] [Accepted: 05/31/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To examine the effectiveness of simulation-based interventions in improving empathy among healthcare students. DESIGN A systematic review and meta-analysis of randomized controlled trials and clinical controlled trials. DATA SOURCES Studies in English language were sourced from seven electronic databases (PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus and ProQuest Dissertations & Theses Global) from their respective inception dates until October 2020. REVIEW METHODS This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Random-effect meta-analyses were conducted. Heterogeneity was assessed using the I2 statistics and Cochran's Q chi-squared test. Quality appraisal was conducted using the Cochrane risk of bias tool and the Grades of Recommendation, Assessment, Development, and Evaluation approach. Publication bias was assessed using funnel plots. RESULTS Sixteen studies were included in this review. Meta-analysis reported statistically significant small, medium and very large effect sizes for empathy reported by healthcare students (SMD = 0.46, 95% CI: 0.25 to 0.66), simulated patients (SMD = 0.65, 95% CI: 0.41 to 0.89) and other personnel (independent observers, faculty members and examiners) (SMD = 1.27, 95% CI: 0.64 to 1.90) respectively, showing the effectiveness of simulation-based interventions in improving empathy among healthcare students. Subgroup analyses found that role-play was more effective than simulated patient and disease-state simulations. Multi-sessional interventions conducted for up to seven months and group-based simulation delivery were found to be more effective. CONCLUSION Educational institutions should conduct regular simulation-based interventions to continuously develop healthcare students' empathy during their academic journey. Future trials should involve students from more diverse healthcare disciplines. Empathy should be measured in a standardized manner and rely less on self-reported measures. Role-play segments and group-based simulations could be added to increase interventions' effectiveness. Studies should conduct longer follow-up assessments to determine the sustainability of students' empathy following intervention. Future research is needed to corroborate the current findings.
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Affiliation(s)
- Joelle Yan Xin Chua
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Emily Ang
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Siew Tiang Lydia Lau
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore
| | - Shefaly Shorey
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Level 2, Clinical Research Centre, Block MD11, 10 Medical Drive, 117597, Singapore.
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Satran C, Tsamri R, Peled O, Zuker H, Massalha L, Ore L. A unique program for nursing students to enhance their mentalization capabilities in relation to clinical thinking. J Prof Nurs 2020; 36:424-431. [PMID: 33039079 DOI: 10.1016/j.profnurs.2020.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 03/11/2020] [Accepted: 03/17/2020] [Indexed: 10/24/2022]
Abstract
While nurses strive to provide optimal patient-centered care, this is not always straightforward, as some cases are more emotionally charged than others - depending on the patient's mental, emotional, and physical state, and on the nurses themselves. Therefore, in order to provide accurate therapeutic responses while maintaining their own personal well-being, nurses must develop strong mentalization capabilities. We present a unique program for nursing students, specifically targeted at enhancing their mentalization abilities as part of their communication skills for dealing with emotionally charged situations. In the program, he students first learn to identify what leads them to experience increased emotional loads and how this affects their mentalization processes. Next, they learn alternative coping patterns for their benefit, enabling their own emotional regulation while providing optimal care for their patients. Conducted in small groups, this holistic four-year program is led by experienced clinical nurses and psychologists; the learning is based on actual experiences encountered by the students during their clinical experience.
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Affiliation(s)
- Carmit Satran
- Department of Nursing, The Max Stern Yezreel Valley College, Israel.
| | - Revital Tsamri
- Department of Nursing, The Max Stern Yezreel Valley College, Israel
| | - Osnat Peled
- Department of Nursing, The Max Stern Yezreel Valley College, Israel.
| | - Heden Zuker
- Department of Nursing, The Max Stern Yezreel Valley College, Israel
| | | | - Liora Ore
- Department of Health Systems Management, The Max Stern Yezreel Valley College, Israel
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Peng X, Wu L, Xie X, Dai M, Wang D. Impact of Virtual Dementia Tour on empathy level of nursing students: A quasi-experimental study. Int J Nurs Sci 2020; 7:258-261. [PMID: 32817846 PMCID: PMC7424149 DOI: 10.1016/j.ijnss.2020.06.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/30/2022] Open
Abstract
Objective As a developable ability, empathy is significantly associated with patient-centered care. The authors intended to evaluate the effect of Virtual Dementia Tour (VDT) upon nursing students' empathy level and propose practical rationales for optimizing future dementia care. Methods A total of 45 second-year undergraduate nursing students were organized to watch a theme movie entitled Still Alice and participate in an 8-min VDT. Jefferson Scale of Empathy-Health Professional Students (JSE-HPS) was employed for evaluating the empathy level of nursing students. After VDT, all nursing students participated in a structured interview. Descriptive statistics and paired t-tests were performed using SPSS 24.0. Results Their empathy levels demonstrated significant overall improvements (106.69 ± 9.49 vs 115.51 ± 10.16, P < 0.01). During the course of VDT, nursing students experienced varying levels of anxiety and frustration. All of them were satisfied with the program since they had gained a deeper understanding of demented patients and the program could change their attitudes toward demented elders. Conclusion Watching a specially selected movie and participating in VDT may be an effective method for enhancing empathy and caring during nursing student education.
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Affiliation(s)
- Xiya Peng
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - Liaofang Wu
- Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Xiaoshu Xie
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - Mengjun Dai
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
| | - Donghua Wang
- School of Nursing, Changsha Medical University, Changsha, Hunan, China
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Sustainable Development of Hotel Food and Beverage Service Training: Learning Satisfaction with the Situated Cognitive Apprenticeship Approach. SUSTAINABILITY 2020. [DOI: 10.3390/su12051951] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The main purpose of this study is to explore the impact of the cognitive apprenticeship teaching approach in food and beverage (F&B) service training courses on learning satisfaction. This study is a quasi-experimental research design conducted using pretest–post-test nonequivalent groups. Its research subjects are primarily new employees from the F&B departments of well-known five-star, high-end hotels in Taiwan who must undergo education and training. The new employees are divided into an experimental group and a control group for the eight-week teaching practicum. This study concludes that learning satisfaction achieved through the cognitive apprenticeship teaching approach during the F&B training course is superior to that achieved through the conventional teaching approach of lecturing. An innovative finding of the current research is that regardless of whether cognitive apprenticeship teaching is adopted, the master–apprentice relationship is the most important factor in the five-facet measurement of learning satisfaction. This point also explains why the cognitive apprenticeship approach is a suitable teaching and training strategy. The greatest contribution of this study is that it provides a direction for the application and sustainable development of hotel staff training and offers references for the improvement of future hotel training programs.
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Empathy training in health sciences: A systematic review. Nurse Educ Pract 2020; 44:102739. [DOI: 10.1016/j.nepr.2020.102739] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 09/30/2019] [Accepted: 02/18/2020] [Indexed: 12/30/2022]
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Fenizia E, Navarini L, Scollo S, Gambera A, Ciccozzi M. A longitudinal study on caring behaviors of Italian nursing students. NURSE EDUCATION TODAY 2020; 88:104377. [PMID: 32120086 DOI: 10.1016/j.nedt.2020.104377] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 12/17/2019] [Accepted: 02/15/2020] [Indexed: 06/10/2023]
Abstract
AIM AND OBJECTIVE The aim of this study was to analyze the caring behavioral differences taking place over the nursing academic period. BACKGROUND Caring is a core value in nursing education and many of its features can be measured as specific behaviors. The Italian Caring Behaviors Inventory is a tested psychometric questionnaire, useful to this aim. The use of the questionnaire facilitates the student's self-reflection and awareness. DESIGN Descriptive longitudinal study. METHOD The Italian Caring Behaviors Inventory questionnaire was filled out by 103 undergraduate nursing students at two Italian universities from May 2016 to May 2018 both during the second and the third year course. The questionnaire features 24 items with four caring factors: Factor 1 'Being with', Factor 2 'Doing with competence', Factor 3 'Responding to individual needs', Factor 4 'Providing effective care'. The Wilcoxon signed-rank test was used to assess differences between factors. Multiple regression analyses were conducted in order to evaluate variables associated with the increase or decrease of factors over time. RESULTS Results show a significant increase in Factor 2 during the selected period, which is positively associated with delta-Factor 1 and delta-Factor 3 and negatively associated with surgery clerkship during the third year of their course. Moreover, there is a significant decrease in Factor 3 between the second and third academic year and the variable positively associated to this decrease is the delta-Factor 4. CONCLUSIONS One of the main risks of nursing education is an asymmetric impact in favour of doing at the expense of being. In this study, we demonstrated that nursing students reported an increase in instrumental caring and a decrease in expressive caring. These results suggest that a specific training in expressive caring in the third term could be a viable answer to this unmet need in nursing education.
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Affiliation(s)
- Elisa Fenizia
- Department of Biomedicine and Prevention, School of Nursing, Faculty of Medicine, Tor Vergata University, Rome, Italy.
| | - Luca Navarini
- Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128 Rome, Italy.
| | - Sarah Scollo
- School of Nursing, Faculty of Medicine, University of Catania, Catania, Italy.
| | - Angelo Gambera
- School of Nursing, Faculty of Medicine, University of Catania, Catania, Italy.
| | - Massimo Ciccozzi
- Department of Medicine, Campus Bio-Medico University of Rome, via Alvaro del Portillo 21, 00128 Rome, Italy.
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Yang C, Zhu YL, Xia BY, Li YW, Zhang J. The effect of structured empathy education on empathy competency of undergraduate nursing interns: A quasi-experimental study. NURSE EDUCATION TODAY 2020; 85:104296. [PMID: 31775084 DOI: 10.1016/j.nedt.2019.104296] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/31/2019] [Accepted: 11/18/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Empathy is a crucial element in fostering a positive relationship between nurses and patients. Recent research indicates that the degree of empathy in nursing students declines as they gain education or experience. A number of teaching strategies have been used to improve nursing students' empathy competence levels. However, little is currently known about how empathy is best taught or enhanced in senior nursing students in China. OBJECTIVES To implement a structured empathy educational program as developed from the Delphi technique, as well as to evaluate its effects on empathy competence among undergraduate nursing interns. DESIGN This study is quasi-experimental, with two-group comparison. PARTICIPANTS Undergraduate nursing students in their fourth year (n = 118) were recruited from an affiliated teaching hospital in Wuhan, Central Part of China, between January 2018 and March 2018. METHODS A convenience sample of 118 undergraduate nursing interns were recruited from a teaching hospital in Wuhan and assigned to either the intervention or the control group according to their preference. Participants in the intervention group had received a 2-week, 12-hour structured empathy-related educational program (two sessions per week, 3 h per session), whereas the control group received no intervention. The Jefferson Scale of Empathy-Health Providers (JSE-HPs) was used to assess students' empathy levels before and after the intervention. RESULTS An independent samples t-test revealed that scores of empathy competence levels in the intervention group were significantly higher than those in the control group following the intervention. Three domains of empathy competence level were also significantly higher in the intervention group after the two weeks' training relative to the control group, namely: perspective taking, compassionate care, and standing in the patient's shoes. CONCLUSIONS This modified empathy educational program may prove beneficial in improving the empathy competence level of undergraduate nursing interns.
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Affiliation(s)
- Chao Yang
- Faculty of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, PR China
| | - Ya-Li Zhu
- Minda Hospital, Hubei Minzu University, Enshi 445000, PR China
| | - Bi-Ying Xia
- Faculty of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, PR China
| | - Ya-Wei Li
- Faculty of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, PR China
| | - Jun Zhang
- Faculty of Nursing, Wuhan University School of Health Sciences, Wuhan 430071, PR China.
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Ding X, Wang L, Sun J, Li DY, Zheng BY, He SW, Zhu LH, Latour JM. Effectiveness of empathy clinical education for children's nursing students: A quasi-experimental study. NURSE EDUCATION TODAY 2020; 85:104260. [PMID: 31778862 DOI: 10.1016/j.nedt.2019.104260] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 07/19/2019] [Accepted: 10/29/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Empathy is a central competence for nursing students in delivering compassionate care. Empathy training might improve the communication skills in children's nursing students. OBJECTIVES To evaluate the effectiveness of the Knowledge, Simulation, and Sharing training programme on empathy skills among children's nursing students. DESIGN A controlled pre-post intervention study with a quasi-experimental design. SETTING Tertiary children's hospital in China. PARTICIPANTS Children's nursing students (n = 250) in clinical internship. METHODS A Knowledge, Simulation, and Sharing (KSS) module related to empathy learning was developed and tested during a 10-month period in 2017. Nursing students were divided into an experimental group (n = 125) and control group (n = 125). Both groups received the standard internship programme. The experimental group received the KSS training. Outcome measures were: Jefferson Scale of Empathy-Health Professions Student, Clinical Communication Competence Scale and Professional Identity Scale. RESULTS At the end of the internship the experimental groups had significantly higher empathy scores than the control group (114.57 versus 110.36; p = .016). The communication skills improved significantly in the experimental group after the training; experimental group mean 90.22 versus control group mean 87.41 (p = .042). The professional identity scores were significantly higher in the experimental group at the end of the internship compared to the control group (mean 116.43 versus 107.68; p < .001). Subgroup analysis revealed only significant differences on professional identity outcomes between experimental and control groups on diploma level (mean 115.78 versus 107.72; p < .001); and bachelor's level (mean 120.05 versus 108.00; p < .016). CONCLUSION The KSS training can enhance empathy and communication skills and the professional identity in children's nursing students. Further long-term effectiveness of the training needs to be tested, ideally with reported outcomes measures of children and parents.
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Affiliation(s)
- Xiang Ding
- Nursing Department, Hunan Children's Hospital, Changsha, China
| | - Li Wang
- Nursing Department, Hunan Children's Hospital, Changsha, China
| | - Jing Sun
- Nursing School, Hunan University of Chinese Medicine, Changsha, China
| | - Dong-Ya Li
- Nursing School, Hunan University of Chinese Medicine, Changsha, China
| | - Bing-Ya Zheng
- Imaging Faculty, Changsha Medical University, Changsha, China
| | - Shi-Wen He
- Nursing Department, Third Xiangya Hospital of Central South University, Changsha, China
| | - Li-Hui Zhu
- Nursing Department, Hunan Children's Hospital, Changsha, China.
| | - Jos M Latour
- Nursing Department, Hunan Children's Hospital, Changsha, China; Faculty of Health and Human Sciences, School of Nursing and Midwifery, University of Plymouth, Plymouth, United Kingdom
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Levett‐Jones T, Cant R. The empathy continuum: An evidenced‐based teaching model derived from an integrative review of contemporary nursing literature. J Clin Nurs 2020; 29:1026-1040. [DOI: 10.1111/jocn.15137] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/29/2019] [Accepted: 11/18/2019] [Indexed: 12/30/2022]
Affiliation(s)
| | - Robyn Cant
- Faculty of Health University of Technology Sydney Ultimo NSW Australia
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Karayiannis G, Papastavrou E, Farmakas A, Tsangari H, Noula M, Roupa Z. Exploration of empathy in Cyprus nursing and health care students: A mixed method study. Nurse Educ Pract 2020; 42:102686. [PMID: 31901489 DOI: 10.1016/j.nepr.2019.102686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Revised: 10/20/2019] [Accepted: 12/05/2019] [Indexed: 12/30/2022]
Abstract
Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3rd and 4th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.
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Goh HS, Zhang H, Lee CN, Wu XV, Wang W. Value of Nursing Objective Structured Clinical Examinations: A Scoping Review. Nurse Educ 2019; 44:E1-E6. [PMID: 30371544 DOI: 10.1097/nne.0000000000000620] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Objective structured clinical examinations (OSCEs) have been used globally in medical education and touted as the "gold standard" for competence-based assessments. However, the value of OSCEs in nursing education has not been extensively evaluated. PURPOSES This review aims to report the global trends in nursing OSCEs; evaluate their validity, reliability, acceptability, and costs; and present the characteristics of validated nursing OSCEs. METHODS This is a scoping review involving a systematic search in 7 electronic databases. RESULTS A total of 204 studies, published between 1982 and 2018, were included in the review. We found that nursing OSCEs were extensively used across various nursing specialties in 33 countries and confirmed their validity, reliability, and acceptability in nursing education. CONCLUSIONS This review confirms the value of OSCEs in nursing education and presents the underlying characteristics of validated nursing OSCE designs.
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Affiliation(s)
- Hongli Sam Goh
- Author Affiliations: Adjunct Lecturer (Dr Goh); Lecturer (Ms Zhang and Dr Wu); Associate Professor (Dr Wang), Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore; Nurse Clinician (Advanced Practice Nurse) (Ms Lee), Singapore General Hospital, Singapore
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Iosifyan M, Schmidt M, Hurbault A, Mayaux J, Delafosse C, Mishenko M, Nion N, Demoule A, Similowski T. "I had the feeling that I was trapped": a bedside qualitative study of cognitive and affective attitudes toward noninvasive ventilation in patients with acute respiratory failure. Ann Intensive Care 2019; 9:134. [PMID: 31792644 PMCID: PMC6888797 DOI: 10.1186/s13613-019-0608-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 11/22/2019] [Indexed: 12/15/2022] Open
Abstract
Background Noninvasive ventilation (NIV) is the application of mechanical ventilation through a mask. It is used to treat certain forms of acute respiratory failure in intensive care units (ICU). NIV has clinical benefits but can be anxiogenic for the patients. This study aimed at describing cognitive and affective attitudes toward NIV among patients experiencing NIV for the first time in the context of an ICU stay. Methods Semi-structured interviews were conducted in 10 patients during their ICU stay and soon after their first NIV experience. None of the patients had ever received NIV previously. Evaluative assertion analysis and thematic analysis were used to investigate cognitive and affective attitudes toward NIV before, during, and after the first NIV experience, as well as patient attitudes toward caregivers and relatives. Results Before their first NIV session, the cognitive attitudes of the patients were generally positive. They became less so and more ambiguous during and after NIV, as the patients discovered the actual barriers associated with NIV. Affective attitudes during NIV were more negative than affective attitudes before and after NIV, with reports of dyspnea, anxiety, fear, claustrophobic feelings, and reactivation of past traumatic experiences. The patients had more positive attitudes toward the presence of a caregiver during NIV, compared to the presence of a family member. Conclusion This study corroborates the possibly negative—or even traumatic—nature of the NIV experience, with emphasis on the role of affective attitudes. This is a rationale for evaluating the impact of NIV-targeted psychological interventions in ICU patients with acute respiratory failure.
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Affiliation(s)
- Marina Iosifyan
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France.,Department of Psychology, National Research University Higher School of Economics, Moscow, Russia
| | - Matthieu Schmidt
- Service de Réanimation Médicale de l'Institut de Cardiologie, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 75013, Paris, France
| | - Amélie Hurbault
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Julien Mayaux
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Christian Delafosse
- Service de Pneumologie-Explorations du Sommeil, Hôpital Simone Veil, 95600, Eaubonne, France
| | - Marina Mishenko
- Laboratoire Psychopathologie et Processus de Santé, EA 4057, Université Paris Descartes, 75005, Paris, France.,Laboratoire de psychologie du développement et de l'éducation de l'enfant, UMR 8240, CNRS, Université Paris Descartes & Université Caen Basse-Normandie, 75005, Paris, France
| | - Nathalie Nion
- Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Alexandre Demoule
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France.,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France
| | - Thomas Similowski
- UMRS1158 Neurophysiologie Respiratoire Expérimentale et Clinique, INSERM, Sorbonne Université, 75005, Paris, France. .,Service de Pneumologie, Médecine Intensive et Réanimation, Département R3S, AP-HP, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
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Watson CS, Leigh G, McCarthy J. Increasing Empathy Through Role-Play: A Meal Planning and Grocery Shopping Activity. TEACHING AND LEARNING IN NURSING 2019. [DOI: 10.1016/j.teln.2019.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Håkansson Eklund J, Holmström IK, Ollén Lindqvist A, Sundler AJ, Hochwälder J, Marmstål Hammar L. Empathy levels among nursing students: A comparative cross-sectional study. Nurs Open 2019; 6:983-989. [PMID: 31367422 PMCID: PMC6650686 DOI: 10.1002/nop2.280] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/12/2019] [Indexed: 12/30/2022] Open
Abstract
AIM Empathy is a crucial component of the nurse-patient relationship, but knowledge is lacking as to when empathy develops during nursing education. The aim of the present study was to compare empathy levels at different stages of undergraduate nursing education and different master's nursing programmes. DESIGN The design was a comparative cross-sectional study. METHODS A total of 329 participants in Sweden, comprised of nursing students in their second and sixth semesters in an undergraduate nursing programme as well as master's nursing students, rated their own empathy using the Jefferson Scale of Physician Empathy. RESULTS Students in their sixth semester in an undergraduate nursing programme expressed more empathy than did students in their second semester and master's nursing students. Among the five master's programmes, public-health nursing students expressed the most empathy and intensive-care nursing students the least.
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Affiliation(s)
| | - Inger K. Holmström
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
- Department of Public Health and Caring SciencesUppsala UniversityUppsalaSweden
| | | | - Annelie J. Sundler
- Faculty of Caring Science, Work Life and Social WelfareUniversity of BoråsBoråsSweden
| | - Jacek Hochwälder
- School of Health, Care and Social WelfareMälardalen UniversityVästeråsSweden
| | - Lena Marmstål Hammar
- School of Education, Health, Care and Social StudiesDalarna UniversityFalunSweden
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Ferri P, Rovesti S, Padula MS, D'Amico R, Di Lorenzo R. Effect of expert-patient teaching on empathy in nursing students: a randomized controlled trial. Psychol Res Behav Manag 2019; 12:457-467. [PMID: 31417325 PMCID: PMC6602298 DOI: 10.2147/prbm.s208427] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/17/2019] [Indexed: 12/30/2022] Open
Abstract
Background: Empathy is a relevant clinical competence for nursing students. Involvement of expert patients in nursing education could help students develop their innate capacity to empathize. Objective: To evaluate the effect of expert-patient teaching on empathy development in nursing students. Methods: This randomized controlled trial was conducted among 144 first-year undergraduate nursing students divided into two equal groups. In the experimental group, the educational intervention consisted of a seminar focused on empathy, followed by a presentation on expert-patient function. Subsequently, each student participated in two interactive meetings with nursing teacher and expert patient. At the end, the nursing teacher encouraged students to reflect on this experience. In the control group, students only attended a similar seminar focused on empathy and afterward participated in two interactive meetings with a nursing teacher to reflect on this topic without expert-patient involvement. Before (T0) and after (T1) the training intervention, the Balanced Emotional Empathy Scale, Jefferson Scale of Empathy — Health Professions Student (JSE-HPS), and a short demographic questionnaire were administered to the two student groups to measure their empathy levels. The study was approved by the Local Ethics Committee of Area Vasta Emilia Nord (protocol 1763, May 11, 2017). Data were statistically analyzed. Results: We found a statistically significant difference between mean scores at T0 and T1 in both scales in the experimental group. Male students, who presented significantly lower levels of empathy at baseline in comparison with females, showed increased in empathy after training on the the Balanced Emotional Empathy Scale in both the experimental and control groups. Conclusion: The present study highlights that involvement of expert patients in teaching is effective in improving empathy levels in both male and female nursing students. Expert-patient teaching can be a promising nursing-education modality for developing empathy.
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Affiliation(s)
- Paola Ferri
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Sergio Rovesti
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Maria Stella Padula
- Department of Biomedical, Metabolic, and Neural Sciences, University of Modena and Reggio Emilia, Modena 41125, Italy
| | - Roberto D'Amico
- Research and Innovation Area, Department of Maternal-Infant and Adult Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena 41124, Italy
| | - Rosaria Di Lorenzo
- Psychiatric Intensive Treatment Facility, Department of Mental Health and Drug Abuse, AUSL Modena, Modena 41122, Italy
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Levett-Jones T, Cant R, Lapkin S. A systematic review of the effectiveness of empathy education for undergraduate nursing students. NURSE EDUCATION TODAY 2019; 75:80-94. [PMID: 30739841 DOI: 10.1016/j.nedt.2019.01.006] [Citation(s) in RCA: 139] [Impact Index Per Article: 23.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 01/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The objective of this systematic review was to identify, critically appraise and synthesize evidence for the effectiveness of empathy interventions in undergraduate nursing education. DESIGN A systematic review of literature. DATA SOURCES A three-stage systematic search of six electronic databases was conducted. REVIEW METHODS The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. English language articles published between 2000 and 2018 were eligible. Methodological rigour was examined using the Medical Education Research Study Quality Instrument. Changes in empathy were assessed using Cohen's effect size correlation (r) and reported as effective when the variance was >0.2 standard deviations (r ≥ 0.2). RESULTS Of 23 included studies, four were experimental and four were case-control studies. Of these, the mean effect size was r = 0.45 and three were regarded as effective empathy interventions. Although 10 of 13 single group studies demonstrated a significant change in empathy between pre-test and post-test (p < 0.05), effect sizes were often low (mean r = 0.26). Six single-group studies reported an intervention effect of r > 0.2. The most effective empathy education involved immersive and experiential simulation-based interventions. Simulation modalities ranged from role plays, manikin-based scenarios, to 3D e-simulations and point-of-view simulations where students wore a hemiparesis suit\ CONCLUSIONS: Nine of 23 empathy education studies in undergraduate nurse education demonstrated practical improvements in empathy. The most effective interventions were immersive and experiential simulations that focused on vulnerable patient groups and provided opportunities for guided reflection. We noted the research designs were limited in terms of levels of evidence and use of subjective measures. Larger experimental studies are required to provide higher levels of evidence to identify unequivocal outcomes in terms of empathy research. Future studies should consider transfer to practice and longer-term changes in empathy as study outcomes.
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Affiliation(s)
- Tracy Levett-Jones
- Nursing Education, University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Robyn Cant
- Faculty of Health (Nursing), University of Technology Sydney, Ultimo, NSW 2007, Australia.
| | - Samuel Lapkin
- Faculty of Science Medicine & Health, School of Nursing, University of Wollongong, South Western Sydney Campus, Liverpool, NSW 2170, Australia.
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Yang N, Xiao H, Cao Y, Li S, Yan H, Wang Y. Does narrative medicine education improve nursing students' empathic abilities and academic achievement? A randomised controlled trial. J Int Med Res 2018; 46:3306-3317. [PMID: 29976109 PMCID: PMC6134671 DOI: 10.1177/0300060518781476] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Objective To determine the effectiveness of a narrative medicine educational intervention on the empathic abilities and academic achievement of Chinese nursing students. Methods A cluster randomised controlled trial was conducted between January 2015 and July 2017. Six class clusters (two controls, four interventions) comprising 180 nursing students were included in this trial. After pre-tests to obtain baseline measurements, two control classes (Group 1) attended regular medical education courses, two intervention classes (Group 2) received theoretical narrative medicine education for 1 term, and two intervention classes (Group 3) received narrative medicine education that integrated theory with practice for 2 terms. The empathic ability and academic achievement of the groups were compared, and longitudinal changes in empathic ability were measured. Results Students in Group 3 showed higher empathic ability and academic achievement than students in Group 1. Empathic ability was measured at six time points and showed between-group differences. The empathy scores of students in Group 3 increased abruptly after the two-term intervention. Conclusions Narrative medicine education that combines theory with practice is an effective strategy for improving nursing students’ empathic ability and academic achievement.
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Affiliation(s)
- Ningxi Yang
- 1 School of Health Sciences, Wuhan University, Wuhan, Hubei, China.,2 Institute of Medical Humanities, Peking University Health Science Center, Beijing, China
| | - Han Xiao
- 1 School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yingnan Cao
- 3 Beijing Jishuitan Hospital/4th Medical College of Peking University, Beijing, China
| | - Shiyue Li
- 1 School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Hong Yan
- 1 School of Health Sciences, Wuhan University, Wuhan, Hubei, China
| | - Yifang Wang
- 2 Institute of Medical Humanities, Peking University Health Science Center, Beijing, China
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