Empathy Development through Case Study and Simulation

BACKGROUND:  Empathy has been identified as a predictor of positive patient outcomes and is integral to the nurse-patient relationship.  Since research indicates that empathy development does not occur through theory and arbitrary experiences, nurse educators are challenged to use evidence-based educational interventions to develop student empathy. The purpose of this study was twofold.  The first purpose of the study was to determine whether consistent exposure to a single patient through case study and simulation impacted empathy levels in senior level baccalaureate nursing students.  The second purpose of the study was to evaluate patient perceptions of nurse empathy. 

METHODS:  During spring and fall semesters in 2014, senior students in a psychiatric-mental health nursing course were asked to complete a demographic form and the Jefferson Scale of Empathy (JSE).  The students were then randomly divided into two groups, a comparison group exposed to multiple, random patients and an experimental group exposed to one consistent, single patient during case studies and simulation.  Throughout each semester, all students were exposed to two case studies completed during class time and a simulation completed during clinical time.  The student learning outcomes for the case studies and simulations were identical for the two groups.  The case studies and simulation completed by the comparison group featured random patients with different names, ages, and backgrounds.  The case studies and simulations completed by the experimental group featured one consistent patient with a consistent background.  At the end of each semester, students were asked to complete the JSE again. Additionally, the standardized patient used in the simulation completed a brief scale reflecting perceived empathy of and overall satisfaction with each student following the final simulation done at the end of the semester.  

RESULTS: A total of 127 students participated.  Pre-test and post-test results indicated that students in both groups felt they displayed empathetic behaviors.  Using analysis of covariance, no significant differences were found between or within groups. Using a t-test for independent groups, no significant differences were found between the students who were exposed to a consistent, single patient and students who had random, multiple patients at pre-test (p= 0.760) and at post-test (p= 0.575).  Additionally, there was no significant difference found between the two groups and the overall patient satisfaction indicated by the standardized patient survey (p= 0.964).

CONCLUSION: The results provide several interesting conclusions for faculty members and offer a basis for ongoing discussion.  First, findings from this study suggest that empathy levels are not affected by the use of a single, consistent patient in case studies and simulation, and, therefore, may impact how active learning experiences are designed by faculty members. Secondly, while findings indicate that faculty members may not be able to teach empathy through consistent patient exposure provided in case studies and simulation, additional strategies that may increase nurse empathy need to be explored.  Lastly, this research study provides a unique perspective of the patient regarding nurse empathy and patient satisfaction that should be further researched.