Abstract:

Background:
Empathy is defined as the ability to understand another's feelings and their meaning and to communicate them. It has a positive effect on improving patient health outcomes, satisfaction, and therapeutic adherence, becoming a fundamental skill in any health personnel-patient relationship. As such, it is absolutely necessary to develop an adequate level of empathy by effective instruction based on scientific evidence.

Objective:
This study was conducted to evaluate the effectiveness of an intervention designed to advance the empathy of nursing students and prove if said training increases the level of the students’ learning perception and the degree of difficulty and improvement in the understanding of the content and the acquisition of skills.

Design:
This study design was a multicentre modified cohort-control study.

Setting/Participants:
This research was conducted at two schools of nursing at a public university in the southwest of Spain (University of Cadiz). The sample was composed of second-year nursing students who were enrolled in an Interpersonal Communication Skills class (N= 116).

Methods:
The data were obtained pre-test, post-test, and follow-up via a simulated clinical interview. Empathy was analysed from the point of view of the patient (using the Consultation and Relational Empathy Measure), of the student/healthcare worker (using the Jefferson Scale of Empathy student version and the Reynolds Empathy Scale), and the independent evaluators (using the Carkhuff Scale). The students’ level of knowledge and how much the training improved the understanding of the content and acquisition of skills (with a specific scale designed for the authors) were also analysed.

Intervention:
The intervention consisted of two weekly meetings of two hours each with seven sessions (14 hours). The training used role-playing, reflective writing, and the methodological guidance of the Flipped Classroom. At the beginning of each session, the theoretical contents were evaluated using a continuous assessment test (CAT). The evaluation was performed using simulated clinical interviews of 15-minute duration with actors (volunteers from the School of Theatre) previously trained to act as patients. The interviews were performed in a simulation room equipped with furniture similar to a nursing consultation room and with a one-way mirror that permitted observation without being seen.

Results:
The data improved in all the concrete measures that were conducted in the experimental groups and at the different educational centres. The mean post-test scores for the Carkhuff Scale, the Reynolds Empathy Scale, and the Consultation and Relational Empathy Measure were higher than the pre-test, and these differences were statistically significant (Carkhuff Scale: Centre 1 GE1 z=-5.269, p=0.000; GE2 z=-5.152, p=0.000; Centre 2 GE1 z=-3.440, p=0.001; GE2 z=-4.123, p=0.000; Reynolds Empathy Scale: Centre 1 GE1 z=-2.384, p=0.017; GE2 z=-2007, p=0.045; Centre 2 GE1 z=-3.604, p=0.000; GE2 z=-2.744, p=0.006; the CARE Measure: Centre 1 z=-3.028, p=0.002; GE2 z=-2.914, p=0.004; Centre 2 GE1 z=-3.541, p=0.000; GE2 z=-4.043, p=0.000). The results were maintained in the follow-up.
The average student's perception of learning was higher than seven point score (maximum score 10 points). The training improved the understanding of the content and the acquisition of skills.

Conclusion:
The effectiveness of the training in empathic competence development was confirmed.

Keywords:

Empathy, Training, Learning Innovation, Simulation, Comunication Skills, Flipped Classroom, Nursing Education.