Empathy and communication in nursing education

1 UF College of Journalism and Communications; 2 Department of Public Relations; 3 Department of Advertising; 4 Division of Graduate Studies and Research; 5 STEM Translational Communication Research Program Thuyvi Luong1,2, Max Sanders1,3, Crismerly Santibañez1,2, Yulia A. Strekalova1,4, M.S., M.B.A., Janice L. Krieger1,5, Ph.D.

Medical professionals undergo a rigorous educational experience that tests multiple abilities such as treatments and other health care services. Training in communication skills is a recognized area of need for medical professionals but lacks evidence for incorporation into formal curriculum. Consequently, communication between the caregiver and patient may be inef�icient and problematic. Empathy, as one of the core communication skills for medical professionals is imperative because expression of empathy and word choice can result in trust, or lack thereof, and impact patients’ level of comfort in disclosing information that is critical for medical care. The goal of this study is to analyze empathetic statements used by nursing students during virtual patient exam training and create robust assessment categories for tailored feedback.

After IRB approval, the data for this research were provided by Shadow Health, a start-up company that develops virtual simulations and interactive learning solutions for nursing students. A team of three undergraduate students used systematic content analysis methods to code empathy statement submitted by 343 nursing students (intercoder reliability Krippendorff’s alpha = .8). Coding categories, informed by message design logics (O’Keefe, 1988), differentiated between statements that include and not include conventional expressions of empathy and solutions for challenging communication scenarios brought up by the virtual human, Tina Jones. Codebook1 = expressive: no conventional expression of empathy (n = 104)2 = conventional: use of a conventionally expected expression ofempathy (n = 350)3 = rhetorical: use of a conventional expression and attention to patient’s physical or mental health needs (n = 91)

0% 10% 20% 30% 40% 50% 60% 70% 80% 90%

100% Expression of Pain

Impact of Injury on Daily Life

Gaps in Health Literacy in Diabetes

Lack of Treatment with Diabetes Medication

Lack of Blood Glucose Monitoring

Gaps in Health Literacy Around Asthma Control

Discomfort in Body Image

Loss of a Family Member

Counseling Around Past Drug Use

EMPATHY OPPORTUNITIES DISCOVERED AND FOLLOWED Students discovered the opportunity Students followed up on the opportunity

[Student]: How are you feeling today?Tina Jones: Not so great... My foot really hurts right now. [Student]: Can you con�irm your name?Tina Jones: Tina Jones.[Student]: How are you feeling Tina?Tina Jones: Not so great... My foot really hurts right now. [Student]: do you mind if I take a look? Tina Jones: Sure...but the scrape is pretty gross. [Student]: What do you mean by gross?

References

O’Keefe, B. J. (1988). The logic of message design: Individual di�erences in reasoning about communication. Communication Monographs, 55(1), 80–103.

Contact Author

Yulia A. Strekalova

yulias@u�.edu

Conclusion

18

34

56

61 62

32 31 33

16

10 12

10

3 1 1 3 2 2 0

10

20

30

40

50

60

70

1 2 3 4 5 6 7 8 9

NUM

BER

OF S

TUDE

NTS

OPPORTUNITIES ENCOUNTERED / FOLLOWED UP ALL ENCOUNTERED OPPORTUNITIES

STUDENT ABILITY TO RECOGNIZE AND COMMUNICATE EMPATHY

Expressive StatementConventional StatementExpressive Statement

[Student]: Have you ever felt depressed or anxious?Tina Jones: The closest I ever came to depression was after Dad died...I just felt sad all the time. [Student]: I'm sorry to hear that your dad has passed.Tina Jones: Thanks.[Student]: Do you feel supported by your friends and family? Tina Jones: Yeah, de�initely. We're all pretty close. […] Mom and my sister and I all go to church, and eat together most of the time, the same as we always did. [Student]: Its nice that you can keep up those traditions.

[Student]: How would you rate your pain from 1 to 10?Tina Jones: Ugh... I'd say an 8. I mean, it hurts so much. [Student]: Other than your foot are you having pain anywhere else?Tina Jones: The pain's worse in my foot, but feel moving up into my ankle, too.[Student]: I'm sorry you are experiencing this pain.

We observed that patient’s expression of physical pain and loss of a family member had higher follow-up with empathetic statements. Opportunities that discussed body image, use of an asthma inhaler, and controlling diabetes, had the least amount of empathetic statements. However, except for the �irst opportunity, not all nursing students were able to discover additional information about the patient and express support and empathy. The results of this study can inform interventions that would lead to a higher level of care for patients through improvements of nurse-to-patient communication. With the coding guideline we are creating, we can suggest which students may need further training in empathy and focused instructor feedback.

Methods

Introduction