Nursing Education, University of Technology Sydney, Ultimo, NSW 2007, Australia.
Faculty of Health (Nursing), University of Technology Sydney, Ultimo, NSW 2007, Australia.
Nurse Educ Today. 2019 Apr;75:80-94. doi: 10.1016/j.nedt.2019.01.006. Epub 2019 Jan 26.
The objective of this systematic review was to identify, critically appraise and synthesize evidence for the effectiveness of empathy interventions in undergraduate nursing education.
A systematic review of literature.
A three-stage systematic search of six electronic databases was conducted.
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).
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.
本系统评价的目的是确定、批判性评价和综合证据，以评估同理心干预在本科护理教育中的有效性。
文献系统评价。
对六个电子数据库进行了三阶段系统检索。
本综述遵循系统评价和荟萃分析的首选报告项目。纳入 2000 年至 2018 年间发表的英语文章。使用医学教育研究质量工具评估方法学严谨性。使用 Cohen 的效应大小相关系数 (r) 评估同理心的变化，并报告方差>0.2 个标准差 (r≥0.2) 时为有效。
在 23 项纳入的研究中，有 4 项为实验性研究，4 项为病例对照研究。其中，平均效应大小为 r=0.45，有 3 项被认为是有效的同理心干预措施。尽管 13 项单组研究中的 10 项研究在前后测之间的同理心变化具有统计学意义 (p<0.05)，但效应大小通常较低（平均 r=0.26）。6 项单组研究报告了 r>0.2 的干预效果。最有效的同理心教育涉及沉浸式和体验式模拟为基础的干预措施。模拟方式包括角色扮演、基于人体模型的情景、3D 电子模拟和视角模拟，学生穿着偏瘫服。
在本科护理教育中，23 项同理心教育研究中有 9 项研究表明同理心有实际改善。最有效的干预措施是沉浸式和体验式模拟，侧重于弱势群体和提供指导反思的机会。我们注意到研究设计在证据水平和使用主观测量方面存在局限性。需要进行更大规模的实验研究，以提供更高水平的证据，以确定同理心研究中明确的结果。未来的研究应考虑将同理心研究的结果转移到实践中，并考虑同理心的长期变化。
