Nursing Students’ Empathy in a Palliative Care Scenario: The Standardized Patient’s Perspective
Abstract Background: Numerous definitions of empathy exist, making it difficult to understand the concept and teach others how to develop the skill. There is no one definition of empathy all healthcare disciplines accept, creating an obstacle to a constructive debate over the role and importance of empathy in nursing practice. The American Association of Colleges of Nursing developed the Essentials to address the education-practice gap. This included meeting the physical, psychological, emotional, social, cultural, and spiritual needs of individuals requiring palliative/supportive care. Purpose/Aim: The purpose of this study is to explore nursing students' empathy during a simulation-based palliative care scenario where standardized patients (SPs) play the patient, and the students’ empathy is described from the patient's perspective. This study aims to answer the research question: How do SPs describe their experiences and perceptions of empathy from senior nursing students during a palliative care scenario? Methods: Guided by M. L. Hoffman’s Theory of Moral Psychology and Development, this two-part qualitative descriptive study explores the patient’s perception of empathy. A purposive sample of six SPs played the part of the patient and provided written feedback for each nursing student. Thick, rich descriptions were taken from the written feedback forms. Following the event, semi-structured interviews with the SPs were conducted to gather additional information about their perception of empathy. Thematic analysis was used to identify patterns and themes from the written feedback and interviews. Findings: In this two-phase study, SPs described empathy as the ability of nursing students to acknowledge emotions, understand the patient’s perspective, and validate the patient's experience. The themes in both phases overlapped closely, except for depersonalization and lack of empathy, which were found only in phase two, mainly because some questions in the semi-structured interview focused on experiences in which their providers lacked empathy. This opened the door to an in-depth discussion of the lack of empathy, which warranted a theme of its own. This study reinforced empathy cannot be reduced to a checklist or scripted performance; it is cultivated through reflection, vulnerability, and intentional practice. The implications extend beyond simulation into the broader context of nursing practice, where empathy remains essential for providing holistic, compassionate care. Implications for Research: This study added to the body of knowledge on empathy training needed to prepare prelicensure nursing students to navigate emotional conversations upon graduation. Comparative studies could examine whether SP perceptions align with faculty evaluations or student self-assessments, providing a more holistic picture of the development of empathic communication. Since empathy is shaped by cultural norms, communication styles, personal experiences, and professional values, cross-cultural studies could examine how it is understood and expressed across diverse student populations or within interdisciplinary teams. Including perspectives from other health disciplines, such as medicine, social work, and public health, would also provide insight into shared and profession-specific understandings of empathy. Future research should examine how empathy evolves throughout nursing education and into clinical practice. Longitudinal qualitative or mixed methods designs could follow cohorts of students from early prelicensure training through graduation and into their first year of professional practice to examine changes in empathic behaviors, communication patterns, attitudes, and reflective self-awareness. Keywords: nursing students, empathy, communication, simulation, standardized patients, palliative care
nursing students, empathy, communication, simulation, standardized patients, palliative care, Nursing, Other Nursing, Palliative Nursing
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