A Harrogate Mystery

A short story by Laura Urness

The Effect of Standardized Patient Encounters of Undergraduate Nursing Student Empathy and Self-Efficacy in Therapeutic Communication

Therapeutic communication between the nurse and patient is an essential component of optimal nursing care. Current evidence supports the use of standardized patient (SP) encounters to assist students in learning therapeutic communication skills. In addition to offering students an opportunity to practice in an environment free of clinical consequence, SP encounters have been shown to increase clinical knowledge and skill, improve diagnostic reasoning, and improve communication skills and interviewing skills. The purpose of this evidence-based practice project was to assess the effect of SP encounters on undergraduate nursing student empathy and self-efficacy related to therapeutic communication. Secondary outcomes included participant satisfaction and evaluation of the learning method. Sophomore-level nursing students participated in a brief SP encounter with junior-level nursing students acting as SPs. Feelings of empathy and self-efficacy related to therapeutic communication were assessed immediately prior to and one week following the intervention using a Likert-style tool developed by the project manager. A Wilcoxon Matched-Pairs Signed-Rank test was completed within each group of participants to evaluate the median difference of scores during the pre-intervention and post-intervention periods. Testing conducted within the junior-level participants revealed statistically significant post-intervention improvements related to awareness of body posture during patient interaction (p = 0.021), comfort using silence when interacting with a patient (p = 0.014), and comfort summarizing a conversation prior to closure of a discussion with a patient (p = 0.011). In addition, statistically significant findings were noted related to the ability of junior-level students to put themselves in the patient’s shoes (p = 0.020), the belief that empathy is an important component of health care (p = 0.025), and the perception that emotional connection with patients may be detrimental to patient care (p = 0.046). No statistically significant results were found in the sophomore intervention group. A Mann-Whitney U test was used to compare the median scores and mean ranks between the sophomore intervention and sophomore comparison groups, as well as the sophomore intervention and junior participant groups. A significant difference was noted between intervention and comparison sophomore participants, in that intervention sophomores were more likely to perceive lack of empathy as a hindrance to patient care (p = 0.015). In addition, sophomore students who participated in the intervention were less likely to perceive an emotional connection with a patient as detrimental to patient care (p = 0.018). A Mann-Whitney U test comparing junior participants and sophomore intervention participants revealed several statistically significant findings. Junior participants were found to have a greater belief that they were able to put themselves in a patient’s shoes while providing care (p = 0.042), were better able to understand a patient’s non-verbal cues and body language (p = 0.004), and had an increased perception that non-verbal communication was an important aspect of patient care (p = 0.003). In addition, junior students were significantly more comfortable using open-ended questions (p = 0.042) and summarizing a conversation (p = 0.043) than sophomore students. These findings support the conclusion that SP encounters improve empathy and self-efficacy related to therapeutic communication, particularly for those students acting as the SPs

The Effect of Standardized Patient Encounters on Undergraduate Nursing Student Empathy and Self-Efficacy in Therapeutic Communication

Therapeutic communication between the nurse and patient is an essential component of optimal nursing care. Current evidence supports the use of standardized patient (SP) encounters to assist students in learning therapeutic communication skills. In addition to offering students an opportunity to practice in an environment free of clinical consequence, SP encounters have been shown to increase clinical knowledge and skill, improve diagnostic reasoning, and improve communication skills and interviewing skills. The purpose of this evidence-based practice project was to assess the effect of SP encounters on undergraduate nursing student empathy and self-efficacy related to therapeutic communication. Secondary outcomes included participant satisfaction and evaluation of the learning method. Sophomore-level nursing students participated in a brief SP encounter with junior-level nursing students acting as SPs. Feelings of empathy and self-efficacy related to therapeutic communication were assessed immediately prior to and one week following the intervention using a Likert-style tool developed by the project manager. A Wilcoxon Matched-Pairs Signed-Rank test was completed within each group of participants to evaluate the median difference of scores during the pre-intervention and post-intervention periods. Testing conducted within the junior-level participants revealed statistically significant post-intervention improvements related to awareness of body posture during patient interaction (p = 0.021), comfort using silence when interacting with a patient (p = 0.014), and comfort summarizing a conversation prior to closure of a discussion with a patient (p = 0.011). In addition, statistically significant findings were noted related to the ability of junior-level students to put themselves in the patient’s shoes (p = 0.020), the belief that empathy is an important component of health care (p = 0.025), and the perception that emotional connection with patients may be detrimental to patient care (p = 0.046). No statistically significant results were found in the sophomore intervention group. A Mann-Whitney U test was used to compare the median scores and mean ranks between the sophomore intervention and sophomore comparison groups, as well as the sophomore intervention and junior participant groups. A significant difference was noted between intervention and comparison sophomore participants, in that intervention sophomores were more likely to perceive lack of empathy as a hindrance to patient care (p = 0.015). In addition, sophomore students who participated in the intervention were less likely to perceive an emotional connection with a patient as detrimental to patient care (p = 0.018). A Mann-Whitney U test comparing junior participants and sophomore intervention participants revealed several statistically significant findings. Junior participants were found to have a greater belief that they were able to put themselves in a patient’s shoes while providing care (p = 0.042), were better able to understand a patient’s non-verbal cues and body language (p = 0.004), and had an increased perception that non-verbal communication was an important aspect of patient care (p = 0.003). In addition, junior students were significantly more comfortable using open-ended questions (p = 0.042) and summarizing a conversation (p = 0.043) than sophomore students. These findings support the conclusion that SP encounters improve empathy and self-efficacy related to therapeutic communication, particularly for those students acting as the SPs

Guanxi and Ethical Decision Making

Guanxi or gift giving in an international business context can mean the difference between continuing a working relationship versus prematurely discontinuing the working relationship. The analysis of gift giving indicates significant economic, cultural, judicial, and ethical differences exist between the United States and China. These differences can be mitigated through the use of a commonly accepted and frequently cited ethical decision making models proposed by Trevino (1986) which take into account cognitive development, individual, and situational moderators. The expected outcome in terms of ethical behavior should be consistent with the established company protocol and at the same time honor the commitment to United States law yet is culturally sensitive to the practices of China

Building A Thriving CS Program In A Small Liberal Arts College

In this paper we describe several techniques that have helped increase enrollment in the computer science program from 23 computer science majors in 2008 to 42 computer science majors in 2010 – an increase of 82.6%. We discuss issues related to curriculum, programming assignments, and professor-student interactions that have made the discipline more attractive and manageable to a variety of students within the setting of a small liberal arts college