2026 Theses Doctoral

Impact of a Telehealth Simulation in Baccalaureate Nursing Education on Therapeutic Communication, Empathy, and Attitudes Towards Mental Illness: A Quasi-experimental Study

Schwenk, Janet

The integration of telehealth technology within today’s health care system has transformed how nurses provide patient care beyond the bedside. Nurses are responsible for providing holistic and person-centered care to all patients, including those with a mental illness. However, negative attitudes towards those with mental illness may impact the care they receive. While telehealth technology allows health care professionals to connect with patients virtually, the ability to use these technologies effectively can be underdeveloped if nurses lack opportunities to practice. Nurse educators are responsible for preparing future nurses to use this technology without sacrificing holistic, person-centered care or the fundamental nurse-patient relationship. Teaching strategies, such as simulation-based education, can be used in undergraduate nursing education to prepare nursing students to provide person-centered care and to begin to recognize their attitudes toward an individual with mental illness.

The purpose of this study was to investigate the impact of a telehealth virtual encounter versus an in-person encounter with standardized patients (SPs) on therapeutic communication skills, empathy, and attitudes toward mental illness among baccalaureate nursing students enrolled in a mental health course. A two-group pretest-posttest quasi-experimental design was conducted with a nonequivalent comparison group. A convenience sample of 202 fourth-year baccalaureate degree (BSN) nursing students from a private, faith-based university in the northeastern United States consented to participate in this study. The intervention group participated in a virtual telehealth simulation with an SP, and the comparison group participated in an in-person simulation with an SP using the same scenario. A debriefing session followed the simulation experience using the Plus-Delta debriefing method. After the encounter, the Global Interprofessional Therapeutic Communication Scale (GITCS) and Consultation and Relational Empathy measure were completed by the SPs. The GITCS, the Jefferson Scale of Empathy for Health Professions Students, and the Opening Minds Scale for Health Care Providers were completed by participants before and after the simulation encounter.

No statistically significant difference was found between the telehealth (virtual) and in-person communication models. Statistically significant improvements were observed in both therapeutic communication skills and attitudes toward mental illness for both groups, while neither group had a significant change in empathy. A statistically significant difference was found between nursing students’ self-assessment of therapeutic communication skills and the SPs' observations of those same skills. Specifically, nursing students reported statistically significantly higher levels of therapeutic communication skills compared to the SPs. Significant, positive correlations were found between nursing students’ and SPs’ ratings of therapeutic communication skills in the in-person setting, as well as empathy ratings in both telehealth and in-person contexts.

Findings from this study contribute valuable insights to nurse educators who prepare students to deliver holistic, person-centered care that extends beyond the bedside. The research findings provide evidence about the impact of telehealth and simulation educational interventions on therapeutic communication skills, empathy, and attitudes toward mental illness. Additionally, the findings contribute to the development of standardized competencies and inform best practices. This study supports the integration and exposure of nursing students to the care of individuals with mental illness, potentially helping them develop more positive attitudes when working with this population. The outcomes of this study further highlight the benefits and challenges of integrating telehealth simulations into the undergraduate nursing curriculum.