2025 Theses Doctoral

Participation Versus Observation: Impact of Role in Simulation on Empathy, Cultural Humility, and Clinical Judgment in Nursing Students

Anathan, Julie

Problem Statement
Nursing education is vital in addressing maternal health disparities in the U.S., which has the highest maternal mortality rate among high-income countries, disproportionately affecting nonwhite women. Empathy, cultural humility, and clinical judgment are recognized as essential skills for addressing health care disparities. Research shows that simulation improves both empathy and clinical judgment; however, studies using simulation to teach cultural humility are limited. Although previous research indicates that both active participants and observers in simulation have significant improvements in knowledge-based outcomes, there are limited studies evaluating other types of outcomes. Overall, gaps remain in nursing education research on integrating empathy, cultural humility, and clinical judgment to address maternal health care disparities.

Method
A quasi-experimental pre-post study using simulation with standardized patients was conducted to determine whether empathy, cultural humility, and clinical judgment differed by participation versus observation role in undergraduate nursing students.

Results
Fifty-two undergraduate nursing students (52/86 or 60% of maternal health students) participated. Role did not have a significant impact on the combined outcome measures of empathy, cultural humility, and clinical judgment. The effect of role on the singular outcomes of empathy, cultural humility, and cultural humility did not show significant differences. Both groups had significant improvements over time in perceived empathy scores. The observer group had significant improvement in perceived cultural humility over time.

Conclusion
Despite the small sample size and a one-time intervention, significant improvements in affective outcomes, namely empathy and cultural humility, were noted in active and observer groups over time. These findings add to prior research demonstrating significant improvements in knowledge-based outcomes using simulation, regardless of role.