Developing Disability Awareness, Attitude, and Empathy in Nursing Students

Official title

A Randomized Controlled Trial Comparing Training Programs Designed to Improve Awareness, Attitudes, and Empathy Toward Individuals With Disabilities in Nursing Students

Overview

Abstract Individuals with disabilities frequently face barriers to accessing healthcare services due to physical, social, economic, and policy-related factors. As essential members of the healthcare workforce, nurses play a critical role in addressing these inequities. Previous studies focusing on disability awareness, attitudes, and empathy highlight the need for high-quality research employing mixed-method, simulation-based interventions aimed at enhancing awareness and empathy, fostering positive attitudes, and supporting learning outcomes. However, the existing literature lacks studies that simultaneously compare different simulation methods and comprehensively evaluate awareness, attitudes, and empathy using a multidimensional approach. This study aims to examine the effectiveness of simulation-based interventions-standardized patient encounters and virtual reality training-in improving nursing students' awareness, strengthening positive attitudes, and increasing sensitivity in the delivery of healthcare services to individuals with disabilities. The findings are expected to support the integration and expansion of disability-focused simulation practices in nursing curricula and contribute to the development of evidence-based nursing education programs. Keywords: nursing students; disability; attitude; simulation; virtual reality

Detailed description

This study aims to evaluate the effectiveness of simulation-based interventions designed to improve nursing students' awareness, attitudes, and empathy toward individuals with disabilities. The study will be conducted using a pre-test, mid-test, and post-test design within a double-blind, randomized controlled framework that includes a control group. A total of 60 third- and fourth-year students from the Nursing Department of Başkent University Faculty of Health Sciences will be enrolled. Participants will be assigned to three groups (20 students per group) using stratified block randomization.

Data will be collected using the Student Information Form, the Disability Awareness Scale, the Multidimensional Attitudes Toward Persons with Disabilities Scale, and the Multidimensional Empathy Scale.

The intervention will begin with Standard Disability Education delivered online via the Zoom platform to both the experimental and control groups in separate sessions. Subsequently, in accordance with schedules arranged by the researcher and students' course availability, Experimental Group 1 will receive a Standardized Patient Simulation, while Experimental Group 2 will participate in a Virtual Reality Simulation. Statistical analyses appropriate to the study design will be performed, and the level of statistical significance will be set at p = 0.05.

Interventions

• Behavioral Disability Awareness Education
  Participants will receive Disability Awareness Training delivered through face-to-face instruction. The training will cover core topics including the concept of disability, physical, social, and attitudinal barriers experienced by individuals with disabilities, challenges related to accessing healthcare services, and the roles and responsibilities of healthcare professionals in providing inclusive and equitable care. The intervention will be delivered using standardized educational content, and
• Behavioral Virtual Reality Group
  Participants assigned to the Virtual Reality Intervention group will receive a Virtual Reality-based simulation intervention following the Disability Awareness Training. The Virtual Reality intervention will provide computer-generated experience designed to simulate situations encountered by individuals with disabilities, with the aim of enhancing participants' understanding, awareness, and empathy. The simulated scenarios will focus on challenges related to daily living, interaction with the en
• Behavioral Standart Patient Group
  Participants assigned to the Standardized Patient Intervention group will receive Disability Awareness Training, followed by a Standardized Patient-based simulation intervention. During the simulation, participants will provide care to a trained standardized patient portraying an individual with a disability, in accordance with the procedures and objectives outlined in the predefined scenarios. The simulation will be conducted using standardized scenarios during the same academic term as the Dis

Primary outcome measures

• Disability Awareness Program (DAP) scale [Time frame: Change from baseline in disability awareness scores measured immediately after the interventions and at 6 weeks post-intervention.]
• The Multidimensional Attitudes Toward Persons with Disabilities Scale [Time frame: Change from baseline in disability attitude scores measured immediately after the interventions and at 6 weeks post intervention.]
• Multidimensional Empathy Scale [Time frame: Change from baseline in disability empathy scores measured immediately after the interventions and at 6 weeks post intervention.]

Eligibility criteria

Inclusion criteria

• Must be a 3rd or 4th-year student in the Department of Nursing at Başkent University.
• Must be willing to participate in the study.

Exclusion criteria

• Any kind of disability.
• A visually-related problem

Criteria are shown verbatim from the registry (in English). Final eligibility is always assessed by the study center.

Healthy volunteers: Yes

Study design

Allocation

Randomized

Model

Factorial

Masking

Single blind

Primary purpose

Supportive care

Study locations

Center list to be confirmed — check the primary protocol.

Publications

• Turan N, Durgun H, Kaya H, Asti T. Turkish adaptation of the Multidimensional Emotional Empathy Scale: A validity and reliability study. Perspect Psychiatr Care. 2021 Apr;57(2):455-462. doi: 10.1111/ppc.12616. Epub 2020 Sep 9. PMID 32902867
• Yelpaze, İ. ve Türküm, A. S. (2018). Engellilere Yönelik Çok Boyutlu Tutum Ölçeğinin Türk Kültürüne uyarlanması: Geçerlik ve güvenirlik çalışması. OPUS Uluslararası Toplum Araştırmaları Dergisi, 8(14), 168-187. doi: 10.26466/opus.377906
• Havercamp SM, Barnhart WR, Robinson AC, Whalen Smith CN. What should we teach about disability? National consensus on disability competencies for health care education. Disabil Health J. 2021 Apr;14(2):100989. doi: 10.1016/j.dhjo.2020.100989. Epub 2020 Sep 11. PMID 32952097
• An X, Zhang D, Wang Q, Shi X, Wang M, Wang Y, Ma J. The role of evidence-based practice and empathy in shared decision-making attitudes among newly graduated nurses: A cross-sectional study. J Adv Nurs. 2025 Feb;81(2):777-786. doi: 10.1111/jan.16236. Epub 2024 May 12. PMID 38736281
• Yıldırım Sarı, H., & Doğan, P. (2022). Öğrencilerin görme engelli simüle hasta ile iletişim becerilerinin değerlendirilmesi: Pilot çalışma. Journal of Infant, Child and Adolescent Health, 2(1), 1-10.
• Newton, R. H., & Krebs, A. (2020). Bridging the theory-practice gap using simulation to teach care of patients with disabilities. Teaching and Learning in Nursing, 15(4), 233-236. https://doi.org/10.1016/j.teln.2020.04.003
• Garcia-Carpintero Blas E, Velez-Velez E, Gomez-Moreno C, Martinez-Arce A, Tovar-Reinoso A, Rodriguez-Gomez P, Vaquero Velerdas L, Lopez-Martin I. Simulation with a standardised patient to reduce stigma towards people with schizophrenia spectrum disorder among nursing students: A quasi-experimental study. Arch Psychiatr Nurs. 2024 Oct;52:24-30. doi: 10.1016/j.apnu.2024.07.015. Epub 2024 Jul 9. PMID 39260980
• Azher S, Mills A, He J, Hyjazie T, Tokuno J, Quaiattini A, Harley JM. Findings Favor Haptics Feedback in Virtual Simulation Surgical Education: An Updated Systematic and Scoping Review. Surg Innov. 2024 Jun;31(3):331-341. doi: 10.1177/15533506241238263. Epub 2024 Mar 14. PMID 38486132

Identifiers

NCT: NCT07609238 · KA26/105

Primary sources (government registries)

• ClinicalTrials.gov (US NIH)

View this study on ClinicalTrials.gov ↗