Empathy is the foundation of caring in the nursing profession. It is critical to an effective patient-nurse relationship and impacts decision-making in nursing care. This study aimed to investigate the impact of virtual simulation on nursing students’ empathy and the relationships of empathy to their demographic characteristics. A randomized pretest and posttest control group design was employed in the study with 140 participants from twelve undergraduate nursing programs across Canada. A virtual simulation scenario was created by the author regarding a patient with substance overuse in an acute care setting. Standardized patients were employed to portray the virtual characters to enhance realism and immersive experience. The participants in the control group reviewed a text-based case study, which consisted of an identical storyline of the virtual simulation scenario, while those in the intervention group experienced the virtual simulation activity. The Kiersma-Chen Empathy Scale-Revised (KCES-R), Substance Abuse Attitude Survey (SAAS), and a demographic survey consisting of age, gender, personal, family, and learning experiences related to substance overuse, were used in the study. The results indicated empathy was significantly increased after the learning activities in both groups, but nonsignificantly different between the participants in the text-based case study and virtual simulation groups before and after the learning activities. Meanwhile, the participants’ attitudes toward substance overuse did not change significantly after their learning activities. All demographic characteristics were nonsignificantly correlated to the participants’ empathy as well. However, the participants’ empathy toward the patients with substance overuse was significantly associated with their attitude toward substance overuse. This study is one of the few studies that employed virtual simulation to promote nursing students’ empathy. Although the study did not demonstrate a significant difference between the text-based case study and virtual simulation groups after the learning activities, it supports that virtual simulation is effective for promoting empathy in nursing education as a text-based application. Future studies will be needed to explore different virtual simulation designs and to determine how individual characteristics influence the cognitive process of perspective-taking in promoting empathy.

The COVID pandemic led to a sudden expansion of telehealth in the delivery of nursing services. At the same time, nursing education was forced to extend clinical learning to online approaches. However, telehealth clinical experiences are limited in the nursing curricula of entry-level programs. Nursing simulation is an educational activity that prepares students for clinical practice by supporting the learning of fundamental clinical competencies. This study was designed to explore prebriefing methods for simulation to prepare entry-level nursing students for telehealth patient care visits. Standardized patient (SP) methodology was used to simulate a telehealth video conferencing call for an infectious disease case interview. Simulations were conducted remotely using Zoom technology with breakout rooms adhering to Healthcare Simulation Standards of Best PracticeTM, and informed by NLN Jeffries Simulation Theory and Experiential Learning Theory. The experiment compared two different methods for prebriefing: traditional prebriefing with a narrated script and structured prebriefing with a narration script plus learners viewed a role modeling video and participated in guided reflection. Participants from one private university in the Northeast (N =126) were randomized and simulations took place over one semester. In conclusion, the standardized patient simulations were an effective teaching strategy for developing fundamental telehealth skills of therapeutic communication and confidence with patient safety. Learners in the structured prebriefing group had significantly higher scores for confidence in quality and safety, faculty assessed therapeutic communication, and simulation effectiveness. There were significant improvements of therapeutic communication scores over time for both groups, but there were no differences between groups. Future research might extend the explanations of how to best prepare learners for telehealth experiences; it is important to further explore telehealth clinical competencies with entry-level nursing students.