The effect of simulation-based experience on the development of self-awareness and empathic skill in nursing students

Aim: This is a randomized controlled experimental study that was conducted to determine the effect of simulation training on the acquisition of self-awareness and empathy skills in nursing students. Methods: The study was carried out in the nursing department of a state university. The population of the study was composed of 4th-year students taking the Clinical Practice Course in the spring semester of the 2023-2024 academic year (N=116). The sample consisted of 80 students, 40 in the experimental group and 40 in the control group, who met the research criteria, were informed about the purpose of the research, and volunteered to participate. The study data were collected using a Student Information Form, the Self-Awareness in Nursing Practices Scale, the Jefferson Scale of Empathy for Nursing Students, the Kiersma-Chen Empathy Scale, the Aging Simulation Experience Scale, and the Student Satisfaction and Self-Confidence in Learning Scale. The students in the experimental group participated in the Geriatric Medication Game Simulation Application, where they played the role of an older individual. The control group followed their routine curriculum without any intervention. The experimental group filled out the data collection tools before the simulation, after the simulation, and at follow-up, and the control group filled out the tools at the first assessment and follow-up measurement. The follow-up measurements were made after the participants completed their three-week clinical practice training in which they provided care for an elderly individual. Results: The mean age of the students included in the study was 22.650±1.233. The majority of them were female (77.5%) and Anatolian high school graduates (78.8%). The rate of the students occasionally following the developments in their field was 62.5% and 61.3% of them stated that they had previously provided care for an elderly individual. No significant difference was found between the students in the experimental and control groups in this respect (p>0.05). Following the simulation, the mean scores of the experimental and control groups on the total and sub-dimensions of the Self-Awareness in Nursing Practices Scale were similar, and no significant difference was observed between the groups (p>0.05). On the other hand, the mean follow-up scores on the sub-dimensions (perspective taking and compassionate care) of the Jefferson Empathy Scale for Nursing Students obtained three weeks after the simulation yielded significant differences in favor of the experimental group, except for the "walking in their shoes" sub-dimension (p<0.05). In addition, the mean follow-up scores of the experimental and control groups on the "affective empathy" sub-dimension and "total mean score differences" between groups of the Kiersma-Chen Empathy Scale that were obtained three weeks after the simulation showed a significant difference in favor of the experimental group (p<0.05), but no significant difference was found between the groups in terms of the mean "cognitive empathy" sub-dimension (p>0.05). The mean follow-up Aging Simulation Experience Scale scores obtained three weeks after the simulation indicated a significant difference in favor of the experimental group in terms of the level of perception toward older individuals (p<0.05). Conclusions: The Geriatric Medication Game Simulation Application in Nursing Students was an appropriate teaching method for gaining empathy toward patient-centered care situations, it increased students' perception levels toward older adults, and the simulation experience improved satisfaction and self-confidence levels in learning. It is recommended that innovative methods be used and multidisciplinary studies be conducted to contribute to the development of the affective field as well as the cognitive and psychomotor fields in nursing education. Keywords: self-awareness, empathy, Geriatric Medication Game, satisfaction, nursing students