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Table of Contents
ORIGINAL ARTICLE
Year : 2022  |  Volume : 23  |  Issue : 2  |  Page : 159-163

Empathic communication skills: A methodological study to develop a validated video


1 Ph.D Scholar, AIIMS, Rishikesh, India
2 Professor & Principal, AIIMS, Jodhpur, India
3 Additional Professor, Department of Psychiatry, AIIMS, Rishikesh, India
4 Dean School of Design, University of Petroleum and Energy Studies, Dehradun, Rishikesh, India
5 Tutor, AIIMS, Rishikesh, India

Date of Submission18-Oct-2021
Date of Decision07-Dec-2022
Date of Acceptance08-Dec-2022
Date of Web Publication31-Dec-2022

Correspondence Address:
Mrs. Rashmi Rawat
AIIMS, Rishikesh, Uttarakhand
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijcn.ijcn_99_21

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  Abstract 

Healthcare industry has seen technological revolution in the strategies of treatment and care which has resulted in fading away of the value of human touch in delivering quality care. Empathy shown by nurses in their communication is still a foremost component driving the satisfaction with the care received by the patients. The present study is conducted with an aim to develop a validated video as an educational tool to teach empathic communication skills to nurses. A methodological design was used to develop video in three phases: Preproduction, production, and postproduction phase. Seven judges having expertise in the field has validated the video and 11 nurses have evaluated the understanding and comprehensiveness content of the video. Content validity index (CVI) was calculated for the video and mean and standard deviation was calculated for the understanding of the video by the target audience. The final version of the video is of 33 min in duration. All the aspects of the video have shown an agreement among the judges between 85% and 100% which is an acceptable range for an instrument to be valid. Furthermore, CVI of the video was calculated which came out to be 0.89 and evaluation of understanding of the content of the video by the participants has shown a mean score of 9.73 ± 0.467 indicating a good understanding of the video by the target audience. Educational video is found to be a valid tool to teach empathic communication skills for nurses. Video has a potential to be utilized as a teaching strategy as part of in-service nursing education on communication skills for nurse.

Keywords: Empathic communication, empathy, healthcare communication, learning strategy, nurse-patient communication, virtual teaching aid


How to cite this article:
Rawat R, Sharma SK, Gupta R, Mohan M, Sharma DK. Empathic communication skills: A methodological study to develop a validated video. Indian J Cont Nsg Edn 2022;23:159-63

How to cite this URL:
Rawat R, Sharma SK, Gupta R, Mohan M, Sharma DK. Empathic communication skills: A methodological study to develop a validated video. Indian J Cont Nsg Edn [serial online] 2022 [cited 2023 Feb 3];23:159-63. Available from: https://www.ijcne.org/text.asp?2022/23/2/159/366612


  Introduction Top


Empathy is a way of keeping oneself in other's situation, understanding their emotions and thoughts correctly and communicating that understanding back to them. Empathy is vital in improving the quality of communication as it conveys to the individual that how his feelings will be understood. This in turn emphasizes the fact that empathic skills are necessary to improve the quality of communication process.[1]

Although nursing education has given importance to enveloping therapeutic relationship with patients and relatives on the basis of empathy, empathy on part of nurses for their clients is on the decline. Studies have shown that patient's emotional expressions are ignored by the healthcare professionals and are not dealt with the expression of empathy.[2] Like every other profession, nursing is also influenced by technological advances in the medical science, but human relations are still the core of the profession. Empathy remains fundamental in forming the helping relationship between nurse and the patient to render quality care.[3],[4]

High level of empathy on part of nurses has been linked with positive patient outcomes and it is depicted in a survey which found that empathy shown by nurses toward their clients played a major role in patients' satisfaction with care.[5],[6] Empathy as a concept is visualized as an inherent trait that exists in individuals on varying extent, some are more empathetic than the others. In spite of this, literature supports the evidence that individuals can be taught empathic skills, which can further be strengthened with practice and experience.[2],[5]

Studies have shown an increase in level of empathy and empathic communication skills of nurses who have undergone training on empathic communication skills.[7],[8],[9] Improper communication is one of the most common reasons for violence against healthcare workers as reported by Pratibha et al.[10] Not much have been done to improve empathic communication skills of nurses in India and the literature suggests the need for communication training for nurses on empathy which ranges from 3.5 h to 20 h[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] and none of which is conducted in the Indian context to best of researchers knowledge. Considering the Indian scenario which is facing a serious shortage of nurses and time constraints, authors have decided to bring an instrument in the form of a video which covers skills required by the nurses to be empathetic in their communication.


  Methods Top


Methodological design was undertaken to describe the process of development and validation of the video to teach empathic communication skills to nurses. The development of video was executed in three phases: Pre-production, production and post-production.

Preproduction phase

In preproduction phase, literature search was done followed by script writing. The literature search was conducted in the following databases: PubMed, CINAHL, Scopus, Embase and Google Scholar. To introduce a dramatic angle in the script, various videos on communication in healthcare were also scrutinized.[21],[22],[23],[24],[25],[26],[27],[28],[29],[30],[31],[32],[33],[34],[35],[36],[37] The themes related to empathy and the empathic skills that emerged from the literature review were used as a framework for developing the video content [Figure 1]. As empathy is an abstract entity and involve emotions of the people, authors have decided to develop video in three sections. First section consists of sensitization of the audience to empathy; second section describes the skills to improve empathic communication skills, and in third section, use of the empathic communication skills is demonstrated through role-plays. The skills are summarized in [Figure 1].
Figure 1: Emergence of the skills to be empathetic from literature review

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Script was formulated for the three sections. In the first section, scenes to be shot of real patient in healthcare setting were decided. For the second section, script for the skills to improve empathic communication was prepared in colloquial language. For the third section, three scenes were decided in which two scenes depicts the common scenarios of communication between nurse and patient and one scenario shows the communication between a senior and a junior nurse.

Production phase

The production phase comprised of the filming of the script decided in the pre-production phase. A professional videographer was hired to shoot all the sections of the video. In first section real patients in the hospital settings were shot for which permission from the hospital authority was taken and informed consent was obtained from the patients to record them in video. The second section was shot with one of the author explaining the skills required to be empathetic. Third section was filmed as role plays in which one of the author played the role of a nurse, one nurse educator played the role of a patient and one BSc. Nursing students also played the role of a relative and in the last scene one nurse educator played the role of senior nurse. The shooting was conducted between the months of January 2020 and April 2020.

Post-production phase

This phase comprised of editing of the video and validation of video by experts. Editing of the video was done with the help of Final Cut Pro X professional non-linear video editing application published by Apple Inc. (2011). In editing of the video inclusion of the images, and animation was done. Audio quality was enhanced; background was adjusted to be effective for the audience. Editing took 1 month and the final video which is of 33 minutes duration was ready in the month of May 2020. Once the video was finalized a 4-point rating scale was developed with the score ranging from 15 to 60 for the validation of the video by the experts. This tool was validated by 5 experts and Content validity index (CVI) was calculated for it which came out to be 0.79. In order to establish the validation of the video seven experts in the field of healthcare were chosen by purposive sampling technique.

Evaluation of content understanding and comprehensiveness

In order to establish the understanding of the content by the target audience 11 nursing officers were recruited from different medical surgical wards by simple random sampling. Content understanding and comprehensiveness was evaluated on basis of a study conducted by Silva et al.[38] For this, 7-item scale was created on which participant had to give score from 0 to 10 on each item. Each nursing officer was asked to watch the video and give score from 0 to 10 [Table 1].
Table 1: Evaluation of comprehensiveness of the video by the participants

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Ethical consideration

The study was approved by Institutional Ethics Committee and an informed consent was taken from the patients and the actors for the video recording to be used for the research purpose. IEC No. 313/IEC/2018.


  Results Top


The seven experts who participated in the validation included one psychiatrist, two clinical psychologist, two nursing faculty specialized in mental health, one nurse and one senior nurse from the clinical area and all experts have an experience more than 5 years in their field. As depicted in [Table 2], all the aspects of the video showed an unanimous 100% agreement among experts except quality in Part I and II, quality of audio in Part II and relevancy of content and dialogues in Part III showed an agreement of 85% among experts which is acceptable. CVI was also calculated for the video which came out to be 0.89 which is also acceptable.
Table 2: Degree of agreement among judges for the content of the video

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Evaluation of content understanding and comprehensiveness

Evaluation of content understanding and comprehensiveness was done by 11 nurses. The mean age of the nurses was 26.27 ± 1.849 years and 6 of them were males. Most of them were having bachelor's degree in nursing and had an experience ranging from 1 to 6 years. As depicted in [Table 1], each domain has a mean score of more than 9 indicating good understanding of the video by the target audience.


  Discussion Top


Technological advancement in healthcare has revolutionised the teaching learning activities putting a challenge on educators to utilise the variety of teaching strategies while giving a makeover to traditional style of teaching.[39] European countries being advanced in technology have already initiated the use of videos to enhance teaching-learning process and Bradley University, USA is experimenting with the production of educational video in order to foster a tutoring system without face-to-face interaction.[40] The present study has come up with an innovative instrument in form of a video to teach necessary skills required by the nurses to be empathetic in communicating with the patients and significant others. Video based teaching enhance learning by breaking the information into smaller chunks and combining static pictures with moving objects including narration and captions giving user a control over the learning process as they can play, pause and replay the video.[41] Video in the present study is developed using animations, narrations and simulated role-plays by the actors creating a relatedness in the minds of the target audience which will enable the learners to acquire the knowledge about empathy and how to use the skills required to be empathetic while dealing with patients.

Video based teaching can act as an adjunct to traditional teaching as well as can be utilized as one strategy for teaching nursing skills.[38] Present video covers all the aspects of empathy required in clinical situations in three sections which could supplement classroom teaching and at the same time can serve as a resource material for reference from time to time. Video content has shown agreement among judges that ranges from 85% to 100% which is in line with the literature that suggests that 80% or more agreement among judges should be accepted.[42],[43] Any education material is said to be a valid instrument if it is easy to comprehend by the target audience, present study has shown that video is easy to be understood by the target audience as the mean score is more than 9 conveying good understanding of the video by the participants.[38] The actors who played the characters in role plays are nurses and nursing students who had an exposure of real encounters with the situations to give it a real appearance which would be difficult to be played by lay actors without any exposure to real hospital settings. Studies in the past have developed video utilising the health workers as actors because of the professional exposure.[44]

Duration of the video plays a significant role as it depends on the attention span of the viewers to grasp the concept. Literature suggests the duration range of an educational video to be between 10 and 20 min[44] but present study video is of 33 minutes duration because empathy is a concept which cannot be taught in one lecture and literature suggests the methods used to teach empathy ranging from 3.5 to 20 h utilising didactic lectures, workshops and role plays as teaching strategies. Hence, in the present study, an effort has been taken to present the concept of empathy and skills required to be empathetic in a simplified manner incorporating theoretical and practical aspects in the form of a video.[11],[12],[13],[14],[15],[16],[17],[18],[19],[20] Further studies can be done to test the effectiveness of the video to improve the empathic skills of nurses while communicating with the patients.

Strengths

The video is prepared in simple, contextualised language form keeping the target audience in mind which makes it unique in grasping the concept easily and makes the audience link the relatedness of the scenarios with them. This video can be utilised as a means of teaching nurses the basic practical empathic communication skill without any teacher explaining the concept.

Limitations

As the video uses the colloquial language of North India, i.e. a mix of Hindi and English making it difficult to be understood by the nurses not familiar with the language but video can utilize English subtitles to make it easier to understand by the nurse distributed over large geographical area.


  Conclusion Top


The emotions involved in caring for the patients can never be replaced by advancement in technologies. There is dearth of research catering to the building of empathy in communication of nurses in India and this study is an initiative with a motive to bring empathy in communication of nurses which has diminished with the process of evolution of healthcare technologies. Video could be utilised as a teaching tool in the in-service education of nurses and can serve as a reference material on empathic communication skills.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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