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
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.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
SINGLE
Enrollment
66
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 no additional simulation-based or technology-assisted interventions will be included.
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 environment, and access to healthcare services. The intervention will be delivered using standardized virtual reality content during the same academic term as the Disability Awareness Training and will be followed by a structured debriefing session facilitated by the researcher. No additional interventions will be applied to this 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 Disability Awareness Training and will be followed by a structured debriefing session facilitated by the researcher. No additional interventions will be applied to this group.
Disability Awareness Program (DAP) scale
The primary outcome is the change in total score on the Disability Awareness Program (DAP) Scale, a 15 item self reported questionnaire designed to assess awareness related to disability. The DAP Scale evaluates three predefined domains: (1) Awareness of Basic Human Rights (5 items), (2) Awareness of Disability based on the ICF framework (6 items), and (3) Awareness of Diversity (4 items). Items are rated on a 5 point Likert scale. Reverse scoring is applied to items Q1-Q5, and weighted scoring is applied to items Q5, Q10, Q11, Q14, and Q15, according to the predefined scoring algorithm. The total score ranges from 0 to 100, with higher scores indicating greater disability awareness As part of this study, a validity and reliability study of the Turkish version of the original English scale will be conducted among first- and second-year undergraduate students enrolled in the Department of Nursing at Başkent University, in order to ensure its suitability for use in the target population
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
The Multidimensional Attitudes Toward Persons with Disabilities Scale (MATPDS) was developed by Findler, Vilchinsky, and Werner in 2007. The scale provides a multidimensional assessment of adults' attitudes toward persons with disabilities across cognitive, affective, and behavioral domains. The Turkish validity and reliability study of the scale was conducted among university students by Yelpaze and Türküm in 2018, and the scale was reported to be suitable for use in the Turkish population. The scale consists of three subscales: Cognition, Affect, and Behavior. The scale is scored using a 5 point Likert format ranging from 1 = Not at all to 5 = Very much. In the Affect subscale, 11 items (items 1, 2, 3, 4, 5, 9, 10, 11, 12, 14, and 15), and in the Behavior subscale, 6 items (items 1, 2, 3, 4, 5, and 6) are reverse coded. Subscale scores as well as a total scale score can be calculated. Higher scores indicate more positive attitudes toward persons with disabilities.
Time frame: Change from baseline in disability attitude scores measured immediately after the interventions and at 6 weeks post intervention.
Multidimensional Empathy Scale
The Multidimensional Empathy Scale (MES) is a valid and reliable 30-item instrument developed by Mayer and Caruso (1998) to provide a multidimensional emotional assessment of individuals' empathic abilities. The Turkish validity and reliability study of the original scale was conducted among university students by Turan et al. (2020), and the Turkish version was accepted as a valid and reliable tool for assessing empathy levels among nursing students. The scale consists of six dimensions: Personal Distress (8 items), Positive Sharing (5 items), Sensitive Crying (3 items), Emotional Attention (4 items), Feeling for Others (4 items), and Emotional Contagion (2 items). The 30-item scale is rated on a 5-point Likert scale ranging from 1 = Strongly disagree to 5 = Strongly agree. The total score ranges from 30 to 150, with higher total scores indicating higher levels of multidimensional empathic ability.
Time frame: Change from baseline in disability empathy scores measured immediately after the interventions and at 6 weeks post intervention.
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