United agency refers to a sense of \'acting as one\' that sometimes occurs when people engage in joint actions such as group music-making, dancing, and team sports. First-hand accounts of united agency have been reported in a variety of settings, but there exists little systematic evidence regarding when and why the sense of united agency arises. The current study addressed this gap using an online survey in which participants reported general information about their experiences of united agency as well as detailed descriptions of a single memorable experience. Most participants reported experiencing united agency at least occasionally, and those scoring higher on extraversion, agreeableness, and cognitive empathy experienced it more frequently. Memorable experiences of united agency were reported more often in joint actions characterized by synchronous or highly rhythmic coordination, salient shared goals, close or long-term relationships among co-performers, and small to medium group sizes. United agency was often accompanied by positive affect, feelings of alignment and social connection with co-performers, a sense of empowerment, and heightened attention. Together, these findings elucidate the individual characteristics and joint action features that facilitate united agency, shed light on its positive social and emotional consequences, and suggest important avenues for further work investigating its underlying mechanisms.

UNASSIGNED: Many studies have demonstrated empathy decline in medical students over the course of training. Burnout negatively affects academic or professional performance and has been negatively correlated with empathy. Neither empathy nor burnout has been previously studied in naturopathic medical students.
UNASSIGNED: The aims of this cross-sectional study were to (1) compare empathy at different levels of training, (2) describe the prevalence of burnout, and (3) identify correlations between empathy and burnout, in naturopathic medical students.
UNASSIGNED: This cross-sectional study used the Interpersonal Reactivity Index and Maslach Burnout Inventory to measure empathy and burnout, respectively, in an online survey of current naturopathic medical students at one institution.
UNASSIGNED: 1) There was no significant difference in empathy between any cohorts or between those in internship versus those not in internship. 2) Among burnout outcomes, 42% of participants met criteria for emotional exhaustion, 19% for depersonalization, and 64% for low sense of personal accomplishment. 3) Cognitive empathy was positively correlated with affective empathy and a higher sense of personal accomplishment and negatively correlated with emotional exhaustion and depersonalization.
UNASSIGNED: While a longitudinal study would provide more definitive evidence, this study suggests that empathy in naturopathic medical students is relatively stable over the course of training. It also demonstrates that burnout is prevalent in this population and has an inverse relationship with empathy. Interventions to prevent burnout and increase empathy are discussed.

UNASSIGNED: This study aimed to investigate the knowledge, attitude and experiences in sharing unpleasant health information and adherence to the SPIKES protocol among physicians at a tertiary hospital in Muscat, Oman.
UNASSIGNED: This cross-sectional study was conducted at the Sultan Qaboos University Hospital from August to October 2022. An electronic, self-administered questionnaire was used to gather data from physicians across various departments.
UNASSIGNED: A total of 89 physicians completed the questionnaire (response rate = 22.3%). Most participants (n = 86, 96.6%) recognised the need for additional training in the delivery of unpleasant health information (\'bad news\'), with 78.7% (n = 70) expressing their willingness to undertake such training. Additionally, 32.6% (n = 29) reported negative experiences due to improper delivery of bad news, with an equal proportion admitting to disclosing bad news to patients\' family without their consent. The majority (n = 77, 86.5%) demonstrated a high level of overall adherence to the SPIKES protocol, with 59.6-85.4%, 12.4-34.8% and 1.1-11.2% reported usually, sometimes and never following specific steps of the protocol, respectively. Marital status (P = 0.015) and qualifications (P = 0.032) were the only variables that were associated with adherence level, with married physicians and those with board and/or fellowship certificates reporting significantly better adherence compared to their counterparts.
UNASSIGNED: Physicians in Oman encounter challenges in delivering unpleasant health information, underscoring the interplay of cultural influences, training and adherence to protocols. To address these challenges, targeted and frequent training programmes are recommended, starting from undergraduate medical education and extending to continuous opportunities for physicians at various career levels.

OBJECTIVE: Compare the effects of Simulation with problem-based learning (SPBL) and Problem-based learning (PBL) in nursing ethics education on nursing students\' moral sensitivity, empathy, critical thinking, test scores and teaching satisfaction.
BACKGROUND: Promoting nursing students\' individual and ethical and abilities through education is an essential way to improve their ethical performance and build trustful relationship with patients. Despite significant efforts in this area, few have evaluated the effectiveness of Simulation with problem-based learning and Problem-based learning as applied to nursing ethics education.
METHODS: A quasi-experimental design based on a non-equivalent control group pre-test/post-test.
METHODS: A quasi-experimental design was used. Participants were 161 undergraduate nursing students from two levels of a university, 88 subjects in the experimental group were taught using Simulation with problem-based learning and 73 subjects in the control group were taught using Problem-based learning. A pre-test, post-test and questionnaire were used to assess the effectiveness of student nursing ethics education. χ2 test was used to examine group differences in students\' characteristics and satisfaction with teaching post-intervention. Student\'s t-test was used to assess group differences in scale scores and test scores.
RESULTS: Compared to the pre-test, empathy as well as critical thinking were significantly higher in the PBL group (P<0.05), but there was no significant change in moral sensitivity (P>0.05); moral sensitivity, empathy and critical thinking were significantly higher in the SPBL group (P<0.05). Moreover, this study also showed that improvement in moral sensitivity, empathy, critical thinking and grades was more significant in the SPBL group of nursing students compared to the PBL group (P<0.05) and no statistically significant difference was found between the two groups in terms of teaching satisfaction (P>0.05).
CONCLUSIONS: The use of Simulation with problem-based learning in nursing ethics education has a positive impact on nursing students\' competency development and knowledge acquisition. Nurse educators should consider this teaching method and promote change to increase the effectiveness of nursing ethics education.

BACKGROUND: Empathy is one of the fundamental factors enhancing the therapeutic effects of physician-patient relationships, but there has been no relevant research in China on the pediatric resident physicians\' capacity for empathy or the influencing factors.
METHODS: A mixed-methods study was undertaken. The student version of the Jefferson Scale of Empathy was used to assess 181 postgraduate residents at Shanghai Children\'s Medical Center and Shanghai Children\'s Hospital. Differences in empathy ability among pediatric resident physicians of different genders and specialties were analyzed using independent sample t-tests and Mann-Whitney U tests. A one-way analysis of variance was used to analyze the differences in empathy ability at different educational levels and years of medical residency training. Seven third-year postgraduate pediatric residents from Shanghai Children\'s Medical Center participated in semi-structured interviews exploring the influencing factors. We analyzed the interview transcripts using thematic analysis.
RESULTS: The scale was completed by 154 pediatric residents. No statistically significant differences in empathy were found between educational level, postgraduate year, gender, or specialty. The factors influencing empathy in doctor-patient communication included the person who accompanied the child to see the doctor, how the children cooperated with doctors for medical treatment, the volume of pediatric outpatient and emergency visits, and the physician\'s ability to withstand pressure. All interviewed resident physicians regarded learning empathy as important but rarely spent extra time learning it.
CONCLUSIONS: The evaluation results of resident physicians on changes in empathy after improving clinical abilities vary according to their understanding of empathy, and the work environment has an important impact on pediatricians\' empathy ability. Their empathy score is relatively low, and this requires exploration and intervention.

BACKGROUND: This study aimed to explore how nurses experience relational work in the emergency department.
METHODS: A qualitative design with 34 focus group interviews using an abductive thematic analysis were completed for this study. Participants were recruited from an annual mandatory continuous learning program in 2020-2022 at 2 university hospitals in the Capital Region of Denmark. We applied semistructured interviews in an instructor-supported reflection session on the topic \"relational nursing care.\" Group discussion was supported by an interview guide addressing key elements of the nurse-patient relationship as described in the fundamentals of care framework.
RESULTS: Acute care nurses\' attention was primarily directed toward the initial patient assessment, rather than toward the later stages of the patient trajectory. Forming a relationship with the patient was highly individual and done at the discretion of each nurse. The key elements of relational nursing were not mutually exclusive, but the findings could be separated into biomedical and relational care, where biomedical tasks took precedence.
CONCLUSIONS: Relational care in the emergency department is optional and individually performed. Moreover, emergency nurses lack a vocabulary to express this type of work. Consequently, there is a risk that patients\' psychosocial needs are not sufficiently met. According to the emergency nurses participating in this study, nurses fall short when performing and describing relational care. Nurses need more knowledge to address the psychosocial patient needs during short-term hospital admissions. Relational care and patient centeredness also need to be acknowledged by nursing leaders and further developed.

BACKGROUND: A physician\'s empathy level substantially impacts clinical competence, patient relationships, and treatment outcomes. Yet, understanding empathy trends from medical students to resident doctors within a single institution is limited. This study delves into empathy trends within a single-center academic setting and identifies factors associated with low empathy.
METHODS: This cross-sectional study enrolled the second-to sixth-year medical students of Phramongkutklao College of Medicine and the first-to second-year residents at Phramongkutklao Hospital. It utilized a standardized questionnaire covering demographics, family relationships, the Maudsley Personality Inventory (MPI), and the Jefferson Scale of Empathy (JSE). The relationship between variables and JSE scores was analyzed using independent t-test, one-way ANOVA, and Chi-square tests. Multivariable logistic and linear regression analyses examined associated factors and trends across educational levels. A quadratic term was incorporated to evaluate the presence of a nonlinear trend.
RESULTS: A total of 520 participants, comprising 189 (36.4%) preclinical students, 153 (29.4%) clinical students, and 178 (34.2%) residents, completed the survey. The JSE showed a Cronbach\'s alpha of 0.83. The average empathy score was 103.8 ± 15.0, with 27.1% of low empathy levels. Specialty preference and sex-adjusted average empathy scores decreased from 114.5 (95%CI: 112.0-117.0) among second-year medical students to 95.2 (95%CI: 92.2-98.2) among second-year residents (Pnon-linear<0.001). The adjusted proportion of low empathy is highest among sixth-year medical students (54.4%, 95%CI: 34.4-73.2%). Factors associated with low empathy included those preferring procedure-oriented specialties (AOR: 4.16, 95%CI: 1.54-11.18) and a higher parental income (AOR: 2.97, 95%CI: 1.09 to 8.10). Subgroup analysis revealed that residents with a GPAX above 3.5 and those in technology-oriented specialties were also associated with lower empathy (AOR: 3.46, 95%CI: 1.40-8.59 and AOR: 2.93, 95%CI: 1.05-8.12, respectively).
CONCLUSIONS: A declining empathy trend was observed among medical students, which then plateaued among residents. Additionally, residents in technology-oriented specialties may require empathy enhancements due to their ongoing patient consultations. Addressing these issues requires collaborative planning between students and teachers to foster empathy throughout the medical curriculum.

Objective Therapeutic relationship is a cornerstone in the treatment of schizophrenia. However, certain personal factors on the part of psychiatrists can hinder it, notably the lack of experience with auditory hallucinations. Such factors can lead to a decrease in empathy and, consequently, a negative alteration in the therapeutic relationship. Previous studies have shown that auditory hallucination simulators have a positive impact on mental health professionals. Yet, to our knowledge, no such test has been conducted on the psychiatry resident population. To address this gap, a research team was formed, including voice hearers, psychiatrists, acoustical engineering researchers, qualitative research experts, and actor-authors. This team collaboratively created the first three-dimensional voice simulator (3DV simulator) using binaural sound reproduction technology. The objective of this pilot study is to evaluate the reaction of psychiatry residents to this 3DV simulator. Methods In this exploratory and descriptive study, psychiatry residents (n=12) were included and invited to listen to the 3DV simulator for 15 minutes. Empathy was assessed before and after the 3DV simulation using the Jefferson Scale of Physician Empathy (JSPE©), a scale to evaluate empathy in healthcare professionals. Following the simulation, participants were invited to participate in a brief semi-structured interview consisting of an open-ended and general question about their experiences, along with additional questions. Results Participants (83.3%) found the 3DV simulator interesting and useful. They perceived the simulation as an aid to better understand the patients\' experience and to better identify with their lived realities. Our study did not find a statistically significant difference in the total JSPE© score before and after the simulation (p = 0.797). Conclusion This article addresses the need to enhance the empathy of psychiatry residents towards individuals suffering from auditory hallucinations. One uniqueness of this pilot project is how the simulator was designed collaboratively by a multidisciplinary and inclusive team involving voice hearers throughout the research process. The results of this pilot study presented in this article underscore the necessity of continually improving educational interventions to support the development of empathy among psychiatry residents. They also suggest that the 3DV simulator was well-received by the residents, encouraging the conduct of larger-scale studies.

This study aimed to determine nursing students\' perceptions of dementia and patients with dementia. Specifically, this study sought to illuminate the essential meaning of dementia among nursing students to uncover insights useful for developing patient-centered care rooted in empathy for patients with dementia. This study used a descriptive phenomenological research method. Between August and September 2023, semi-structured interviews were conducted with 15 nursing students. Colaizzi\'s method was used for the manual analysis. After analyzing the interview data on nursing students\' awareness of dementia, four categories, nine theme clusters, and 28 formulated meanings were derived. The four categories were \"View of dementia\", \"Feelings about dementia\", \"Efforts made regarding dementia\", and \"Dementia as a nursing student\". Although nursing students\' perceptions of dementia resulted in negative perspectives and emotions, by looking into coping methods and wishes for dementia, this study also confirmed that nursing students had an awareness of caring for patients with dementia.

UNASSIGNED: The aging of the population highlights the need to establish empathetic connections with older adults. To achieve this, age simulation suits have been designed, allowing users to experience the physical limitations associated with aging. This study aimed to evaluate the experience of dental students with these devices, using psychometric tools to measure the impact on their understanding and empathy.
UNASSIGNED: A pre/post-test study was conducted with the participation of 63 dental students from Rey Juan Carlos University who were fitted with an age simulation suit and asked to perform different tasks. Psychometric tools were used to assess specific parameters. Empathy was measured using the Jefferson Empathy Scale, emotional intelligence was assessed with the Trait Meta-Mood Scale-24 (TMMS-24), and the emotional attention dimension was analyzed using the Positive and Negative Affect Schedule (PANAS).
UNASSIGNED: The scores on the Jefferson Empathy Scale significantly improved from 88.44 ± 6.8 to 91.06 ± 10.11 after using the simulation suit (P < 0.026). Pearson\'s product moment correlation analysis showed no significant positive association or correlation between age and scores from the three questionnaires. In the rest, a positive and significant correlation was observed (P < 0.0001).
UNASSIGNED: Age simulation activities effectively enhance empathy among dental students. However, more studies are needed to foster positive attitudes toward aging and prevent negative stereotypes.