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
Must be a 3rd or 4th-year student in the Department of Nursing at Başkent University.
Must be willing to participate in the study.
Any kind of disability.
A visually-related problem
Factorial
Disability Awareness Education
BehavioralParticipants 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.
Virtual Reality Group
BehavioralParticipants 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.
Standart Patient Group
BehavioralParticipants 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
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.
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.
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