Evaluating a nursing teaching ward-round model integrating empathy mapping into a BOPPPS framework: a cluster-randomized controlled trial

Nursing teaching ward rounds are central to obstetric clinical nursing education, but conventional approaches may give limited attention to empathy and patient-centered care. We evaluated an integrated teaching model incorporating empathy mapping into the Bridge-in, Objectives, Pre-assessment, Participatory Learning, Post-assessment, and Summary (BOPPPS) framework. This parallel, two-arm cluster-randomized controlled trial enrolled 100 nursing interns in 20 naturally formed rotation clusters at a tertiary teaching hospital in China. Clusters were randomized 1:1 to routine nursing teaching ward rounds or the integrated teaching model. Both arms received a 45-min communication-skills session and three 70-min nursing teaching ward rounds over 4 weeks; the intervention arm also received a 45-min empathy-mapping workshop. Critical-thinking disposition was the primary outcome; secondary outcomes were empathy, self-reported communication skills, self-directed learning, and satisfaction with nursing teaching ward rounds. The first four outcomes were assessed at baseline and within one week after the intervention; satisfaction was assessed after the third ward round. All models included a random intercept for rotation cluster; the first four also adjusted for their baseline scores. P values across the five outcomes were Holm-adjusted. Multiple-imputation and cluster-robust sensitivity analyses were performed. The primary analysis included all 20 randomized clusters and 93 interns (intervention, n = 46; control, n = 47). Adjusted mean differences (95% CIs) favoring the intervention were 15.85 (12.67–19.03) for critical-thinking disposition, 4.43 (2.62–6.25) for empathy, 4.55 (2.31–6.80) for self-reported communication skills, 2.38 (0.84–3.93) for self-directed learning, and 6.54 (4.69–8.39) for satisfaction. All Holm-adjusted P values were ≤ 0.005. Multiple-imputation and cluster-robust analyses supported the primary findings. By combining structured instruction with explicit patient-perspective learning in obstetric clinical teaching, the integrated teaching model may improve undergraduate nursing interns’ critical-thinking disposition, empathy, self-reported communication skills, and self-directed learning. It may also increase satisfaction with nursing teaching ward rounds. Longer-term follow-up and performance-based assessments are needed to determine whether the observed differences persist and translate into clinical performance.