Physical Therapy Students' Reflective Thinking With Narrative Photography in Heart Transplantation

Physical therapy students must learn about heart transplantation, and must be able to communicate with patients using empathy and moral sensitivity. The aim of the study is to compare the narrative photography (NP) and traditional learning (TL) methods applied to heart transplantation physical therapy, as they relate to physical therapy students' knowledge, empathy, satisfaction, and moral sensitivity.

Study Overview

• Status: Completed
• Conditions: Students
• Intervention / Treatment: Other: Narrative photography; Other: Traditional learning

Detailed Description

Physical therapy students must learn about heart transplantation. They need to know how to attend to the needs and emotions of these patients using empathy and moral sensitivity. The aim of the study is to compare the narrative photography (NP) and traditional learning (TL) methods applied to heart transplantation physical therapy, as they relate to physical therapy students' knowledge, empathy, satisfaction, and moral sensitivity.

This is a randomized contorlled trial with 117 participants of third year of Physiotherapy Degree. Students were divided into two groups: i) NP group (n = 56), and ii) TL group (n = 61).

Physical therapy knowledge in heart transplantation, empathy, and moral sensitivity were measured pre-intervention and post-intervention in both groups. Satisfaction was measured post-intervention in the NP group.

• Study Type: Interventional
• Enrollment (Actual): 117
• Phase: Not Applicable

Contacts and Locations

Study Locations

• Spain
  • Valencia, Spain, 46010
    • University of Valencia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 19 years to 50 years (Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

Inclusion Criteria:

• Third-year physical therapy students who were studying the heart transplantation physical therapy course in a Physical therapy Degree.

Exclusion Criteria:

• Who did not meet the above inclusion criteria.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Other
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Single

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Narrative photography group; Students in the NP group performed training activities on empathy and care for patients undergoing heart transplantation.	Other: Narrative photography; Students were shown real-life written stories, audio, and videos using a private online platform. The training activity included four modules: i) heart transplantation waiting list; ii) life expectancy, fear of death, and organ rejection; iii) post-transplant physical and functional limitations; and iv) lack of knowledge of physical exercise patients can perform. The students were encouraged to think about how they would feel if they had undergone heart transplantation. Afterward, they had to communicate these feelings using up to three photographs and reflective explanatory text. Two weeks later, the students met a heart transplantation expert patient followed by an educator-guided debate. Students' images were shared and discussed. Moreover, students were encouraged to explain their feelings and their acquired skills (two hours).
Active Comparator: Traditional learning group; Students in the TL group performed a conventional intervention without real patients.	Other: Traditional learning; A participatory lecture was carried out, in which cardiac rehabilitation in heart transplantation patients was explained. Then, there was an educator-guided debate about protocols and actions (one hour). Second, the students autonomously prepared clinical cases on physical limitations, physical exercise, risk factors, and life after transplantation (two hours). Two weeks later, the clinical session was held among students (2 hours). They adopted the roles of physical therapists or transplant patients to work on: i) post-transplant physical and functional limitations; ii) lack of knowledge of the physical exercise the patient can perform; iii) control of cardiovascular risk factors; iv) life post-transplant.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Knowledge of physical therapy in heart transplantation	Knowledge of physical therapy in heart transplantation was measured using an ad-hoc multiple-choice questionnaire. To avoid any test preparation, students were not informed that there would be knowledge tests. The tests included 10 multiple-choice questions that assessed physical therapy knowledge of heart transplantation-related issues-this included rate of perceived exertion, cardiopulmonary exercise test, cardiac rehabilitation, symptoms, and signs. The minimum and maximum values were 0 and 10, respectively. Higher scores mean a better outcome.	Baseline
Knowledge of physical therapy in heart transplantation	Knowledge of physical therapy in heart transplantation was measured using an ad-hoc multiple-choice questionnaire. To avoid any test preparation, students were not informed that there would be knowledge tests. The tests included 10 multiple-choice questions that assessed physical therapy knowledge of heart transplantation-related issues-this included rate of perceived exertion, cardiopulmonary exercise test, cardiac rehabilitation, symptoms, and signs. The minimum and maximum values were 0 and 10, respectively. Higher scores mean a better outcome.	After the intervention (2 weeks)

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Empathy using the Interpersonal Reactivity Index	Empathy was measured using the Interpersonal Reactivity Index (IRI). The tool comprises 28 Likert questions ranging from 1 to 5 (1 = it does not describe me at all; 5 = it describes me very well). Four dimensions were explored using this questionnaire. These were perspective taking, fantasy, empathetic concern, and personal distress. Each scale score was the sum of the responses given for each item. The minimum and maximum values were 28 and 140, respectively. Higher scores reflected greater empathy.	Baseline
Empathy using the Interpersonal Reactivity Index	Empathy was measured using the Interpersonal Reactivity Index (IRI). The tool comprises 28 Likert questions ranging from 1 to 5 (1 = it does not describe me at all; 5 = it describes me very well). Four dimensions were explored using this questionnaire. These were perspective taking, fantasy, empathetic concern, and personal distress. Each scale score was the sum of the responses given for each item. The minimum and maximum values were 28 and 140, respectively. Higher scores reflected greater empathy.	After the intervention (2 weeks)
Moral sensitivity with the Revised Moral Sensitivity Questionnaire	Moral sensitivity was measured with the Revised Moral Sensitivity Questionnaire (RMSQ). The questionnaire included nine items rated on a 6-point Likert scale (1 = totally disagree, 6 = totally agree). The RMSQ comprises three dimensions. These are a sense of moral burden, moral strength, and moral responsibility. The minimum and maximum values were 9 and 54, respectively. Higher scores reflected greater moral sensitivity.	Baseline
Moral sensitivity with the Revised Moral Sensitivity Questionnaire	Moral sensitivity was measured with the Revised Moral Sensitivity Questionnaire (RMSQ). The questionnaire included nine items rated on a 6-point Likert scale (1 = totally disagree, 6 = totally agree). The RMSQ comprises three dimensions. These are a sense of moral burden, moral strength, and moral responsibility. The minimum and maximum values were 9 and 54, respectively. Higher scores reflected greater moral sensitivity.	After the intervention (2 weeks)
Satisfaction questionnaire	Satisfaction questionnaire was measured using a narrative photography questionnaire. This tool has previously been used to evaluate students' satisfaction with the narrative photography methodology as a tool to improve their skills and attitudes. This 32-item questionnaire was composed of sociodemographic questions, satisfaction with improving attitude, satisfaction with improving skills, and general satisfaction. It uses a 5-point Likert scale (1 = totally agree, 5 = totally disagree). The percentage of people who have rated each item is then calculated. Additionally, the questionnaire included a reflective open-ended question.	After the intervention (2 weeks)

Collaborators and Investigators

• Sponsor: University of Valencia
• Investigators: Principal Investigator: Elena Marqués Sulé, PhD, Univeristy of Valencia

Publications and helpful links

General Publications

• Leyva-Moral JM, Aguayo-Gonzalez M, Folch C, San Rafael S, Gomez-Ibanez R. Nursing students' perceptions of the efficacy of narrative photography as a learning method: A cross-sectional study. Nurs Health Sci. 2022 Jun;24(2):380-386. doi: 10.1111/nhs.12932. Epub 2022 Mar 3.
• Leyva-Moral JM, Gomez-Ibanez R, San Rafael S, Guevara-Vasquez G, Aguayo-Gonzalez M. Nursing students' satisfaction with narrative photography as a method to develop empathy towards people with Hiv: A mixed-design study. Nurse Educ Today. 2021 Jan;96:104646. doi: 10.1016/j.nedt.2020.104646. Epub 2020 Nov 1.

Study record dates

Study Major Dates

• Study Start (Actual): September 1, 2021
• Primary Completion (Actual): June 30, 2022
• Study Completion (Actual): June 30, 2022

Study Registration Dates

• First Submitted: March 11, 2023
• First Submitted That Met QC Criteria: March 23, 2023
• First Posted (Actual): April 6, 2023

Study Record Updates

• Last Update Posted (Actual): April 6, 2023
• Last Update Submitted That Met QC Criteria: March 23, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: Physiotherapy; Education; Heart transplantation
• Other Study ID Numbers: 1821073

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No