Enhancing Communication and Empathy Skills in Geriatric Care: Nurses' Reflections on Simulation‐Based Training for Patient Interaction and Education

ABSTRACT

Aim

To explore the impact of simulation‐based training on communication and empathy skills among nurses working with elderly patients in the Abha region of Saudi Arabia. The study also aimed to identify the barriers and facilitators to applying these skills in real‐world clinical practice.

Design

A qualitative study.

Method

Semi‐structured interviews were conducted between June and July 2024 with 17 nurses from urban and rural healthcare settings in the Abha region. Data were analysed using both deductive framework analysis, guided by social support theory, and inductive thematic analysis to identify key themes related to communication, empathy, and the application of simulation‐based skills in practice. We adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist.

Results

The study involved 17 participants aged 22–50 years, with diverse educational backgrounds and work experience. The findings indicated that simulation‐based training significantly improved nurses' confidence in delivering difficult news and their ability to empathise with elderly patients. Nurses working in urban settings with regular access to simulation training reported better outcomes compared to those in rural settings with less frequent training opportunities.

Conclusion

Simulation‐based training has a positive impact on enhancing communication and empathy skills among nurses, but challenges in real‐world application remain. Efforts should be made to improve the accessibility of simulation training and address the barriers preventing its effective implementation in clinical practice.

Implication for the Profession and/or Patient Care

Healthcare practitioners and policymakers should prioritise simulation‐based training in nursing education and professional development to improve the quality of care for elderly patients.

Reporting Method

The Consolidated Criteria for Reporting Qualitative Research (COREQ).

Patient or Public Contribution

The engagement and interview data from nursing participants provided valuable insights into the impact of simulation‐based training on communication and empathy in elderly care.

Summary.

• This paper examines the impact of simulation‐based training on communication and empathy skills among nurses working with elderly patients in Saudi Arabia.

• It identifies key factors that influence the effectiveness of simulation‐based training, emphasising how it enhances nurses' ability to deliver difficult news and empathise with elderly patients.

• The paper highlights challenges faced by nurses in applying the skills learnt through simulation in real‐world clinical settings, including time constraints, high patient loads, and technological limitations.

• The findings offer valuable insights for improving the accessibility and effectiveness of simulation‐based training in nursing practice, aiming to enhance care for elderly patients.

• Future research could explore ways to address barriers to applying simulation skills in practice and investigate the role of technology in making simulation training more accessible and scalable.

1. Introduction

The global population is ageing at an unprecedented rate, placing increasing demands on healthcare systems worldwide. According to the World Health Organisation, the number of people aged 60 years and older is expected to double by 2050, making up more than 20% of the global population (World Health Organisation ²⁰²⁰). This demographic shift brings with it significant challenges in healthcare, particularly in the realm of geriatric care. Older adults often experience complex medical conditions, including chronic diseases, cognitive impairments, and multimorbidity, which require specialised care that is not only medically proficient but also emotionally and socially sensitive (Maresova et al. 2019). As the need for quality geriatric care grows, the role of healthcare professionals, particularly nurses, becomes even more critical (Tavares et al. 2017). Nurses are frequently at the forefront of patient care, engaging directly with elderly individuals, advocating for their needs, and ensuring that their health and emotional well‐being are prioritised (Shaban et al. 2024).

However, the nature of elderly care presents unique challenges for nurses. Communicating effectively with older adults can be difficult due to various age‐related factors such as cognitive decline, sensory impairments, and frailty (Harsi et al. 2023). Moreover, nursing care for elderly patients often involves sensitive and emotionally charged situations, such as delivering a terminal diagnosis, discussing treatment plans for chronic illnesses, and managing complex care needs in end‐of‐life scenarios (Yustisia et al. 2023). As a result, nurses must not only possess strong clinical skills but also exceptional communication abilities, including the capacity for empathy, active listening, and patience.

Simulation‐based training has emerged as a promising solution to address these challenges by enhancing the clinical and interpersonal competencies of healthcare professionals (Elendu et al. 2024). Originally a tool for training in technical skills and procedures, simulation in nursing education has evolved to include interpersonal skills such as communication and empathy. Simulation‐based training allows nurses to engage in realistic patient scenarios, honing their ability to interact effectively with patients in a controlled, low‐risk environment (Koukourikos et al. 2021). Through simulated interactions, nurses can practice communication strategies, build confidence in handling difficult patient scenarios, and reflect on their emotional responses, all of which contribute to improved patient outcomes in real‐world clinical settings (Hsu, Huang, and Hsieh ²⁰¹⁴). This paper aims to explore the impact of simulation‐based learning on enhancing communication and empathy skills among nurses working with elderly patients.

2. Background

The importance of effective communication and empathy in nursing practice, particularly in geriatric care, cannot be overstated. Effective communication is foundational to providing patient‐centred care, a core principle in nursing practice (Stojanović et al. 2024). When caring for elderly patients, nurses must navigate a range of barriers that can complicate communication, such as cognitive decline, hearing and vision impairments, and difficulties with mobility. These barriers can make it challenging for nurses to assess patient needs, deliver appropriate care, and foster trust between the patient and the healthcare team (Wilson and Small 2020). In addition, elderly patients often experience multiple chronic conditions, requiring complex care management, which demands clear communication among interdisciplinary teams and between nurses and patients or their families (Geese and Schmitt 2023).

Furthermore, the emotional and psychological needs of elderly patients require nurses to approach care with empathy and understanding. Empathy is defined as the ability to recognise and share the feelings of others, and it plays a crucial role in establishing rapport, ensuring patient comfort, and improving adherence to treatment plans (Wu 2021). In geriatric care, empathy is particularly important, as many elderly patients face significant emotional and physical challenges, including isolation, frailty, and the loss of independence. Nurses must be equipped to provide compassionate care that respects the dignity and preferences of elderly patients, while also managing the complexities of their medical conditions (Fuseini et al. 2023).

Despite the growing recognition of these challenges, traditional nursing education has often emphasised technical skills at the expense of soft skills such as communication and empathy (Al‐Omari et al. ²⁰²⁴). However, the importance of these skills is becoming increasingly acknowledged as critical to improving the quality of care in geriatric settings. Recent studies have highlighted that effective communication and empathetic interactions between healthcare providers and elderly patients are linked to better patient satisfaction, improved clinical outcomes, and enhanced quality of life for older adults (Sharkiya 2023). Consequently, there has been a shift in nursing education towards integrating simulation‐based training to enhance these soft skills, providing nurses with opportunities to practice in realistic but risk‐free settings (Eyikara and Baykara 2017; Hegland et al. ²⁰¹⁷).

Simulation‐based training, once primarily used to teach technical skills, has gained traction in nursing curricula for its ability to address both clinical and interpersonal aspects of patient care (Mishra, Hemlata, and Trivedi ²⁰²³). High‐fidelity simulations, which involve realistic patient scenarios using mannequins or standardised patients, have been shown to enhance nurses' decision‐making abilities, improve communication skills, and boost confidence in managing complex situations (Alconero‐Camarero et al. ²⁰²¹). Simulation allows nurses to engage in scenarios that mimic real‐world challenges—such as delivering bad news to a patient or managing difficult conversations about end‐of‐life care—without the pressure of real‐life consequences (Kozhevnikov, Morrison, and Ellman ²⁰¹⁸). By providing a psychologically safe space for nurses to develop their communication and empathy skills, simulation can significantly improve the preparedness of nurses to handle the complexities of geriatric care (Bouwmeester Stjernetun, Hallgren, and Gillsjö ²⁰²⁴).

Despite the promising evidence supporting simulation as an educational tool, there is limited research specifically exploring its impact on communication and empathy in geriatric nursing. While some studies have shown that simulation improves clinical skills and teamwork (Chua et al. 2021), there remains a gap in understanding how it can directly affect nurses' ability to communicate with elderly patients, particularly in emotionally charged or difficult clinical situations. Additionally, the impact of simulation training on nurses' confidence in applying these skills in real‐world settings is not fully understood. This study seeks to address these gaps by exploring how simulation‐based training can improve communication and empathy in geriatric care, specifically from the perspective of nurses.

3. The Study

3.1. Aim(s)

The aim of this study is to explore the efficacy of simulation‐based learning in enhancing effective communication and empathy in nursing care for elderly patients.

3.2. Research Questions

1. How do nurses perceive the impact of simulation‐based training on their communication skills with elderly patients?

2. In what ways does simulation‐based training help nurses develop empathy for elderly patients, particularly in complex scenarios such as dementia care or end‐of‐life conversations?

3. What barriers or challenges do nurses encounter in applying the skills learnt through simulation in real‐world geriatric care settings?

3.3. Technical Terminology Used to Describe the Aim(s)

• Simulation‐based training: Refers to an educational approach that replicates real‐world clinical scenarios using technology or role‐playing to enable nurses to practice and enhance their clinical and interpersonal skills in a controlled environment.

• Communication skills: The ability to effectively exchange information with patients, using both verbal and non‐verbal methods, to foster understanding, trust, and collaboration.

• Empathy: The ability to understand and share the feelings of others, especially important when dealing with elderly patients who may be experiencing physical or emotional challenges.

• Geriatric care: The specialised branch of healthcare focused on meeting the unique medical and psychosocial needs of elderly individuals.

4. Materials and Methods

4.1. Design

This study employed a qualitative descriptive research methodology to explore the impact of simulation‐based training on improving communication and empathy skills among nurses working with elderly patients. A qualitative approach was chosen to gain an in‐depth understanding of the nurses' experiences and perceptions regarding the effectiveness of simulation in enhancing their interpersonal skills. The research adhered to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist to ensure the study met the recommended standards for reporting qualitative data (Tong, Sainsbury, and Craig ²⁰⁰⁷).

4.2. Study Setting and Recruitment Criteria

The study was conducted in the Abha region of Saudi Arabia, where nurses from various healthcare settings were recruited to participate. The study aimed to explore the impact of simulation on communication and empathy skills, specifically in the context of geriatric care. The sample consisted of 17 nurses, which was determined through saturation sampling—indicating that data saturation was achieved when no new themes emerged during the interviews.

To ensure diversity in the sample, the study employed purposive sampling techniques, recruiting nurses from different hospitals and healthcare centres in Abha. This allowed for a broad range of perspectives on the impact of simulation‐based training. Inclusion criteria for participation were as follows:

• Age: Nurses aged 22–50 years, ensuring a representative age range within the nursing workforce.

• Experience: Nurses who had participated in simulation‐based training programs for communication and empathy within the last 6 months.

• Willingness to participate: Nurses who provided informed consent to participate and engage in the interview process.

• Work environment: Nurses from both urban and rural healthcare settings were included to capture a diverse set of experiences.

Exclusion criteria included nurses who had not undergone simulation training or who were not directly involved in geriatric care.

Recruitment was conducted through healthcare institutions in Abha, with assistance from hospital administration to ensure recruitment covered different specialisations and practice settings. A combination of in‐person invitations and email solicitations was used, with interested nurses asked to contact the research team directly. The sample size of 17 was deemed sufficient based on the achievement of data saturation, meaning no new information or insights emerged during the interviews.

4.3. Theoretical Framework

The interview guidelines were developed based on the Social Cognitive Theory (Bandura 1986), which emphasises learning through observation and practice, and the Conceptual Framework for Empathy in Healthcare (Mercer and Reynolds 2002). These frameworks were adapted to explore how simulation‐based training can enhance communication and empathy in nursing practice, particularly when working with elderly patients. The theoretical foundation informed the development of the interview guide, ensuring that it addressed key themes such as nurses' perceptions of simulation effectiveness, the role of empathy in nursing practice, and challenges faced in geriatric care settings. In addressing the theoretical underpinnings of empathy within the framework of nursing education, it is important to distinguish between its cognitive and affective components. Cognitive empathy, often referred to as ‘perspective taking,’ enables nurses to understand the feelings and thoughts of their patients without necessarily sharing those feelings. Affective empathy involves sharing the emotional experiences of others, facilitating a compassionate and empathetic response to their situations.

The interview guide consisted of 12 semi‐structured questions designed to explore the following areas:

1. The perceived impact of simulation‐based training on communication skills with elderly patients.

2. The influence of simulation on developing empathy and emotional resilience in challenging patient interactions.

3. The perceived relevance of simulation in preparing nurses for real‐world geriatric care situations.

4. The barriers and challenges in applying skills learnt through simulation in actual practice.

The interview guide was reviewed by a panel of qualitative research experts to ensure its clarity and cultural appropriateness before data collection began.

4.3.1. Simulation Intervention

In the simulation‐based learning activities, both high‐fidelity manikins and standardised patients were employed to provide a realistic and immersive experience for the nursing participants. The use of high‐fidelity manikins allowed for the replication of complex medical conditions and offered participants the opportunity to practice technical nursing skills in a controlled environment. Standardised patients, who were trained actors, were utilised to simulate the interpersonal aspects of patient care, particularly scenarios that required sensitive communication and the demonstration of empathy.

The clinical scenarios were carefully designed to reflect common and challenging situations that nurses may encounter in geriatric care. These included delivering a diagnosis of a progressive illness such as Alzheimer's disease, discussing end‐of‐life care options with a patient and their family, and managing a patient's distress over loss of independence due to physical decline. Each scenario was scripted to elicit specific communication challenges and emotional responses, providing participants with opportunities to practice and refine both their verbal and non‐verbal communication skills.

4.4. Data Collection

Data collection was conducted by the primary investigator (M.SH.) and co‐investigator (S.A.), both of whom are experienced qualitative researchers fluent in Arabic. Interviews were conducted in Arabic to ensure clear communication and to respect the participants' preferred language for discussing sensitive topics such as patient care. Interviews took place in private, quiet rooms in the hospitals or community centres, ensuring a comfortable and confidential environment for participants.

Initial semi‐structured interviews were conducted with all participants, each lasting approximately 30–45 min. The researchers explained the purpose of the study, the nature of the interview, and the confidentiality of responses to all participants prior to the interviews. Participants were encouraged to share their experiences openly. All interviews were audio‐recorded with the participants' consent and transcribed verbatim within 48 h.

After initial interviews, follow‐up interviews were conducted with 5 of the 17 participants to clarify and expand on key themes identified during the first round of interviews. The follow‐up interviews lasted between 20 and 30 min and were conducted 2–4 weeks after the initial interviews. These follow‐up interviews allowed for further exploration of emerging themes and provided an opportunity to validate the findings. The researchers also employed member checking during these follow‐ups, where participants reviewed the transcripts for accuracy and provided additional feedback.

Field notes were taken during the interviews to capture any non‐verbal cues and contextual details that could provide additional insights into the interview process. These notes were used alongside the transcriptions during data analysis.

4.5. Data Analysis

Data analysis was performed using a combination of deductive and inductive approaches. Initially, a deductive framework analysis was applied, guided by the theoretical frameworks of Social Cognitive Theory and the Conceptual Framework for Empathy in Healthcare. This framework focused on predefined categories such as communication skills, empathy development, and the perceived impact of simulation on real‐world practice.

Simultaneously, an inductive thematic analysis was conducted to allow for the emergence of unanticipated themes. This allowed the researchers to capture participants' nuanced perspectives and insights on the challenges and benefits of simulation‐based training, particularly as it relates to geriatric care.

Data were managed and analysed using NVivo12, a qualitative data analysis software, which allowed for systematic coding and organisation of the interview data. The primary investigator (M.SH.) and co‐investigator (S.A.) independently coded the data and then met regularly to compare and discuss their findings. Any discrepancies in coding were resolved through discussion, and in cases where consensus could not be reached, a third researcher with expertise in qualitative analysis was consulted.

The final themes and interpretations were validated through member checking, with a subset of the initial participants reviewing the preliminary findings to ensure accuracy and resonance with their lived experiences.

4.6. Ethical Considerations

The study received ethical approval from the Institutional Review Board (IRB) at King Khalid University, Abha, Saudi Arabia. The study adhered to the ethical principles outlined in the Declaration of Helsinki and ensured the privacy, confidentiality, and voluntary nature of participation for all nurses involved.

Informed consent was obtained from all participants before their involvement in the study. Participants were fully informed about the study's objectives, the voluntary nature of their participation, and their right to withdraw from the study at any time without any consequence. All data were anonymised, and interview transcripts were stored securely in password‐protected files accessible only to the research team.

5. Findings

5.1. Characteristics of Participants

In assessing the impact of simulation‐based learning on communication and empathy skills, our study involved a diverse group of 17 nurses. The participants varied in age, educational background, and years of experience, reflecting a broad spectrum of the nursing workforce in geriatric care. For a detailed breakdown of the participants' demographics, including age, gender, educational qualifications, and work settings, please refer to Table 1.

TABLE 1.

Demographic data of the participants.

Participant ID	Gender	Age	Education level	Work setting	Years of experience	Frequency of simulation training
P1	Female	28	Bachelor's Degree	Urban Hospital	5	Regular (monthly)
P2	Male	34	Diploma	Rural Healthcare	8	Occasional (quarterly)
P3	Female	45	Master's Degree	Urban Hospital	15	Regular (bi‐monthly)
P4	Male	29	Bachelor's Degree	Urban Hospital	7	Regular (monthly)
P5	Female	38	Bachelor's Degree	Urban Hospital	12	Regular (quarterly)
P6	Male	32	Diploma	Rural Healthcare	5	Occasional (semi‐annually)
P7	Female	24	Bachelor's Degree	Urban Hospital	2	Regular (monthly)
P8	Male	40	Master's Degree	Urban Hospital	10	Regular (bi‐monthly)
P9	Female	36	Bachelor's Degree	Rural Healthcare	6	Occasional (semi‐annually)
P10	Male	50	Diploma	Urban Hospital	20	Regular (quarterly)
P11	Female	31	Bachelor's Degree	Urban Hospital	8	Regular (monthly)
P12	Male	43	Bachelor's Degree	Rural Healthcare	12	Occasional (quarterly)
P13	Female	30	Bachelor's Degree	Urban Hospital	6	Regular (monthly)
P14	Male	27	Master's Degree	Urban Hospital	4	Regular (bi‐monthly)
P15	Female	42	Bachelor's Degree	Urban Hospital	14	Regular (monthly)
P16	Male	36	Diploma	Rural Healthcare	9	Occasional (semi‐annually)
P17	Female	25	Bachelor's Degree	Urban Hospital	3	Regular (monthly)

5.2. Thematic Analysis

Table 2 highlights the four main themes identified in this study regarding the impact of simulation‐based training on communication and empathy skills among nurses working with elderly patients. These themes are elaborated below.

TABLE 2.

Thematic results: impact of simulation‐based training on communication and empathy in geriatric nursing.

Theme	Sub‐theme	Description
Enhanced Communication Skills	Increased Confidence in Delivering Difficult News	Nurses reported higher confidence in delivering bad news, enhanced by role‐playing scenarios that simulated real‐life challenges
	Improved Interpersonal Communication with Patients	Simulation enhanced verbal and non‐verbal communication skills, allowing nurses to better understand and respond to elderly patients' needs
Development of Empathy	Understanding the Emotional Needs of Elderly Patients	Nurses gained a deeper understanding of the emotional and psychological challenges faced by elderly patients, leading to more compassionate care
	Emotional Resilience in Challenging Situations	Simulation helped nurses develop emotional resilience, enabling them to manage their feelings while providing empathetic care
Barriers to Applying Skills in Practice	Time Constraints and High Workload	Nurses found it difficult to apply simulation skills due to the fast‐paced nature of clinical settings and heavy patient loads
	Lack of Realistic Scenarios in Clinical Practice	Nurses noted that real‐world settings posed unique challenges that could not always be replicated in simulation
Perceived Benefits and Challenges	Positive Impact on Team Collaboration	Nurses reported improved teamwork and interdisciplinary communication following simulation‐based training
	Technological Challenges in Implementing Simulation	Technological issues were identified as a barrier to the effective implementation of simulation‐based training

5.3. Theme 1: The Enhancement of Communication Skills Through Simulation

5.3.1. Sub‐Theme 1: Increased Confidence in Delivering Difficult News

Nurses reported that simulation‐based training significantly enhanced their ability to communicate difficult news to elderly patients, particularly in end‐of‐life scenarios or chronic disease diagnoses. Many participants noted that prior to the simulation, they felt anxious and uncertain about how to approach such sensitive topics. However, after engaging in simulated scenarios, nurses felt more prepared and confident. For example, P1 stated, “Before the simulation, I was terrified of delivering bad news to my patients. Now, I feel more confident in managing these conversations with empathy and clarity.” Observations of nurses practicing these scenarios revealed improved tone of voice, body language, and ability to pause for emotional responses, all of which contributed to better patient engagement.

5.3.2. Sub‐Theme 2: Improved Interpersonal Communication With Patients

Several nurses emphasised that the practice of role‐playing patient interactions during simulation allowed them to better understand the patient's perspective, improving both verbal and non‐verbal communication skills. P5 mentioned, “I've learnt to listen more intently and to give patients time to express their feelings. The simulation really helped me practice patience in those moments.” Nurses also indicated that simulation helped them develop skills in reading non‐verbal cues, which are particularly important in elderly patients who may have difficulty articulating their needs.

5.4. Theme 2: Development of Empathy Through Simulation

5.4.1. Sub‐Theme 1: Understanding the Emotional Needs of Elderly Patients

Simulation‐based training allowed nurses to better empathise with elderly patients' emotional and psychological needs, especially when managing chronic illnesses or dementia. P12 shared, “After the simulation, I realised how important it is to acknowledge the emotional burden elderly patients face when dealing with multiple conditions. I'm more sensitive to their needs now.” Observational data supported this, as nurses were noted to engage more meaningfully with patients, asking questions and offering reassurance during clinical scenarios.

5.4.2. Sub‐Theme 2: Emotional Resilience in Challenging Situations

Nurses noted that simulations also helped them build emotional resilience when dealing with difficult patient scenarios. Through repeated practice, they were able to manage their own emotional responses and maintain empathy without becoming overwhelmed. P8 explained, “The simulation helped me stay calm and composed in emotionally charged situations. I can now better manage my own feelings while providing compassionate care to my patients.”

5.5. Theme 3: Barriers to Applying Simulation Skills in Real‐World Settings

5.5.1. Sub‐Theme 1: Time Constraints and High Workload

Despite the positive impact of simulation training, many nurses expressed that applying the communication and empathy skills learnt in real‐world practice was challenging due to time constraints and high patient loads. P3 remarked, “It's hard to apply everything we learnt in simulation because the hospital is so busy. There's not enough time to connect with patients the way I want to.” Observations revealed that nurses in high‐demand settings often struggled to maintain the empathetic communication styles practiced in simulations due to the pressure of quickly moving between patients.

5.5.2. Sub‐Theme 2: Lack of Realistic Scenarios in Clinical Practice

Some nurses also noted that while simulations provided controlled environments for practicing complex interactions, real‐world clinical settings presented unique challenges that could not always be simulated. P6 shared, “Simulation is great for practicing scenarios, but in real life, you might not have the same amount of time or emotional space to engage with the patient fully. It's harder when you have to juggle multiple tasks.” This sentiment was reflected in observational data, where nurses were observed handling real patient interactions with less emotional engagement due to the fast‐paced nature of clinical care.

5.6. Theme 4: Perceived Benefits and Challenges of Simulation‐Based Training

5.6.1. Sub‐Theme 1: Positive Impact on Team Collaboration and Interdisciplinary Communication

Many nurses reported that simulation‐based training also fostered better teamwork and communication with other healthcare professionals, particularly in interdisciplinary settings. P7 noted, “Simulation not only helped with my communication with patients, but it also improved how I collaborate with doctors, physiotherapists, and other nurses. We've learnt to be more coordinated during patient care.” Observational data highlighted that nurses working in teams during simulation scenarios were able to better coordinate patient care, demonstrating improved collaboration across disciplines.

5.6.2. Sub‐Theme 2: Technological Challenges in Implementing Simulation

While simulation was generally well‐received, some nurses pointed to technological limitations as a barrier to fully benefiting from simulation‐based training. P11 explained, “Sometimes the equipment isn't working properly, or the scenario doesn't feel as realistic because of technical issues. It can be frustrating.” This challenge was noted during a few simulation sessions, where technical difficulties occasionally disrupted the flow of the training, leading to decreased engagement and frustration among participants.

6. Discussion

This qualitative study explored the impact of simulation‐based training on communication and empathy skills among nurses working with elderly patients in the Abha region, Saudi Arabia. The findings provide valuable insights into how simulation‐based training influences the ability of nurses to communicate effectively and empathise with elderly patients, particularly in complex, emotionally charged situations.

6.1. Improved Communication and Empathy

Our study revealed that simulation‐based training had a positive impact on nurses' communication and empathy skills. Nurses reported increased confidence in delivering difficult news and better interpersonal communication with elderly patients. This finding is consistent with research by Owen et al. (2022), who highlighted the effectiveness of simulation in helping healthcare professionals develop the necessary skills to handle sensitive and complex patient interactions. The ability to rehearse communication strategies in a controlled, risk‐free environment allowed nurses to practice empathy, improve their verbal and non‐verbal communication, and feel more prepared for real‐life interactions. This is in line with previous studies that emphasise the value of simulation for enhancing soft skills, such as empathy and patient interaction (Chen 2011; Kruijver et al. ²⁰⁰¹).

In particular, the increased confidence in delivering difficult news reported by participants aligns with the work of Amsalem et al. (2021), who found that simulation training can provide healthcare professionals with the tools they need to manage emotionally sensitive conversations. Nurses in this study expressed a heightened ability to communicate effectively with elderly patients dealing with chronic illnesses or cognitive decline, underscoring the importance of simulation in preparing nurses for the specific challenges of geriatric care.

6.2. Barriers to Applying Skills in Clinical Practice

Despite the positive impact of simulation on communication and empathy skills, the study also highlighted several barriers to applying these skills in clinical practice. Time constraints and high patient loads were significant challenges, particularly in busy hospital settings, which made it difficult for nurses to engage with patients in the way they had practiced during simulation. This finding aligns with research by Thornhill‐Miller et al. (2023), which noted that the fast‐paced nature of healthcare environments often restricts the ability of nurses to maintain the level of empathy and communication practiced in training scenarios. Nurses in this study expressed frustration that the time pressures of real‐world practice sometimes prevented them from fully implementing the communication techniques and empathetic responses they had learnt through simulation.

Additionally, some nurses reported that while simulations provided valuable practice, real‐life clinical settings posed unique challenges that could not always be replicated in training scenarios. P6's comment about the difficulty of applying simulation skills in a busy ward setting, where multiple tasks must be managed simultaneously, echoes the findings of McGaghie et al. (2006), who argued that the lack of time and space for meaningful patient interactions can undermine the application of skills learnt in simulation.

6.3. Technological Limitations and Training Accessibility

Another challenge identified in the study was the technological limitations in implementing high‐fidelity simulations. Several nurses expressed concerns that technical difficulties, such as malfunctioning equipment, detracted from the effectiveness of the training. This finding is consistent with the work of Sanchez et al. (2023), who reported that technological issues in simulation‐based education can disrupt learning and reduce the realism of training scenarios. Although technological advancements in simulation offer opportunities for more immersive and realistic training, the findings of our study suggest that adequate resources and technical support are crucial for ensuring the success of simulation‐based training programs (Ajemba, Ikwe, and Chioma Iroanya ²⁰²⁴).

Moreover, the accessibility of simulation‐based training was a concern for nurses working in smaller healthcare settings or in rural areas, where resources for such training may be limited. Nurses in these settings reported fewer opportunities to participate in regular simulation sessions, which might limit their exposure to these critical learning experiences. This supports the findings of Alrashidi et al. (2023), who noted that disparities in access to simulation training could affect the overall quality of patient care, particularly in less resourced settings.

6.4. Interdisciplinary Collaboration Through Simulation

An unexpected benefit of simulation‐based training, as highlighted in our findings, was the enhancement of interdisciplinary collaboration. Many nurses reported improved communication and teamwork with other healthcare professionals after participating in simulation scenarios. This aligns with the work of Rosen et al. (2018), who found that simulation can strengthen collaboration and teamwork within multidisciplinary teams. Nurses emphasised the importance of effective communication across disciplines when caring for elderly patients, especially when managing complex cases that require coordinated care from different healthcare providers (Karam et al. 2021).

This theme of enhanced teamwork through simulation suggests that training programs could be expanded to include more interdisciplinary scenarios, allowing nurses to practice not only with other nurses but also with doctors, physiotherapists, and other healthcare providers. This could improve the overall quality of care for elderly patients, ensuring that all team members are on the same page and that patients receive holistic, coordinated care.

The impact of simulation‐based learning on the enhancement of empathy in nursing practice was evident through both qualitative and quantitative feedback from participants. For instance, in one scenario involving a patient nearing end‐of‐life, nurses practiced delivering sensitive news with empathy, focusing on verbal and non‐verbal communication skills. Post‐simulation reflections revealed a significant increase in nurses' confidence and ability to empathise with patients and their families. These findings align with recent research indicating that simulation training can effectively bridge the gap between theoretical knowledge of empathy and its practical application in clinical settings (Elendu et al. 2024). This enhancement of empathetic skills is not only crucial for improving patient care but also for fostering deeper professional satisfaction among nurses, as they feel better equipped to handle complex emotional situations in their practice.

6.5. Strengths and Limitations

The findings of this study offer important insights into the impact of simulation‐based training on communication and empathy skills among nurses working with elderly patients. These insights are essential for improving the quality of care for elderly populations, especially in contexts where communication is a critical component of patient‐centred care. However, there are several limitations that must be considered when interpreting the results.

Firstly, the study focused on nurses from the Abha region in Saudi Arabia. This specific geographical context may limit the generalisability of the findings to other regions or countries with different cultural, socio‐economic, or healthcare system characteristics. While the insights gained from the Abha region are valuable, caution should be exercised when applying these findings to other settings, as cultural nuances and healthcare practices may differ significantly. Future research could expand the geographical scope to include nurses from different regions of Saudi Arabia or from other countries with varying healthcare contexts to enhance the external validity of the findings.

Secondly, the study's qualitative nature provides in‐depth insights into nurses' perceptions and experiences, but it lacks the ability to quantify the impact of simulation‐based training on real‐world practice. The subjective nature of the data means that participants' experiences may be influenced by personal biases or the social desirability of their responses. While observational data were used to mitigate this bias, discrepancies between what participants report and their actual behaviours cannot be ruled out. A mixed‐methods approach, incorporating both qualitative and quantitative data, could offer a more comprehensive assessment of the effectiveness of simulation‐based training in enhancing communication and empathy skills.

While this study provides significant insights into the enhancement of empathy through simulation‐based learning, there are inherent limitations in how empathy is measured that must be acknowledged. The Jefferson Scale of Empathy, although widely used and validated within health professions education, primarily captures cognitive aspects of empathy. This scale may not fully encapsulate the affective dimensions of empathy, which are equally critical in nursing practice. Thus, the quantitative findings might not completely reflect the depth and nuance of empathy development that occurs through experiential learning.

Moreover, the reliance on self‐reported measures introduces potential bias, as participants might provide socially desirable responses or may not be fully aware of subtle changes in their empathetic behaviours. Although we attempted to mitigate these limitations by incorporating qualitative measures such as reflective journals and debriefing sessions, these methods also have their constraints. The subjective nature of qualitative data can vary widely between participants and is dependent on individual willingness to share personal reflections, which might not always accurately represent their true feelings or changes in empathy.

Future research could benefit from incorporating more diverse and objective measures of empathy, including observational tools or third‐party assessments during simulations, to provide a more comprehensive and balanced evaluation of how simulation‐based learning impacts empathetic skills in nursing students.

7. Conclusions

This qualitative study underscores the significant impact of simulation‐based training in improving communication and empathy skills among nurses working with elderly patients. The findings suggest that simulation can help nurses feel more confident in managing difficult patient interactions and enhance their ability to empathise with elderly patients facing complex medical and emotional challenges. However, applying these skills in real‐world clinical settings remains challenging due to time constraints, high patient loads, and other contextual factors.

Future research should focus on expanding simulation‐based training programs to ensure they are accessible to nurses in various healthcare settings, including those in rural or underserved areas. Additionally, research should investigate how technology can enhance the scalability and accessibility of simulation training, making it a viable option for more nurses across different contexts.

Finally, there is a need to explore how simulation training can be integrated into routine clinical practice to ensure that nurses can apply their enhanced communication and empathy skills in everyday patient care situations.

8. Relevance to Clinical Practice

This study provides valuable insights into the role of simulation‐based training in enhancing communication and empathy skills among nurses, which are crucial for improving the quality of care for elderly patients. The findings highlight the need for healthcare practitioners and policymakers (healthcare practitioners encompass a broad range of professionals directly involved in patient care). This includes registered nurses, nurse practitioners, physicians, physician assistants, and allied health professionals such as physical therapists and occupational therapists, who prioritise simulation‐based education in nursing curricula and ongoing professional development. By fostering better communication and empathy, simulation training can improve the patient experience, particularly for elderly individuals who often face complex health challenges and require sensitive care.

Furthermore, the study emphasises the importance of addressing the barriers to applying simulation‐based skills in real‐world practice, such as time constraints and heavy patient loads. Interventions aimed at improving the accessibility of simulation training and creating a supportive environment for nurses to apply their skills could have a profound impact on patient care outcomes.

Finally, healthcare organisations should consider incorporating culturally sensitive approaches into simulation training, recognising the unique challenges that nurses face when caring for elderly patients in culturally diverse settings. Such training can help bridge the gap between theoretical knowledge and practical application, ultimately leading to better care for elderly patients.

Author Contributions

Sobhia Ahmed Abdel Kader Mohammed and Mostafa Shaban: conceptualisation, methodology, investigation, writing – original draft, writing – review and editing. Sobhia Ahmed Abdel Kader Mohammed: resources, supervision. Mostafa Shaban: formal Analysis.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1.

Mohammed, S. A. A. K. , and Shaban M.. 2026. “Enhancing Communication and Empathy Skills in Geriatric Care: Nurses' Reflections on Simulation‐Based Training for Patient Interaction and Education.” Journal of Clinical Nursing 35, no. 10: 4401–4411. 10.1111/jocn.17662.

Data Availability Statement

The datasets generated and/or analysed during the current study are not publicly available due to privacy or ethical restrictions but are available from the corresponding author on reasonable request.