Auditory Hallucination Simulation and the Development of Empathy Among Undergraduate Nursing Students: An Integrative Review

BACKGROUND: Auditory hallucinations (AHs) are perceptual experiences that can impact communication, daily functioning, and safety. Empathy is essential for effective therapeutic engagement. Nursing students often report feeling unprepared in dealing with individuals who experience AHs. Auditory hallucination simulation (AHSim) has been used in undergraduate nursing education as an experiential learning strategy to enhance empathy and insight. However, evidence regarding its impact on empathy among undergraduate nursing students remains limited. AIMS: This integrative review aimed to synthesize and critically appraise the available evidence on the impact of AHSim on empathy among undergraduate nursing students. METHODS: A systematic search was conducted across PubMed, MEDLINE Complete, and CINAHL Ultimate for studies published between 2016 and 2026. Included studies involved undergraduate nursing students participating in AHSim with reported empathy outcomes. Article selection followed PRISMA 2020 guidelines, and quality was appraised using the Mixed-Methods Appraisal Tool. RESULTS: Four empirical studies met the inclusion criteria. Overall, participation in AHSim was associated with increased self-reported empathy and enhanced understanding of the lived experiences of AHs. Students reported emotional distress and difficulty concentrating during the AHSim, highlighting the burden associated with AHs. CONCLUSION: AHSim appears to be a promising educational strategy to foster empathy among undergraduate nursing students. Incorporating AHSim into mental health nursing education may enhance nursing students' readiness to foster therapeutic nurse-to-patient relationships and to engage effectively with patients. Further research is needed to evaluate the long-term outcomes and the clinical impact of AHSim.