The learning method used with the intervention group was role-playing with videos and guided reflection.

The control group was exposed to classroom lectures without video-recorded role-play and guided reflection.

The experimental group was divided into 6 teams. Before the course, the teacher in charge and each group developed six scenarios: restraint, suicidal intent, respiratory distress, chronic heart failure, medication refusal, and accidental amputation. The researcher guided each group to write scripts about the clinical situations (30 minutes), create role-play videos (50 minutes), and share literature that was helpful in understanding this context (30 minutes). Each student played a role in the filming process. The final film was viewed by all the students during class. Each live class session was 50 minutes in length, with one session per week for 6 weeks. All students were asked to attend six video-viewing sessions and participate in a reflective discussion.

The Nursing Student Competence Scale was used to measure students' nursing competence (Huang et al., 2022). Total scale scores ranged from 30 to 150. Higher scores indicate better nursing competence.

Empathy was measured using the Chinese version of the Jefferson Scale of Empathy- Healthcare Providers, developed based on a literature review (Cheng et al., 2011). Total scale scores ranged from 20 to 140. Higher scores indicate more positive empathy.