Empathy in Nursing
The most studied empathy literature outside basic psychology is in nursing and medicine. Decades of work using the Jefferson Scale have produced robust findings on what shapes nurse empathy and what it predicts.
The Jefferson Scale of Empathy
Mohammadreza Hojat and colleagues at Thomas Jefferson University developed the Jefferson Scale of Empathy (JSE) in the early 2000s specifically for healthcare contexts. Versions exist for physicians (JSE-HP), medical students (JSE-S), and nursing students. The scale has 20 items rated on a 7-point Likert and yields a single empathy score from 20 to 140.
See Hojat et al. 2001, “The Jefferson Scale of Physician Empathy: Development and preliminary psychometric data,” Educational and Psychological Measurement, doi:10.1177/00131640121971158.
The empathy-decline finding
One of the most discussed (and replicated) findings in healthcare empathy research is the apparent decline in self-reported empathy through medical training. Hojat and colleagues 2009, “The devil is in the third year: A longitudinal study of erosion of empathy in medical school,” Academic Medicine, doi:10.1097/ACM.0b013e3181b17e55, showed that medical students’ JSE scores declined significantly during clinical training.
Similar patterns have been documented in nursing education, though the effect size is generally smaller. Possible mechanisms include emotional self-protection in response to repeated exposure to suffering, hidden-curriculum effects (witnessing senior staff modelling detachment), and sleep deprivation during clinical rotations.
What nurse empathy may predict
| Outcome | Direction of evidence |
|---|---|
| Patient satisfaction | Higher with higher nurse empathy |
| Patient pain reports | Patients report better pain management with more empathic nurses |
| Adherence to care plans | Modest positive association |
| Communication quality | Higher with higher nurse empathy |
| Nurse burnout | Mixed: high empathy without recovery raises risk; high empathy with compassion practice may protect |
| Patient safety incidents | Some evidence empathy is protective via attentiveness; not definitive |
Empathy interventions in nursing education
Several intervention approaches have been studied in nursing curricula:
- Narrative medicine: reading and discussing patient narratives to deepen perspective-taking.
- Simulation with standardised patients: structured practice with feedback on empathic communication.
- Mindfulness training: evidence for reduced burnout and modest improvements in empathy maintenance.
- Reflective journaling: structured reflection on emotionally significant patient encounters.
- Empathy mapping in shift handover: explicit attention to the patient’s emotional state, not just clinical status.
Meta-analyses generally find these interventions produce small to moderate effects on self-reported empathy, with mixed evidence on whether the effects transfer to observed clinical behaviour or patient-reported outcomes.