Over the last decades, there has been a growing amount of empirical scientific research on the importance of a good relationship between health professionals and patients for the improvement of the cure and treatment process [1]. The biopsychosocial approaches recognized that health professionals have to consider patients as a whole [2, 3, 4], considering biological, psychological, emotional, and social aspects for appropriate treatment and intervention. A central assumption of the biopsychosocial approach is that every health condition is the result of the interaction between biological, psychological, and social factors.
According to the traditional approach towards health and disease, the disease-centred models in healthcare consider and treat illness merely as an alteration of biological variables, and care and treatment are aimed at compliance [5]. Patients are seen as passive persons for the application of clinical decisions and prescriptions of health specialists, and they do not have the ability to make decisions regarding their illness. The emphasis is placed on the assessment and treatment of the disease. Aspects relating to patients’ life, such as their social life, how their condition affects their relationships, or the emotional reactions to the disease, are mostly overlooked [6].
Conversely, the biopsychosocial approach to health uses a holistic perspective, adopting a person-centred model in which care and treatment are oriented towards concordance [2, 3, 7, 8, 9]. Patients are considered active participants in their care process, and they are responsible for engaging themselves in shared decision-making and influencing their treatment process. Patients are also responsible for the consequences of their decisions and actions taken regarding their health. Biological, psychological, and social factors related to the illness, as well as their interactions, are integrated and considered by healthcare professionals for the comprehension of health, illness, and care [10]. The affective and relational implications of the disease, the treatment, and therapeutic outcomes are brought to the foreground, and they are important together with the biological aspects and diseases.
To this end of placing patients and their illness at the centre of medical attention, physicians and health professionals should recognize relationships and communication as crucial in providing health care. Health specialists need to master interpersonal and communication skills, including the willingness to listen, grasping with interest what the patient communicates, and being aware of the attitudes and psychological characteristics of the patient [11]. Consequently, many educational programs have focused on promoting communication and relationship skills in undergraduate students and healthcare professionals [12, 13, 14, 15, 16]. Effective communication is deemed crucial to high-quality cure and treatment. Besides the technical and practical skills of healthcare professionals, the quality of the relationship between care professionals and patients is essential to affect treatment outcomes and quality of the assistance positively.
To determine if the interaction between clinicians and patients has a beneficial effect on health-related outcomes, different studies were conducted. Kelley et al. [1] conducted a systematic review and meta-analysis of research in which this specific relationship was examined. They suggested that the clinician-patient relationship has a small but statistically significant effect on healthcare outcomes, such as blood pressure, or pain scores. Good interpersonal skills of healthcare professionals and their empathy towards patients have a positive and significant impact on patient satisfaction and adherence to treatment [17, 18, 19], the outcomes of care [20], and a higher agreement on decisions made in the clinical consultation [21]. Studies have also determined empathy as a useful skill for nurses regarding the impact on improved patient outcomes, such as distress and anxiety [22].
Empathy is one of the meaningful skills within the healthcare professional-patient relationship [1, 23]. Moreover, empathy is one of the most powerful personal attributes that health professionals can use to encourage patients’ health modification, such as positive clinical outcomes [24]. Patients should perceive health professionals as empathetic people. Empathy allows patients to feel understood, validated, and respected [25].
More attention has been dedicated to this issue, and the importance of an empathic approach by healthcare personnel has been stressed [26]. However, the research debate on the description and operationalization of empathy is still open, with the related considerations about specific instruments for empathy measurement in the health sector in general and in nursing [26, 27, 28, 29, 30].
Empathy does not have a clear and unambiguous definition [27]. It is a multi-dimensional construct, characterized by cognitive and affective aspects [26]. The cognitive empathy refers to the ability by which health professionals understand patients’ experiences and emotions and have the competence to communicate this understanding to patients. Emotional empathy is related to emotional responses of participation and sharing of healthcare personnel to the patients’ feelings. In a caring relationship, such as the nurse-patient relationship, empathy is principally characterized by the cognitive component [26]. This competence is developed over the course of life and, usually, all individuals are found to have intermediate levels of this ability. However, there are people who have developed more or less empathy. Research studies show that health profession students’ empathy decline over the course of their training [31, 32, 33]. Conversely, some recent studies reported no change or an increase of empathy during undergraduate education [34, 35, 36].
Various instruments were created to measure the empathy level in health-related contexts [27, 28, 30]. One of the most used surveys to measure empathy in the healthcare sector is the Jefferson Scale of Empathy (JSE) [37]. Different versions of the JSE were developed, one for physicians and other health professionals (HP version), one for medical students (S version), and a version for students of other healthcare specialties (HPS version) [26], which has been used in this study.
In recent years, based on these research and theories, health schools have devoted more attention to the implementation of training paths to enhance students’ relational attitudes and skills and improve empathic competence [12, 38].
In this study, we measured the extent of first-year nursing students’ orientation towards empathy. We also evaluated the students’ motivation for choosing nursing studies. Students’ motivation and reason for choosing a nursing university course and nursing as a career have been explored in different research studies. This choice is a result of a combination of internal and external motivational factors and, sometimes, it is not the first option. Students choose the nursing profession based on their desire to help other people and engage in activities and perform a work with a social benefit [39, 40, 41, 42, 43, 44, 45]. External motivational factors, such as career opportunity and job security, are also important in the career choice [39, 43, 44]. Personal health-related experiences, such as hospitalization, illness of a family member, or a volunteering experience, are detected as additional motivations [39, 41, 42]. Furthermore, students choose nursing studies for their interest in science subjects. Internal motivational factors for entering nursing, such as helping others, are the motivational factors most commonly indicated by students.
We expected an association between students’ positive attitude towards the value of health professional empathy and the altruistic motivations for choosing nursing studies. Altruistic motivations refer to the desire to perform voluntary actions in order to generate a benefit for others, promote well-being, and alleviate a need of others [46].
This relationship was previously explored in medical students. A weak association between empathy and reasons for enrolling in medicine was observed [47]. Another research study showed a significant association between empathy scores of first-year medical students and their intention to pursue people-oriented specialties after graduation [48]. In a recent study, a significant positive association between internal motivational factors (such as altruism or caring for patients) for studying medicine and empathy was shown [49]. A different study concluded that there is no association between the JSE scores and speciality interest in osteopathic medical students [50].
This study aimed to observe the association between empathy and reasons for enrolling in nursing, using a qualitative research method to stimulate the disclosure of most subjective information from students. It was expected to find a significant association between empathy scores and altruistic motivations for a nursing choice. Knowing the attitudes towards empathy is useful to plan effective educational interventions to enhance excellent communication skills of students, which are an essential component of clinical competence.