Academic journal article Journal of Nursing Measurement

Reliability and Validity of the Jefferson Scale of Empathy in Undergraduate Nursing Students

Academic journal article Journal of Nursing Measurement

Reliability and Validity of the Jefferson Scale of Empathy in Undergraduate Nursing Students

Article excerpt

Evidence has been reported in support of the reliability and validity of the Jefferson Scale of Physician Empathy (JSPE) when used with physicians, medical students, and nurses. This study examined the psychometrics of a modified version of the scale in undergraduate nursing students. The modified version of the JSPE was administered to 333 nursing students at different levels of training. Three underlying constructs, that is, "Perspective Taking," "Compassionate Care," and "Standing in Patient's Shoes" emerged from the factor analysis of the scale that were consistent with the conceptual framework of empathy, thus supporting the construct validity of the scale. The coefficient alpha was .77. Scores of the empathy scale were significantly correlated with the scores of the Jefferson Scale of Attitudes toward Physician-Nurse Collaboration ( r = .38, p < .001). Women scored higher than men, and those with more clinical experiences scored higher than others. It was concluded that the empathy scale used in this study is a psychometrically sound instrument for measuring empathy in undergraduate nursing students.

Keywords: empathy; nursing students; validity; reliability

Empathy is well established as the attribute most essential in understanding another person and for promoting the health of that person (Benner & Wrubel, 1989; Kalisch, 1973). It has been reported that empathy in the clinical environment leads to greater patient satisfaction (Bertakis, Roter, & Putman, 1991; Zachariae et al., 2003), better compliance (DiMatteo et al., 1993; Roter et al., 1998; Squire, 1990), and lower rates of malpractice litigation (Beckman, Markakis, Suchman, & Frankel, 1994; Levinson, Roter, Mullooly, Dull, & Frankel, 1997; Moore, Adler, & Robertson, 2000).

Empathy in nursing has been studied in regard to the relationship between nurseexpressed empathy and measures of patient distress (Olson, 1995; Reynolds, 2000). In a study conducted by LaMonica, Wolf, Madea, and Oberst (1987), high levels of empathy in nurses were associated with reduced anxiety, depression, and hostility in cancer patients. Sullivan (1990) found that empathic communication resulted in increased patient satisfaction and decreased levels of stress among patients, while also serving as a buffer against potential psychological and health related problems among nurses.

Alligood (1992) viewed empathy as cognitive responses learned and developed through basic nursing instruction and clinical practice. Nurse educators have universally accepted and incorporated empathy as the basis of therapeutic communication into nursing curricula (Morse, Bottorff, Anderson, O'Brien, & Solberg, 1992).


Despite the importance of empathy as a backbone of patient-nurse relationships, empirical research on the topic is scarce due to the lack of consensus about the conceptualization and measurement of empathy (Hojat, 2007). Empathy has been viewed by some as a cognitive attribute, by others as an emotional (affective) characteristic, and by a third group as a combination of both (for a review see Hojat, 2007). Accordingly, two types of empathy, cognitive and emotional, have been identified. However, it has been suggested that emotional empathy is analogous to sympathy that leads to different clinical outcomes than empathy in the context of patient care (Hojat, 2007; Nightingale, Yarnold, & Greenberg, 1991). Thus, empathy and sympathy should be treated differently in patient care (Hojat, 2007; Wispe, 1986).

We adopted the following definition of empathy in the context of the patient-nurse relationship as "predominantly a cognitive (rather than an emotional) attribute that involves an understanding (rather than feeling) of experiences, concerns, and perspectives of the patient, combined with a capacity to communicate this understanding" (Hojat, 2007, p. 80). Three key terms in the definition are italicized to underscore their significance in the construct of empathy in the context of the patient-nurse relationship. …

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