Original Article

The Effect of Empathy Skill Training on Therapeutic Communication of Nursing Students in the Care of Hospitalized Children

Please cite this article as follows: Nouri M, Pashaei N, Rezaee Moradali M, Baljani E. The effect of empathy skill training on therapeutic communication of nursing students in the care of hospitalized children. Avicenna J Care Health Oper Room. 2025;3(1):16-20. doi:10.34172/ajchor.84

Introduction

In clinical settings, the relationship between nurses and patients is key to ensuring that patients’ needs are met (1,2). Empathy is defined as the ability to put oneself in another’s position to better understand their feelings and experiences (3). It can reduce patients’ defensiveness and encourage them to discuss their emotions and needs (4). It also shortens treatment duration, thereby reducing financial demands and resource needs (5). Nurses who care for patients empathetically can better understand patients’ reactions to health issues and the sources and goals of these reactions (6,7). Empathy skills are highly valued among nursing students worldwide but require further improvement, which is why nursing educators should pay more attention to fostering these skills in students (8).

A longitudinal study conducted by Ward et al on 214 nursing students found a significant decline in empathy from the beginning to the end of their training, particularly among students who had more clinical exposure to patients (9). Other studies on changes in empathy during education also indicate a decline in empathy as medical students progress through their studies (10), despite empathy being a fundamental aspect of all human interactions and a critical component of the nurse-patient relationship (11). A study conducted by Derksen et al in 2017 found that empathizing with patients calms and motivates them, increasing their willingness to cooperate, while a lack of empathy frustrates patients and discourages them from returning to healthcare providers (12). Nunes et al (13) and Ferri et al (14) also found that empathy among healthcare students declines over the course of their studies.

Communication is a key element between nurses, patients, and their families in healthcare. The primary goal of communication is to provide comfort and enhance feelings of trust and security in patients (15,16). Therapeutic communication is a planned conscious process aimed at improving patient outcomes (17). Nurses encourage patients to express their feelings, thoughts, and perceptions related to observable behaviors during communication (17,18). Implementing therapeutic communication methods by nurses not only leads to behavioral changes in themselves but also results in positive changes in patients’ clinical conditions (19,20).

Many nursing students find communication skills challenging, which may lead to high levels of anxiety and hinder their ability to care for patients safely (21). Communication in pediatric wards is even more critical and challenging, as children at different developmental stages are more vulnerable and require better care (22). Therefore, healthcare workers must possess effective communication skills, particularly therapeutic communication skills, which include techniques to facilitate the comfortable expression of feelings and perceptions among patients and healthy individuals (23). For this reason, pediatric nursing education should include both theoretical and practical training in communication and therapeutic communication skills (24). Kudubes et al reported that the average therapeutic communication skills score was significantly low among nursing students who had completed pediatric internships (25). Similarly, a study by Loghmani et al found that nurses faced challenges in establishing appropriate communication with patients and their families due to overcrowding, time constraints, increased workload, financial issues, and workplace environment. Families expressed dissatisfaction with nurses’ emotional responses, lack of reassurance, empathy, and failure to educate them (26).

A review of the literature indicates that studies on therapeutic communication with hospitalized children highlight positive outcomes such as patient participation in treatment, successful management of communication scenarios (27), and increased confidence and clinical performance among students (28). However, factors influencing and enhancing therapeutic communication have received less attention. Given the lack of studies on the impact of empathy skills training on the therapeutic communication of nursing students, this study aimed to determine the effectiveness of such training in the care of hospitalized children.

Materials and Methods

This quasi-experimental study was conducted on final-year nursing students at the Islamic Azad University of Urmia during the 2023-2024 academic year. Census sampling was used in the study, and the sample consisted of 40 final-year nursing students in a single group. Inclusion criteria included being a final-year nursing student in the internship phase and providing informed consent to participate in the study. The demographic questionnaire included age, gender, grade point average, marital status, and residency status. The therapeutic communication questionnaire by Han et al consisted of 15 items on a 4-point Likert scale. The tool comprised two domains: relationship building (9 items) and problem-solving (6 items) (29). The minimum and maximum scores were 15 and 60, respectively, with higher scores indicating better therapeutic communication. Cronbach’s alpha was used to confirm the reliability of the tool, with an overall reliability of 0.89 (29).

To conduct the study, the researcher obtained a list of all final-year nursing students (in the internship phase) from the nursing faculty. Students completed the demographic and therapeutic communication questionnaires at the beginning of the study. Then, they were divided into groups of 6 and received eight 90-minute training sessions, held four times a week. Training was delivered through lectures using a video projector, and students’ questions were addressed during the sessions. After the intervention, students completed the questionnaires again. The training content was based on the empathy skills training package from studies by Gholami et al (30) and Mohammadi Nesbat et al (31) (Table 1).

Data Analysis

SPSS version 26.0 was used for data analysis in this study. Descriptive statistics were employed to describe demographic characteristics, including mean ( ± standard deviation) and frequency (percentage). The Shapiro-Wilk test was used to assess the normal distribution of quantitative data, and the paired t test was used to compare the therapeutic communication scores of students before and after the intervention.

Results

The results of the study showed that the frequency of nursing students participating in the study by gender included 29 females (72.5%) and 11 males (27.5%). The majority of them were in the age group of 22-27 years, and 36 (90%) were single. The demographic characteristics of the nursing students are presented in Table 2.

The results presented in Table 3 indicate that “empathy skills training” had a significant impact on improving the scores of therapeutic communications and all its dimensions, including relationship building, problem-solving, and overall therapeutic communication, among final-year nursing students.

As shown in Table 3, empathy skills training had a positive impact on the overall score of “therapeutic communication”, particularly on the scores of the two domains of relationship building and problem-solving. The results of the paired t test indicated a significant difference between the mean therapeutic communication scores of nursing students before and after the empathy skills training (t = -3.99, P < 0.001). The average overall score of therapeutic communication after intervention in this study was 47.97, indicating that nursing students had a higher level of therapeutic communication.

In the relationship-building domain, the mean scores before the intervention (28.76 ± 3.72) compared to after the intervention (30.61 ± 3.38) showed a significant difference (t = -3.93, P < 0.001). This finding suggests that empathy skills training was effective in improving students’ ability to establish initial relationships with patients.

Additionally, the results of the paired t test showed a significant difference in the mean scores of students before and after the intervention in the problem-solving domain (t = -2.25, P < 0.05). This indicates an improvement in students’ ability to use communication skills to identify and resolve patients’ problems.

Discussion

The results of the study demonstrated that empathy training was effective in enhancing the therapeutic communication skills of nursing students at the Islamic Azad University of Urmia. Given the significant improvement in overall therapeutic communication scores after the intervention, it can be concluded that improvement in one domain (e.g., relationship building) can contribute to improvement in other domains (e.g., problem-solving and overall therapeutic communication). This relationship highlights the synergistic effect of training on communication skills. In this study, the improvement in the problem-solving domain was less pronounced compared to the other domains. This difference may be due to the inherent complexity of problem-solving in the therapeutic communication process, which requires more practice and experience. The highest level of change in mean scores was observed in the relationship-building domain, indicating that the intervention was particularly effective in improving students’ foundational skills in establishing relationships with patients. This skill, as the most basic aspect of therapeutic communication, holds significant importance (32).

Several studies have emphasized empathy as a crucial component of the communication process in medical sciences (33,34). Donovan et al taught therapeutic communication techniques through simulation (video clips) and scenario discussions in a study and found that these techniques increased nursing students’ confidence, satisfaction, and perceived learning in the therapeutic communication process (35).

Managheb and Bagheri concluded that empathy skills training was effective in improving the performance of medical students, which is consistent with the results of the present study (36). Similarly, Spiro showed that empathy is a teachable skill with a significant impact on medical students’ performance, particularly during patient interviews (37). In the study titled “The Effectiveness of Empathy Skills Training on the Responsibility of Nursing Students”, Mohammadi Nasab et al found that empathy skills training significantly increased the sense of responsibility among nursing students, which is in line with the present study (31).

The results of this study can be explained by the fact that empathy training in educational environments enhances the adaptability of nursing students and influences their ethical sensitivity, especially since the participants in this study were nursing students undergoing clinical training. These students had previously participated in professional ethics classes or workshops and had gained sufficient experience in interacting with patients during their years of study and patient care.

Regarding the practical implications of this study, it is worth noting that, compared to other skills, empathy, while somewhat dependent on personality, can be taught and learned, as demonstrated by this study and many similar studies. Empathy improves nurse-patient communication and accelerates the treatment process. Additionally, since the cognitive domain of students is influenced by education, nursing faculties can play a significant role in developing students’ understanding of empathy and incorporating empathy skills as a specialized skill in therapeutic communication with hospitalized children. Therefore, empathy skills training should be integrated into the nursing curriculum, and workshops should be organized for nursing graduates to enhance patient satisfaction, reduce hospitalization time, improve health outcomes, and increase job satisfaction among nurses.

Conclusion

The results of this study indicate that empathy has the potential to establish effective communication between patients and nursing students. Communication is the foundation of their care, so the communication between nursing students and patients helps patients understand their health conditions. Empathy skills training in the nursing student’s curriculum can significantly improve the quality of therapeutic communication in the care of hospitalized children and have positive effects on the mental and physical health of patients. The results of this study emphasize that this skill, as an essential part of the nursing profession, should be continuously reinforced so that students can interact with patients in a more humane and effective manner. Ultimately, the results of this study suggest that empathy skills training can be considered a key factor in improving the quality of therapeutic communication and increasing patient satisfaction. However, it is necessary for these trainings to be structured and interactive, utilizing practical methods, so that nursing students can apply them in real-world settings, thereby enhancing the quality of care provided to patients.

Acknowledgments

The authors express their gratitude to the community staff for their invaluable contributions to the project execution and data collection. The authors also would like to thank nursing students for their participation in interviews.

Competing Interests

None to declare.

Data Availability Statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Ethical Approval

This study was approved by the Ethics Committee of Urmia Islamic Azad University (IR.IAU.URMIA.REC.1403.050). Informed consent was obtained from all participants.

Funding

No particular grant from a public, private, or nonprofit organization was received for this research.

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