Journal of Nursing Education

Major Article 

Effects of Nursing Students' Empathy and Interpersonal Competence on Ideal Nurse Attributes

Jihyun Oh, PhD, RN

Abstract

Background:

Nurse attributes encompass one's character, competence, proficient skills, and ability to participate in hospital policies and social problems. Previous studies have not adequately examined the factors influencing the formation of nurse attributes. Therefore, this study explored 10 ideal nurse attributes and analyzed effects of influential factors on their formation.

Method:

This is a descriptive quantitative study that examined nursing students' empathy, interpersonal competence, and nurse attributes. Participants were 247 nursing students from two universities in South Korea. The correlations among the variables and the factors affecting nurse attributes were identified.

Results:

Positive correlations existed between empathy, interpersonal competence, and 10 ideal nurse attributes. A stepwise multiple regression analysis showed that interpersonal competence, grade level, satisfaction with major, empathy, club participation, and peer relations were major factors influencing nurse attributes.

Conclusion:

It is necessary to develop an effective education program to improve nursing students' empathy, interpersonal competence, and nurse attributes. [J Nurs Educ. 2019;58(3):130–135.]

Abstract

Background:

Nurse attributes encompass one's character, competence, proficient skills, and ability to participate in hospital policies and social problems. Previous studies have not adequately examined the factors influencing the formation of nurse attributes. Therefore, this study explored 10 ideal nurse attributes and analyzed effects of influential factors on their formation.

Method:

This is a descriptive quantitative study that examined nursing students' empathy, interpersonal competence, and nurse attributes. Participants were 247 nursing students from two universities in South Korea. The correlations among the variables and the factors affecting nurse attributes were identified.

Results:

Positive correlations existed between empathy, interpersonal competence, and 10 ideal nurse attributes. A stepwise multiple regression analysis showed that interpersonal competence, grade level, satisfaction with major, empathy, club participation, and peer relations were major factors influencing nurse attributes.

Conclusion:

It is necessary to develop an effective education program to improve nursing students' empathy, interpersonal competence, and nurse attributes. [J Nurs Educ. 2019;58(3):130–135.]

In clinical practice, nurses are required to be competent, academically accomplished, and equipped with practical skills to understand and perform professional nursing jobs that meet the high demands of nursing service (Jansson & Ene, 2016; Wolf, 2012). Within the health care system, nurses perform professional roles in education, health promotion, disease prevention, treatment, and rehabilitation. Therefore, they are placed in a complex situation that calls for an understanding of the scope of their roles and the characteristic professional qualities that a nurse should exemplify (Pitt, Powis, Levett-Jones, & Hunter, 2012). The term nurse attributes refers both to the abilities required to provide nursing service (Cowan, Wilson-Barnett, & Norman, 2007) and to qualities such as good character, sincerity, trustworthiness, and proficient skills that instill and reinforce these abilities. Cultivating such attributes is the ultimate goal of nursing education, and nursing schools educate their students to develop these attributes with curricula focused on fostering the most essential skills (Lee-Hsieh, Kao, Kuo, & Tseng, 2003).

To date, studies on nurses' attributes have simply focused on nursing students' perception of nurse attributes (Bae & Eun, 2014; Johnson & Cowin, 2013), qualitatively analyzed the attitudes of a good nurse (Catlett & Lovan, 2011; Lee, Kwon, Cha, & Kim, 2017), investigated nurses' attributes in nursing students and graduates (Bang & Cho, 2008), and examined the relation between cultural competence and perceived importance of nurse attributes (Choi et al., 2016). Thus, previous studies on nurse attributes have only investigated either the perceptions that nursing students have about nurse attributes or the attitudes of a good nurse. However, studies that analyze the significant influential factors on nurse attributes, as well as those that examine the differences in nurse attributes perceived to be important according to grade level, are lacking.

Nurses with ideal nurse attributes proficiently handle nursing duties in practice, understand how to maintain a good relationship with other medical professionals, and effectively perform and facilitate detailed work and more difficult tasks (Choi et al., 2016). Due to the centrality of good teamwork to the nature of nursing work, interpersonal competence is a crucial attribute for nurses to have. Interpersonal competence improves nursing performance when nurses work with colleagues within a nursing organization and across medical departments; in this way, it promotes the development of excellent nursing professionals (Medigovich, 2012; Slusarska, Zarzycka, Dobrowolska, & Cuber, 2009). Moreover, it has a positive impact on students' participation in extracurricular activities (e.g., volunteer activities, women's clubs, men's clubs, exercise clubs), which promotes their overall growth, as well as intellectual, moral, and emotional development (Rawat, 2016; Rubin, Bommer, & Baldwin, 2002). Furthermore, interpersonal competence is critical because it helps nurses establish a therapeutic rapport with various patients who are physically and emotionally vulnerable so that they can provide continuous, supportive care (Chae, 2016).

It is these characteristics and the level to which nurse attributes are cultivated that have an impact on nurses' relationship-centered work (Catlett & Lovan, 2011). The personal tendencies and characteristics of each nurse can potentially provoke unprofessional and unreasonable behaviors instead of therapeutic communication in their relationships with patients (Wolf, 2012). Empathy—the basis for a therapeutic relationship between nurse and patient—requires a clear understanding of one's own emotions, as well as that of others. Moreover, cultivating true empathy not only allows nurses to provide quality nursing care but also lowers the incidence of safety accidents (Chae, 2016).

Demands for studies that investigate the presence of nurse attributes among nursing students and that identify the factors influencing their formation in students are rising in the nursing education curriculum setting (Choi et al., 2016; Park, 2018). Accordingly, this study aims to investigate the desirable attributes of being a nurse as perceived by nursing students. It also seeks to analyze the correlations among factors and variables that affect nurses' attributes. The specific objectives of this study are as follows:

  • Examine the general characteristics of nursing students and the differences of nurse attributes in relation to their general characteristics.
  • Examine the levels of empathy, interpersonal competence, and nurse attributes.
  • Examine the relationships among empathy, interpersonal competence, and nurse attributes in nursing students.
  • Examine the factors that affect the presence of ideal nurse attributes in nursing students.

Method

Study Design and Participants

This study is a descriptive quantitative study aiming to examine in nursing students the attributes that nurses should exemplify and the factors that influence their formation. The participants of this study were first- to fourth-year nursing students attending two 4-year universities in K Province and G Province; all voluntarily provided an informed consent. A total of 257 students participated in this study, and after excluding 10 students for submitting incomplete questionnaires, a total of 247 students were included in the final analysis. The minimum sample size was calculated to be 153 for a significance level of .05, medium effect size of .15, and power of .95 in multiple regression analysis using G*Power version 3.1 (Faul, Erdfelder, Lang, & Buchner, 2007). Therefore, the actual sample size satisfies the requirement.

Data Collection

Data were collected from first- to fourth-year nursing students of two 4-year universities in the K Province and G Province from October 26 to December 13, 2017, using structured questionnaires. Empathy was measured with the Korean version of the Interpersonal Reactivity Index (IRI). The original tool was developed by Davis (1980) and was verified for reliability and validity after it was translated into Korean by Kang et al. (2009). The tool comprises 28 items, with seven items for each of the following subscales: perspective-taking (spontaneously adopting another's point of view), fantasy (imagination), empathic concern (other-oriented), and personal distress (self-oriented). Each item is rated on a 5-point Likert scale from 1 (Does not describe me well) to 5 (Describes me very well). Negative items were reversely converted, and a higher score indicates a higher level of empathy. Cronbach's alpha in the study by Kang et al. (2009) was .80, and in this study it was .75.

Interpersonal competence was measured with the Korean version of the Interpersonal Competence Questionnaire. The scale was originally developed by Buhrmester, Furman, Wittenberg, and Reis (1988) and was translated into Korean, modified, and adapted for use on college undergraduates by Han and Lee (2010). The scale comprises 31 items, and each item is rated on a 5-point Likert scale from 1 (poor at this) to 5 (extremely good at this). A higher score indicates higher interpersonal competence. Cronbach's α in the study by Han and Lee (2010) was .84, and in this study it was .90.

Nurses' attributes perceived to be important by nursing students were measured with a tool developed by Choi et al. (2016) based on a review of the attributes and characteristics of outstanding nurses and the competences required of professional nurses identified by Cowan et al. (2007). The 10 ideal attributes required to perform professional nursing tasks are as follows:

  • Displaying technical skills.
  • Having a professional nursing knowledge base.
  • Communicating well with patients and family members.
  • Forming collaborative relationships with colleagues.
  • Paying attention to and showing love for patients.
  • Maintaining one's own physical health.
  • Demonstrating nursing professionals' code of ethics.
  • Contributing to the advancement of nursing.
  • Teaching and researching ability.
  • Having a sense of humor.

The importance of these attributes was measured with a 5-point scale, with a higher score indicating a higher level of the corresponding attribute. Cronbach's alpha in the study by Choi et al. (2016) was .79, and in this study it was .80.

Data Analysis

The collected data were statistically analyzed using SPSS® version 21.0 software. Participants' general characteristics were presented as frequency and percentage, and level of empathy, interpersonal competence, and nurse attributes were presented as the mean and the standard deviation. Differences in nurses' attributes in relation to the general characteristics were analyzed using a t test and ANOVA; Scheffe's test was compared and analyzed with a post hoc test. The correlations among empathy, interpersonal competence, and nurses' attributes were analyzed using Pearson's correlation coefficients. The factors that affect nurses' attributes were analyzed using stepwise multiple regression after testing for multicollinearity.

Ethical Considerations

This study was approved by the institutional review board at the investigator's affiliated university. Questionnaires were distributed only to those who had provided a written consent form after being told about the study aims, data collection process, benefits and risks of participation, ability to withdraw from the study, protection of personal information, confidentiality, and use of data only for research purposes. The participants were also informed that they could withdraw their consent to participate at any point in the study.

Results

Participants' General Characteristics and Differences in Nurse Attributes

Participants' characteristics are reported in Table 1. There were 247 participants in the study: 218 (88.3%) women and 29 (11.7%) men, with a mean age of 20.63 years. The majority of participants were third-year students (n = 76, 30.8%). A total of 134 students (54.3%) claimed to have good peer relations. One hundred thirty-six students (55.1%) were satisfied with their college lives, whereas 153 (61.9%) were satisfied with their major. The majority of participants (n = 202, 81.8%) belonged to at least one club. Nurses' attributes significantly differed in relation to grade level, peer relations, satisfaction with college life, satisfaction with major, and club participation. Third- and fourth-year students were more aware of nurses' attributes than first- and second-year students (F = 7.29, p < .001). In addition, there were significant differences between participants who had good peer relations and those who had neutral peer relations (t = 4.58, p < .001), between participants who were satisfied with college life and those who were less than satisfied with college life (t = 5.98, p < .001), between participants who were satisfied with their major and those who were less than satisfied with their major (t = 6.28, p < .001), and between participants who were active in at least one club and those who were not (t = 3.10, p = .002).

General Characteristics of Participants and Differences in Ideal Nurse Attributes in Relation to the General Characteristics (N = 247)

Table 1:

General Characteristics of Participants and Differences in Ideal Nurse Attributes in Relation to the General Characteristics (N = 247)

Empathy, Interpersonal Competence, and Ideal Nurse Attributes

Tables 23 report the mean scores on all measures. The mean empathy score was 3.56 (± 0.39) of 5. For the four subscales of empathy, the highest score was fantasy (3.66 ± 0.67), followed by perspective-taking (3.61 ± 0.55), personal distress (3.20 ± 0.35), and empathic concern (3.17 ± 0.50). The mean interpersonal competence score was 3.39 (± 0.51) of 5 (Table 2). The mean perception of nurses' attributes was 3.47 (± 0.51) of a score of 5 (Table 2), and among the 10 nurses' attributes, the highest score was in the perception of forming a collaborative relationship with colleagues (3.91 ± 0.70), followed by maintaining a healthy body (3.85 ± 0.89), paying attention to and showing love for patients (3.81 ± 0.78), and demonstrating nursing professionals' code of ethics (3.74 ± 0.78). Regarding nurses' attributes in relation to grade level, the highest mean score was in forming collaborative relationships with colleagues (3.81 ± 0.74 and 3.73 ± 0.66) among first- and second-year students, respectively. Third-year students perceived paying attention to and showing love for patients to be the highest (4.12 ± 0.65), whereas fourth-year students perceived demonstrating nursing professionals' code of ethics (4.09 ± 0.84) to be the highest. When combined, nursing students perceived forming a collaborative relationship with colleagues as the most important attribute among nurses (3.91 ± 0.70; Table 3). There was a positive correlation between empathy and interpersonal competence (r = 0.27, p < .001), between empathy and nurses' attributes (r = 0.33, p < .001), and between interpersonal competence and nurses' attributes (r = 0.45, p < .001).

Level of Empathy, Interpersonal Competence, and Ideal Nurse Attributes (N = 247)

Table 2:

Level of Empathy, Interpersonal Competence, and Ideal Nurse Attributes (N = 247)

Degree of 10 Key Nurse Attributes by Academic Level (N = 247)

Table 3:

Degree of 10 Key Nurse Attributes by Academic Level (N = 247)

Factors That Affect Nurses' Attributes

Table 4 shows that empathy, interpersonal competence, and particular general characteristics were significantly different in relation to nurses' attributes; for instance, grade level, peer relations, satisfaction with college life, satisfaction with major, and club participation were analyzed with multiple regression analysis to identify the factors that affect nurse attributes. There was a significant difference between the regression models used to identify the factors that affect the formation of nurses' attributes in nursing students (F = 27.79, p < .001). The major influential factors were interpersonal competence (ß = 0.31, p < .001), grade level (ß = 0.24, p < .001), satisfaction with major (ß = −0.21, p < .001), empathy (ß = 0.16, p =.001), club participation (ß = −0.16, p = .002), and peer relations (ß = −0.12, p = .023), with these variables explaining 39% of the dependent variance.

Factors That Affect Nurse Attributes

Table 4:

Factors That Affect Nurse Attributes

Discussion

This study found that, overall, nursing students perceived forming collaborative relationships with colleagues as the most important attribute of nurses. This was in line with the study by Bae and Eun (2014), in which nursing students of a 4-year university perceived the ability to form such collaborative relationships as the most important nurse attribute. However, in this study, over the course of providing care to patients through the experience of clinical training while moving to higher class grades, third-year nursing students perceived paying attention to and showing love for patients as more important than forming collaborative relationships. Further, fourth-year nursing students began to heighten their perception of the importance of demonstrating professional ethics as they internalized the concepts of the nursing profession.

The differences in nurse attributes revealed that nurses' attributes significantly differed in relation to grade level, peer relations, satisfaction with college life, satisfaction with major, and club participation. In particular, third- and fourth-year students perceived nurses' attributes as more important than first- and second-year students did. Furthermore, nurses' attributes were perceived as more important among students with good peer relations, high satisfaction with major, and active club participation. In our study, third- and fourth-year students had already undergone clinical practice training, during which they acquired the attributes that are demanded of nurses (Kim, 2018). Thus, nursing curricula for this period should be designed so students are able to gain professional knowledge and acquire practical skills to become competent nursing professionals. Peer relations, identified as an influential factor on the development of nurse attributes (Green, 2017), have a significant impact on students' college lives, as well as their maturity. Particularly, students in lower grade levels exhibit high satisfaction with college life and their major when they have good peer relations and are supported by a systematic mentor–mentee system. Hence, peer relations play the role of improving nursing students' self-esteem, thus increasing their perception of the nursing profession (Green, 2017). Students who are actively involved in a school club demonstrated a higher perception of nurses' attributes than those who are not. This may be attributable to the fact that voluntary club participation fosters students' communication and problem-solving skills (Cha & Kim, 2014), as well as engages them in their nursing major, thereby increasing their satisfaction with both major and college life and subsequently increasing their perception about the attributes of a nursing professional.

The results of our study about the significantly positive correlation of the perceived importance of nurse attributes with empathy and interpersonal competence are in line with the findings of previous studies reporting that interpersonal competence rises with increasing empathy (Chae, 2016; Chung, 2014). Empathy is a prosocial behavior in which one understands others' positions and experiences their emotional states (Davis, 1980). Empathy enables one to respond to others' expectations by understanding their emotions and needs, thereby enabling the construction of an intimate relationship with others by paying attention to and listening to them. Thus, empathy plays an important role in building and maintaining relationships with others. In this context, empathy and interpersonal competence would have had a positive effect on fostering nurses' attributes.

Finally, interpersonal competence, satisfaction with major, grade level, club participation, empathy, and peer relations were identified as major influences on nursing students' perception of nurses' attributes, and the explanation power of these variables to nurses' attributes of nursing students was 39.5%. Of them, interpersonal competence, which is related to nursing students' perception of the nursing profession, had the greatest effect on students' formation of nursing competency. Interpersonal competence affects nursing students' school performance, empathy, trustworthiness, and maturation of relationship skills; while nursing students undergo clinical training, they encounter professional and social opportunities and come to understand the nursing profession (Glass, 2010). Moreover, in clinical practice, interpersonal competence may be developed as an essential skill needed for communication with patients and other medical professionals (Rebeiro, Edward, Chapman, & Evans, 2015). Therefore, institutions that educate nurses should provide students with opportunities to improve their interpersonal competence and to foster pride in and responsibility for the nursing profession through voluntary and active participation to increase their perception of the attributes of a good nurse.

The current study investigated the effects of nursing students' empathy and interpersonal competence on their perception of the attributes that nurses should exemplify. The findings show that empathy and interpersonal competence have positive effects, but interpersonal competence has the most significant impact on nursing students' perceptions of ideal nurse attributes. Particularly, students of different grade levels commonly perceived the formation of collaborative relationships as the most important attribute from the ten key attributes of a nurse. Therefore, this study's findings suggest that nursing curricula should encourage students to participate voluntarily in curricular and extracurricular activities. These curricular and extracurricular activities advance students' hobbies and talents, thereby promoting their social adaptation and cultivation of moral character. Furthermore, by interacting with one another, nursing students can experience competition and collaboration, have an opportunity to express their opinions logically, and build interpersonal relationships. Schools should create an environment and implement educational programs that can improve students' interpersonal competence.

Limitations and Recommendations

This study has several limitations. First, the sample comprised nursing students from only two universities in South Korea; thus, the findings cannot be generalized to all nursing students worldwide. Second, in the relationship between nurses' attributes as perceived by nursing students, empathy and interpersonal competence were not given long-term examination. Third, the study was undertaken with the consideration that empathy, which is highly discussed throughout, is an essential element of nursing. However, these limitations provide an opportunity for follow-up studies. Thus, future studies investigating our topic should systematize findings by including additional factors that may affect the development of nurses' attributes.

Conclusion

This study aimed to investigate the effects of nursing students' empathy and interpersonal competence on their development of ideal nurse attributes. Empathy, interpersonal competence, peer relations, satisfaction with major, grade level, and club participation were found to affect ideal nurse attributes in nursing students, with these factors explaining 39% of the variance. Interpersonal competence had the greatest impact. Therefore, nursing students' interpersonal competence and empathy should be improved, as they affect nursing students' perceived importance of the attributes of exemplary nurses. From the first year of clinical training, it is particularly important to implement nursing education programs that foster pride in and responsibility for the nursing profession and provide continuous and systematic support to encourage active participation in programs so as to nurture the attributes of a good nurse in their students.

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General Characteristics of Participants and Differences in Ideal Nurse Attributes in Relation to the General Characteristics (N = 247)

Variable Category n (%) Nurse Attributes

Mean ± SD t/F(p) Scheffe
Age (years) 20.63 ± 2.06
Gender Male 29 (11.7) 3.47 ± 0.76 −0.02 (.982)
Female 218 (88.3) 3.47 ± 0.47
Grade level Freshmana 47 (19) 3.32 ± 0.61
Sophomoreb 67 (27) 3.31 ± 0.47 7.29 (< .001)
Juniorc 76 (30.8) 3.60 ± 0.46 c,d > a,b
Seniord 57 (23.1) 3.62 ± 0.44
Peer relations Good 134 (54.3) 3.60 ± 0.41 4.58 (< .001)
Neutral or poor 113 (45.7) 3.31 ± 0.57
Satisfaction with college life Satisfied 136 (55.1) 3.64 ± 0.42 5.98 (< .001)
Neutral or dissatisfied 111 (44.9) 3.27 ± 0.54
Satisfaction with major Satisfied 153 (61.9) 3.62 ± 0.43 6.28 (< .001)
Neutral or dissatisfied 94 (38.1) 3.23 ± 0.54
Club participation Yes 202 (81.8) 3.52 ± 0.46 3.10 (.002)
No 45 (18.1) 3.26 ± 0.64

Level of Empathy, Interpersonal Competence, and Ideal Nurse Attributes (N = 247)

Variable Possible Range Min–Max Mean ± SD
Empathy 1–5 1.11–4.32 3.56 ± 0.39
Perspective-taking 1–5 0.86–4.86 3.61 ± 0.55
Fantasy 1–5 0.86–5.00 3.66 ± 0.67
Empathic concern 1–5 0.71–4.29 3.17 ± 0.50
Personal distress 1–5 1.86–4.29 3.20 ± 0.35
Interpersonal competence 1–5 1.71–4.65 3.39 ± 0.51
Nurses' attributes 1–5 1.00–4.70 3.47 ± 0.51

Degree of 10 Key Nurse Attributes by Academic Level (N = 247)

Characteristic Freshman Mean ± SD Sophomore Mean ± SD Junior Mean ± SD Senior Mean ± SD Total Mean ± SD
Displaying technical skills 2.62 ± 0.78 3.01 ± 0.66 3.25 ± 0.69 3.37 ± 0.72 3.09 ± 0.75
Having a professional nursing knowledge base 2.72 ± 0.76 2.81 ± 0.72 3.05 ± 0.65 3.18 ± 0.71 2.95 ± 0.75
Communicating well with patients and family members 3.47 ± 0.92 3.52 ± 0.76 3.86 ± 0.82 3.88 ± 0.80 3.70 ± 0.84
Forming collaborative relationships with colleagues 3.81 ± 0.74 3.73 ± 0.66 4.04 ± 0.66 4.02 ± 0.71 3.91 ± 0.70
Paying attention to and showing love for patients 3.62 ± 0.82 3.51 ± 0.70 4.12 ± 0.65 3.91 ± 0.85 3.81 ± 0.78
Maintaining one's own physical health 3.81 ± 0.97 3.55 ± 0.90 4.00 ± 0.80 4.02 ± 0.71 3.85 ± 0.89
Demonstrating nursing professionals' code of ethics 3.34 ± 0.96 3.51 ± 0.68 3.95 ± 0.71 4.09 ± 0.60 3.74 ± 0.78
Contributing to the advancement of nursing 3.43 ± 0.97 3.19 ± 0.80 3.38 ± 0.95 3.51 ± 0.92 3.37 ± 0.91
Teaching and researching ability 3.11 ± 0.91 2.88 ± 0.64 2.92 ± 0.87 3.00 ± 0.98 2.96 ± 0.85
Having a sense of humor 3.34 ± 0.98 3.39 ± 0.79 3.45 ± 0.91 3.28 ± 0.95 3.37 ± 0.90

Factors That Affect Nurse Attributes

Variable B SD β t p R2 Adjusted R2 F p
Constant 2.04 0.31 6.48 < .001 0.41 0.39 27.79 < .001
Interpersonal competence 0.31 0.05 0.31 5.96 < .001
Satisfaction with major −0.22 0.05 −0.21 −4.05 < .001
Grade level 0.12 0.02 0.24 4.90 < .001
Club participation −0.21 0.06 −0.16 −3.14 .002
Empathy 0.22 0.06 0.16 3.23 .001
Peer relations −0.12 0.05 −0.12 −2.29 .023
Authors

Dr. Oh is Assistant Professor, Department of Nursing, Daejeon University, Dong-gu, Daejeon, Korea.

This study was supported by the Daejeon University Research Grants (2016).

The author has disclosed no potential conflicts of interest, financial or otherwise.

Address correspondence to Jihyun Oh, PhD, RN, Assistant Professor, Department of Nursing, Daejeon University, 62 Daehak-ro, Dong-gu, Daejeon 300-716, Korea; e-mail: grape0123@hanmail.net.

Received: August 27, 2018
Accepted: December 10, 2018

10.3928/01484834-20190221-02

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