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Impact of empathy interventions on cognitive, affective, and behavioral empathy in nursing students: a systematic literature review Cover

Impact of empathy interventions on cognitive, affective, and behavioral empathy in nursing students: a systematic literature review

Open Access
|Jun 2025

Figures & Tables

Figure 1.

PRISMA flow diagram of study selection for the systematic review.
PRISMA flow diagram of study selection for the systematic review.

Characteristics of included studies and the educational outcomes for empathy_

StudyAim/designParticipantInterventionMeasurementResult
Gür and Yilmaz (2020)4Aim: Investigating the effectiveness of the MBET program on empathy and age discrimination in nursing studentsDesign: Two-group experimental design.Data collection: Pre-test and post-test with an 8-week intervention (no follow-up)Undergraduate nursing students at the faculty of health sciencesMBET
  • DIF

  • JSENS

  • ADAS

  • Following the training, there was a significant increase in student empathy.

  • There was no significant difference in student age discrimination after training.

  • The Negative Discrimination Towards Elderly subscale, on the other hand, shows a significant difference

Yang et al. (2022)Aim: Improving the empathy competence of nursing undergraduate internship students using the Structured Empathy Educational ProgramDesign: Two-group quasi experimental design.Data collection: Pre-test and post-test with an 2-week intervention (no follow-up)Undergraduate nursing internship studentsStructured EEM based on Delphi Technique
  • Demographic Questionnaire

  • The JSE-HPs

  • After participating in the program, students’ empathy increased significantly.

  • There was a significant increase in three empathy subscales: perspective taking, compassionate care, and standing in the patient’s shoes

Arrogante et al. (2022)42Aim: To assess the impact of HFS training toward older people and empathy.Design: One-group quasi experimental design.Data collection: Pre-test and post-test with a 2.5-month intervention (no follow-up)Undergraduate nursing studentsHFS training
  • KAOP

  • JSE-HPS version

  • After participating in the program, students’ empathy and attitudes toward older people improved significantly.

  • There was a significant increase in three empathy subscales: perspective taking, compassionate care, and standing in the patient’s shoes.

  • According to dimensional analysis, the perspective taking dimension had the largest effect size, the compassionate care dimension had a low effect size, and standing in the patient’s shoes dimension had a medium effect size

Ding et al. (2020)49Aim: Develop and evaluate the effectiveness of an empathy learning module.Design: Two-group quasi experimental design.Data collection: Pre-test and post-test with an 7-month intervention (no follow-up)Pediatric nursing studentsKSS module
  • JSE-HPS version

  • CCCS

  • PIS

After training, there was a significant increase in empathy in the experimental group, indicating the effectiveness of SSC training toward empathy
Peng et al. (2020)Aim: To evaluate the effect of VDT toward empathy, and provide practical reasons to optimize dementia treatment for future use.Design: One-group quasi experimental design.Data collection: Pre-test and post-test with a 1-month intervention (no follow-up)Undergraduate nursing studentsWatch a movie called Still Alice and VDT simulation
  • Jefferson Scale of Empathy-Health Professional Students (Chinese version)

  • Semi-structured interviews

Students’ empathy increases after watching movies and participating in the VDT simulation
Heidke et al. (2018)Aim: Evaluating the impact of educational innovations that incorporate the patient’s voice and perspective on empathyDesign: One-group quasi experimental design.Data collection: Pre-test and post-test with a 12-week intervention (no follow-up)Undergraduate nursing studentsRedesign learning to include the voices and perspectives of various patients from various population groups.KCESFollowing the given learning design resulted in an increase in empathy levels
Cingol et al. (2021)Aim: To investigate the impact of the INC on cultural sensitivity and empathy levels.Design: Two-group quasi experimental design.Data collection: Pre-test and post-test with a 6-month intervention (no follow-up)Undergraduate nursing studentsINCESS–BThere was no significant difference in students’ levels of empathy or cultural sensitivity after the intervention
Ayed et al. (2021)Aim: The purpose of this study was to evaluate how HFS affected self-awareness, empathy, and PCCDesign: One group quasi experimental design.Data collection: Pre-test and post-test with an 4-week intervention (no follow-up)Undergraduate nursing studentsHFS
  • Self-Consciousness Scaled Revised

  • KCES

  • Patient Practitioner Orientation Scale

  • Demographic data questionnaire

After participating in the intervention program, there was a significant increase in self-awareness, empathy, and PCC
Shao et al. (2018)43Aim: The purpose of this study was to determine whether simulation-based empathic communication training improves nurses’ ability to recognize and respond to parents’ emotions with empathy.Design: One-group quasi experimental design.Data collection: Pre-test and post-test with an 3-month intervention (no follow-up)NICU nursesSimulation-based empathic communication training
  • Participants’ Satisfaction Questionnaire

  • Confidence Questionnaire

  • Attitude Questionnaire

  • Jefferson Physician Empathy Scale

  • Global Rating Scale

Nurses’ understanding of empathy improved. After attending training, nurses’ empathic communication skills improved
Lee et al. (2018)44Aim: To evaluate situated teaching programs designed to increase empathyDesign: Two-group quasi experimental design.Data collection: Self-reported data from pre-test and post-test, and also post-test observation (no follow-up)Undergraduate nursing studentsSituated teaching program (based on experiential learning)
  • JSE-HPS version

  • OSCE

There was a significant increase in students’ empathy after participating in the program, both subjectively (based on self-report) and objectively (objective empathy) (assessed by selected lecturers and patients)

Descriptive data_

VariablesNumber of studies
Design
  Experimental1
  Quasi-experimental9
Participant
  Undergraduate nursing student8
  Pediatric nursing student1
  Nurse1
Location
  Turkey2
  China5
  Spain1
  Australia1
  Palestine1
Instrument
  JSENS1
  JSE-HPs1
  JSE-HPS version4
  Jefferson Physician Empathy Scale1
  KCES2
  ESS–B1
DOI: https://doi.org/10.2478/fon-2025-0020 | Journal eISSN: 2544-8994 | Journal ISSN: 2097-5368
Language: English
Page range: 185 - 194
Submitted on: Nov 4, 2023
Accepted on: Aug 4, 2024
Published on: Jun 11, 2025
Published by: Shanxi Medical Periodical Press
In partnership with: Paradigm Publishing Services
Publication frequency: 4 issues per year

© 2025 Atikah Ainun Mufidah, Farida Kurniawati, published by Shanxi Medical Periodical Press
This work is licensed under the Creative Commons Attribution 4.0 License.