Rev. Latino-Am.

Enfermagem
2023;31:e3969
DOI: 10.1590/1518-8345.6591.3969
www.eerp.usp.br/rlae

Original Article

Working nurses’ empathy with patients in public hospitals

Yolanda Dávila Pontón1

https://orcid.org/0000-0001-9982-1009

Víctor Patricio Díaz Narváez2

https://orcid.org/0000-0002-5486-0415
Highlights: (1) The levels of empathy are low in the nursing
Bernardo Montero Andrade1 professionals studied. (2) These levels are not associated
https://orcid.org/0000-0002-1651-8707
with age and type of work performed. (3) Low levels of
Joseline Janeth López Terán1 empathy could imply a negative alteration of humanized
https://orcid.org/0000-0002-1015-8886 attention.
Alejandro Reyes-Reyes3
https://orcid.org/0000-0002-2404-0467

Aracelis Calzadilla-Núñez4 Objective: to determine the levels of empathy in professional nurses

https://orcid.org/0000-0002-6391-2563 of a high-complexity hospital, to relate age to empathy (and each one
of its dimensions), and to establish if there are differences between
these levels according to the type of working schedules. Method:
comparative, correlational and cross-sectional design. The sample
used (n=271) constituted 40.9% of the total number of nursing
professionals. Psychometric properties of the Jefferson Scale of
Empathy for Health Professionals were studied. Descriptive statistics
were calculated: mean and standard deviation. The association between
empathy and age was estimated using regression equations and
statistical significance of the regression coefficients, after evaluating
the type of curve using variance analysis. Results: the underlying
model of three dimensions of empathy was identified. The values of the
descriptive statistics observed were relatively low in empathy and its
1
Universidad del Azuay, Facultad de Medicina, Cuenca,
dimensions. Empathy levels were not associated with the age range.
Ecuador.
2
Universidad Andres Bello, Facultad de Odontología, No differences in empathy were found between the types of work
Santiago, Región Metropolitana, Chile. schedules. Variability was found in the dimensions: “compassionate
3
Universidad Santo Tomás, Facultad de Ciencias Sociales y care” and “Walking on the patient’s shoes”. Conclusion: these results
Comunicación, Concepción, Región del Bío Bio, Chile.
show that the levels of empathy observed may imply a deficient
4
Universidad Bernardo O’Higgins, Departamento de
performance in empathetic care for patients.
Investigaciones, Santiago, Región Metropolitana, Chile.

Descriptors: Cross-Sectional Study; Correlation of Data; Empathy;

Nursing Staff; Public Hospital; Ecuador.

How to cite this article

Dávila Pontón Y, Díaz-Narváez VP, Montero Andrade B, López Terán JJ, Reyes-Reyes A, Calzadilla-
Núñez A. Working nurses’ empathy with patients in public hospitals. Rev. Latino-Am. Enfermagem. 2023;31:e3969.
[Access ]; Available in: . https://doi.org/10.1590/1518-8345.6591.3969
month day year URL
2 Rev. Latino-Am. Enfermagem 2023;31:e3969.

Introduction care, enhances said care and increases the possibility

that the necessary intersubjectivity can be generated
Assistance activity in the field of health must be so that the nursing professional can perform with high
permeated by humanization . The humanization of
(1)
degrees of success(18-19). Therefore, the importance of
nursing professionals in patient care is one of the essential empathy consists in the practical fact of establishing the
aspects of their work (2-3)
. Empathy is an attribute that appropriate interaction with the patient to provide the
plays an important role in the patient care process humanized care that every patient needs and, at the
and allows an intersubjective connection between two same time, generate human satisfaction in the patient
human components of health care: nurses and patients(4). under care. Empathy is considered as a modulator of
Therefore, empathy is one of the constituent elements the factors that positively or negatively influence this
of the structure of the concept of humanization in attribute(9-12). The acquisition of empathy is not a purely
patient care .
(2)
innate attribute but is formed through complex processes
Empathy is structured by cognitive(5) and emotional(6) during a person’s natural development(12-20). Due to the
factors or components. Cognitive factors are sensitive complexity of this attribute, the empathic training of future
to teaching-learning processes(7) throughout life, but nursing professionals should be the object of attention
emotional aspects (especially compassionate care) from the first years in the teaching-learning process(20-29).
are complex processes(8) and are difficult to modify(9). There are several instruments to measure empathy,
The complexity of empathy lies in the fact that cognitive among which are those that have a cognitive approach,
and emotional factors are constantly interacting with for example: Hogan Empathy Scale (EM); affective, for
each other dialectically (5-7)
and, as a consequence, they example: Questionnaire Measure of Emotional Empathy
form a system. Therefore, a “deficit” of any of them (in (QMEE); and integrators, for example: Interpersonal
whatever form) will necessarily imply an alteration of Reactivity Index (IRI)(30). At present, the most used is
the empathy “system” that, according to the “severity” the integrative vision(31). However, the measurement of
of such insufficiency (or simply the absence of some of empathy in students and health sciences professionals
these factors), will determine a decrease in empathy until required an instrument that measured empathy but in a
its cancellation as a complex attribute. This “decrease” precise context: empathy with the patient. The Jefferson
of empathy may be due to a “failure” of the capacity Medical Empathy Scale (32-33), the Jefferson Medical
and ability to understand or read what the other person Empathy Scale for medical students (Version-S), emerged.
thinks and take perspective about this understanding, This scale has been adapted for different specialties,
or compassion for the other person’s physical and/or including the Empathy Scale for Health Professionals (HP)
mental pain(10). and the Health Sciences Student Version (HP-S). All these
Currently, technological development has allowed adaptations are characterized by having a good internal
the creation of complex instruments that participate consistency: alpha [0.75; 0.89]. Convergent validity has
in the care of patients. Therefore, the presence of the been confirmed by significant correlation coefficients
risk that nurses prioritize technical assistance over the between Jefferson Scale of Empathy (JSE) scores and
humanized attention of the nursing staff is admissible. conceptual measures of compassion. The same occurred
Nursing practice requires an understanding of the with discriminant validity due to the lack of significant
intimate relationship of nursing (as a profession), the association with irrelevant conceptual measures such as
sense of care and being aware of internal ethical values(11) self-protection(31-32). Authors(34) have recently published a
and having prosocial attributes that this profession paper that exhaustively describes other characteristics of
naturally demands(12). this scale, which has been used in its different versions
In professional nursing practice, the core of care to measure students and health professionals. This scale
must necessarily be present because this core transforms is also characterized by its stability. Studies that have
this practice into a real action consisting of the best care used this scale report that it repeatedly maintains the
for the patient. In addition, the concept of care, it is three dimensions stable: two cognitive, Perspective Taking
also necessary for the nursing professional to have a (PT) and “Walking in Patient Shoes” (WIPS), and one
conception that contemplates an integrated understanding emotional, Compassionate Care (CC). The facts described
of care, suffering, health, the environment, and the person above justify the use of the JSE in the study of empathy
as a human being(13-17). In this sense, empathy is an with the patient in professionals and students of health
attribute that makes it possible to mitigate or control all sciences due to the results observed in the psychometric
the factors that may have a negative impact on patient and trustworthiness studies.

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Studies of empathy in professional nurses are The sampling was convenience. The Hospital where the
scarce, but they provide relevant information that must study was conducted (May 2022) is classified as Third
be studied and explained(16-19), with greater production in Level (High Complexity). It is run by a decentralized public
populations of nursing students (9,13-16)
. In the first case, entity that belongs to the Ecuadorian Social Security
these studies dealt with empathic performance in adverse Institute (IESS) whose non-delegable purpose is the
work conditions and patients’ perception of the attitude of provision of Compulsory General Insurance throughout
nurses, and, in the second case, they evaluated the levels the national territory(36).
of empathy in the training process of nursing studies.
However, there are few studies on nursing professionals Instruments
in Latin America that massively evaluate the empathy
of nursing staff with the patient and, at the same time, Empathy was measured using the Jefferson Scale
practice in highly complex hospitals in relatively large of Empathy version for Health Professionals (JSE-HP
cities. It is also unknown how the levels of empathy with version). This scale is a psychometrically sound instrument
the patient are distributed in relation to the different developed specifically to measure physicians’ empathetic
types of work schedules (hour load) even though there orientation in the context of patient care. It is made up
are studies that establish some degree of relationship of 20 items and each one of them is evaluated using a
between this type of load and the presence of depressing Likert scale (from one to seven points with a total of
factors, for example, Burnout (35)
. On the other hand, 140 points) and the higher the score, the greater the
it has been observed that, in general, the published empathic orientation. It is structured by three factors:
literature refers that age is not correlated with the levels Compassionate Care (CC), Perspective Taking (PT), and
of empathy in nursing students and professionals and “Walking in the Patient’s Shoes” (WIPS)(7,18-20,37). The
concludes, implicitly or explicitly, that this variable findings support the underlying factor structure of the
does not seem to be important(13-16). Consequently, the Jefferson Empathy Scale in a Hispanic-American sample(38).
theoretical and practical meaning of the absence of this
correlation has not been discussed about the causes Procedure
that can produce it and the effect that this could have
on patient care, especially of those nursing professionals The translation and adaptation of the JSE-HP were
who show low or insufficient levels of empathy. carried out through the process of translation and retro-
This paper aims to determine the levels of empathy translation of the original instrument in English(39).
(and its dimensions) in nursing professionals from a highly Subsequently, it was subjected to a pilot study made up
complex hospital, relate age to empathy (and each of its of 30 nursing professionals, drawn from the same study
dimensions) and establish whether there are differences population, to verify the understanding of the questions.
between them. To meet this objective, it is necessary Finally, the underlying three-dimensional model was
to previously submit the empathy data to psychometric verified by factorial analysis establishing factorial validity.
studies to confirm the structure of three underlying
dimensions in the empathy construct in relation to the Data analysis
data observed in the present study(9,20,26,33-34).
Before to data analysis, the Kolmogorov-Smirnov
Method statistic was evaluated to test univariate normality and
Mardia’s multivariate kurtosis coefficient(40) to check if
Design the data presented multivariate normality. Subsequently,
the various descriptive statistics were calculated, and a
Comparative, descriptive and cross-sectional study. confirmatory factor analysis (CFA) model was established
based on the Maximum Likelihood method and using
Participants Bootstrap, simulating 5000 samples, as a technique that
allows making a better fit in the context of the absence
The sample is composed of 271 professional nurses of multivariate normality(41). To assess the fit of the CFA
at a public hospital in Cuenca, Ecuador. This sample model, various goodness-of-fit indices were used: chi-
corresponds to 40.9% of the total number of nursing square, the comparative fit index (CFI > .90); Tucker
professionals working at the mentioned hospital (N=663). Lewis index (TLI > .90), goodness-of-fit index (GFI >
The participation of the people evaluated was voluntary. .95) the root mean square error approximation index

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4 Rev. Latino-Am. Enfermagem 2023;31:e3969.

(RMSEA < .10); and the standardized root mean square (Mean=36.59, Standard deviation=8.54, Confidence
residual (SRMR < 0.05), the magnitude of the factor interval= [35.57; 37.61]). Specifically in men:
loadings (> .50), and the reliability of the construct Mean=31.58, Standard deviation= 7.064; Confidence
with the McDonald’s omega coefficient and Cronbach’s interval= [27.10; 36.07] and in women: Mean=36.84;
alpha (> .70). Standard Deviation= 8.546; Confidence interval= [35.78;
The following descriptive statistics were estimated: 37.87].
arithmetic mean, standard deviation, standard error
of the mean, coefficient of variation (CV), confidence Assessment of normality
interval (CI), and minimum and maximum values of
empathy and its dimensions. The association between Before data analysis, compliance with the normality
age (independent variable) and levels of empathy and assumption was tested. Observe a significant Kolmogorov-
its dimensions (dependent variables) was made by Smirnov statistic for all the empathy variables (p<.001),
estimating the regression equation with standardized indicative of the absence of univariate normality. With
data and transforming it to a logarithmic scale, analysis of the absence of multivariate normality when observing a
variance (ANOVA) was carried to evaluate the significance multivariate kurtosis coefficient of Mardia(40) of 111.621
of the coefficient of regression and sequential ANOVA to (critical ratio= 30.971).
determine the type of curve. The standard deviation of the
regression curve and the adjusted and unadjusted variance Confirmatory factor analysis
were estimated. Finally, the comparisons between the levels
of empathy and its dimensions between the two types of To provide evidence of the validity of the empathy
working schedules were compared using a Mann-Whitney construct, confirmatory factor analysis is used, observing
U test, after comparing homoscedasticity using the Levene a bad adjustment of the data to the three-factor model
test. SPSS 25.0, AMOS 25, and Minitab 18.0 programs of empathy proposed by Hojat (2002) (χ2=379.981,
were used. The level of significance used was α <0.05. df= 167, p= .0001; χ2/df= 2.275, GFI= .876, TLI= .84,
CFI = .86, RMSEA=.069 [90% CI= .060 – .078], SRMR=
Ethical aspects .070), with factorial weights that vary from λ= .11 to
λ=.82. Based on the above, it was decided to respecify
The participation of nursing professionals was the model, eliminating items with factor loadings lower
voluntary and confidential. The participants signed than 0.50(42). Retaining the three original factors, but
informed consent before taking the measurements, only 16 items, with significant factor loadings that vary
adjusted to the ethical principles of the Declaration of between λ = .53 and λ= .82. Adequate goodness-
Helsinki. This study was approved by the Research Ethics of-fit indices, were observed (χ2=111.418, df= 162,
Committee of the University of Azuay (CISH-UDA), with p= .0001, χ2/df= 1.797, GFI= .94, TLI= .94, CFI = .95,
a resolution issued on June 17, 2020. RMSEA= .054 [90% CI= .038 – .070], SRMR= .047)
(Figure 1). Observing correlations of r= .19 between
Results PT and CC, r=-.26 between PT and WIPS, and r= .44
between CC and WIPS. The observed psychometric
Sample characteristics results methodologically support, as a prior condition,
the possibility of estimating the levels of empathy and
The sample consisted of 259 women (95.6%) its dimensions and, therefore, these results contribute
and 12 men (4.4%), aged between 22 and 60 years to achieving the objective of this study.

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 Dávila Pontón Y, Díaz-Narváez VP, Montero Andrade B, López Terán JJ, Reyes-Reyes A, Calzadilla-Núñez A. 5

Figure 1 - Three-factor model of the Jefferson Empathy Scale in Nurses (JSE-HP version)

Reliability Compassionate Care (S=0.0622914; R 2 unadjusted

=7.8%; R 2 adjusted= 6.8%), Perspective Talking
The reliability estimated by McDonald’s omega is (S=0.06418; R2 unadjusted =1.1; R2 adjusted =0.7%)
0.82, showing adequate internal consistency, with a and Walking in Patient’s Shoes (S=0.191302; R 2
standardized Cronbach’s alpha of 0.79. unadjusted=0.7%; R2 adjusted=0.0%).

Associations Descriptive analysis

The results of the association of the variable age The results of the estimation of the descriptive
and empathy (in its dimensions) were not significant. statistics are presented in Table 1. The highest CV values
It was found that age explains very little the behavior are concentrated in the CC and WIPS dimensions, revealing
of empathy (S=0.0622914; R unadjusted =7.6%;
2
the heterogeneity of the data, unlike the PT dimension
R2 adjusted = 6.6%) and in each of its dimensions: and the total empathy score which show homogeneity.

Table 1 - Descriptive statistics of empathy and its dimensions according to types of shifts in which practicing nurses
work. Cuenca Province, Ecuador, 2022

95% CI* for the mean

n M† SD‡ CV(%)§ Min. Max.
Lower limit Upper limit

Empathy

Full time 252 70.52 12.50 14.8 68.97 72.02 42 95

Half day or less 19 71.53 7.78 10.4 67.78 75.27 53 84

Total 271 70.59 12.22 14.5 67.78 75.27 42 95

Compassionate Care

Full time 252 29.65 9.83 30.7 28.43 30.87 6 42

Half day or less 19 32.00 6.16 19.2 29.03 34.97 15 41

Total 271 29.81 9.62 30.0 28.43 34.97 6 42

(continues on the next page...)

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6 Rev. Latino-Am. Enfermagem 2023;31:e3969.

(continuation...)

95% CI* for the mean

n M† SD‡ CV(%)§ Min. Max.
Lower limit Upper limit

Perspective Taking

Full time 252 31.42 4.19 12.9 30.90 31.94 7 35

Half day or less 19 31.26 3.53 11.6 29.56 32.96 22 35

Total 271 31.41 4.14 12.8 29.56 32.96 7 35

Walking in Patient Shoes

Full time 252 6.26 2.858 45.7 5.91 6.62 2 14

Half day or less 19 6.05 2.934 48.5 4.64 7.47 2 12

Total 271 6.25 2.859 45.7 5.91 6.59 2 14

*CI = Confidence interval; †M = Arithmetic average; ‡SD = Standard deviation; §CV(%) = Coefficient of variation

Table 2 shows the results of the comparison of in all cases, which implies that there are differences
empathy and its dimensions between the types of between the means compared, assuming eminently
working schedules. The test was not significant (p≥0.05) equal means.

Table 2 - Comparison of empathy means and their dimensions according to the type of work shift of nurses. Cuenca
Province, Ecuador, 2022

Full time Half day or less

Variable M*
SD †
M *
SD† Z‡ p§

Empathy 70.52 12.50 71.53 7.78 -0.020 0.984

Compassionate Care 29.65 9.83 32.00 6.16 -0.599 0.549

Perspective Taking 31.42 4.19 31.26 3.53 -0.736 0.461

Walking in Patient´s Shoes 9.46 3.56 8.26 3.02 -1.618 0.106

*M = Arithmetic average; †SD = Standard deviation; ‡Z= U of Mann-Whitney; §p= p ≥ 0.05 is not significant

Discussion The exact cause of this difference is unknown,

but it could relate to topological networks with unequal
Empathy is a complex construct. Its roots are found characteristics that determine individual differences in the
in the phylogenetic development and the ontogeny of dimensions of empathy(49). The formation of the specific
the subject of the human species(43-44). The phylogenetic topology of the networks in each human being will be
component is still active and its action could be expressed strongly influenced by external stimulations more than
through a “synthesis of development systems where by genotypic potentiality(45). Some of these stimuli can
morphological inheritance, motor skills, and socio-ecological be as specific as the family environment(51) or as general
factors converge”(36), but this development is characterized as society as a whole(50). Questions arise from the ideas
by the fact that the mechanisms that install quantitative expressed above. One of them is whether empathy can
and, above all, qualitative changes are extremely slow(44-45). be developed indefinitely during the lifetime of a human
It is then inferred that the development of empathy in a being. It has been suggested that the neurogenesis
person is fundamentally modulated by the influence of the present in adults shows the possibility of generating brain
processes associated with ontogeny (46-47)
. plasticity and some studies show a high structural and
Empathy has cognitive and affective components or synaptic plasticity in adults(52). However, this plasticity
dimensions (48)
. These components interact with each other tends to decrease over time(53). From the above, it is
dialectically. The interactions between the dimensions of inferred that empathy is not an attribute that develops
empathy materialize in neural networks and the properties indefinitely and constantly over time(44,46), at least, there
of these networks are essentially referred to as a flow are no studies that demonstrate, directly or indirectly,
of information between them. The interactions between that brain plasticity can contribute significantly to the
networks may be different (different flows), which could development of empathy in the course of a person’s life.
also determine different functional organizations of the In fact, it is known that the prefrontal cortex of the brain
network and, therefore, may give rise to different traits is responsible for executive functions and, therefore, for
of empathy (48-50)
. the control of cognition(54). This process is reached between

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 Dávila Pontón Y, Díaz-Narváez VP, Montero Andrade B, López Terán JJ, Reyes-Reyes A, Calzadilla-Núñez A. 7

the ages of 25 and 30 with the complete maturity of the neurogenesis, myelination, and neuronal pruning, with
prefrontal cortex (55)
. Therefore, the topology described consequences on the limbic system and the cerebral
above reaches its definitive structure in the interval of cortex. The brain vulnerability hypothesis shows us that
years mentioned. However, this does not mean that “damage may imply a subsequent neurodevelopment that
a person above this age stops their learning activity will not be equivalent to the path it could take without
associated with the cognitive dimension of empathy. the damage produced” (32) and that brain plasticity,
The issue is that empathy is a system constituted by a in adults, would not be sufficiently effective to repair
close relationship between the cognitive and the emotional this damage. If the damage finally occurs, it will affect (to
processes and the interaction between all the dimensions one degree or another) the neurobiological conformation
of empathy and not an attribute resulting from additive of the components of the limbic system and with this,
properties. Indeed, the finding that increasing age does not the ability to generate the necessary interconnections
imply an increase in empathy (and its dimensions) in the of the network associated with the affective dimension
professional nurses examined could be explained, in part, (feeling of compassion) will also be affected. Depending
because the networks associated with the development on the degree of affectation, the network that emerges
of neural connections within each dimension, as well as from the affected dimension will not be able to interact
between the networks of the different dimensions that adequately with the rest of the networks generated for
constitute empathy (as a system), reached its maturity, and the other (cognitive) dimensions. Of course, in normal
acquired a certain architecture. The differences between subjects, there are no damages as severe as those
the values of empathy (and its dimensions) between “low” described, but there are non-severe “damages” that affect
and “high”, including the variations observed in these the development of empathy as a whole.
measurements (homogeneous and heterogeneous CV), The variability of the levels of empathy observed
could be explained by the differentiated grouping of the in the sample of nursing professionals in this study (with
levels of empathy (and its dimensions), the differentiated almost extreme maximum and minimum values) raises
individual interactions determined by the empathic the urgent need to take measures in relation to the
architecture achieved in each nursing professional and by empathic behavior of the nurses studied. The causes that
the effects of physical and emotional exhaustion , all of
(56)
originate these results, in light of the theoretical elements
which would suppose a different empathic response and exposed, could be explained by the presence of problems
behavior with the patient. that have not yet been solved in the empathic training
The absence of differences between the levels of of nursing students and health sciences in general(59). It
empathy and the dimensions observed between the type is known that the humanization process in patient care
of working schedules of the professional nurses could is multifactorial and the empathy of the nursing staff
be explained by the same arguments already raised with the patient is an important element of it. But if it is
as possible explanations for the absence of association affirmed that humanization must be built from patient
between age and empathy. The possible empathic care training(60), empathy with the patient in the nursing
response is already determined by the topological profession must also be built longitudinally and from the
neural architecture achieved. Therefore, professional first year of training with nursing professionals(7,20,25-26).
nurses would not have to modify their empathic attitude The possible contribution of this work could be
towards the patient due to work pressure, but rather the summarized in the following points: a) The scarcity of
mentioned attitude could not exceed the threshold that studies that evaluate these levels in practicing nursing
the topological architecture reached would allow. professionals should be a matter of concern for the
The essential basis of the possible explanations of corresponding researchers; b) The presence of relatively
the empirical findings lies in the fact that the development low levels of empathy in practicing nursing professionals is
of the cognitive structures of the brain (associated with a finding that must be studied and determine the possible
the cognitive dimensions of empathy) can continue to causes that produce it; c) The absence of association
develop with age, but with the affective dimension, between age and empathy is a frequent finding in studies
the situation is different. The emotional formation is of empathy with the patient. This finding, however, has
strongly influenced by ontogeny factors that operate from not been associated with ontogenetic processes imbricated
the earliest childhood (57-58)
. Child abuse, for example, in empathy training, among them, the training process
seriously alters neurological development and delays brain during their stage as a nursing student and d) The absence
maturation. The consequences can fluctuate from the of differences in the levels of empathy between nursing
affectation of attention capacity to the deficit of intellectual professionals with different workloads is a finding that
development. It negatively influences the processes of should be studied and exceeds the objectives of this study.

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8 Rev. Latino-Am. Enfermagem 2023;31:e3969.

The limitations of this study can be systematized in an Emergency Department. Int J Environ Res Public
in the following points: a) The sample size is not Health. 2020 Apr 24;17(8):2939. https://doi.org/10.3390/
representative of the population studied. For ethical ijerph17082939
reasons, studies of this type are characterized by the fact 5. Irorutola F, Gerhardt C, Hamouda K, Rose M,
that participation is voluntary, and their results are rarely Hinkelmann K, Senf-Beckenbach P. Emotional and
extrapolated to the population studied; b) It was only cognitive empathy in patients with non-epileptic seizures.
performed in a hospital in a region of Ecuador. Therefore, Seizure. 2020;81:280-6. https://doi.org/10.1016/j.
its results cannot be extrapolated to the population of seizure.2020.08.009
nursing professionals working in other hospitals in this 6. Thompson NM, Uusberg A, Gross JJ, Chakrabarti B.
country and c) The comparisons between the subsamples Empathy and emotion regulation: An integrative
of nursing professionals, with different workloads, were account. Prog Brain Res. 2019;247:273-304. https://doi.
distributed with different sample sizes. Taking these org/10.1016/bs.pbr.2019.03.024
limitations into account, the results and findings found 7. López-Labarca C, Allende-Salamanca MT, Godoy-
should be considered only as trends. It is recommended Huanchicay S, Calzadilla-Núñez A, Torres-Martínez P, Díaz-
to continue these studies in different hospitals in Ecuador, Narváez VP. Evaluation of empathy in midwifery students
as well as in the rest of Latin America. in Copiapó (Chile). Matronas Prof. 2021;22(2):e27-e34
8. Abramson L, Uzefovsky F, Toccaceli V, Knafo-Noam A.
Conclusion The genetic and environmental origins of emotional
and cognitive empathy: Review and meta-analyses of
In the studied sample of professional nurses, the twin studies. Neurosci Biobehav Rev. 2020;114:113-33.
levels of empathy are relatively low and are not associated https://doi.org/10.1016/j.neubiorev.2020.03.023
with age or the type of work schedule. The values observed 9. Díaz-Narváez V, Dávila-Pontón Y, Martínez-Reyes F,
in the levels of empathy (especially in the CC and WIPS Calzadilla-Núñez A, Vélez-Calvo X, Reyes-Reyes A, et al.
dimensions) in some of the nursing professionals studied Psychometrics, Jefferson medical empathy scale and
could imply poor performance in empathic patient care. medical care in Ecuador. Salud Uninorte. 2021;37(1):
The main limitation of this work lies in the fact that 96-111 https://doi.org/10.14482/sun.37.1.150.15
the results observed were obtained from a non-random 10. Campos C, Pasion R, Azeredo A, Ramião E, Mazer P,
sample (due to the characteristics of the work) and with Macedo I, et al. Refining the link between psychopathy,
a sample that does not exceed 50% of the population, antisocial behavior, and empathy: A meta-analytical
all of which can lead to concluding terms of trends about approach across different conceptual frameworks. Clin
the population of nurses examined. Psychol Rev. 2022;94:102145. https://doi.org/10.1016/j.
cpr.2022.102145
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Authors’ contribution

Study concept and design: Yolanda Dávila Pontón,

Víctor Patricio Díaz Narváez, Alejandro Reyes-Reyes,
Aracelis Calzadilla-Núñez. Obtaining data: Yolanda Dávila
Pontón, Bernardo Montero Andrade, Joseline J. López
Terán. Data analysis and interpretation: Yolanda Dávila
Pontón, Víctor Patricio Díaz Narváez, Bernardo Montero
Andrade, Alejandro Reyes-Reyes, Aracelis Calzadilla-
Núñez. Statistical analysis: Víctor Patricio Díaz Narváez,
Alejandro Reyes-Reyes. Obtaining financing: Yolanda
Dávila Pontón, Víctor Patricio Díaz Narváez, Bernardo
Montero Andrade, Joseline J. López Terán, Alejandro
Reyes-Reyes, Aracelis Calzadilla-Núñez. Drafting the
manuscript: Yolanda Dávila Pontón, Víctor Patricio
Díaz Narváez, Bernardo Montero Andrade, Joseline J.
López Terán, Alejandro Reyes-Reyes, Aracelis Calzadilla-
Núñez.Critical review of the manuscript as to its
relevant intellectual content: Yolanda Dávila Pontón,
Víctor Patricio Díaz Narváez, Bernardo Montero Andrade,
Joseline J. López Terán, Alejandro Reyes-Reyes, Aracelis
Calzadilla-Núñez.

All authors approved the final version of the text.

Conflict of interest: the authors have declared that

there is no conflict of interest.

Received: Nov 30th 2022

Accepted: May 25th 2023

Associate Editor:
Andrea Bernardes

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