What this article is about
In brief
Among 204 eighth-semester students at Alexandria University, mean self-reported empathy scores increased from 52. 47 to 62.
For nursing students
Study summary
At Alexandria University in Egypt, 204 eighth-semester nursing students completed the same empathy measure immediately before and after a psychiatric nursing and mental health course. The course ran for 15 weeks and combined weekly theory with six weeks of clinical training at El-Maamoura Hospital for Psychiatric Medicine. The clinical experience used groups of 10 to 12 students and included role play, interpersonal process recording, and other assignments.
The outcome was the 16-item Empathy toward the Mentally Ill Scale. The paper reports a possible score range of 16 to 80 and classifies scores above 48 as high empathy. The instrument was translated into Arabic for this study, reviewed by five psychiatric nursing experts, and tested with 20 students before the main data collection.
Before the course, 79.9% of participants were already above the study's high-empathy threshold. Immediately afterward, all 204 were above that threshold. The mean score increased from 52.47 to 62.64, and 95.6% of students had a higher score at the second assessment. Two students had no change and seven had a lower score. The size of the score change was not significantly associated with sex, age, residence, previous psychiatric study or work, or previous contact with a person experiencing mental illness.
These results document a change in students' self-reported empathy during the course period. They do not show which part of the course mattered most, whether students behaved more empathically with patients, or whether the higher scores lasted. Everyone received the course and there was no comparison group, so other experiences during the semester and familiarity with the questionnaire remain possible explanations. The paper is best read as evidence that empathy scores can change during psychiatric nursing education, followed by a question about how a stronger study could test causation and durability.
Original publication
Source abstract and study details
Read the source abstract
Empathy is an ability and skill that can be learned and developed through appropriate education and practice. While the importance of nurses' empathy is widely acknowledged, little is known about the impact of passing through the psychiatric nursing and mental health educational experience at the Faculty of Nursing, Alexandria University on students' level of empathy. This study aimed to assess the change in level of empathy toward patients with mental illness among baccalaureate nursing students before and after completing a psychiatric nursing and mental health educational experience. The study followed a cross-sectional exploratory research design. It was conducted on 204 students in the eighth semester of the academic year 2012-2013, who were enrolled in the course of psychiatric nursing and mental health. A Student's Socio-demographic Characteristics and Previous Experience with Mental Illness Questionnaire and Empathy toward the Mentally Ill Scale were used to collect data. The results indicated that all students significantly achieved high levels of empathy after the psychiatric nursing experience. It was concluded that passing through a psychiatric nursing and mental health educational experience can improve baccalaureate nursing students' empathy toward patients with mental illness. Recommendations included the need for further studies compare between students' levels empathy toward people with mental illness before and after completing various psychiatric nursing educational experiences at different faculties of nursing.
Reviewed findings
Main findings
- Mean Empathy toward the Mentally Ill Scale scores increased from 52.47±5.84 before the course to 62.64±5.77 immediately afterward (t=21.743, p<0.001).
- The proportion above the study's high-empathy threshold increased from 79.9% to 100% (χ²=45.580, p<0.001).
- Of 204 students, 195 had a higher post-course score, two had no change, and seven had a lower score.
- None of the tested demographic or previous-experience variables had a statistically significant relationship with the percentage change in empathy score.
For teaching and learning
Education implications
- The study supports measuring empathy during psychiatric nursing education, but its self-report outcome should not be treated as evidence of improved patient communication or patient experience.
- Because theory, clinical contact, role play, reflective recording, and instructor modelling were delivered together, educators cannot infer which component accounted for the score change.
- A stronger evaluation would add a concurrent comparison group, an observed or patient-rated communication outcome, and a delayed assessment to determine whether any change persists.
For educators
Teaching and appraisal notes
Mousa assessed one cohort of 204 Alexandria University nursing students immediately before and after a psychiatric nursing and mental health course. Although the paper calls the design cross-sectional exploratory, the procedure is more clearly understood as an uncontrolled single-group pre/post assessment.
The educational exposure bundled 15 weeks of theory with six weeks of psychiatric clinical training. Lectures, discussion, role play, small-group placement, interpersonal process recording, instructor modelling, and direct patient contact occurred within the same course. The study therefore cannot estimate the contribution of any individual teaching method.
The Empathy toward the Mentally Ill Scale increased from 52.47±5.84 to 62.64±5.77. High scores were common before the course, at 79.9%, and universal at the immediate post-course assessment under the study's cutoff. The result is statistically clear within this cohort, but its educational meaning is narrower than a demonstrated improvement in observed communication or patient experience.
For appraisal teaching, the most useful issues are the absence of a concurrent comparison group, reliance on a translated self-report measure, a high baseline score distribution, and the lack of delayed measurement. The source also contains an unresolved reporting discrepancy: the abstract identifies academic year 2012–2013, whereas the methods identify 2013–2014. Students can examine how such inconsistencies affect extraction and citation without dismissing the reported numerical results.
Critical appraisal
Limitations
- All participants received the course, leaving no concurrent comparison group against which to separate course-related change from other semester experiences or repeat testing.
- Empathy was measured by student self-report immediately after the course; the study did not assess observed communication, patient ratings, or persistence after training.
- The cohort came from one nursing faculty in Egypt, and 79.9% were already above the scale's high-empathy threshold before the course.
- The source reports different academic years in the abstract (2012–2013) and methods (2013–2014), so the enrolment year should not be presented as settled.
Classroom use
Discussion Questions
- The paper calls its design cross-sectional exploratory, yet it measured the same students twice. What design label would communicate the procedure more accurately, and why?
- What can a higher self-reported empathy score establish that an observed nurse–patient interaction or patient rating cannot, and vice versa?
- How would you design a study that separates the effects of theory, role play, reflective recording, and direct psychiatric clinical contact?
- When the abstract and methods report different academic years, how should an evidence reviewer document the discrepancy?
Source-based questions
Frequently asked questions
Can the study show that the course caused the increase?
No. The same cohort was assessed before and after the course without a concurrent comparison group. The increase occurred during the course period, but repeat testing, other learning, or other changes over the semester cannot be excluded.