GENERAL SIR JOHN KOTELAWALA

DEFENSE UNIVERSITY
FACULTY OF ALLIED HEALTH SCIENCES
DEPARTMENT OF NURSING & MIDWIFERY

RESEARCH PROPOSAL
Basic Research Methodology
2nd year 2nd semester end examination 2021

STUDENT NAME : I D T Dinushika

REGISTRATION NUMBER : D/BNP/20/0016
DUE DATE : 2021/12/16
SUBMITTED TO : Dr.Thamarasi Senarathne

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A study on importance of training Empathy
skills in nursing undergraduates of KDU for
better patient care.

Name of reporter - I D T Dinushika

Registration number - D/ BNP / 20/ 0016

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 CONTENT

1. Introduction

2. Review of literature

3. Problem in brief

4. Objectives

5. Materials and methodology and resource requirements

6. Ethical issues

7. Work plan

8. References

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Introduction

Nursing encompasses autonomous and collaborative care of individuals of all ages,

families, groups and communities, sick or well and in all settings. It includes the
promotion of health, the prevention of illness, and the care of ill, disabled and dying
people(WHO). Nurses comprise nearly half of all health care professionals in many
countries, and they play a critical role in how health measures are organized and
implemented, both on the front lines and in management. They are frequently the first
and, in some cases, the only health professional a patient may encounter, and the
quality of their first assessment and subsequent care are critical to achieving positive
health outcomes. Nurse is not only a caregiver but also an advocate, teacher, leader,
manager, communicator, researcher, counselor, critical thinker etc. As you can see
nursing is a highly demanded noble profession and the greatest service to humanity
which helps to maintain and recovers individuals’ health and quality of life.

Empathy has been referred to as the "art of nursing." (Carper, 1978) It is the ability to
understand what other people feel by replacing yourself in their position and see the
things from their point of view. In simple words it means how you will feel if you
experience the same situation which undergoes with another person. Empathic
nursing care, should be appreciated like scientific nursing care by both the profession
and the people who receive it. Nurses with higher assessed empathy are likely to
provide more empathic nursing care than nurses with lower measured empathy.

Expressing empathy is highly recommended in nursing profession to improve

patient’s quality of life by understanding the patient well and respond appropriately to
the situation. It builds trust between nurse and the patient which improves the bond
between two parties and leads to improve the health outcomes. Empathy is essential in
establishing a productive conversation between a nurse and a patient since patients are
more likely to share their actual condition in front of an empathic nurse. Being
empathetic reduces malpractice, reduces mistakes, reduces patient anxiety, and
ultimately improves patient satisfaction.

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Review of literature
By considering the research topic empathy is considered as a basic component to
practice by nurses to improve patient’s quality of care. There are several articles have
been published related to empathy and patient care.

2.1) Aestheticians first proposed the concept of empathy in the mid-nineteenth

century. They adopted the German word "Einfühlung" to express the emotional
"knowing" of a work of art from within, when one feels an emotional resonance with
it. The psychologist Theodore Lipps broadened this idea to imply "feeling one's way
into another's experience" at the end of the 19th century, believing that inner mimicry
of others' behaviours played a significant role in generating empathy. Martin Buber, a
philosopher, offered more depth to the concept of empathy by characterizing
empathetic relationships as "I and Thou," as opposed to unempathic disdain as "I and
It". Humane respect and concern for the other are contrasted in this compelling
depiction with objectification and dehumanization of another person, which is all too
often in today's communities. (Riess, 2017)

2.2) Historically, empathy was considered an inborn trait that could not be taught, but
research has shown that this crucial human competency can be learned and taught to
healthcare providers. A large-scale observational study found that teaching physicians
communication skills boosts patient satisfaction. (Boissy et al., 2016) Patient
satisfaction, adherence to treatment recommendations, better clinical results, fewer
medical errors and malpractice claims, and higher physician retention are all
connected with empathic medical care. (Riess et al., 2012) Empathy appears as a
major feature in primary care when it comes to patients' own notions of quality of
care. (Lewis, 1994) However, there is a limited research on the function of empathy in
primary care clinical outcomes. Empathy has been shown to improve both patient and
doctor satisfaction through improving the doctor–patient connection. Empathy can
also help to improve diagnosis accuracy. A correlation has recently been
demonstrated between the patient's assessment of the doctor's empathy and the

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outcome of patient enablement at the end of the consultation. (Mercer, Watt and
Reilly, 2001)

2.3) Nine studies were conducted to investigate nurses' or nursing students' empathy
levels. The levels ranged from underdeveloped to moderately developed. There were
seven reports of relatively high levels of self-reported empathy (Åström et al.,
1990,1991; Warner, 1992; Kuremyr et al., 1994; Bailey, 1996) La Monica's Empathy
Construct Rating Scale (1981) was used in six of these. These included a Swedish
study of staff (n=20) caring for older people in community settings (Kuremyr et al.,
1994); two Swedish studies of nurses and nursing aides caring for patients with
dementia (Åström et al., 1990,1991); an Australian study of nurses (n=183) working
in critical care units (Bailey, 1996); a US study of nurses (n=20) in medical-surgical
units (Warner, 1992); and a Swedish study of nurses (n=30 (Pålsson et al.,
1996).When empathy was measured using third-party ratings on the Staff-Patient
Interaction Response Scale, similar results were obtained (Watt-Watson et al., 2000).
Two studies, however, called these findings into question (Daniels, Denny and
Andrews, 1988; Reid-Ponte, 1992).Reid-Ponte (1992) discovered low empathy levels
among nurses (n=65) working in surgical care units using the La Monica Empathy
Profile and a revised Empathy Construct Rating Scale(Monica, 1981).The Carkhuff
Index of Communication (Carkhuff, 1969) was used to assess empathy in the other
study, and most respondents in both the intervention and control groups reported low
levels of empathy prior to attending an empathy training session ((Daniels, Denny and
Andrews, 1988). These inconsistencies could be caused by a variety of circumstances.
To begin with, most researchers utilized a convenience sample, and no papers
included any statistical power information. The sample sizes ranged from 20 to 358
(Warner, 1992; Kuremyr et al., 1994) Second, certain critical confounding factors
were overlooked. Some evidence implies a link between empathy and demographic
factors such as age, gender, clinical experience, and educational level (Reid-Ponte,
1992; Watt-Watson et al., 2000). Some reports of research gauging empathy levels, on
the other hand, included no or limited demographic data regarding respondents
(Kuremyr et al., 1994; Pålsson et al. 1996; Reid-Ponte, 1992). Furthermore, the wide

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range of measures used in these studies makes direct comparison impossible, as
various tools may examine different aspects of empathy.

2.4) While some research suggests that nursing students' empathy levels decrease
during their undergraduate education (Ward et al., 2012) others suggest that nursing
students have more empathic inclinations than students from other disciplines,
perhaps reducing the teaching effect (Gallagher et al., 2017). McKenna et al. (2012)
found that nursing students from first to third year showed consistently high empathy
levels when tested using the JSPE Health Professions questionnaire (Lewis, 2012).
Several research in the current review supported this idea, such as (Everson et al.,
2015), who looked at the empathetic attitudes of n = 460 second year nursing students
and found that their empathy scores on the Modified Kiersma-Chen Empathy Scale
averaged 86 percent (47.86/56) at pre-test. It should be noted, however, that many of
these research relied on self-report surveys, which are susceptible to social desirability
bias. The use of numerous measurement tools, small samples, and the varied character
of the included research limited a formal meta-analysis, hence the current study
provides little to help untangle these underlying difficulties.

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03. Problem in brief

Nurses are often the first to notice health emergencies and are on the front lines of
disease prevention and basic health care. For a positive health outcome, they must
provide high-quality initial assessment and care. A well-developed empathy and
communication skills play a crucial part in properly assessing and understanding a
patient.

In this research I hope to reflects the importance of empathy education to improve the
quality of patient care in the future.

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04.Objectives

General objective

 To identify the advantages and impact of empathy education for undergraduate

nursing students preparing to work as nurses in the near future.

Specific objectives

 To identify how important, it is to be empathic as a nurse.

 To learn what happens when a nurse lacks empathy.
 How empathy can help to have a more productive conversation.
 To study the link between nurse empathy and patient satisfaction.

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05. Materials and Methodology and Resource requirements

05.1 Research design:

This study will be carried out in the form of a descriptive cross sectional study
05.2 Study setting
Second year (Intake 37) and Third year (Intake 36) undergraduate nursing students of
General Sir John Kothalawala Defense University
05.3 Sampling & sample size
A total of 100 students will be randomly divided into two groups, with 50 students
chosen from each intake.
05.4 Inclusion & exclusion criteria
05.4.1. Inclusion criteria
Intake 37 and Intake 36 CIVIL Undergraduate Nursing Students
05.4.2. Exclusion criteria
Intake 37 and Intake 36 Lateral Undergraduate Nursing Students

05.5 Data collection and data collection tools

Data will be collected using both qualitative and quantitative methods.
Questionnaires, interviews, discussions and documents are used to collect qualitative
data, whereas clinical experiments, clinical records, observations, surveys, google
forms and documents are used to collect quantitative data.
First and foremost, all groups will receive the same google form questionnaire, and
interviews and discussions will be performed for further explanation. Following the
education of one group on empathy, another set of two survey questionnaires with
closed-ended questions will be presented. Finally, another set of data will be obtained
through clinical trials, observations, and documentation.

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05.5.1 Methods of collection
 Questionnaires (google forms)-A questionnaire with 20 questions will be
given to each group
 Interviews-Face to face
 Discussions- Group discussions via teams or zoom
 Surveys- closed ended questionnaire
 Observations –clinical trials
 Documents
 Research papers
 Articles

05.6 Data entry and analysis

Data will be collected using the above way, organized, and then analyzed using the
latest version of the prepackaged package for service solution. (SPSS).

05.7 Resource requirements (Budgets)

For my research, I will be required to pay the following expenses.
Expenses Required cost (LKR)
Internet charges 1500
Telephone charges 500
Travel cost 1500
Stationaries 2000
Refreshments 1500
Printouts 1000
Bindings 300
Photocopy 1000
Other 1000
Total 10300

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06. Ethical issues
All details and information were submitted, and consent was obtained from the ethical
review committee of Faculty of Medicine at Kothalawala Defense University, the
Faculty of Allied Health Sciences, the Department of Nursing, the University Hospital
KDU and the research participants.
The participants are asked to sign a written consent form and are told that their
privacy will be respected during the procedure.

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07. Work plan
Tasks to be Dates Person assign to task Person
performed days
required
1 Finalize the Week 1-3 Research team 15 days
. research proposal 1st Apr-
and literature 22nd Apr
review 2022
2 Permission from Week 2-5 Kotelawala Defense University, 5 days
. authorities 8th Apr-6th Faculty of Medicine, Faculty of
May 2022 Allied Health Sciences,
Department of Nursing and
University Hospital KDU
3 Ethical clearance Week 3-7 Research team & Ethical 2 days
. 22nd Apr- committee
20th May
2022
4 Pre-test and Pilot Week 7-8 Research team 5 days
. study
20th May
to 27th
May 2022

5 Data collection Week 8- Research team 90 days

. 20
27th May
to 26th
Aug 2022
6 Data entry and Week 20- Research team 10 days
. preliminary data 22 26th

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 analysis Aug-9th
Sep 2022
7 Data analysis Week 22- Research team 10 days
. 24
9th Sep-
23rd Sep
2022
8 Report Week 24- Research team 7 days
. finalization 25
23rd Sep-
30th Sep
2022

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References

 Carper, B.A. (1978). Fundamental patterns of knowing in nursing. Advances

in Nursing Science, 1(1), pp.13–23.
 Riess, H. (2017). The Science of Empathy. Journal of Patient Experience,
[online] 4(2), pp.74–77.
 Boissy, A., Windover, A.K., Bokar, D., Karafa, M., Neuendorf, K., Frankel,
R.M., Merlino, J. and Rothberg, M.B. (2016). Communication Skills Training
for Physicians Improves Patient Satisfaction. Journal of General Internal
Medicine, 31(7), pp.755–761.
 Riess, H., Kelley, J.M., Bailey, R.W., Dunn, E.J. and Phillips, M. (2012).
Empathy Training for Resident Physicians: A Randomized Controlled Trial of
a Neuroscience-Informed Curriculum. Journal of General Internal Medicine,
27(10), pp.1280–1286.
 Lewis, J.Rees. (1994). Patient views on quality care in general practice:
Literature review. Social Science & Medicine, 39(5), pp.655–670.
 Mercer, S.W., Watt, G.C. and Reilly, D. (2001). Empathy is important for
enablement. BMJ (Clinical research ed.), [online] 322(7290), p.865.
 Åström, S., Nilsson, M., Norberg, A., Sandman, P.-O. and Winblad, B.
(1991). Staff burnout in dementia care—relations to empathy and
attitudes. International Journal of Nursing Studies, 28(1), pp.65–75.
 Àstrom, S., Nilsson, M., Norberg, A. and Winblad, B. (1990). Empathy,
experience of burnout and attitudes towards demented patients among nursing
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 Bailey, S. (1996). Levels of empathy of critical care nurses. Australian
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teach RN nursing students skills of therapeutic communication. The Journal

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n_cancer_patients_and_primary_nurses_.6.aspx [Accessed 15 Dec. 2021].
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 Ward, J., Cody, J., Schaal, M. and Hojat, M. (2012). The Empathy Enigma:
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