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International Journal of Mental Health Nursing (2016) , doi: 10.1111/inm.12198

Original Article
Nurses caring and empathy in Jordanian psychiatric
hospitals: A national survey
Majdi M.B. Alhadidi,1 Maysoon S. Abdalrahim2 and Mahmoud Al-Hussami1
Departments of 1Community and Mental Health and 2Clinical Nursing, The University of Jordan, Amman, Jordan

ABSTRACT: Nurses working in psychiatric hospitals need to acquire the skills of therapeutic
communication and empathy, and have higher levels of caring. The present study aims to investigate
the level of caring and empathy among nurses working in psychiatric hospitals. A cross-sectional
survey was utilized to collect data from 205 nurses recruited from three psychiatric hospitals in
Jordan. The Background Information Questionnaire, Modified Caring Dimensions Inventory, and
Toronto Empathy Questionnaire were administered to the recruited participants. The findings
revealed that the sampled nurses had a high level of caring and empathy. Significant correlations were
found between caring and having a specialized training in mental health nursing, and having organi-
zational and managerial support. However, no significant correlations were found between empathy
and participants characteristics. Specialized training in mental health nursing, having organizational
and managerial support, and empathy were found predictors for caring.
KEY WORDS: caring, empathy, Jordan, mental health nursing.

INTRODUCTION plans, and seek to care for an individual as a whole. How-

ever, the emphasis of mental health nursing is on the devel-
Mental health nursing is a specialty of nursing that
opment of a therapeutic relationship or rapport with
cares for people with mental illness or mental distress
patients (Wilkin 2003). In practice, this means that the nurse
(American Psychiatric Nurses Association 2014). Nurses in
should seek to engage with patients care in a positive and col-
this area receive more training in psychological therapies,
laborative way that will empower the patient to draw on his or
building a therapeutic alliance, dealing with challenging
her inner resources in addition to any other treatment they
behaviour, and skills of administering psychiatric medica-
might be receiving (Wilkin 2003). However, mental health
tion (American Psychiatric Nurses Association 2007). In
nursing faces numerous challenges, such as increased patient
addition, mental health nurses provide essential expertise
acuity, decreased length of stay, and changing patient expec-
for meeting the health needs of people with mental
tation (Hamdan-Mansour et al. 2011), all of which might bur-
health issues across health settings. They provide inte-
den nurses and negatively affect the quality of nursing care.
grated health services to people with serious mental
Nationwide, mental health issues in many parts of
illness, as well as to those who are not served in behav-
Jordan continue to be an undiscussed topic (Ayoub, 2014).
ioural health settings (American Psychiatric Nurses
In Jordan, there is limited information available concerning
Association 2013).
these fundamental aspects (caring, empathy), which are
As with other areas of nursing practice, mental health
necessary for maintaining therapeutic affiliation in mental
nurses work within nursing models, utilize nursing care
health nursing. To the best of our knowledge, no studies
have been found in the literature that have assessed caring
Correspondence: Majdi M.B. Alhadidi, Department of Community and empathy levels among nurses in psychiatric health set-
and Mental Health, Faculty of Nursing, The University of Jordan,
Queen Rania Street, Amman 11942, Jordan. Email: m.hadidi@ju.edu.jo tings in Jordan. Therefore, the present study might contrib-
Majdi M.B. Alhadidi, M. S. ute to the body of knowledge and make a significant
Maysoon S. Abdalrahim, PhD.
Q3 Mahmoud Al-Hussami, PhD.
contribution to evaluating the quality of nursing care pro-
Accepted November 15 2015. vided to patients diagnosed with a mental illness.

2016 Australian College of Mental Health Nurses Inc.

2 M. M. B. ALHADIDI ET AL.
Nurses working in the psychiatric hospitals need to
acquire the skills of therapeutic communication, empathy,
genuine and active listening, and advocacy (Dinga &
Karvinen 2008). Yet in mental health nursing, the interper-
sonal interaction is the core element of the practice that can
help to establish and maintain a therapeutic nurseclient
relationship using relevant professional nursing knowledge,
skills, and caring attitudes in order to promote the well-
being of the person with the mental illness (Dziopa &
Ahern 2009). This requires mental health nurses to recog-
nize the necessity of caring and empathy in the clientnurse
relationship. Although mental health services are to some
extent inadequate in Jordan (World Health Organization
2011), some research has been published regarding caring
and empathy. Moreover, no studies were found in nursing
literature that assessed the levels of caring and empathy
among mental health nurses.
In relation to the mental health system in Jordan,
there is no central mental health authority. The Ministry
of Health is considered the main authority that governs
the mental health specialty. However, the structure of
the mental health system is centralized in the centre of
Jordan. The majority of mental hospitals are organization-
ally integrated within the outpatient facilities that are
connected with the hospitals. In addition, there is one
private day-care centre for mental health services in
Jordan (WHO 2011). Therefore, the present study
might contribute to the body of knowledge and make a
significant contribution to evaluating the quality of nurs-
ing care provided to patients diagnosed with a mental
illness.
The aim of the present study was to investigate
nurses level of caring and empathy in psychiatric hospi-
tals in Jordan. Understanding the impact of caring and
empathy on health care can also shape the interventions
for nurses who are working in psychiatric healthcare
organizations.
MATERIALS AND METHODS
Setting and sampling
The cross-sectional survey was conducted in Jordan
between September 2013 and January 2014. Data were
collected from three psychiatric hospitals and one psychiat-
ric ward: A hospital is a governmental hospital with a
capacity of 220 beds, B hospital is a governmental hospital
with a capacity of 125 beds, and C hospital is a private hos-
pital with a capacity of 75 beds. The psychiatric ward is part
of a large educational hospital with multispecialties and has
a capacity of 10 beds. According to the data obtained from
the human resources departments in the selected hospitals,
the total number of nurses was 260 nurses. Thus, the sam-
ple size was calculated using the G power program V.3
(Faul et al. 2009), with a power of 0.95, alpha of 0.05, and
an effect size of 0.3, yielding a need for a minimum of
111 nurses to represent the study population.
After obtaining ethical approval from the Academic
Research Committee at the University of Jordan (Amman,
Jordan) and the Institutional Review Board at the selected
psychiatric hospitals, invitations were made throughout
the continuous education departments in the selected
hospitals. A list with the demographics of all the nurses
(n = 260) working in the selected hospitals was scanned
for the inclusion criteria; 220 nurses were found to eligible
for this study. Those who met the inclusion received a pack-
age containing the questionnaires used in the present study.
Instruments
The study utilized the Caring Dimensions Inventory and
Toronto Empathy Questionnaire in addition to 10 demo-
graphic items. Permission to use the instruments was
obtained from the original authors. The Caring Dimensions
Inventory (CDI-29/Mental Health Version) was developed
by Watson and Lea (1997) to measure caring behaviour
among nurses. It includes 25 statements that fall within five
themes: nursepatient relationship, nursing interventions,
nursing attitudes, nursing skill, and communication, stem-
ming from the following question: Do you consider the
following aspects of your nursing practice to be caring?.
(Salimi et al. 2014; Watson 2004). The statements are rated
using a five-point Likert scale ranging from 1 (strongly
disagree) to 5 (strongly agree), with the total score ranging
between 29 and 145. Higher scores signal an elevated
level of caring. However, the CDI-29 was modified (from
the CDI-25) to be more applicable to the study sample,
in which the researcher added four items: item 26
(assessing the psychosocial aspects of the patient), item
27 (assessing if the patient has a high risk of suicide),
item 28 (assessing if the patient has a high risk of
violence), and item 29 (modify the environment to be
more therapeutic). The term patient was also used
instead of someone. All the modification processes were
applied according to the pre-pilot committee suggestions
(two assistant professors, one lecturer, and a clinical
nurse specialist in psychiatric/mental health nursing) and
after obtaining permission from the original author of
the instrument. From the perspective of the panel, the
rationale for these modifications was because caring in a
specialized area, such as the psychiatric unit, involves
dealing with special situations, such as psychological
2016 Australian College of Mental Health Nurses Inc.
NURSES CARING AND EMPATHY
aspects and violent and suicidal behaviours, which affect
nurses level of caring.
The Toronto Empathy Questionnaire (TEQ) was de-
veloped by Spreng et al. (2009) and comprises of 16
items. Participants were asked to rate each item using
the following systems: 0 = never, 1 = rarely, 2 = some-
times, 3 = often, and 4 = always. The total scores ranged
between zero and 64, with higher scores signalling an el-
evated level of empathy. The TEQ exhibited good inter-
nal consistency ( = 0.87) and high testretest reliability
(0.79 and 0.73, respectively) (Totan et al. 2012). The
TEQ contains a wide range of attributes associated with
the theoretical aspect of empathy, including emotional
contagion (items 14), emotion comprehension (item 8),
sympathetic physiological arousal (items 5, 14, and 11),
non-specific altruism (items 5, 14, and 16), emotional
states (items 2, 7, 10, 12, and 15), and the frequency of
empathic response (item 13) (Spreng et al. 2009). Items
2, 4, 7, 10, 11, 12, 14, and 15 were considered negative
items. For both instruments, the researcher considered
the average of participants responses as informative data
for the level of caring and empathy among mental health
nurses. The highest and lowest scores in each instrument
were reported as indicators for the perceived levels of
empathy and caring.
A pilot study with 25 nurses was carried out to assess the
instruments feasibility and to determine if any modifica-
tions were needed prior to using the study instruments,
also, to determine the suitability and quality of the trans-
lated Arabic version of the instruments. The total CDI scale
alpha coefficient was 0.89, which indicated good reliability.
In addition, content validity was measured using the con-
tent validity index for the two instruments, which showed
0.91 for CDI, and 0.87 for TEQ.
For the purpose of the present study, all of the instru-
ments were translated from English to Arabic, and the trans-
lated versions were checked as equivalent to the originals
according to Brislins model format (1970). This is a well-
known method for providing reliable and valid instruments
for cross-cultural usage. The translation process included
the following steps: (i) the scales were forward-translated
from English into Arabic by a bilingual expert; (ii) the scales
were back-translated from Arabic into English by another bi-
lingual; and (iii) the two English versions (the original and
the translated) were compared by another bilingual expert.
Data analysis
Data were analysed using the Statistical Package for Social
Science Software (version 21.0; SPSS, Chicago, IL, USA).
Descriptive and inferential statistics were used to answer
the research questions that guided this study. Descriptive
2016 Australian College of Mental Health Nurses Inc.
3
statistics, such as mean, standard deviation (SD), and range,
were used to measure nurses level of caring and empathy.
Pearson correlation was used to find the relationship
between caring and empathy, and between caring/empathy
and participants demographic characteristics. In addition,
independent t-test was used to examine the relationship
between caring/empathy and the nurses sex. Finally,
hierarchical multiple regression analyses were applied to
investigate the predictors of caring and empathy.
RESULTS
Participants characteristics
A total of 220 nurses were selected from a number of public
and private hospitals to complete the study questionnaires.
A total of 205 nurses (93%) completed the survey. Missing
data were minimal and given a value equal to the mean
score during the data analysis (Munro 2005).
The mean age of the participants was 33.6 years; more
than half of the participants were male (n = 110, 54%).
Over two-thirds of the participants were married
(n = 150, 73%). A total of 66% (n = 135) of the study partic-
ipants held a bachelor degree, and their average nursing
experience in the psychiatric field was 7 years. Over half
of the participants had some training in psychiatric nursing
(n = 105, 51%), and 58% (n = 118) received organizational
and managerial support. The mean number of working
hours was 45.5 hours per week, and the mean of the overall
time in their current department was 7 years.
Level of caring among nurses
The CDI-29 was used to measure the level of caring among
Jordanian nurses working in psychiatric hospitals. The aver-
age score of caring for all nurses was 124.3 out of 145
(SD = 10.7), ranging from 87 to 145. Individual item analysis
of the CDI revealed that the highest-ranked caring aspects
of nursing practice were item 17 (keeping relatives informed
about a patient) (mean = 2.53, SD = 0.24) and item 8
(exploring a patients lifestyle) (mean = 2.1, SD = 0.24).
However, the lowest-reported caring aspects of nursing
practice were item 1 (assisting a patient with an activity of daily
living; e.g. washing, dressing) (mean = 1.06, SD = 0.36) and
item 2 (making a pursing record about the patient) (mean = 1.09,
SD = 0.43). The results are presented in Table 1.
Level of empathy among nurses
The TEQ was used to measure the level of empathy among
Jordanian nurses working in psychiatric hospitals when they
establish therapeutic relationships with their patients. The
mean score of empathy for all nurses was 46.07 out of 64
(SD = 6.7) with a range of 3164.
4 M. M. B. ALHADIDI ET AL.

TABLE 1: Caring aspects of nursing practice among nurses in psychiatric hospitals (n = 205)
Item no. Item Item ranking Mean Standard deviation
1 Assisting a patient with an activity of daily living (e.g. washing, dressing) 29 1.06 0.36
2 Making a pursing record about the patient 28 1.09 0.43
3 Feeling sorry for a patient 25 1.3 0.71
4 Getting to know the patient as a person. 13 2.01 0.3
5 Explaining a clinical procedure to a patient 26 1.98 0.3
6 Being neatly dressed when working with a patient 5 2.04 0.29
7 Sitting with a patient 7 2.03 0.36
8 Exploring a patients lifestyle 1 2.1 0.24
9 Reporting a patients condition to a senior nurse 22 2.0 0.25
10 Being with a patient during a clinical procedure 17 2.0 0.15
11 Being honest with a patient 20 2.0 0.23
12 Organizing the work of others for a patient 6 2.03 0.2
13 Listening to a patient 18 2.01 0.12
14 Reporting with the doctor about a patient 21 2.01 0.32
15 Instructing a patient about an aspect of self-care (e.g. washing, dressing.) 11 2.01 0.72
16 Sharing your personal problems with a patient 27 1.91 0.5
17 Keeping relatives informed about a patient 3 2.53 0.24
18 Measuring the vital signs of a patient (e.g. pulse and blood pressure) 23 2.0 0.35
19 Putting the needs of a patient before your own 8 2.02 0.33
20 Being technically competent with a clinical procedure 9 2.01 0.22
21 Involving a patient with his or her care 16 2.01 0.33
22 Giving reassurance about a clinical procedure 11 2.01 0.22
23 Providing privacy for a patient 24 2.01 0.28
24 Being cheerful with a patient 4 2.06 0.18
25 Observing the effects of a medication on a patient 12 2.01 0.21
26 Assessing the psychosocial aspects of the patient 2 2.01 0.25
27 Assessing if the patient is at high risk for suicide 14 2.02 0.18
28 Assessing if the patient is at high risk for violence 15 2.01 0.21
29 Modifying the environment to be more therapeutic 10 2.01 0.25

The highest-ranked empathy aspects of nursing practice
were found with item 14 (when I see the patients being treated
unfairly, I do not feel very much pity for them) (mean = 2.03,
SD = 0.23) and item 5 (I enjoy making other patients feel
better) (mean = 1.92; SD = 0.27). However, the lowest-
ranked aspects were found in item 9 (I find that I am in tune
with patients moods) (mean = 1.049, SD = 0.5) and item 11
(I become irritated when a patient cries) (mean = 1.17;
SD = 0.38). The results are presented in Table 2.
Correlation between caring and empathy
Pearson correlation coefficient was performed to detect the
relationship between caring and empathy. The analysis
showed that there was a significant positive, moderate cor-
relation between the caring scores and empathy scores
(r = 0.5, P = 0.001).
Predictors of caring and empathy among mental
health nurses
The total CDI scores showed a significant positive
correlation with training in psychiatric mental health
nursing and with organizational and managerial
support (r = 0.14, P = 0.04) (r = 0.15, P = 0.004), re-
spectively. However, the results showed an insignifi-
cant correlation between caring with the following
participants characteristics: age, marital status, educa-
tion, years of experience, and number of working
hours per week. In addition, the results indicated that
there were no significant differences (P = 0.43) be-
tween levels of caring between male nurses and female
nurses. Similarly, the total score of the TEQ showed
no significant correlation between empathy and all of
the participants characteristics.
DISCUSSION
Levels of caring among nurses
The results of the present study showed that Jordanian
nurses have high levels of caring while working with
patients in psychiatric hospitals. In addition, it was evident
from the nurses responses that exploring a patients
lifestyle and assessing their psychosocial aspects were the
primary caring concern in their practice. It seems that
nurses caring for people with a mental illness need to have

2016 Australian College of Mental Health Nurses Inc.

NURSES CARING AND EMPATHY 5

TABLE 2: Level of empathy among nurses in psychiatric hospitals (n = 205)

Item no. Item Item ranking Mean Standard deviation
1 When the patient is feeling excited, I tend to get excited too 15 1.45 0.49
2 Other peoples misfortunes do not disturb me a great deal 14 1.46 0.49
3 It upsets me to see patient being treated disrespectfully 3 1.88 0.32
4 I remain unaffected when a patient close to me is happy 12 1.51 0.5
5 I enjoy making other patients feel better 1 1.92 0.27
6 I have tender, concerned feelings for patients less fortunate than me 4 1.82 0.38
7 When a client starts to talk about his/her problems, I try to steer the conversation 11 1.61 0.49
towards something else
8 I can tell when the patients are sad, even when they do not say anything 8 1.7 0.47
9 I nd that I am in tune with patients moods 13 1.049 0.5
10 I do not feel sympathy for patients who cause their own serious illnesses 10 1.63 0.48
11 I become irritated when a patient cries 16 1.17 0.38
12 I am not really interested in how the patients feel 7 1.72 0.45
13 I get a strong urge to help when I see patient who is upset 5 1.79 0.4
14 When I see the patients being treated unfairly, I do not feel very much pity for them 6 2.03 0.23
15 I nd it silly for patients to cry out of happiness 9 1.75 0.43
16 When I see the patient being taken advantage of, I feel kind of protective towards him/her 6 1.64 0.47

a sense of personal accountability for the welfare of the
patients in their care, because personal accountability usu-
ally develops from a culture that promotes the importance
of treating mental health problems professionally and posi-
tively (Office of the Nursing & Midwifery Services 2012).
High levels of caring among mental health nurses have
been reported in many studies (Green 2004; Palese et al.
2011; Pai et al. 2013; Wu et al. 2009). The similarities of
the findings with the previously-mentioned studies empha-
size that caring is a crucial component in building a caring
alliance with patients, which is considered the foundation
of the therapeutic relationship between nurses and patients
with mental illnesses.
However, the findings of the present study are in
contrast to those of Schofield et al. 2005, which revealed
lower scores of caring attributes. The results in Scholfied
et al.s study could be related to the participants being
qualified and unqualified nurses working with the elderly
in Hong Kong, the UK, and Scotland. The perception of
nurses might differ because of cultural differences between
Western countries and Arab countries, in that caring in
Arab countries is highly influenced by religion; nurses in
the Arab region have a belief system based on Islamic
values that form their attitudes towards caring for patients
(Kozier et al. 2012). In Jordan, more than 95% of the
population are Muslim; thus, Jordanian nurses might
exhibit the same beliefs.
Levels of empathy among nurses
The results of the present study showed that Jordanian
nurses have high levels of empathy while working with
patients in the psychiatric hospitals. This indicates that
nursing has always centred on empathy as an important
component of the therapeutic relationship and the core of
caring (Watt-Watson et al. 2000). This finding is congruent
with previous studies on nursing students (McKenna et al.
2011; Watt-Watson et al. 2000), which found that empathy
is a vital element in the patientnurse relationship. This
could help us to clarify the belief that empathy must be re-
fined over time, and requires cognitive ability to be compe-
tent to relay ones past experience to those of another
(Paciello et al. 2013).
Nursing has always centred on empathy as an important
complex of the therapeutic relationship and the core of
caring. Rising levels of caring and empathy are linked with
rising holistic care results and overall better nursing care;
a link that could be developed and fortified as part of
professional nursing education. However, many studies
challenge these findings (Mealem et al. 2012; Hawamdeh
& Hawamdeh 2012; Kraemer et al. 2013; Hasan et al.
2013). It is implied that empathy is a major complex of so-
ciability; thus, less sociable nurses move towards occupa-
tions that include less contact with clients and a greater
employment of technical skills.
Nurses in the present study reported high level of empa-
thy compared to nurses in other healthcare settings; studies
have reported that physicians also have high scores of
empathy. For example, Kliszcz et al. (2006) and Austin
(2012) found that both nurses and physicians reported
higher empathy scores; however, the scores were a little
higher among nurses than among physicians. The reviewed
studies revealed that little to no significant differences in
the level of empathy was found when comparing nurses
with other healthcare professionals, mainly physicians.

2016 Australian College of Mental Health Nurses Inc.

6 M. M. B. ALHADIDI ET AL.
Correlations between caring and empathy
Mental health nurses levels of caring and empathy results
revealed that psychiatric nurses who were more caring were
also more likely to have high levels of empathy. This finding
was supported by Juujrvi et al.s (2012) study, which found
that care-based moral development was linked more with
affective empathy than personal values. Individuals who
feel empathy for others obtain the highest achievement in
care development.
It seems that the more the individual empathizes with
others, the higher the accountability in relationships and
the more that individual practises ethical problem solving;
thus, the further the nurse grows in care development
(Slote 2007). Hoffmans (2006) found that a connection
between caring and empathy is redirected in the prosocial
moral reasoning that accompanies peoples behaviour when
they face someone in distress. The notions of caring and
empathy are important for accepting both our responsibility
to appreciate others and the circumstances under which
autonomy itself, as understood in interpersonal terms, can
be established and flourish (Slote 2007).
Predictors of caring and empathy among mental
health nurses
One interesting finding in the present study was that nurses
with specialized training in psychiatric/mental health nurs-
ing were more likely to have a higher level of caring. This
finding is supported by Wu et al. (2009) and Brown et al.
(2005), who found that nurses who were involved in train-
ing programmes also had significantly higher scores of car-
ing. There is more than one explanation to clarify this
relationship. First, mental health nurses who participate in
specialized psychiatric mental health nursing training might
feel they have a strong connection with patients and their
families (Brown et al. 2005). Similarly, when there is some-
one caring for them, patients and families feel personally
cared for by nursing staff (Office of the Nursing & Mid-
wifery Services 2012). Second, caring is seen to be a crucial
way of showing the essence of the nurses role, in that those
who care for their patients feel that their role and actions
should express their passion for being a nurse (Green
2004). This passion for nursing and the caring that is
expressed appear as a fixed theme in the patientnurse re-
lationship (Hoffmans 2006). This is where nurses with
additional training can have an advantage, by demonstrating
highly-developed interpersonal skills and the ability to
mediate resolutions, which are acceptable to all parties, to
provide a service to the patient (Wu et al. 2009).
To the best of our knowledge, no previous studies have
addressed the correlation between organizational support
and levels of caring among mental health nurses. The find-
ings of the present study showed that nurses who have orga-
nizational and managerial support have high caring levels.
Nurses view their convenient or inconvenient treatment
as a sign that the institution either supports or does not
support them. Managerial support might include financial
incentives, such as salaries and a rewarding system, and
non-financial incentives, such as recognition, promotions,
and support for nursing activities. Based on the institutions
embodiment, it seems that nurses receiving support from
their institutions will have greater commitment towards
their patients, positively affecting the way they communi-
cate and establish therapeutic relationships (World Health
Organization 2005). The results of the present study
showed that nurses levels of caring were not influenced
by their personal characteristics. This finding lends support
to the findings of Starcher (2006), Hoffmans (2006), and
Stopper (2012), who found that demographic associations
with caring were not significant. Consequently, they found
that the majority of nurses viewed caring as a vital compo-
nent in nursing practice, and have tried to mould an aca-
demic environment led by the nursing value of caring, as
it relates to the health of individuals and populations,
regardless of nurses demographics.
The results also revealed that there was no statistically-
significant difference in nurses sex for the levels of their
caring. This is supported by many studies in the literature
(Kursun & Arslan 2012; Khademian & Vizeshfar 2008;
Green 2004). All nurses in the present study demonstrated
high caring scores, indicating that they considered them-
selves to have great concern for their patients, regardless
of their sex. The nursing profession provides care that is
focused on essential human needs. Therefore, caring is
the dominant focus of nursing practices (Khademian &
Vizeshfar 2008).
The finding of the present study revealed no statistical
significant relationship between nurses empathy levels and
nurses characteristics and work experience background.
This is supported by many studies, which have confirmed
that work experience and level of empathy are not signifi-
cantly related (Coulmas 2006; Kane et al. 2013; Ward et al.
2009). For instance, Coulmas (2006) examined whether
novice nurses would be expected to display a higher level
of empathy than nurses with more experience, and found
that there was no difference between years of experience
and level of empathy between the two groups.
The reason for not having a correlation between nurses
characteristics and level of empathy could be related to the
mental health nurses motivating factors of entering the nurs-
ing career in the first place. It could be suggested that nurses
have the quality of empathy in their personality, which
2016 Australian College of Mental Health Nurses Inc.
NURSES CARING AND EMPATHY
directs their practice with mental health patients. Choosing
to work in a difficult industry, such as nursing profession,
reiterates nurses determination to gain satisfaction from
their caring and empathy, rather than financial benefits
(Reynolds & Scott 2000). Coulmas (2006) found that the
expression of empathy by nurses for their patients might
not influenced as much by years of experiences itself, as
by the effect of time constraints on the nursepatient
relationship, which has only worsened with managed care
and the financial urge to decrease as much cost-related
product out of each nurse on the hospitals staff. As present
research has shown, positive nursepatient interactions
result in amended clinical results and in minimized clinical
costs, so all interested parties benefit. Enhanced verbal com-
munication skills might also be integrated, especially stan-
dardized time-saving interviewing scenarios that expound a
consciousness of patient needs (Watt-Watson et al. 2000).
Furthermore, the results of the present study have
shown that nurses empathy scores were not affected by
their sex. This finding is consistent with that of Kliszcz
et al. (2006), who reported an insignificant difference in
empathy scores between sexes. This can help explain the
insignificance of sex in relation to empathy. For example,
it has been proposed that both women and men are sensi-
tive to emotional signals in the same way, a quality that
can lead to a more accepting and, therefore, more empa-
thetic relationship (Kliszcz et al. 2006).
LIMITATIONS AND FUTURE
RECOMMENDATIONS
Some limitations affected the study outcomes; using a self-
reported questionnaire in data collection means that the re-
searcher is unable to determine actual behaviours and there
is a possibility of reporting bias. However, the
questionnaires utilized in the present study measured the
perceived level of caring/empathy by mental health nurses
in Jordan, rather than the observed level of caring and
empathy.
Nevertheless, observation was not possible, as it was
costly and could influence behaviours. Therefore, a combi-
nation of both self-reported and observational methodology
would be more beneficial. There was limited information
on the use of TEQ in the literature, so it was hard to
make a comparison between studies. Interventional or
post-educational studies about caring and empathy among
nurses in psychiatric hospitals necessitate future attention.
The integration of a qualitative approach in further studies
could be helpful to the in-depth study of the phenomena of
caring and empathy. Comparisons between mental health
2016 Australian College of Mental Health Nurses Inc.
7
nurses and non-mental health nurses in relation to their
level of caring and empathy would also be recommended.
IMPLICATIONS FOR PRACTICE
The findings of the present study could be used by mental
health nurses to direct their efforts towards establishing
therapeutic relationships, particularly with regards to
improving the quality of care for patients with a mental
illness and to highlight the benefits of mental health
nursing as a future career option. In addition, the present
study findings add to current knowledge in mental health
nursing by identifying nurses perceived levels of caring
and empathy, and can therefore be considered baseline
data for future national and international studies that
focus on these nurses experiences. More research is
required to enhance our understanding of caring and
empathy among mental health nurses.
REFERENCES
American Psychiatric Nurses Association (2014). Psychiatric-
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