The correlation between the clinical competency and empathy of

ORIGINAL ARTICLE

nurses: Case study, Intensive Care Units of the educational hospitals

of Kerman Medical Sciences University, Iran
Zohre Jahanshahi, Alireza Ghahri Sarabi1, Fariba Borhani2, Malihe Nasiri3, Sima Zohari Anboohi3
Departments of Nursing, 1Faculty of Operation Room and Anesthesiology, College of Nursing and Midwifery, Shahid Beheshti University
of Medical Sciences, 2Medical Ethics and Law Research Center, College of Nursing and Midwifery, Shahid Beheshti University of Medical
Sciences, 3Department of Biostatistics, Faculty of Paramedical Sciences, College of Nursing and Midwifery, Shahid Beheshti University of
Medical Sciences, Tehran, Iran

ABSTRACT
Background and Purpose: Special nursing is considered an expertise in nursing profession and requires a special
competency. Empathy is complementary to the skills and knowledge needed to effectively treat a patient. Clinical
competency and empathy are followed by effective health cares. The aim of this study was to assess the correlation
between clinical competency and empathy of nurses employed in Intensive Care Units (ICUs). Methodology: This
descriptive, correlational study was carried out on 231 nurses employed in the ICUs of the educational hospitals of
Kerman University of Medical Sciences that were selected through a census. The data collection tools included an
intensive care nursing competency scale and a nursing empathy assessment questionnaire. Data were analyzed using
the SPSS version 20 software and the independent t‑test, ANOVA, Pearson’s correlation coefficient and regression.
Results: The study results indicated that the mean score of nurses’ clinical competency was 574.08 ± 86.51, and
the mean score of empathy was 150.12 ± 17.04. The highest level of clinical competency belonged to the field of
knowledge, and the lowest level belonged to the field of skill. The highest level of empathy was related to the behavioral
area, and lowest level was related to the emotional area. There was a correlation between the two variables of clinical
competency and empathy and all of their areas (the overall correlation coefficient r = 0.7 and P < 0.001). Conclusion:
Given the relationship between clinical competency and empathy, it can be concluded that a higher clinical competency
in nurses makes them more likely to establish an empathetic relationship with patients. According to the findings of
this research, nursing managers and nursing education planners can provide appropriate conditions to enhance the
clinical competency of nurses and improve their chance of establishing empathetic relations.

Key words: Clinical competency, empathy, intensive cares, nurse

Introduction professional position.[2] According to the opinion of the

One of the controversial topics in the field of health
is clinical competency.[1] Competency is introduced
as a special adjective for judgment of the quality
or capability of individuals and is a reflection of the
knowledge, critical thinking, individual, and technical
skills that lead professional individuals to a clinical and
Access this article online
Quick Response Code: Website:
www.atmph.org
International Council of Nurses, the knowledge, skills,
and competency of nurses are vital to ensure the quality
of patient care.[3] Assessment of clinical competency
has a very important role in the management of the
This is an open access article distributed under the terms of the
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License, which allows others to remix, tweak, and build upon the
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Cite this article as: Jahanshahi Z, Sarabi AG, Borhani F, Nasiri M,

DOI: Anboohi SZ. The correlation between the clinical competency and
10.4103/ATMPH.ATMPH_233_17 empathy of nurses: Case study, Intensive Care Units of the educational
hospitals of Kerman Medical Sciences University, Iran. Ann Trop Med
Public Health 2017;10:694-701.

Correspondence:
Prof. Alireza Ghahri Sarabi, Department of Operation Room and Anesthesiology, College of Nursing and Midwifery, Shahid Beheshti University of
Medical Sciences, Tehran, Iran. E‑mail: args1340@yahoo.com

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694 © 2017 Annals of Tropical Medicine and Public Health | Published by Wolters Kluwer - Medknow
 Jahanshahi, et al.: Clinical competency and empathy of nurses
process of providing care, ensuring the appropriate
provision of cares, achievement of care provision
goals, identification of fields requiring promotion,
determination of the educational needs of nurses, and
safety of care.[4]
Clinical competency in nursing has a high relationship
with increased safe performance, quality of care,
patient satisfaction, decreased medical errors, hospital
infections, mortality, postoperative complications, and
accidental dislocation of endotracheal tube, particularly
in Intensive Care Units (ICUs).[5,6] A competent person
improves and guarantees the quality of care and patient
satisfaction.[7] Since patients in ICUs are responsible
for the provision of specialized cares to patients
with severe conditions with potential and active
complications in their vital organs and are subject to a
high risk of complications threatening their health, it
is significantly important to have clinical competency
for the provision of care to these patients in the
complicated environments of the ICU.[8]
Conceptually, clinical competency and empathy are
followed by more effective medical cares. A relationship
between a medical team and a patient based on empathy
compliments the skills and knowledge required for the
effective treatment of the patient.[9] Researchers believe
that although there have been many developments in
the field of physical cares in the ICU, but in general,
care of all the human aspects that include the mental
and spiritual care of patients is neglected.[10] Therefore,
nurses of ICUs should not only provide for the
physiological needs of patients but also provide the
mental needs of the patients by establishing a correct
relationship.[11] In ICUs, the relationship with a patient
is of special importance and priority because nurses in
the ICU are responsible to provide care for patients who
may die at any moment. An appropriate relationship
with a patient in these units, decrease their anxiety
and worries and improves the treatment process of the
patients. One way of establishing a relationship with a
patient is to create empathy with him.[12] Empathy is
a fundamental component in the relationship between
a nurse and a patient, and nurses are expected to use
this ability in providing medical care.[13] Empathy
includes the ability to understand the experiences,
worries, and opinions of others and the capability to
establish a relationship based on this understanding,[14]
and in a general, it is the ability to place oneself in the
position of others to better understand the experiences
and feelings in a mutual interaction.[15] Empathy has
a fundamental role in interpersonal commitments,
social interactions, friendship and maintenance of
it, improved health, increased possibility of receiving
or giving assistance, altruism, social cohesion, and
Annals of Tropical Medicine and Public Health | Volume 10 | Issue 3 | May - June 2017
creation and maintenance of interpersonal relations.[16]
When an empathetic nurse cares for a patient, outcomes
such as relief from tension, a high level of physical and
mental well‑being, reception of emotional responses
to conditions, increased conformity and increased
cooperation with the medical team will be provided
to patients.[17] An empathetic relationship between a
nurse and a patient not only improves the experience
of the patient as the receiver of the care but will also
lead to positive medical outcomes.[14] Empathy can
increase patient satisfaction, lead to a more correct
diagnosis and treatment[18] and it particularly influences
adherence to care recommendations and decreases care
errors[19] and has a direct relationship with the positive
clinical outcome of patients, decreased exhaustion, and
dissatisfaction.[20,21] A lack of empathy in the relationship
between the medical personnel and a patient can disrupt
the processes of diagnosis, treatment, and care.[14] Given
the necessity of the empathetic relationship of nurses
with patients to access medical goals and promote the
quality of care and also the importance of the relationship
between a patient and a nurse in ICUs, it is necessary to
investigate the empathy of nurses with these patients.
Nurses’ empathetic attitude has a special place for the
adhesion of patients to treatment and prediction and
rating of clinical competency and correct diagnosis by
nurses.[22]
Currently, despite the importance of the subject,
there is little awareness about the status of nurses’
competency and empathy in ICUs, and few studies have
been performed in this area in Iran, and even in these
few studies, nurses’ clinical competency has not been
measured with specialized tools for clinical competency.
However, the results of studies performed about the
relationship between clinical competency and empathy
area contradicting. Casas et  al. (2016)  indicate the
existence of a relationship between empathy and
clinical competency,[21] while in Maleki, no significant
relationship was seen between empathy and clinical
competency.[23] Ogle et  al. concluded in their study
that there is a strong relationship between clinical
competency and empathy assessed by a supervisor,
but there is no relationship between self‑assessed
empathy and clinical competency.[9] Given the issues
mentioned about clinical competency, empathy and
the importance of evaluating them and also limited
studies about the investigation of the correlation
between clinical competency and empathy, existence
of contradicting results in previous studies, it seems
necessary to perform this study and by performing this
study, it is possible to assess the relationship between
various areas of clinical competency and empathy,
and investigate the synergic or decreasing effect of the
desired areas.
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 Jahanshahi, et al.: Clinical competency and empathy of nurses
Methodology
This is a descriptive, correlational study. The study
population consists of nurses employed in ICUs and
cardiac care units (CCUs) of the educational hospitals
of Kerman University of Medial Sciences who at least
had a bachelor’s degree in nursing.
In this study, sampling was performed through a
census. Such that the questionnaires were given to all
the nurses employed in ICU and CCU, with a total
number of 260 nurses, out of this number, 231 nurses
completed the questionnaire. The attrition rate was
11% which is statistically acceptable.
For data collection, three questionnaires were used:
(1) Demographic data questionnaire consisting
of 14 questions about age, gender, marital status,
employment status, level of education, overall years
of service, work background in ICU, work shift,
average weekly work hours, overtime, history of
illness and history of drug use, history of the stay of
a family member, or friend in an ICU. (2) Farsi scale
of ICU nursing competency used to assess the clinical
competency of nurses. This scale was designed by
Lakanema et al. in 2012 and underwent psychometry
and introduced as a valid and reliable scale for the
assessment of ICU nursing competency. This scale has
the four areas of knowledge base, skill base, attitude
and value base, and experience base and 144 items with
each area including 36 items. Each item is investigated
in a 5‑point Likert Scale with the scores ranging from
1 = very poor to 5 = very good. The tools’ scores are
categorized as poor competency (144–288), average
competency (289–432), good competency (433–576),
and excellent competency (577–720). These tools were
translated by Shouryabi in 2014 in Iran and underwent
psychometry.[24] (3) The questionnaire of nurses’
empathy was prepared by Rahmatizadeh in 2015 under
the supervision of Hojjat by adopting his tools.[25]
This questionnaire consists of 38 questions, out of
which twenty questions were taken from the standard
20‑item questionnaire of Jefferson which was created
by Hojat et al. to investigate the level of physiologists’
empathy, and 18 questions were added to it after
consultation with nursing and psychology professors.
The advantage of this questionnaire over the standard
20‑item questionnaire of Jefferson is that the questions
of this questionnaire are categorized in the four areas
of cognitive, emotional, behavioral, and ethical. The
scores obtained are based on a Likert scale (5 = very
much, 4 = much, 3 = almost, 2 = little, and 1 = very
little) which are given to the areas of cognitive,
emotional, behavioral, and ethical empathy of nurses
with patients. The total score of the individuals is at
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696 Annals of Tropical Medicine and Public Health | Volume 10 | Issue 3 | May - June 2017
the range of 38–190 and a higher score means a higher
sympathy with an individual patient.
In this research, to determine the validity of the tool of
empathy, a content validity index (CVI), and content
validity ratio (CVR) were used. For this purpose, the
empathy assessment questionnaire was given to ten
professors of this field who were of the professors of
Shahid Beheshti University of Medical Sciences. Next,
they were asked to determine the necessity level of each
term based on the CVI (level of clarity, relevance, and
simplicity based on a 4‑part score criterion) and CVR.
The CVI of each question was determined which for
all the questions amounted to a value higher than 0.8,
and the overall value of it for all the tools was 0.89. The
CVR of each question was determined which ranged
from 0.8 to 1 and the overall value of it for all the tools
was 0.94.
To determine the reliability of the questionnaire,
internal consistency, and re‑testing were used. To
measure the internal consistency, the questionnaire
was given to twenty nurses working in an ICU, and
its Cronbach’s alpha was calculated. The overall
Cronbach’s alpha coefficient of the empathy assessment
questionnaire was 0.94, and the Cronbach’s alpha
coefficient of the ICU nursing competency scale was
0.97. Also to measure external consistency using retest,
the questionnaire was given 20 nurses working in an
ICU, and 2 weeks later, the questionnaire was given to
the same individuals again, and then, its reliability was
calculated through an intraclass correlation coefficient.
The intraclass correlation coefficient in the cognitive,
emotional, behavioral, and ethical fields of the
empathy assessment questionnaire were 0.90, 0.85,
0.78, and 0.92, respectively, and in the dimensions of
knowledge, skill, attitude, and value and competency
scale experience this value was 0.90, 0.88, 0.83, and
0.92, respectively.
In this research, after receiving the approval of the Ethics
Committee in Shahid Beheshti School of Nursing and
Midwifery and also receiving permissions from the study
hospitals, to collect the data, the researcher visited the
ICU and CCU of the educational hospitals of Kerman
in the three work shifts of morning, evening, and night
while carrying the questionnaire and after going through
the stages of self‑introduction, statement of research
goals, ensuring the participants of the confidentiality
of the information and receiving a written permission
from the nurses participating in the research, and
attempted to collect the data. The participants were
asked to complete the questionnaires (utmost within
3 days) any time that they consider appropriate and
return them.
 Jahanshahi, et al.: Clinical competency and empathy of nurses
The SPSS version 20 statistical software developed
by IBM Corporation was used for data analysis. First
descriptive indices such as mean and standard deviation
were reported and to determine the correlation between
clinical competency and empathy; the Pearson’s
correlation coefficient was used. Mutual relations
between clinical competency, empathy, and effective
variables were investigated using ANOVA, t‑test, and
linear regression. In the tests performed, a confidence
coefficient of 95% and degree of significance of (α =
0.05) were considered. The Kolmogorov–Smirnov test
was used to investigate the normality of the data and
all the variables were normal (P > 0.05).
Results
The results showed that out of the 231 participating
nurses, 67.96% (157 individuals) worked in an ICU and
32.04% (74 individuals) worked in a CCU. Most of the
nurses were in the age range of 31–38. The overall service
years of most of the nurses ranged from 6% to 10. 90.5%
of the nurses (209 individuals) were female, 74.9% (173
individuals) were married, 95.2% (220 individuals) had
a bachelor’s degree, 32.5% (75 individuals) had contract
employment, 91.3% (211 individuals) had rotational
shiftwork, 66.2% (153 individuals) had compulsory
overtime, 92.2% (213 individuals) had no history of
illness. 90.9% (210 individuals) had no history of drug
use. 58% (134 individuals) had no history of the stay of
a family member or friend in an ICU. The weekly work
hours of the majority of the nurses ranged from 41 to 60.
The overall minimum and maximum mean clinical
competency of the nurses were 144 and 720,
respectively, 574.08 ± 86.51, which is good. The
score of the clinical competency of the majority of the
nurses (56.7%) was excellent [Table 1]. The highest
competency score belonged to the field of knowledge,
and the lowest competency score belongs to the field of
skill [Table 2].
The overall empathy mean of the nurses ranged
from 38 at the minimum to 190 at the maximum
Table 1: Frequency distribution of nurses employed in
the Intensive Care Units of the educational hospitals of
Kerman University of Medical Sciences in 2016 based on
the scores obtained in clinical competency
The score obtained in clinical Level of clinical
competency competency
144-288 Poor
289-432 Average
433-576 Good
577-720 Excellent
Total
Annals of Tropical Medicine and Public Health | Volume 10 | Issue 3 | May - June 2017
150.12 ± 17.04. Since the number of the questions of
the four fields are not equal, therefore in order for it
to be clear that, in which field the lowest or highest
empathy levels are, the mean of empathy with the
number of the questions must be considered. The
highest mean of empathy belonged to the behavioral
category, and the lowest mean of empathy belonged to
the emotional category [Table 3].
The result of the Pearson’s correlation coefficient test
showed that since r = 0.7 and P < 0.001, therefore,
there is a direct relationship between the amount of
nurses’ clinical competency and their empathy level,
which was statistically significant. This means that a
higher clinical competency of nurses indicates that they
are more likely to establish an empathetic relationship
with patients. There is a direct relationship between
all the fields of clinical competency (knowledge,
skill, attitude and value, and experience) and all the
categories of empathy (cognitive, ethical, emotional,
and behavioral). The highest level of correlation
was between the field of attitude and value and
the behavioral category, and the lowest amount of
correlation was between the field of attitude and value
and the emotional category [Table 2].
In investigating the demographic components related
to clinical competency, findings suggested that there
was a relationship between clinical competency and
variables such as marital status, compulsory overtime,
history of drug use, history of the stay of a family
member or friend in an ICU, the type of ICU that
nurses are employed in, employment status, work
shift, work background in ICUs, overall years of service
in an ICU, age and number of weekly work hours, and
factors such as gender, different levels of education, and
history of illness had no effect on the amount of the
clinical competency of nurses.
Factors such as the type of employment of nurses,
overall years of service in an ICU, number of weekly
work hours, age, marital status, compulsory overtime,
the type of ICU that the nurses are employed in,
history of the stay of a family member or friend in
an ICU and work shift affected the level of empathy
in nurses but a history of the presence of illness,
history of drug use, different levels of education,
and gender did not affect the level of the empathy
n (%) of nurses.
4 (1.7) In the present study, regression analysis of the study
13 (5.7) variables showed that clinical competency affects the
83 (35.9) level of empathy in nurses such that for each 1 score
131 (56.7) increase of clinical competency, the score of empathy
231 (100)
increases by a value of 0.11 [Table 4].
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 Jahanshahi, et al.: Clinical competency and empathy of nurses

Table 2: The correlation between the categories of clinical competency and the categories of empathy of nurses employed
in the Intensive Care Units of the educational hospitals of Kerman University of Medical Sciences in 2016
Empathy Clinical competency
Knowledge (r, P) Skill (r, P) Attitude and value (r, P) Experience (r, P)
Cognitive 0.49, <0.001 0.53, <0.001 0.51, <0.001 0.50, <0.001
Emotional 0.44, <0.001 0.40, <0.001 0.34, <0.001 0.40, <0.001
Ethical 0.57, <0.001 0.58, <0.001 0.53, <0.001 0.55, <0.001
Behavioral 0.57, <0.001 0.60, <0.001 0.63, <0.001 0.58, <0.001

Table 3: Clinical competency, empathy, and their their study (empathy is relate to clinical competency
categories in nurses employed in the Intensive Care Units in medical cares) showed that the observed behavioral
of the educational hospitals of Kerman University of criteria of empathy measured by the supervisor, are
Medical Sciences in 2016 greatly related to clinical competency, and a strong
Categories Number of Mean±SD Mean±SD of a score by relationship was seen between empathetic behaviors
questions taking into account the and clinical competency in medical positions. However,
number of questions
a self‑assessed empathy is not related to clinical
Clinical
competency
competency.
Knowledge 36 149.37±23.20 4.14±0.64
Skill 36 140.09±22.57 3.89±0.62 The overall mean of clinical competency of nurses
Attitudes 36 142.86±24.85 3.96±0.69 employed in the ICUs of the educational hospitals of
and values Kerman University of Medical Sciences in 2016 was
Experience 36 141.74±21.28 3.93±0.59 574.08 ± 86.51 which was at a good level. The clinical
Total 144 574.08±86.51 3.98±0.60 competency score of the majority of nurses (56.7%)
Empathy was excellent. Since the present study is the first study
Cognitive 11 43.77±6.31 3.97±0.57 performed to investigate the clinical competency of
Ethical 7 27.46±3.76 3.92±0.53 nurses employed in ICUs using these tools; therefore,
Emotional 8 30.90±4.70 3.86±0.58 it was not possible to compare the results of this study
Behavioral 12 47.99±6.82 3.99±0.56
with other studies for different categories. In the study
Total 38 150.12±17.04 3.95±0.44
of Maleki performed to assess the clinical competency
SD=Standard deviation
of nurses employed in the cancer wards of the selected
hospitals of Tehran University of Medical Sciences, Iran,
Discussion the value of clinical competency in 72.3% of the nurses
was assessed as being good. The study by Bahreini et al.
There is a direct relationship between the mean of the in 2010 performed on the self‑assessment of clinical
overall clinical competency of nurses and the mean competency of nurses employed in various wards of
of their overall empathy. This means that a higher Shiraz Hospital Iran, indicated a good level of clinical
clinical competency in nurses makes them more likely competency where the greatest clinical competency
to establish an empathetic relationship with patients. belonged to the nurses of CCU. The research findings
The results of this research are in alignment with the of the study of Shatery performed to investigate the
results of the studies of Hojat et  al. in 2002[26] and clinical competency of nurses in the ICUs of Tehran
Ogle et  al. and contradict the results of Maleki. The University of Medical Sciences, showed that the
results of the study of Maleki showed that there is level of clinical competency of 22.8% of ICU nurses
no relationship between the amount of empathy and was poor, 67% was average, and 9.8% was strong.[27]
clinical competency of nurses employed in the cancer Ghalgeh et al. in their study performed to investigate
wards of the selected hospitals of University of Tehran, the correlation between the clinical competency of
Iran. Hojat et  al. in 2002 in their study (with the nurses and patients’ satisfaction of nurses’ services,
title: investigating the empathy of medical students reported the clinical competency of 82.9% of the
and its relation to gender, academic performance, and nurses of the clinical wards participating in their study
clinical competency) concluded that samples with a as being at the expected level.[28] The study of Karimi
higher empathy enjoyed a higher clinical competency. Moneghy et  al. showed that the clinical competency
However, it cannot be certainly said that a person of nurses employed in general, special, specialized,
with a high empathy will doubtlessly have the best and emergency wards as begin good.[29] In this study,
performance and a high level of clinical competency. there is a relationship between the clinical competency
Ogle et  al. in 2013 in Australian Medical School in and number of overall service years of nurses and their
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 Jahanshahi, et al.: Clinical competency and empathy of nurses

Table 4: Investigating the linear regression of empathy with relevant factors in nurses employed in the Intensive Care Units
of the educational hospitals of Kerman University of Medical Sciences in 2016
Regression factors Nonstandardized Standardized beta coefficients t statistic P
coefficient
B coefficient SE
Constant factor 69.962 14.107 ‑ 4.959 0.001
Clinical competency 0.109 0.012 551 9.140 0.001
Marital status −0.783 2.073 −0.020 −0.378 0.706
Compulsory overtime −1.138 1.865 −0.032 −0.610 0.543
Type of ICU −1.115 1.854 −0.031 −0.602 0.548
History of hospitalization of a family member or close friends in an ICU 1.286 1.699 0.037 0.757 0.450
Work shifts 2.044 1.638 0.065 1.248 0.213
Employment status −0.401 1.177 −0.023 −0.341 0.733
The work experience of nurses −0.043 0.033 0.172 1.307 0.193
Work experience in an ICU −0.005 0.023 −0.019 −0.221 0.825
Weekly working hours −0.123 0.113 −0.059 −1.096 0.274
Age 0.435 0.345 0.150 1.263 0.208
SE=Standard error, ICU=Intensive Care Units

number of service years in ICUs, given that the mean
overall work years and overall work years in ICUs of
the nurses participating in the study are 9.62 and 7.51,
respectively, their enjoyment of clinical competency
is at a good and reasonable level because nurses with
a longer work experience can better adapt themselves
with different circumstances and feel more competent
due to their use of past experiences.
Conclusion
In this study, in addition to the overall mean of
clinical competency, the scores in each category were
calculated individually. The greatest mean score of
competency is related to the field of knowledge, and
the lowest score of competency is related to the field of
skill. ICU nurses must have sufficient theoretical and
clinical knowledge because they deal with patients with
bad health conditions and ethical challenges. Advanced
and complete knowledge about equipment and subjects
related to special cares are the necessary and strong
conditions for supporting nursing care which results in
the provision of quality care.[30] One of the important
and key elements in the development of nurses’
competency is education which leads to the provision
of high‑quality care.[31] In regards with professional
skills, nurses as a part of the human resources in the
health system play an important role in improving
the health of the individuals in society. Education of
nurses must take place in coordination with the new
knowledge and findings related to the method of the
provision of health services, so nurses can fully exhibit
their job abilities, skills, and competency.[32] In 2011 in
his study, Khodayarian called experience as the most
important factor affecting the acquisition of competency
through feeling realities and called direct experiences
Annals of Tropical Medicine and Public Health | Volume 10 | Issue 3 | May - June 2017
as a valuable factor in improving clinical competencies
which places individuals in a real test with all the
associated challenges and difficulties, and considered
the continuous repetition of care, especially in technical
areas as an effective method in the acquisition of skills
in this area. According to some nurses, the role of
practice and repetition in improving competency is not
only limited to technical measures but also includes
fields such as establishing a relationship with a patient
or making a decision. An experience is in fact the
process of refining past opinions and knowledge of an
individual through encountering several real‑life cases.
The understanding obtained from each experience is
accumulated with past experiences, and at the end,
they collectively lead to the understanding of details.[33]
The mean of overall empathy of nurses employed
in ICUs is 150.12 ± 17.04. The greatest mean of
empathy was related to the behavioral category, and the
lowest mean of empathy was related to the emotional
category. The results of the study of Ouzouni and
Nakakis on nursing students in Greece performed with
the 20‑item questionnaire of Jefferson showed that
the empathy of students was 20 at the minimum and
140 at the maximum, 88.63 ± 8.93.[34] The results
of the study of Rahmatizadeh, 2015[25] performed
to investigate the empathy of nurses employed in
an oncology ward using the empathy assessment
tool of the present study showed that the empathy
score of nurses was 38 at the minimum and 190 at
the maximum 149.24 ± 16.63. The greatest amount
of the empathy of nurses of the oncology ward was
related to the ethical category, and the lowest amount
of empathy was related to the emotional category. The
cognitive and behavioral empathy of nurses were equal.
O’Connell and Landers (2008) in their study state that
699
 Jahanshahi, et al.: Clinical competency and empathy of nurses
the emotional aspect of care is more important than all
the other aspects.[35] Maybe the reason for the low level
of emotional care in Iran is due to cultural factors or
nurses’ little opportunity to express their emotions for
patients. A nurse will establish a relationship with a
patient by the amount that she understands the feelings
of the patient. Such that in the opinion of Jabbarifard
et al. (2011), identification of the internal experiences
and opinions of patients and their interactional ability,
in addition to increasing clinical skills, is effective in
creating a correct relationship and strengthening it and
improving the effectiveness of the services and duties
of patients. In the study of Negarandeh et  al., out of
the caring behavioral subscales of patients, the subscale
of nursing ethics acquired an average score. Nurses
consider that observing professional ethics is more
important and sensitive than general matters. Any job
which involves a direct communication with clientele
requires ethics. Although ethics is necessary in all jobs,
nurses require nursing ethics because they directly deal
with patients. Because the spiritual behaviour of nurses
and their responsibility in relation to the patients has
an effective impact on improving and recovering the
patients health. Therefore, the profession of nursing is
based on ethics.[36]
It seems that if nurses enjoy a good level of clinical
competency, they will have a more positive view
toward empathy with patients. During the study, the
researcher obtained results that she hopes will be
considered by the managers and authorities of the
nursing community and will be useful for progressing
the goals of nursing and facilitating nursing activities
and lead to increased competency and empathy in
nurses and improve caring quality and satisfaction level
of nurses and patients. Based on the results of the study
about the existence of a relationship between clinical
competency and empathy, it can be stated that if ICU
nurses, enjoy an appropriate empathy in addition to
having sufficient knowledge, experience and skills, they
can realize an organization’s goals with lower costs and
a higher quality.
Acknowledgment
This research is adopted from a master’s thesis in
intensive care nursing with the ethical code of IR.SBMU.
PHNM.1395.394 in Shahid Beheshti School of Nursing
and Midwifery. The researchers thank the authorities
of Shahid Beheshti School of Nursing and Midwifery,
managers, and nurses employed in the ICUs of the
educational hospitals of Kerman University of Medical
Sciences and all the colleagues who participated in this
project.
700
700 Annals of Tropical Medicine and Public Health | Volume 10 | Issue 3 | May - June 2017
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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