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\author{}
\date{}

\begin{document}

\textbf{A Study of Empathy Levels among Nursing Interns: A
Cross-sectional Study}

Ghazwani, S*, Alshowkan, A** \& AlSalah, N**

*Master of Psychiatric and Mental Health Nursing, College of Nursing,
Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
Corresponding author

**Department of Community Nursing, College of Nursing, Imam Abdulrahman
Bin Faisal University, Dammam, Saudi Arabia.

\textbf{ABSTRACT}

\textbf{Background}: Empathy is one of the therapeutic communication
techniques used to help the client feel better. However, there are a few
studies have investigated level of empathy among enrollers at nursing
colleges. The aim was to examine the level of self-reported empathy
among nursing interns.

\textbf{Methods}: The study was a descriptive, cross-sectional in
nature. A total of 135 nursing interns fill in the Interpersonal
Reactivity Index from August to October 2022. Data was analyzed through
the SPSS program. An independent --sample t-test and one way- ANOVA was
used to explore differences in the degree of empathy with respect to
academic and sociodemographic factors.

\textbf{Results:} The results of this study showed that nursing interns
showed a mean level of empathy of 67.46 (SD = 18.86). This result
indicated that the nursing interns have moderate levels of empathy
overall. There was statistical significant difference in the mean level
of subscales of perspective-taking and empathic concern between males
and females. Additionally, nursing interns who are less than 23 years
old scored high in the subscale of perspective-taking. Married nursing
interns and who preferred nursing as a profession scored higher in the
subscale of empathic concern than unmarried ones and who did
not~preferred nursing as a profession.

\textbf{Conclusion:} Perspective taking incresed with younger male
nursing interns, this reflects high cognitive flexibility with younger
age nursing interns. Morover, the empathic concern incresed with male
married nuring interns who preferred nursing as a profession. This
implies that they should engage in continuous reflection and educational
activities as part of their clinical training as nursing interns in
order to improve their empathic attitudes.

\emph{\textbf{Keywords}}

Empathy, Interpersonal Reactivity Index, Nursing Interns, Quantitative
study

\textbf{BACKGROUND}

The term "empathy" first emerged in the field of psychology as a result
of Titchener\textquotesingle s translation of the German word
"einfühlung," which literally means "feeling into," or the ability to
understand another person\textquotesingle s feelings (1). Empathy has
been researched in a variety of domains of psychology, including
developmental psychology (2), social psychology (3), and forensic
psychology (4), these domains cover a wide range of themes, including
relationships and marriage, violence and sexual offenses, early
development, and autism. There is a growing focus in empathy in relation
to management and marketing in occupational psychology (5, 6), and
empathic processes in client and colleague relationships (7). Empathy
studies in healthcare has likewise spanned 50 years, with early studies
conducted by Aring (8) in medicine, Peplau (9) in nursing, and Rogers
(10) in counselling.

One of the characteristic of a good nurse is empathy in patient care
(11). Patients benefit from the use of empathy as a part of therapeutic
communication. It is the capacity to comprehend and recognize the
reality of another individual, as well as to effectively recognize and
convey one\textquotesingle s own feelings to others (12). Empathy is an
expression of understanding what it is like for a distressed, suffering,
or upset client (13). According to Davis (14), empathy encompasses both
cognitive and affective or emotional domains. The cognitive domain
refers to one\textquotesingle s capability to comprehend
another\textquotesingle s inner thoughts and feelings.
It\textquotesingle s also the ability to see the world through the eyes
of another person (15). The affective domain, instead, encompasses the
ability to enter or take part another person\textquotesingle s emotional
experience. Empathy and sympathy are not the same thing. These are
frequently combined into a single terminological category. A sympathetic
nurse shares their own feelings with the patient, whereas an empathetic
nurse shares the patient\textquotesingle s thoughts (16).

A number of characteristics have been linked to the
nurses\textquotesingle{} empathetic behavior. Nurses who are empathetic
and concerned about their patients and who communicate effectively with
them are more likely to provide the highest quality of care (17).
Empathy is still taught in nursing programs due to previous
characteristics; undergraduate nursing students are learning the
significance of creating an empathic relationship with patients as well
as fundamentals communication skills (18). Nursing students with a
higher level of empathy had a more positive attitude toward elderly
patients (19). Nursing students who were more empathic were better at
taking histories and performing health assessments (20). They were
satisfied, and their therapeutic relationship with the patients was
better (21).

Nursing students complete an internship year during their final year of
nursing education (22). Internships are available for students after
fourth year of bachelor education who have accomplished their formal
education up to that point. It is a transitional time. Nursing Interns
earn more clinical skills through this time because there is less
lecture room instruction and more clinical skills (22). Nursing interns
work around the clock in psychiatry wards, emergency departments,
operating room, primary health clinics, labor rooms, and other clinical
areas. These nursing interns are expected to pay attention to the
patients\textquotesingle{} needs and desires and to develop therapeutic
relationships with them in order to better meet patients' expectations.
As a result, internship is a time of significant personal and
professional transformation. Longer work hours, increased patient care
demands, and less time for family are just a few of the changes that
have occurred.

Empathy plays a crucial role in nurse-patient encounters as well as
clinical outcomes; for this reason, nursing education and nursing
internship programs should make it a priority in their curriculum (13,
23). However, the nursing curriculum did not provide teaching empathy
skills as a separate course or in the form of a preparation workshop for
nursing students or interns in nursing schools in Saudi Arabia. Instead,
the nursing curriculum integrated these skills into broader courses on
patient care, psychology, and professional ethics (24).

Studying the varying empathy levels among nursing interns could provide
insight into their educational paths, which is relevant to nursing
education and clinical practice. Empathy is linked to a reduction in
clinical practice~stress and burnout among nursing interns (25). Song
(26) found that reducing personal distress of empathy is important for
nursing interns, and that it may help to reduce clinical practice stress
and burnout. Identifying the level of empathy in nursing interns at risk
of stress and anxiety may assist curriculum developers in effectively
integrating interventions to promote empathy levels in nursing interns.
Identifying nursing interns at risk of having a low level of empathy can
also help professionals predict complications and use appropriate
intervention. As a result, the aim of the present study is to examine
the level of self-reported empathy among nursing interns as well as the
factors influencing them during their internship.

\hypertarget{methods}{%
\subsection{Methods}\label{methods}}

\textbf{Research Design}

The study aim is addressed using a descriptive, cross-sectional design.

\textbf{Study Setting}

The study was carried out at a college of nursing at Imam Abdulrahman
Bin Faisal University in Saudi Arabia Study from August to October 2022.
The Bachelor of Basic Science in nursing program consists of four years
of formal education and one year of internship. Following successful
completion of the undergraduate nursing program\textquotesingle s four
years, the student must complete a 52-week hospital-based internship in
recognized hospitals that can provide a proper training area to meet the
internship program\textquotesingle s objectives (27).

\textbf{Sample Description}

The study\textquotesingle s target population was nursing interns who
had completed four years of study and have begun their 52-week
internship training period. A non-probability convenience sampling
method was used to recruit nursing interns. A convenience sample
obtained by approaching the subjects who are available at the time of
data collection until the required sample size reached.

\hypertarget{inclusion-and-exclusion-criteria}{%
\subsubsection{\texorpdfstring{\emph{Inclusion} \emph{and Exclusion
Criteria}
}{Inclusion and Exclusion Criteria }}\label{inclusion-and-exclusion-criteria}}

The selection and inclusion criteria were required that the nursing
interns (a) who~are~willing~to~take~part~in~the~study, (b) who
successfully completed the four-year undergraduate nursing program at
IAU\textquotesingle s college of nursing, (c) who have completed the
orientation program (2 months) and are now in the clinical setting).
Nursing interns who were still enrolled in the orientation program at
the IAU\textquotesingle s college of nursing were excluded.

\hypertarget{sample-size}{%
\subsubsection{\texorpdfstring{\emph{Sample
Size}}{Sample Size}}\label{sample-size}}

The sample size was calculated prior to data collection using the
G*power software version 3.1 (28).The researcher estimates the sample
size on the basis of a desired power = 0.80, a present α = 0.05 and
medium effect size (0. 5). The total sample consists of 128 participants
to strengthen the study findings. However, over sampling is intended to
gain more understanding of the phenomena. The final sample size in this
study was 135 nursing interns.

\textbf{Study Instruments}

\begin{itemize}
\item ~
  \hypertarget{interpersonal-reactivity-index-iri}{%
  \subsubsection{\texorpdfstring{\emph{Interpersonal Reactivity
  Index~(IRI)}}{Interpersonal Reactivity Index~(IRI)}}\label{interpersonal-reactivity-index-iri}}
\end{itemize}

The IRI (Davis (14) is a 28-item scale with four, seven-item subscales:
the Fantasy Scale (FS), Perspective Taking Scale (PT), the Empathic
Concern Scale (EC), and the personal distress scale (PD). Compassion and
concern for others are referred to as EC. Perspective Taking Scale (PT)
evaluates unintentional attempts to adopt other people\textquotesingle s
viewpoints. The Fantasy Scale (FS) stands for the probability that a
person will identify with an imaginary character. When exposed to the
negative experiences of others, PD indicates the degree to which an
individual feels uneasy or worried. Each item is rated on a Likert-like
scale of 5-point ranging from 0 =does not describe me well to 4
=describes me very well. The possible overall score ranges from 0 (very
low level of empathy) to 112 (very high level of empathy), with a mean
score of 56. This suggests that nursing interns with higher mean scores
are generally geared toward a high level of empathy (14). The aggregate
scores for each sub-dimension are calculated by averaging the responses
to each seven-item subscale.

The ISI produced moderate internal consistency ranging from.70 to.78 in
Davis\textquotesingle s original report (Davis, 1994). Internal
consistency of the subscales was moderate (FS =.78; PT =.75; EC =.71; PD
=.78). Other previous studies report Cronbach\textquotesingle s alpha
values ranging from 0.70 to 0.83 for IRI subscales and correlation
coefficients ranging from 0.01 to 0.37 between subscales (29-31). A
pilot study to evaluate the readability and clarity of the instruments
was conducted using a convenient sample of 20 nursing interns who had
characteristics similar to those of the study subjects. All participants
reported that the wording of the instruments and the instructions were
clear. Cronbach\textquotesingle s alpha was 0.89 in the current study,
indicating that IRI has very good internal consistency.

\begin{itemize}
\item ~
  \hypertarget{sociodemographic-and-educational-questionnaire}{%
  \subsubsection{\texorpdfstring{\emph{Sociodemographic} and
  \emph{Educational} \emph{Questionnaire}
  }{Sociodemographic and Educational Questionnaire }}\label{sociodemographic-and-educational-questionnaire}}
\end{itemize}

The researchers created a demographic questionnaire to collect
demographic and educational characteristics. Sociodemographic
characteristics included gender, marital status, and age. Academic
characteristics included nursing intern's preference of nursing as
profession, clinical training area, and Grade Point Average (GPA). The
questions were derived from previous reviewed studies in similar study
samples (16, 32) .

\textbf{Ethical Considerations}

The current study was approved by Imam Abdulrahman Bin Faisal
University\textquotesingle s (IAU) Institutional Review Board (Ref. No.
IRB-PGS-2022-04-164). Furthermore, the author notified the dean of
nursing and the nursing internship coordinator. Nursing interns were
persuaded that completing the questionnaires would have no effect on
their academic status and progress within the college of nursing.
Nursing interns were notified that involvement in the study was
completely optional, and their privacy and confidentiality would be
respected. Consent form was secured from study's participants.

\textbf{Data Analysis}

The Statistical Package for Social Science (SPSS) SPSS®-PC version 28
For Windows was used to analyze the data. For all statistical analysis,
the level of significance was set at 0.05. Descriptive statistics were
used to define the socio-demographic features of the sample as well as
the instrument of IRI. An independent --sample t-test was used to
examine difference in the level of empathy relation to gender, marital
status, and preferred nursing as a profession. Furthermore, one-way
analysis of variance (One way- ANOVA) was used to explore differences in
the degree of empathy with respect to the age groups, GPA, and clinical
training area.

\hypertarget{results}{%
\section{\texorpdfstring{\textbf{RESULTS} }{RESULTS }}\label{results}}

\hypertarget{sociodemographic-characteristics-of-participants}{%
\subsection{Sociodemographic Characteristics of
Participants}\label{sociodemographic-characteristics-of-participants}}

A total of 135 nursing interns participated in this study with a
response rate of 100\%. Majority of participants were female (64.4\%),
unmarried (74.8\%) and age ranged from 21 to 26 years, with a mean (SD)
of 23.10 (1.05). Most of the participants (86.7\%) prefer nursing as a
profession. More than half of nursing interns (55.6\%) had
\textgreater4.1 GPA points, with a mean (SD) of 4.06 (.51). There were
several training areas for nursing interns at the time of data
collection, but the most common training location was the emergency
department (17.8\%) (Table1).

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.4904}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.1251}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.1344}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.2501}}@{}}
\toprule()
\begin{minipage}[b]{\linewidth}\raggedright
Variable Mean
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
SD
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
NO (\%)
\end{minipage} \\
\midrule()
\endhead
Age 23.10

Grade point average (GPA) 4.06

Age Groups

≤ 23

\textgreater24

Grade point average (GPA)

≤ 3

3.1-4

\textgreater{} 4.1

Gender

Female

Male

Marital Status

Unmarried

Married

Preferred nursing as a profession

Yes

No

Training Area

Medical Ward

Surgical Ward

Emergency Department

Catheterization Lab.

Gynaecology Ward

Coronary Care Unit~(CCU)

Operative Room

Hemodialysis

Intensive Care Unit (ICU)

Pediatric Ward

Outpatient Department (OPD)

Endoscopy Ward

Orthopedic Ward & & 1.05

.51 & \begin{minipage}[t]{\linewidth}\raggedright
93(68.9)

42(31.1)

9(6.7)

51(37.8)

75(55.6)

87(64.4)

48(35.6)

101(74.8)

34(25.2)

117(86.7)

18(13.3)

\begin{quote}
21(15.6)

14 (10.4)

24 (17.8)

9 (6.7)

5 (3.7)

9 (6.7)

11 (8.1)

10 (7.4)

13 (9.6)

6 (4.4)

10 (7.4)

2 (1.5)
\end{quote}

1 (.7)
\end{minipage} \\
\bottomrule()
\end{longtable}

\textbf{Table 1 : Socio-demographic Characteristics of Nursing Interns,
N= 135.} SD= standard deviation.

\hypertarget{the-results-of-nursing-interns-self-reported-empathy-level}{%
\subsection{The Results of Nursing Interns\textquotesingle{}
Self-Reported Empathy
Level}\label{the-results-of-nursing-interns-self-reported-empathy-level}}

The mean level of total self-reported empathy that was measured by
Interpersonal Reactivity Index (IRI) among nursing interns was 67.46 (SD
= 18.86). The mean score is slightly above the midpoint of the IRI
scale, which is 56, indicating that the nursing interns in the study may
have moderate levels of empathy overall. Regarding to the subscales of
IRI, Perspective-taking has the highest mean 17.7 (SD = 5.34) among
nursing interns (Table 2). Therefore, the nursing interns in this study
are capable of viewing a situation or comprehending a subject from a
different perspective, such as that of another person.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 8\tabcolsep) * \real{0.4235}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 8\tabcolsep) * \real{0.1631}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 8\tabcolsep) * \real{0.1733}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 8\tabcolsep) * \real{0.1348}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 8\tabcolsep) * \real{0.1053}}@{}}
\toprule()
\begin{minipage}[b]{\linewidth}\raggedright
Variables
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
Minimum
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
Maximum
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
Mean
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
SD
\end{minipage} \\
\midrule()
\endhead
Interpersonal Reactivity Index (IRI) & 23 & 112 & 67.46 & 18.86 \\
Fantasy scale (FS) & 3 & 28 & 16.6 & 6.15 \\
Perspective-taking scale (PT) & 4 & 28 & 17.7 & 5.34 \\
Empathic concern scale (EC) & 4 & 28 & 16.7 & 4.73 \\
Personal distress scale (PD) & 1 & 28 & 16.3 & 5.65 \\
\bottomrule()
\end{longtable}

\textbf{Table 2: Measures of Central Tendency of Interpersonal
Reactivity Index and the Subscales.} SD= standard deviation.

\hypertarget{the-results-of-relationship-between-level-of-self-reported-empathy-and-sociodemographic-factors-among-nursing-interns}{%
\subsection{\texorpdfstring{The Results of Relationship between Level of
Self-Reported Empathy, and Sociodemographic Factors among Nursing
Interns
}{The Results of Relationship between Level of Self-Reported Empathy, and Sociodemographic Factors among Nursing Interns }}\label{the-results-of-relationship-between-level-of-self-reported-empathy-and-sociodemographic-factors-among-nursing-interns}}

\emph{\textbf{Gender:}} An independent --sample t-test was used to
examine difference in the total level of empathy and subscales with
respect to gender. The result of study showed that there is statistical
significant difference in the mean level of perspective-taking subscale
in scores between males (M=19.21, SD= 5.31) and females (M=16.95, SD =
5.21, t (133) = 2.38, p = 0.01) (Table 3). Moreover, there is
statistical significant difference in the mean level of empathic concern
subscale in scores between males (M=18.04, SD= 5.04) and females
(M=16.07, SD = 4.43, t (133) = 2.35, p = 0.02) (Table 3). This means
that male nursing interns are capable of viewing a situation or
comprehending a subject from a different perspective, such as that of
another person than female interns. Moreover, male nursing interns felt
more sympathy and caring for others than female nursing interns. On the
other hand, no statistical significant difference at the p\textless{}
.05 between gender with total level of empathy (t (133) = 1.28, p =
.20), and subscales of fantasy (t (133) = .58, p = .55), and personal
distress (t (133) = -.50, p = .61). These results show that male and
female nursing interns had the same total level of empathy and subscales
of fantasy and personal distress.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.3267}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1248}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0966}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0962}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1250}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1058}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1250}}@{}}
\toprule()
\endhead
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.4515} + 2\tabcolsep}}{%
\textbf{Variable} Gender} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Mean
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
SD
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{t -Value}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{df}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{P-value}
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Interpersonal Reactivity Index (IRI)
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Male
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
70.27
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
20.24
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
1.28
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.200
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Female
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
65.91
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.99
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Fantasy
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Male
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.02
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.30
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.58
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.557
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Female
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.37
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.09
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Perspective-taking
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Male
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
19.21
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.31
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
2.38
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textbf{.018*}
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Female
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.95
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.21
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Empathic concern
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Male
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.04
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.04
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
2.35
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textbf{.020*}
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Female
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.07
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.43
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Personal distress
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Male
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.00
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.71
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-.50
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.612
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Female
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.52
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.00
\end{quote}
\end{minipage} \\
\bottomrule()
\end{longtable}

\textbf{Table 3 : Difference between Gender and Level of IRI with
Subscales, *Significant at p ≤ 0.05.}

\textbf{\emph{Age}:} Pearson product --Moment correlation (Pearson's r),
coefficient for a 2-tailed test of significant was used to determine the
relationship between total level of empathy and subscales with respect
to age (Table 4). The result reveled that there is statistical
significant negative relationship between the level of
perspective-taking subscale and age in years (r = -.195; n=135;
p=0.023). This means that as nursing intern age increases, the level of
perspective-taking subscale decreases.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.1922}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.1923}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.2821}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3334}}@{}}
\toprule()
\begin{minipage}[b]{\linewidth}\raggedright
\textbf{Variable}
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
\textbf{Age}
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
\begin{quote}
\emph{r}
\end{quote}
\end{minipage} & \begin{minipage}[b]{\linewidth}\raggedright
\begin{quote}
\emph{P-value}
\end{quote}
\end{minipage} \\
\midrule()
\endhead
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3845} + 2\tabcolsep}}{%
Interpersonal Reactivity Index} & -.030 & .734 \\
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3845} + 2\tabcolsep}}{%
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Fantasy
\end{quote}
\end{minipage}} & .008 & .924 \\
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3845} + 2\tabcolsep}}{%
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Perspective-taking
\end{quote}
\end{minipage}} & \textbf{-.195*} & .023 \\
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3845} + 2\tabcolsep}}{%
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Empathic concern
\end{quote}
\end{minipage}} & -.060 & .492 \\
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 6\tabcolsep) * \real{0.3845} + 2\tabcolsep}}{%
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Personal distress
\end{quote}
\end{minipage}} & .127 & .142 \\
\bottomrule()
\end{longtable}

\textbf{Table 4: Correlations between age and IRI with Subscales,
*Significant at p ≤ 0.05.}

An independent --sample t\textbf{-}test was used to examine difference
in the total level of empathy and subscales with respect to age group.
The result reveled that there is statistical significant difference in
the mean level of perspective-taking subscale in scores between nursing
interns less than 23 years (M=18.61, SD= 4.87) and nursing interns more
than 24 years old (M=15.86, SD = 5.87, t (133) = 2.84, p = 0.005) (Table
5). These results reveled that nursing interns who are less than 23,
scored higher in perspective-taking dimension more than nursing interns
above 23 years. This means that younger nursing interns in this study
are capable of viewing a situation or comprehending a subject from a
different perspective, such as that of another person than older nursing
interns.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.3552}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0963}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0966}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0962}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1250}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1058}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1250}}@{}}
\toprule()
\endhead
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.4515} + 2\tabcolsep}}{%
\textbf{Variable} Age} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Mean
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
SD
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{t -Value}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{df}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{P-value}
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Interpersonal Reactivity Index
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
≤23
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
69.30
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.90
\end{quote}
\end{minipage} & \multirow{2}{*}{1.70} & \multirow{2}{*}{133} &
\multirow{2}{*}{.092} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textgreater24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
63.38
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
20.47
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Fantasy
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
≤23
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.11
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.96
\end{quote}
\end{minipage} & \multirow{2}{*}{1.43} & \multirow{2}{*}{133} &
\multirow{2}{*}{.155} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textgreater24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
15.48
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.49
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Perspective-taking
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
≤23
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.61
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.87
\end{quote}
\end{minipage} & \multirow{2}{*}{2.84} & \multirow{2}{*}{133} &
\multirow{2}{*}{\textbf{.005*}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textgreater24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
15.86
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.87
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Empathic concern
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
≤23
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.72
\end{quote}
\end{minipage} & \multirow{2}{*}{1.71} & \multirow{2}{*}{133} &
\multirow{2}{*}{.089} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textgreater24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
15.74
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.66
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Personal distress
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
≤23
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.34
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.59
\end{quote}
\end{minipage} & \multirow{2}{*}{.03} & \multirow{2}{*}{133} &
\multirow{2}{*}{.974} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textgreater24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.31
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.83
\end{quote}
\end{minipage} \\
\multicolumn{7}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{1.0000} + 12\tabcolsep}@{}}{%
*Significant at \emph{p} ≤ 0.05.} \\
\bottomrule()
\end{longtable}

\textbf{Table 5: Difference between Age Group and IRI with Subscales}

\textbf{\emph{Marital status:}} An independent --sample t-test was used
to examine difference in the total level of empathy and subscales with
respect to marital status. The result of study showed that there is
statistical significant difference in the mean level of empathic concern
subscale in scores between unmarried (M=16.34, SD= 4.91) and married
(M=18.06, SD = 3.97, t (133) = -1.84, p = 0.044) (Table 6). These
results reveled that married nursing interns scored higher in the
empathic concern subscale than unmarried nursing interns. This mean that
married nursing interns felt more sympathy and caring for others than
unmarried nursing interns.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.2845}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1568}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0984}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0979}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1273}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1077}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1273}}@{}}
\toprule()
\endhead
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.4413} + 2\tabcolsep}}{%
\textbf{Variable} Marital status} &
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Mean
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
SD
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{t -Value}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{df}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{P-value}
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Interpersonal Reactivity Index (IRI)
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Unmarried
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
66.33
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
20.09
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.20
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.231
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Married
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
70.82
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
14.38
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Fantasy
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Unmarried
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.39
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.45
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-.69
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.489
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Married
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.24
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.21
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Perspective-taking
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Unmarried
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.51
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.62
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-.90
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.369
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Married
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.47
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.39
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Empathic concern
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Unmarried
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.34
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.91
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.84
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textbf{.044*}
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Married
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.06
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
3.97
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Personal distress
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Unmarried
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.09
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
6.05
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-.86
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.389
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Married
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.06
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.20
\end{quote}
\end{minipage} \\
\multicolumn{7}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{1.0000} + 12\tabcolsep}@{}}{%
*Significant at \emph{p} ≤ 0.05.} \\
\bottomrule()
\end{longtable}

\textbf{Table 6: Difference between Marital Status and IRI with
Subscales}

\textbf{\emph{Grade Point Average (GPA}):} Participants in this study
were divided into three groups according to their GPA. One way- ANOVA
was used to examine difference in the level of empathy and subscales
with respect to GPA. The result of study showed that there is no
statistical significant difference at the p \textless.05 between
different GPA points with total level of empathy and its subscale.

\emph{\textbf{Clinical Training Area:}} Participants in this study were
divided into thirteen groups according to their training areas. One way-
ANOVA was used to examine difference in the level of empathy and
subscales with respect to training areas. The result of study showed
that there is no statistical significant difference at the p
\textless.05 between different training areas with level of empathy, and
subscales of fantasy, perspective-, empathic concern, and personal
distress.

\emph{\textbf{Preferred Nursing as a Profession:}} An independent
--sample t-test was used to examine difference in the level of total
empathy and subscales with respect to preferred nursing as a profession.
The result of study showed that there is statistical significant
difference in the mean level of empathic concern subscale in scores
between preferred nursing as a profession (M=17.09, SD= 4.56) and not
preferred nursing as a profession (M=14.72, SD = 5.45, t (133) = -1.99,
p = 0.049) (Table 7). These results reveled that nursing interns who
preferred nursing as a profession had a statistically significant higher
mean of subscale of empathic concern than nursing interns who did not.

\begin{longtable}[]{@{}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.2350}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.2063}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0984}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.0979}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1273}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1077}}
  >{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.1273}}@{}}
\toprule()
\endhead
\multicolumn{2}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{0.4413} + 2\tabcolsep}}{%
\textbf{Variable} Preferred Nursing} &
\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Mean
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
SD
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{t -Value}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{df}
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\emph{P-value}
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Interpersonal Reactivity Index
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
No
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
60.11
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
22.44
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.78
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.076
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Yes
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
68.59
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.10
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Fantasy
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
No
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
14.28
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
7.05
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.73
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.086
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Yes
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.96
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.96
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Perspective-taking
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
No
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
15.78
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
7.03
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.69
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.092
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Yes
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
18.06
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.00
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Empathic concern
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
No
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
14.72
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.45
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-1.99
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
\textbf{.049*}
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Yes
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
17.09
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
4.56
\end{quote}
\end{minipage} \\
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Personal distress
\end{quote}
\end{minipage}} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
No
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
15.33
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.07
\end{quote}
\end{minipage} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
-.80
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
133
\end{quote}
\end{minipage}} &
\multirow{2}{*}{\begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
.422
\end{quote}
\end{minipage}} \\
& \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
Yes
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
16.49
\end{quote}
\end{minipage} & \begin{minipage}[t]{\linewidth}\raggedright
\begin{quote}
5.73
\end{quote}
\end{minipage} \\
\multicolumn{7}{@{}>{\raggedright\arraybackslash}p{(\columnwidth - 12\tabcolsep) * \real{1.0000} + 12\tabcolsep}@{}}{%
*Significant at \emph{p} ≤ 0.05.} \\
\bottomrule()
\end{longtable}

\textbf{Table 7: Difference between Preferred Nursing as a Profession
and IRI with Subscales}

\hypertarget{section}{%
\section{}\label{section}}

\hypertarget{discussion}{%
\section{\texorpdfstring{\textbf{DISCUSSION}}{DISCUSSION}}\label{discussion}}

The purpose of this study was to examine the level of self-reported
empathy among nursing interns. The results of this study showed that
nursing interns showed a mean level of empathy of 67.46 (SD = 18.86).
This result indicated that the nursing interns in the study have
moderate levels of empathy overall. When compared to another recent
Indian study conducted among nursing interns, this result implies a
similar level of empathy (16). In this regard, the literature shows that
nursing interns have a significantly higher mean score of empathy than
students in other professions (33, 34). As stated by Giovanna, Chiara
(35), among nursing professions, some specific skills are needed, such
as knowing the basics of effective communication, using communication
facilitation strategies, listening actively to the patient and
understanding what it means to be in a demanding relationship. Nurses
can develop tailored adaptation processes by using empathy and
reflective thinking to deeply understand their
patients\textquotesingle{} feelings and lives. As a result, nursing care
programs should assist nursing interns in communicating empathically
with the patient as well as the interdisciplinary team.

The findings of this study demonstrated that there are no statistically
significant changes in the mean level of empathy between different GPA
points of nursing interns. This results is consistent with earlier
studies (36, 37). Other studies contradict the study\textquotesingle s
finding that higher GPA students are more empathetic than lower GPA
students (38, 39). The difference in study results can be explained by
nursing interns do not consider their GPA because they have completed
their nursing education and their GPA will not be included in the
internship period.

According to the findings of this study, there are no statistically
significant differences in the mean level of empathy between different
training areas. This result is similar to the findings of Ghaedi,
Ashouri (40) which showed that nurses\textquotesingle{} empathy levels
are similar across hospital wards. However, the study result is not in
line with most studies in others professions which highlight that
medical students who chose general internal medicine and psychiatry
residency as training area had the highest mean empathy ratings than
physicians trained in anesthesia and surgery area (41, 42). According to
the author of this study, empathy is vital in any clinical environment,
and nurses should be empathic with all patients regardless of clinical
setting.

In this study, some sociodemographic characteristics that differ with
empathy level were identified. Surprisingly, the current study reveals
that there is a gender difference in empathy, with male students
reporting a statistically significant higher mean of empathetic concerns
and perspective-taking dimensions than female interns. This result
contradicts most studies, which show that females are more empathic than
males (33, 36, 38, 39, 43).

This divergent result might be explained by empathy, which is also
defined from a cognitive component, which requires more complicated
mental processes, allowing the individual to understand feelings in
certain circumstances. This viewpoint is strongly related to theory of
mind since it requires the ability to read and place ourselves in the
mental and emotional place of another individual (perspective taking)
(3). The impact of gender on perspective taking may be explained by
women being seen as more emotionally sensitive, while men are viewed as
being less sensitive and more oriented towards a cognitive perspective.
Another point of view, Persson and Hostler (44), perspective-taking
mixed with self-affirmation improved empathic feelings toward feminists
(as expressed by perspective-taking emotions). The effect on empathy was
particularly significant among men who had previously had strong
prejudices against feminists. As a result, male nursing interns may be
able to reduce prejudice toward feminists by improving their empathic
feelings. In addition, as the result of our study contradicts most of
the previous studies, we suggest future studies to investigate more
about empathy and gender through phenomenological study design.

The current study found that there is an age difference in empathy
level, with younger nursing interns (≤23), reporting a statistically
significant higher mean of perspective-taking dimension than older
nursing interns (\textgreater23). This result is consistent with the
findings of Berduzco-Torres, Medina (38), who found that younger nursing
students are more empathic than older nursing students and contradict
studies of Ouzouni and Nakakis (43), Kesbakhi and Rohani (45) which
highlight that older nursing students have higher empathy levels than
younger students. The study\textquotesingle s findings can be justified
by the fact that perspective taking declines with age. This
justification was due to the cognitive requirements of taking another
person's perspective, which is reflected in evolutionary models of
empathy whereby perspective taking is a higher-level process than
experiencing empathic concern, and thus more vulnerable to decline with
age process (46). The results support this justification in general,
with stronger perspective taking related with younger age. There is
evidence of age-related declines in the cognitive ability to
appropriately understand the emotions of others (47).

The current study found that marital status has an effect on empathy
level, with married nursing interns reporting a statistically
significant higher mean of empathic concern dimension than single
nursing interns. This result is consistent with the findings of
Sedaghati, Rohani (48) which found that married nurses had higher
empathy concern scores, and contradicting a study by Kesbakhi and Rohani
(45) that found single nursing students to be more empathic. Another
study on oncology nurses in Turkey found that marital status had no
effect on nurses\textquotesingle{} empathetic concern (49). According to
the author, the conflicting results could be due to the low percentage
of married students (25.2\%) in this study, which has resulted in biased
results.

\hypertarget{implications-for-nursing-practice}{%
\subsection{\texorpdfstring{IMPLICATIONS FOR NURSING PRACTICE
}{IMPLICATIONS FOR NURSING PRACTICE }}\label{implications-for-nursing-practice}}

Relevant university decision makers, as well as nurse educators, should
take seriously the current study\textquotesingle s finding that female,
older, unmarried nursing interns appear to be less empathic than other
nursing interns. This implies that they should engage in continuous
reflection and educational activities as part of their clinical training
as nursing interns in order to improve their empathic attitudes. For
instance, The Empathy Educational Model (EEM) (50), was established
specifically as an urgent requirement for empathy training with the
increasing number of nursing schools, health organizations, community
services and nursing homes. The EEM is based on the following training
program steps with includes; enlightening nursing student with empathy
world through using medical film and empathy experience, then, introduce
nursing students to principle of empathy besides patient personality
traits, after that, nursing students practice empathetic skills and
later they need to evaluate and provide reflection report in their
empathy skills. In addition, emphasis was giving for nursing students
empathy training through situation teaching, task-based learning, video
demonstration, and problem-based leaning. The EEM has been proved as an
effective model that improve nursing empathy level which facilitate
establishing nurse-patient relationships and enhance the mental health
of both patients and nurse.

Furthermore, it is recommended teach and train nursing students on
communication techniques, reflection skills, meditation and cultural
aptitudes through the use of simulation techniques with mannequins or
dealing with high-risk group can enhance the level of empathy. In
addition, faculty and teaching staff play can use experiential learning
techniques besides simulations and immersion in teaching and training
different nurses' course and workshop (51).

\hypertarget{limitations}{%
\subsection{\texorpdfstring{LIMITATIONS
}{LIMITATIONS }}\label{limitations}}

A number of limitations affect the interpretation of the
study\textquotesingle s results. The use of only self-ratings is one
limitation. It is commonly known that in self-rating empathy studies,
individuals are likely to overestimate their empathy due to factors like
social desirability. Other limitations include the fact that based on
the nature of the study, the number of participnats consider small and
was conducted at only one university, limiting the generalizability of
the findings. Furthermore, because this is a cross-sectional analytic
study, it is difficult to know the process and direction of the
relationships that were identified, and the focus was on
sociodemographic and academic associations.

\hypertarget{conclusion}{%
\subsection{\texorpdfstring{CONCLUSION
}{CONCLUSION }}\label{conclusion}}

This is a study of self reported empathy among nursing interns in saudi
Arabia. Perspective taking incresed with younger, male nursing interns,
this reflects high cognitive flexibility with younger age nursing
interns. Morover, the empathic concern incresed with married nuring
interns who preferred nursing as a profession. Research results were
discussed in details and recommendations were proposed in order to
improve leve of empathy among nursing intern. For instance, the use of
emotional educaitonal model, and teach and train nursing students on
communication techniques, reflection skills, meditation and cultural
aptitudes through the use of simulation techniques with mannequins can
improve empathy level.

\textbf{AVAILABILITY OF DATA AND MATERIALS}

The data that were generated and analyzed in this study are mostly
included within the published article. However, source material and the
raw datasets are available from the corresponding author upon request

\hypertarget{abbreviations}{%
\subsection{ABBREVIATIONS}\label{abbreviations}}

\emph{\textbf{GPA:}} Grade Point Average

\emph{\textbf{IRI:}} Interpersonal Reactivity Index

\emph{\textbf{IAU:}} Imam Abdulrahman Bin Faisal University

\emph{\textbf{SPSS:}} Statistical Package for the Social Sciences

\emph{\textbf{EEM}}: Empathy Educational Model

\hypertarget{declarations}{%
\section{\texorpdfstring{\textbf{DECLARATIONS}}{DECLARATIONS}}\label{declarations}}

\hypertarget{acknowledgements}{%
\section{\texorpdfstring{\textbf{ACKNOWLEDGEMENTS}}{ACKNOWLEDGEMENTS}}\label{acknowledgements}}

The researchers would like to thank all nursing interns at the
participating hospitals for facilitating and supporting data collection.

\hypertarget{funding}{%
\section{\texorpdfstring{\textbf{FUNDING}}{FUNDING}}\label{funding}}

There is no source of funding.

\hypertarget{authors-information}{%
\section{\texorpdfstring{\textbf{AUTHORS\textquotesingle{}
INFORMATION}}{AUTHORS\textquotesingle{} INFORMATION}}\label{authors-information}}

\textbf{Authors and Affiliations}

\textbf{Master of Psychiatric and Mental Health Nursing, College of
Nursing, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia}

\emph{Suaad Ghazwani.}

\textbf{Department of Community Nursing, College of Nursing, Imam
Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.}

\emph{Amira Alshowkan, Najla Alsaleh}

\hypertarget{authors-contributions}{%
\section{\texorpdfstring{\textbf{AUTHORS\textquotesingle{}
CONTRIBUTIONS}}{AUTHORS\textquotesingle{} CONTRIBUTIONS}}\label{authors-contributions}}

The authors confirm contribution in to the paper as follows:
conceptualization S. G and A. A, Methodology: all authors. Formal
analysis: S. G, Original Writing: S. G. Preparation of manuscript: A. A.
Final review of manuscript: all authors.

\hypertarget{corresponding-authors}{%
\section{\texorpdfstring{\textbf{CORRESPONDING
AUTHORS}}{CORRESPONDING AUTHORS}}\label{corresponding-authors}}

Correspondence to Suaad Ghazwani

\hypertarget{ethics-declarations}{%
\section{\texorpdfstring{\textbf{Ethics
declarations}}{Ethics declarations}}\label{ethics-declarations}}

\textbf{Ethics approval and consent to participate}

The study is carried out in an ethical and confidential~way. After
explaining the research\textquotesingle s purpose to participants, their
informed written consent was acquired, and participation in the study
was optional. Before conducting the survey, the researchers got
permission from the Institutional Review Board (IRB). The surveys were
answered anonymously and were only gathered for study purposes. The
surveys did not contain any personal information. Participation was
entirely voluntary, with the option to withdraw at any moment. All
methods were used in conformity with the applicable standards and
regulations. The study was approved by the institutional review board
(IRB) of the Imam Abdulrahman Bin Faisal University\textquotesingle s
(IAU) (Ref. No. IRB-PGS-2022-04-135).

\hypertarget{consent-for-publication}{%
\section{\texorpdfstring{\textbf{Consent for
publication}}{Consent for publication}}\label{consent-for-publication}}

Not Applicable.

\hypertarget{competing-interests}{%
\section{\texorpdfstring{\textbf{Competing
interests}}{Competing interests}}\label{competing-interests}}

The authors state that they do not have any conflicts of interest.

\hypertarget{references}{%
\section{\texorpdfstring{\textbf{REFERENCES}}{REFERENCES}}\label{references}}

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