Levels of empathy in undergraduate midwifery students: An Australian cross-sectional study

doi:10.1016/j.wombi.2011.02.003

Women and Birth

Volume 24, Issue 2, June 2011, Pages 80-84

https://doi.org/10.1016/j.wombi.2011.02.003 Get rights and content

Abstract

Objective

This exploratory study investigated empathy and attitudes towards specific medical conditions, two important aspects of the midwife–woman relationship, amongst undergraduate midwifery students at one university.

Method

Fifty-two Bachelor of Midwifery students across three years of the course completed questionnaires, the Jefferson Scale of Physician Empathy-Health Professional (JSPE-HP) version and the Medical Condition Regard Scale (MCRS). Both the JSPE-HP and the MCRS are standardised, self-report questionnaires with established reliability and validity.

Findings

An overall respectable level of empathy was measured, which was shown to increase consistently and substantially with each year level of the student undergraduate program. Attitudes to selected diagnoses were very good with the exception being substance abuse, which received a significantly lower mean.

Conclusion

The results of this study indicate that the Bachelor of Midwifery course, or studying midwifery, has a positive effect on students’ empathy. Low results in participants’ attitudes towards patients presenting with substance abuse raises concern that students may harbour prejudice that could impinge upon their professional practice and the way in which they care for these mothers. Hence, this aspect in particular may need further development within midwifery curriculum development. Further research around other conditions may extend on our understandings of empathy and attitudes in midwifery students and practitioners.

Introduction

Being supportive, compassionate, and caring are fundamentally important roles of an effective midwife.1, 2 At a time when technology, economics, and health bureaucracy have turned childbirth from a social event into a medical event, it is important to give consideration to the caring side of the profession.³ However, empathy in the context of midwifery practice has not been widely explored. As such, this study explored two aspects involved in midwifery students’ abilities to care: their abilities to empathise, and whether negative attitudes towards women with certain diagnoses were being harboured.

Section snippets

Background

A number of authors have described aspects of the midwife–woman relationship, including connectedness⁴ and responsiveness.⁵ Women seek partnerships with midwives that embody trust,6, 7 respect⁷ empathy, and caring.⁸ It is argued that such relationships are important in the delivery of quality maternal care.⁹

Empathy is an attribute that facilitates understanding of both physical and emotional situations of a woman and her family but one that is difficult to teach. The definition of empathy

Method

A cross-sectional study design was used to measure empathy, the Jefferson Scale of Physician Empathy (JSPE)-Health Professional (HP) version¹² was employed. To explore empathy in the medical profession, the JSPE was designed primarily with physicians in mind; however, items were written in such a way that it can be easily applied to other health care disciplines, such as midwifery, with little methodological difficulty. To measure attitudes towards patients presenting with specific clinical

Results

Fifty-two midwifery students participated in this study, with approximately one-third coming from each of the three-year levels (e.g., first year, second year, third year). Participants were entirely female and represented a broad range of ages. One-half (50.0%) were between 18 and 25 years of age and another one-quarter (23.1%) were between 31 and 35 years of age. This demographic profile is consistent with the profile of all students enrolled in the Bachelor of Midwifery, thus was a

Discussion

The mean empathy for this cohort of undergraduate midwifery students is somewhat lower than the mean empathy reported in other studies to use the JSPE-HP. However, to the best of the authors’ knowledge there are no other published studies of midwives or midwifery students that have used the JSPE-HP. It is, however, possible to do a comparison against studies of nurses using the JSPE-HP. One study found their cohort of nurses to have a mean JSPE-HP empathy score of 124 and another study a mean

Conclusion

Empathy is a crucial component in the midwife–woman caring relationship. This study has sought to examine how this attribute develops in midwives, as well as attitudes to different clinical diagnoses. The increase in the JSPE-HP mean empathy scores from first year to third in students enrolled in the Bachelor of Midwifery is a very promising result; however, a causal relationship between empathy and year level was not confirmed. For this reason a longitudinal study is recommended as a follow up

Ethical approval

Ethical approval to conduct this study was obtained by the Standing Committee for Ethics in Research on Humans (SCERH) at Monash University. The study was conducted according to approved processes.

Conflict of interest

The authors have no conflict of interest to declare.

Acknowledgements

This study was funded by a Learning and Teaching Performance Fund Grant from the Faculty of Medicine, Nursing and Health Sciences, Monash University. The authors are grateful to the students who participated.

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Cited by (32)

The comparison of spiritual well-being and empathic tendencies in midwifery students: A cross-sectional study from Turkey
2024, Heliyon
This study aimed to investigate the relationship between spiritual well-being and empathic tendencies of midwifery students and the affecting factors. The sample of this descriptive-correlation type study, one of the descriptive research methods, included 237 midwifery students. The data were collected using the Descriptive Information Form, the Empathic Tendency Scale, and the Spiritual Well-Being Scale. Empathic tendency was higher among those who chose the midwifery department voluntarily, those who liked the department, those who felt that the department was suitable for them, those who participated in social and scientific activities, those who wanted to progress in the profession, those who wanted to work in the field and those who followed publications related to the field; Spiritual well-being was higher among those who felt that the department was suitable for them, those who participated in social and scientific activities, those who wanted to progress in the profession, those who participated in activities that provided the development of the profession, those who wanted to work in the field and those who followed publications related to the field. It was determined that the empathic tendencies and spiritual well-being of midwifery students were at a moderate level, and as a result of the comparison of Empathic Tendency Scale and Spiritual Well-being scale scores, there was a significant positive relationship between them.
Empathy, emotional intelligence and interprofessional skills in healthcare education
2023, Journal of Medical Imaging and Radiation Sciences
According to the World Health Organization (WHO), health professionals maintain the health of citizens through evidence-based medicine and caring. Students enroled in health professional programmes are required to have successfully attained all core learning outcomes by reaching key milestones throughout the course of their studies, demonstrating they have developed the required graduate skills and attributes upon completion of the programme. While some of the knowledge, skills and competencies that make up these learning outcomes are very discipline specific, there are more general professional skills across all disciplines which are difficult to define, such as empathy, emotional intelligence and interprofessional skills. These are at the heart of all health professional programmes that once defined, can be mapped through curricula and further evaluated.
Literature will be presented on these three professional skills: empathy, emotional intelligence, and interprofessional skills, based on studies that focussed primarily in health professional programmes and highlight some of the key findings and issues at undergraduate and postgraduate levels. The paper will present the need for these skills to be defined and then mapped through curricula so that students are better supported in their professional development. Empathy, emotional intelligence and interprofessional skills transcend the discipline specific skills and as such it is important that all educators consider how best these may be fostered. Efforts should also be made to further the integration of these professional skills within curricula to produce health professionals with an enhanced focus on person-centred care.
Selon l'Organisation mondiale de la santé (OMS), les professionnels de la santé préservent la santé des citoyens grâce à une médecine et à des soins fondés sur des preuves. Les étudiants inscrits dans des programmes professionnels de santé doivent avoir atteint tous les résultats d'apprentissage de base en franchissant des étapes clés tout au long de leurs études, démontrant ainsi qu'ils ont développé les compétences et attributs requis à la fin du programme. Alors que certaines des connaissances, aptitudes et compétences qui constituent ces résultats d'apprentissage sont très spécifiques à une discipline, il existe des aptitudes professionnelles plus générales dans toutes les disciplines qui sont difficiles à définir, comme l'empathie, l'intelligence émotionnelle et les compétences interprofessionnelles. Ces compétences sont au cœur de tous les programmes professionnels de santé qui, une fois définies, peuvent être mises en correspondance avec les programmes d'études et évaluées. La littérature sera présentée sur ces trois compétences professionnelles: l'empathie, l'intelligence émotionnelle et les compétences interprofessionnelles, en se basant sur des études qui se sont principalement concentrées sur les programmes professionnels de santé et en soulignant certains des principaux résultats et problèmes au niveau du premier cycle et du troisième cycle. L'article présentera la nécessité de définir ces compétences, puis de les intégrer dans les programmes d'études afin que les étudiants soient mieux soutenus dans leur développement professionnel. L'empathie, l'intelligence émotionnelle et les compétences interprofessionnelles transcendent les compétences spécifiques à une discipline et, à ce titre, il est important que tous les éducateurs réfléchissent à la meilleure façon de les encourager. Des efforts devraient également être faits pour intégrer davantage ces compétences professionnelles dans les programmes d'études afin de former des professionnels de la santé qui mettent davantage l'accent sur les soins centrés sur la personne.
Humanistic caring ability of midwifery students in China and its associated factors: A multi-centre cross-sectional study
2022, Nurse Education Today
Citation Excerpt :
Such assertion is also corroborated by Watson's theory of human caring, which recognises empathy as one of the ten key carative factors (Watson, 1979). Empathy could allow midwives to gauge various situations, understand mothers' situation, perspective and emotions, and administer appropriate women-centred care (McKenna et al., 2011). By contrast, the lack of empathy can make mothers feel traumatised and disempowered with enduring repercussions (Moloney and Gair, 2015).
Research regarding humanistic caring has proliferated to enable person-centred and holistic care. Empirical evidence investigating the humanistic caring ability is largely derived from studies recruiting general nursing students. Midwifery students, however, remain underrepresented.
To assess the humanistic caring ability of midwifery students in China and investigate its associated factors.
A multi-centre cross-sectional descriptive study.
Five medical colleges spreading across Eastern, Central and Southern China.
Secondary vocational, higher vocational and undergraduate midwifery students (N = 303).
The Caring Ability Inventory (CAI), the Jefferson Scale of Physician Empathy for Nursing Students (JSPE-NS), the Connor–Davidson Resilience Scale (CD-RISC) and the Professional Identity Scale for Nursing Students (PISNS) were used to measure humanistic caring ability, empathy, resilience and professional identity, respectively. Stepwise multiple linear regression was used to explore associated factors.
The midwifery students' total mean CAI score was 184.63 ± 19.88. In the multiple linear regression analysis, empathy (β = 0.394, p < 0.001), resilience (β = 0.233, p < 0.001) and professional identity (β = 0.161, p = 0.002) were positively associated with the humanistic caring ability of midwifery students. The humanistic caring ability was also influenced by educationl level, perceived concern from peers and recognition of caring ability as a prerequisite for midwifery profession.
Midwifery students in China have poor humanistic caring ability, which needs to be further improved. Interventions that cultivate the empathy, resilience and professional identity have the potential to advance the humanistic caring ability of midwifery students. Promoting a supportive and caring atmosphere among peers is also important.
Cultural empathy in midwifery students: Assessment of an education program
2018, Nurse Education Today
Citation Excerpt :
The JSE has been validated with students in several health professions (Table 1). Two Australian studies assessed empathy amongst midwifery students (McKenna et al., 2011; Williams et al., 2014). Most studies were cross-sectional, measuring empathy at a single point in time, although some generated longitudinal data (Dean et al., 2017; Hojat et al., 2009; Nunes et al., 2011; Ward et al., 2012; Williams et al., 2016).
The ability of midwives to provide empathic care that is culturally appropriate is critical for women to feel accepted by the midwives who support them. Australia is a culturally diverse society, yet there is evidence of poorer maternity outcomes for some women and infants, related to their cultural background.
This study's objective was to evaluate the effectiveness of an education program for student midwives. The program was intended to increase the cultural empathy of future midwives, to help ensure greater cultural safety and optimal maternity outcomes across all sections of Australian society.
This quantitative study compared pre- and post-intervention measures of students' empathy.
The health faculty of a large urban university in Australia.
Fifty-five students from all three years of an undergraduate midwifery program participated.
The study examined students' scores on the Jefferson Scale of Empathy for health profession students, measured before and immediately after the education program, and again after four weeks.
The midwifery students had a high mean baseline score on the empathy scale. Scores increased significantly after the education program. Students with lower pre-test scores recorded significantly greater increases in their empathy levels than those who were more empathic initially. Empathy scores declined one month after the program, but remained higher than baseline levels.
Several studies have explored empathy levels amongst current and future health professionals. However, few studies of health professional students have evaluated the impact of specific education interventions addressing cultural empathy. This study found that midwifery students tended to have higher empathy scores than students in other health disciplines. The education workshop further increased participants' scores.
Introducing sensitive issues and self-care strategies to first year midwifery students
2018, Midwifery
Citation Excerpt :
Although the workshop did not specifically aim to address cultural safety in midwifery practice, the self-reflection activity allowed students to begin to understand differing opinions which is a useful tool for beginning practitioners and may lead to increased cultural safety and enhanced empathy in the future. Empathy levels have been measured in first year undergraduate midwifery students and found to be quite low increasing over the three year duration of the course (McKenna et al., 2011). Our introductory workshop for first year midwifery students may help develop empathy as students unpick each other's opinions and begin to ‘normalise’ these opinions as found in our evaluation.
first year midwifery students learn early in semester about situations in midwifery where a high level of emotion is expressed, such as taking a sexual history, being faced with the body image changes of pregnancy and working with women in the extreme pain of labour. Commencing students usually have not had exposure to the realities of studying and working in midwifery, and often have an idealised view of midwifery that may lead to attrition from the course. We aimed to equip students with personal and professional tools to discuss sensitive issues in midwifery and promote self-care through the development of two workshops. The first workshop focussed on sensitive issues in midwifery and the second on self-care strategies.
quantitative and qualitative data were collected pre and post workshops using a survey.
the workshops were developed at one university in New South Wales, Australia. Participants: Beginning first year midwifery students
feeling more comfortable, confident and knowledgeable was measured using a paired t-test from the responses on a pre and post workshop survey. Content analysis was performed on the qualitative survey responses.
there were significant increases in the students feeling more comfortable to discuss sensitive issues in midwifery following the first workshop. They found meeting new people, respecting opinions, normalizing confronting topics to be valuable and useful. The second workshop found significant differences in being more confident and knowledgeable to access and try new self-care strategies in both their personal and professional life. Students discussed learning to be more mindful in order to prepare for stressful situations. They became aware of their feeling and thoughts when under stress and said they would practice techniques including meditation.
the workshops assisted the students to develop peer support, self-care strategies and coping mechanisms when faced with the intimate and sometimes confronting nature of midwifery practice. Through embedding these first year workshops early in the degree we hope to address attrition rates and facilitate the students' to become the compassionate, caring, woman-centred midwives that they envisioned.
the workshops have the potential for replication in other universities to support and nurture beginning midwifery students.
Empathy and spiritual care in midwifery practice: Contributing to women's enhanced birth experiences
2015, Women and Birth
Citation Excerpt :
Equally, Byrom and Downe28 identified empathy, kindness, warmth, friendliness and caring as necessary traits, and Hall1 included midwives’ use of intuition and caring touch as communicating their empathy. Building on the work of others,3,27 McKenna et al.29 reported that empathy allows midwives to gauge a diverse range of situations from needing to care for and console mothers who have experienced a miscarriage, to sharing the happiness of a new family and everything in between. Conversely, in a recent study by Mollart et al.,30 empathy appeared limited, and factors including years in the profession, night shift only, and women with multiple psychosocial issues contributed to midwives “not really caring what happens with some clients” (p. 29).
Research has identified empathy as a crucial ingredient in effective practice for health professionals, including midwifery. Equally, the role of spirituality has been recognised as enhancing the quality of the birth experience through the care, compassion and presence of the midwife. Yet literature discussing birthing women's lived experiences of caregiver empathy and spiritual care appears uncommon.
The aim of this article is to highlight women's stories about midwives’ empathy and spiritual care or lack thereof during birth, in order to contribute to the promotion of more empathic, spiritually aware midwifery practice.
Ten interviews and seven focus groups were conducted with forty-eight women, including mothers, midwives and staff from a women's service. A secondary analysis of the data was conducted examining women's descriptions and reflections on midwives’ levels of empathy and spiritual care.
When midwives’ empathy and spiritual care were evident, women's birth experiences appeared enhanced, providing a solid foundation for confident mothering. Conversely, participants appeared to link a lack of caregiver empathy, compassion or spiritual care with more enduring consequences, birth trauma and difficulty bonding with their babies.
Midwives’ empathy and spiritual care can play a key role in creating positive birth and mothering experiences. More research into the role of empathy and spiritual care in enhancing midwifery practice in all birth settings is recommended, as is the increased embeddedness of empathic regard and the notion of ‘birth as sacred’ into midwifery curricula.

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Levels of empathy in undergraduate midwifery students: An Australian cross-sectional study

Abstract

Objective

Method

Findings

Conclusion

Introduction

Section snippets

Background

Method

Results

Discussion

Conclusion

Ethical approval

Conflict of interest

Acknowledgements

Journal of Obstetric, Gynecologic, and Neonatal Nursing

Midwifery

Midwifery

Midwifery

Midwifery

Midwifery

Seminars in Integrative Medicine

Personality and Individual Differences

Central concepts in the midwife-woman relationship

Scandinavian Journal of Caring Sciences

What makes a good midwife? An integrative review of methodological-diverse research

Journal of Advanced Nursing

Bloody footprints: learning to be ‘with woman’

Evidence Based Midwifery

Empathy in patient care: antecedents, development, measurement and outcomes

The medical condition regard scale: measuring reactions to diagnoses

Academic Medicine

A cross-sectional measurement of medical student empathy

Journal of General Internal Medicine

The Jefferson scale of physician empathy: further psychometric data and differences by gender and specialty at item level

Academic Medicine

Empathy in medical students as related to academic performance, clinical competence and gender

Medical Education