Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5, 1765-1775 2025 Publisher: Learning Gate DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate © 2025 by the authors; licensee Learning Gate History: Received: 19 February 2025; Revised: 30 April 2025; Accepted: 6 May 2025; Published: 17 May 2025 * Correspondence: aschoi@bscu.ac.kr Enhancing caring efficacy: The role of empathy (E) and caring needs in Nursing education Sook Lee1, Ae Sook Choi2*, So-Youn Yim3, Yeol-eo Chun4 1College of Nursing, Dankook University, Cheonan, South Korea; moonlight@dankook.ac.kr (S.L.). 2,4Deparment of Nursing, Baekseok Culture University, Cheonan, South Korea; aschoi@bscu.ac.kr (A.S.C.) yeoleo2011@bscu.ac.kr (Y.C.). 3Deparment of Nursing Science, Baekseok University, Cheonan, South Korea; ysybest@bu.ac.kr (S.Y.Y.). Abstract: This study aimed to provide foundational insights for enhancing nursing students' caregiving effectiveness by exploring associations among caregiving needs, empathy (E), and caregiving efficacy. Data from nursing students in a Korean province were analyzed. Descriptive statistics, t-tests, and ANOVA were used. Pearson's correlation assessed variable relationships. Mediation regression analyzed caregiving needs, empathy (E), and efficacy using the Baron and Kenny (1986) three-step approach. Caregiving efficacy was significantly associated with factors like motivation, academic grades, volunteer work, health, relationships, and major satisfaction. Empathy (E) showed a partial mediating effect between caregiving needs and efficacy. Acknowledging the influence of empathy (E) alongside caregiving needs is crucial for improving nursing students' caregiving effectiveness. Collaborative efforts are needed to create a conducive learning environment for acquiring and refining caregiving skills, enhancing efficacy. Keywords: Nursing students, Health needs, Sympathy, Caring Effectiveness, Nursing Education. 1. Introduction Care represents a fundamental and indispensable concept within the realm of nursing, recognized as a foundational element of the profession [1]. Nursing students must enhance their efficacy in providing care through patient interactions and the practical application of nursing processes during their educational journey. Moreover, enhancing CE as a crucial nursing competency among students necessitates a holistic approach that considers emotional support, socio-psychological well-being, and the delivery of educational content [2]. Caregiving efficacy encompasses individual competence and socio-psychological health at the personal level, as well as social support and educational factors at the environmental level. The confidence of nursing students in their ability to offer care to patients, known as CE, is significantly associated with emotional intelligence and interpersonal skills [3]. Factors such as subjective health status, living standards impacting physical and mental well-being, satisfaction with the chosen field of study, clinical practice experiences, and relationships with instructors and professors all contribute to the level of CE. Building a sense of CE is intricately linked to emotional empathy, fostering a relationship with patients during clinical practice, and cultivating a sense of confidence in providing care [4]. Throughout their nursing education, students encounter various stressors during clinical practice, including fear and anxiety, unfamiliar environments, heavy workloads, role ambiguity, theory-practice gaps, and interpersonal challenges with patients and caregiver [5, 6]. The stress levels experienced by nursing students surpass those of their peers in other academic disciplines, and unaddressed stress can lead to fear, diminished confidence, and skepticism towards pursuing a career in nursing, ultimately impacting performance outcomes [7-9]. The requirement for care entails a specific https://orcid.org/0000-0002-8451-8573 https://orcid.org/0000-0002-1982-3926 https://orcid.org/0000-0002-2605-6198 https://orcid.org/0000-0002-2698-9975 1766 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5: 1765-1775, 2025 DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate appeal for interpersonal care grounded in affection and concern, acknowledging the emotions of others to avert emotional turmoil, mend emotional wounds, and nurture relationships. It denotes the desired support from others for personal advancement [10]. Individuals receiving interpersonal care exhibit contentment with their care requisites, bolster their self-worth, uphold a state of well-being, and enhance their quality of life. Care providers proficient in delivering care should prioritize others' needs over their own, fostering empathetic connections with patients to fulfill the role of exemplary care providers as perceived by themselves or by patients and acquaintances [11]. Instances of incivility encountered during clinical practice by nursing students are found to impact care effectiveness [12]. Nursing students, undergoing the process of cultivating nursing professionalism, might have their care efficiency influenced by the various care demands and attributes encountered in clinical settings. It is imperative to enhance their sense of care efficiency through safeguarding against adverse influences from parents, guardians, and supervising nurses, and by enabling the fulfilment of care requisites under the guidance of nursing educators. Reports indicate that within the academic journey of nursing students and educators, students benefiting from attention, support, information, and acknowledgement from educators exhibit a positive transformation [13] with the nurturing of caring experiences enhancing their confidence as future nurses. This transformation positively influences the students' nursing capabilities and adaptability in clinical settings, contributing to their performance as nurses upon graduation [14]. The association between the need for care and the establishment of a caring relationship with the care recipient, along with the belief in one's ability regarding care-oriented expression, attitude, and behaviour, is of significant importance. individuals who have experienced certain medical conditions or situations, such as breast cancer survivors, patients undergoing radiation therapy for cancer, spouses of women with gynaecological cancer, family members caring for hospice patients, primary caregivers of stroke patients, and individuals with significant disabilities, have expressed specific needs for care and support [15-25]. These needs likely encompass various aspects of physical, emotional, and practical care, indicating the challenges and requirements faced by these individuals and their caregivers in managing their health conditions or supporting their loved ones. Furthermore, there is a demand for care among healthy individuals like French learners, and nurses. This research endeavor seeks to validate the caring needs of nursing students. Empathy (E) or compassion is defined as the capacity to empathize with and share the suffering and sorrow of others [26]. In an investigation focusing on nursing students, it was found that a higher level of cognitive and behavioural understanding of pain causes, and a willingness to empathize and alleviate suffering were associated with enhanced clinical performance. This understanding instilled confidence in providing care [27]. This study is to investigate how nursing students' Empathy (E) affects the effectiveness of their care. Prior research has indicated that care behaviour and social support positively influence the care efficacy of nursing students [28, 29]. Dementia care practices and empathy have been shown to enhance care efficacy, with social support acting as a mediator [30, 31]. Nonetheless, there remains a gap in empirical evidence concerning the relationship between Empathy (E), which influences the self- assurance of nursing students and enhances empathy towards the pain of others, and care efficacy. Hence, this study seeks to offer fundamental insights to enhance care efficacy by examining the interplay among caring needs, Empathy (E), and care efficacy among nursing students who are striving to enhance their care performance skills through educational interventions. 1.2. Aim of the Study This study intends to investigate the potential mediating function of care in the relationship between nursing students' care efficaciousness and caring needs. The particular objectives of this 1767 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5: 1765-1775, 2025 DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate research are to: (1) characterise the empathy (E), caring needs (CN), and care efficacy (CE) of nursing students; (2) determine variations in CE according to nursing student features; (3) identify the relationships among nursing students between E, CN, and CE; and (4) explore the intermediary effect of E in the relationship between E and caring needs(CN) and care efficacy (CE). 2. Material and Method 2.1. Research Plan This study is a descriptive research study to confirm the relationship between Care Needs (CN), Empathy (E), and Care Efficacy (CE) of nursing students. The proposed research plan is given in Figure 1. Figure 1. Flow diagram for the Research plan. 2.2. Participants Four nursing departments in a single province across two cities consented to participate in the study. The sample size was determined using the G*Power 3.19 software, taking into account an effect size of .5, a significance level (a) of .05, and a power (1-β) of .95 for regression analysis. Consequently, 220 samples were deemed necessary. With a 20% dropout rate in mind, a survey was conducted on a population exceeding 264 individuals. 2.3. Variables Used in the Present Study Care Needs (CN): To measure CN, a scale developed by Yoon [32] was used. The questionnaire's validity was confirmed by Lee, et al. [33]. The questionnaire has 32 items in total with five sub- domains: • First is the ‘active listening’ (10 items), • Second is the ‘acceptance and forgiveness’ (8 items), • Third is the ‘hope and praise’ (7 items), • Fourth is the ‘finding out (5 items), • Fifth is the ‘companionship’ (2 items). 1768 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5: 1765-1775, 2025 DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate Aa 5-point Likert scale, that ranged from 'strongly agree' coded with the number ‘5’ to 'strongly disagree' coded with number ‘1’. The reliability during development was Cronbach's α = 0.97, while in this study, Cronbach's α = 0.95. Empathy (E): A scale, constructed by Kim and Shin [34] was derived from the 21-item Compassionate-Love Scale (ACLS scale, as revised by Sprecher and Fehr [35]. Through factor analysis and validation on 207 college students, 12 items were selected for use. The Korean version of the Ajou Compassionate-Love Scale (ACLS) was employed to measure Empathy (E). Here again, a five-point Likert scale (1 to 5), ( 5 meaning "strongly agree" and 1 meaning "strongly disagree” was used. Care Efficacy (CE): In the domain of CE, a self-reported CE scale (Form B) developed by Coates [27] was adjusted, supplemented, and translated by Jeong [36]. Comprising a total of 30 questions, evenly split between positive and negative. For this Likert scale of six-point was used where 6 representing "strongly agree" and 1 for "strongly disagree". 2.4. Data Collection The researcher visited each school in person, elucidated the study's objectives to students post- lecture, distributed URLs, and gathered data anonymously through online means. 2.5. Data Analysis The data was analysed utilizing SPSS 23.0 for Windows. Each method of analysis conducted is delineated as follows. Descriptive analysis of the general traits of CN, E and CE were in terms of frequency, percentage, mean, and standard deviation. Independent sample t-test, one-way analysis of variance (ANOVA), and post-hoc testing utilizing Scheffe's method were implemented. Moreover, a Pearson's correlation analysis was performed to unveil the interrelation among CN, Empathy (E), and CE within the cohort of nursing students. In order to understand the mediating role of Empathy (E) in the association between the CN of individuals and their CE, a multiple regression analysis was executed following the 3-step protocol outlined by Baron and Kenny [37]. The Sobel test was employed to ascertain the statistical significance of the mediating effect. 3. Results 3.1. Demographic Details Table 1 presents the demographic characteristics of the study participants. The mean age of the respondents was 22.4 years, with 84.0% (n=326) being female and 16.0% (n=62) being male. Notably, individuals in their 3rd year comprised the largest portion at 32.7% (n=127), while 56.2% (n=218) were students in their 3rd and 4th years who had completed clinical practice. Furthermore, a significant proportion of the cohort, specifically 60.1% (n=233), did not affiliate with any religious denomination. The majority of students reported an average monthly allowance of approximately 500,000 won. In terms of residential arrangements, 47.4% (n=184) lived independently, with over 70% of students living away from home, including in dormitory facilities. The primary motivations for selecting the nursing department were intrinsic factors such as aptitude and interest (30.7%, n=119), followed by considerations such as the high employability in the field, professional aspirations, parental guidance, and academic performance. Regarding practical training experiences, a majority of students, accounting for 58.2% (n=226), had undergone such training and expressed a desire to pursue careers in hospital settings (88.4%, n=343). Furthermore, 65.2% (n=253) perceived their academic performance as average. Notably, 81.2% had engaged in volunteer activities, reported above-average health conditions, and maintained a satisfactory level of interpersonal relationships, rated at 4.0. The satisfaction level with their major was 3.59 points, whereas students who had participated in clinical practice reported a slightly lower satisfaction score of 3.07 points. 1769 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5: 1765-1775, 2025 DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate Table 1. Demographic details. Demographic variables (N-388) Groups n(%), Mean±SD Mean age = 22.44±3.68 Sex Male 62(16.0) Female 326(84.0) Grade 1 67(17.3) 2 103(26.5) 3 127(32.7) 4 91(23.5) Religion Yes 155(39.9) No 233(60.1) Motive High school results 19(4.9) Suggested by Parents or Peers 60(15.5) Better Employment Opportunities and Foreign-going chances 113(29.1) Interest towards the profession 119(30.7) Financial Reasons 66(17.0) etc 11(2.8) Pin money 200,000 less 63(16.2) 300,000 88(22.7) 400,000 83(21.4) 500,000 91(23.5) over 600,000 63(16.2) Residence Main house 112(28.9) dormitory 92(23.7) Living on one’s own 184(47.4) Hands-on experience Yes 226(58.2) No 162(41.8) Hope course hospital employment 343(88.4) Nursing public official 34(8.8) etc 11(2.8) Record Top(mean A) 66(17.0) Middle( mean B) 253(65.2) Lower(mean C) 69(17.8) Volunteer Yes 315(81.2) No 73(18.8) Health Status Likert scale (1 to 5) 3.88±.79 Relationship Likert scale (1 to 5) 4.00±.65 Major Satisfaction Likert scale (1 to 5) 3.59±.75 Satisfaction with clinical practice(N=226) Likert scale (1 to 5) 3.07±.95 3.2. CN, Empathy (E), And CE Table 2 displays the respondents' levels of Empathy (E), CE, and CN. The sub-items revealed that theirs need for caring was 3.84 points, with the need for "listening" being the highest at 4.10 points and 1770 Edelweiss Applied Science and Technology ISSN: 2576-8484 Vol. 9, No. 5: 1765-1775, 2025 DOI: 10.55214/25768484.v9i5.7285 © 2025 by the authors; licensee Learning Gate the need for "noticing" being the lowest at 3.57 points. CE was 4.17 points, while Empathy (E) was 3.20 points. Table 2. Degree of CN, Empathy (E), and CE of the subject. N=388 variables Category M±SD (range) CN Total CN 3.84±.64(1~5) active listening Listening 4.10±.64 3.91±.62 Comforting 4.02±.72 Sharing 3.90±.70 Participating 4.02±.76 Forgiving & Accepting Forgiving 4.02±.68 3.97±.63 Accepting 3.86±.70 Complimenting & hoping Complimenting 3.92±.79 3.79±.74 Hoping 3.71±.76 Noticing 3.57±.82 Companioning 3.89±.78 Empathy (E) 3.20±.78 (1 ~ 5) CE 4.17±.56 (1~ 6) 3.3. Care Efficacy According to The Demography Table 3 displays the CE based on the attributes of nursing students. When compared to students who replied with other forms of support, the CE of the students was lower. Furthermore, there existed a noteworthy distinction in the grades and the existence or non-existence of volunteer activity. Students with high scores, in particular, were more likely than those with middle or low scores to exhibit CE. Additionally, students with volunteer experience scored higher on care efficacy questionnaires than students without any volunteer experience. A statistically significant link between health state, major satisfaction, interpersonal relationships and care efficacy was also seen. 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