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Background: The perioperative period can be a stressful time for many patients. Concerns for the procedure or fearing potential complications contribute to perioperative anxiety and depression, which significantly impact patient wellbeing and recovery. Understanding the psychological impact of the perioperative period can inform individualized care focused on each patient's unique stressors. Compassion-based interventions are limited but have shown benefits in non-surgical healthcare settings, and can provide support by prioritizing empathy and understanding in the perioperative period. This review evaluates the impact of compassion-based interventions on anxiety and depression among adult surgical patients., Methods: A systematic review of 25 randomized controlled trials was conducted with a meta-analysis of 14 studies for anxiety and 9 studies for depression that provided sufficient information., Results: The included studies tested compassion-based interventions that focused on enhanced communication, emotional support, and individualized attention from healthcare professionals. In 72 % of the studies, the interventions decreased anxiety and depression, compared to control groups. These interventions improved health-related outcomes such patient satisfaction and postoperative complications. The meta-analysis indicated a large effect of the compassion-based interventions for anxiety (g = -0.95) and depressive symptoms (g = -0.82). The findings were consistent among various surgeries and patient populations., Limitations: Many of the included studies lacked clarity in their methods and only 14 studies provided sufficient information for the meta-analysis., Conclusions: Given the growing evidence suggesting that compassion-based psychological interventions are feasible and applicable in the perioperative setting, their inclusion in routine care could reduce depression and anxiety around surgery and improve patient outcomes and experiences., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Patient-directed Electronic Health Record (EHR) messaging is used as an adjunct to enhance patient-physician interactions but further burdens the physician. There is a need for clear electronic patient communication in all aspects of medicine, including plastic surgery. We can potentially utilize innovative communication tools like ChatGPT. This study assesses ChatGPT's effectiveness in answering breast reconstruction queries, comparing its accuracy, empathy, and readability with healthcare providers' responses., Methods: Ten deidentified questions regarding breast reconstruction were extracted from electronic messages. They were presented to ChatGPT3, ChatGPT4, plastic surgeons, and advanced practice providers for response. ChatGPT3 and ChatGPT4 were also prompted to give brief responses. Using 1-5 Likert scoring, accuracy and empathy were graded by 2 plastic surgeons and medical students, respectively. Readability was measured using Flesch Reading Ease. Grades were compared using 2-tailed t tests., Results: Combined provider responses had better Flesch Reading Ease scores compared to all combined chatbot responses (53.3 ± 13.3 vs 36.0 ± 11.6, P < 0.001) and combined brief chatbot responses (53.3 ± 13.3 vs 34.7 ± 12.8, P < 0.001). Empathy scores were higher in all combined chatbot than in those from combined providers (2.9 ± 0.8 vs 2.0 ± 0.9, P < 0.001). There were no statistically significant differences in accuracy between combined providers and all combined chatbot responses (4.3 ± 0.9 vs 4.5 ± 0.6, P = 0.170) or combined brief chatbot responses (4.3 ± 0.9 vs 4.6 ± 0.6, P = 0.128)., Conclusions: Amid the time constraints and complexities of plastic surgery decision making, our study underscores ChatGPT's potential to enhance patient communication. ChatGPT excels in empathy and accuracy, yet its readability presents limitations that should be addressed., Competing Interests: Conflicts of interest and sources of funding: none declared., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

The successful team concept extends beyond the operating room and into many areas of hand surgery practice. Effective leadership is critical in creating highly effective teams. Evidence suggests that leadership skills can be learned and developed. The authors synthesize and translate findings from organizational psychology to provide insight and recommendations for clinical practice. Specifically, the role of broad emotional intelligence in leadership is explored. This includes self-awareness (eg, understanding one's strengths, challenges, behavioral tendencies, and emotional reactions), emotion regulation, managing others' emotions (eg, supporting others' needs, managing interpersonal conflict, and displaying empathy), and high-quality communication and establishing/maintaining boundaries., Competing Interests: Disclosure The authors have nothing to disclose., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Background: Compassion and moral intelligence occupy a very significant place in ensuring quality in health care services, increasing patient satisfaction, reducing side effects, increasing patient safety and accelerating the healing process., Aim: This study was conducted to determine the relationship between moral intelligence and compassion fatigue in nurses working in intensive care units., Study Design: In this descriptive and cross-sectional study, 180 nurses working in intensive care units of a hospital comprised the population of the study. Of them, 114 who agreed to participate in the study were included in the study sample. The Personal Information Form, Yakut Moral Intelligence Scale (YMIS) and Compassion Fatigue-Short Scale were used as data collection tools. The scales and forms used in the study were created on Google Form. Nurses were visited in intensive care units, and the forms were given to them. Then the participating nurses filled in the forms., Results: Of the nurses participating in the study, 69.3% were women and 65.4% had a bachelor's degree. The analysis of the correlation between the scores obtained from the sub-dimensions of the YMIS by the nurses participating in the study demonstrated that there was a negative, low-level significant relationship between the self-control and kindness sub-dimensions of the YMIS. As the nurses' compassion fatigue levels increased, their self-control and kindness levels decreased., Conclusions: It can be said that as compassion fatigue levels increase in nurses, their moral intelligence levels decrease. Therefore, diagnosing compassion fatigue in nurses and taking precautions to prevent them from suffering from fatigue are of significant importance., Relevance to Clinical Practice: By determining the healthy intelligence and compensation spending levels of health workers, organizing maid training will increase the service and care provided., (© 2024 The Author(s). Nursing in Critical Care published by John Wiley & Sons Ltd on behalf of British Association of Critical Care Nurses.)

Objective: Effective communication about serious illness is pivotal in delivering surgical palliative care-a crucial component of comprehensive surgical critical care (SCC). However, limited educational strategies exist for fellow-level trainees, who are often directing clinical decision-making and building mutual trust with patients and families. This pilot study assess implications of a novel serious illness communication training opportunity tailored specifically for SCC fellows., Design: Prospective implementation of a multimodal training session (1 hour-didactic lecture, 2 hours-live-action simulation), using pre- and postcourse surveys to assess self-perceived confidence., Setting: University of Michigan in Ann Arbor, Michigan., Participants: Eleven ACGME-accredited SCC fellows during the 2023 to 2024 academic year participated and completed all 3 survey assessments., Results: Following the course, 6 of 7 confidence domains showed improvement, with 2 reaching statistical significance-communication skills to discuss goals of care and/or code status (3.73 vs. 4.36, p = 0.018) and end-of-life care or transition to comfort-focused care (3.36 vs. 4.18, p = 0.023) with a patient or family member. At 6-month follow up, fellows reported further increases in all queried domains, though changes were nonsignificant. Greatest absolute increases were noted in delivering serious news (4.18 vs. 4.55, p = 0.143) and expressing nonverbal empathy (4.09 vs. 4.50, p = 0.197). The majority (91%) of respondents felt more comfortable having serious illness conversations with patients and families due to their training course experience., Conclusion: Implementation of a 3-hour training course tailored for SCC fellows significantly boosted both the immediate and long-term confidence in their serious illness communication skills and ability to manage complex care scenarios., (Copyright © 2024 Association of Program Directors in Surgery. Published by Elsevier Inc. All rights reserved.)

Compassion in healthcare is valued by patients, healthcare professionals (HCPs), and leads to improved outcomes. Notwithstanding reports of systemic failings in the provision of compassionate care, research regarding ways to intervene remains limited. The aim of this study is to clarify compassion intervention needs in a diverse HCP workforce in public secondary healthcare in Aotearoa New Zealand (NZ) by utilising a co-design process. The co-design process involved a series of workshops with clinicians followed by in-depth interviews with healthcare leaders to derive input regarding feasibility and implementation. Reflexive thematic analysis was used to analyze the data. There was a great deal of interest in compassion interventions from healthcare professionals and leaders. However, for compassion interventions to be acceptable, feasible, and effective, compassion interventions design should be reimagined and reflected at each step of interventional design and implementation and span across organizational levels. Namely, the results of the study showed the preference for non-individual focused multi-level interventions to build bridges and connections. The desired compassion intervention components included practising connecting with others' humanity, improving compassion knowledge and relational and reflective skills, and cultural safety and anti-racism training. Experiential training embedded in models of cultural dialogue was the preferred interventional modality. Prioritising leadership as an intervention site was suggested to improve leadership's buy-in of compassion interventions and possibly serve as a starting point for transforming the broader culture, reviving interconnectedness in a healthcare system described as fragmented, disconnected, and alienating with compassion also acting as an equalizer of power., Competing Interests: Declaration of competing interest The authors declare no competing interests and have not received any support from any organisation for the submitted work. There have been no financial relationships with any organisations that might have an interest in the submitted work in the previous three years. We declare no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Moral sensitivity may play a role in dealing with ethical issues in ICUs. However, the moral sensitivity of adult ICU nurses in China and its predictors have not been well investigated., Aim: To analyse the moral sensitivity of intensive care unit (ICU) nurses and its predictors., Study Design: A cross-sectional study through convenience sampling was conducted in the ICUs of five hospitals in China between November and December 2022. A total of 331 ICU nurses were recruited. Data were obtained using a self-developed socio-demographic characteristic questionnaire, the Moral Sensitivity Questionnaire, the Jefferson Scale of Empathy-Health Professionals and the Organizational Climate Scale for Nursing. The participating institutions received a link to the tools used for online data collection, which they then forwarded to nursing staff., Results: The valid response rate was 96.98% (n = 321). The total mean moral sensitivity score of nurses was 43.04 ± 5.95. The mean scores for empathic ability and organizational climate for nursing were 91.97 ± 17.88 and 101.28 ± 14.77, respectively. Regression analyses revealed that the primary factors associated with moral sensitivity among critical care nurses included work tenure (p < .05), empathic ability (p < .001) and organizational climate (p < .001)., Conclusions: High levels of moral sensitivity were found in critical care nurses in China. Work tenure, empathic ability and organizational climate were significant predictors of moral sensitivity in critical care nurses., Relevance to Clinical Practice: To enhance the ethical sensitivity of ICU nurses, we suggest to strengthen the training of novice nurses so that they can better face the moral dilemma in clinical practice. In addition, organizational managers should also take measures to create a positive and harmonious working atmosphere, promote the application of moral knowledge in nursing practice and enhance their moral sensitivity., (© 2024 British Association of Critical Care Nurses.)

Background: Quality nursing care and ethical responses to patient pain and suffering are very important in the preoperative period. However, few studies have addressed these variables., Objective: This study aimed to examine the relationship between compassionate care and preoperative anxiety from the perspective of hospitalized patients., Methods: The current study was a cross-sectional descriptive one. The participants were selected using convenience sampling. The data were collected using a demographic questionnaire, Burnell Compassionate Care Tool, and Amsterdam Preoperative Anxiety and Information Scale (APAIS). The collected data were analyzed with SPSS software (version 22) through descriptive and inferential statistics at a significance level of 0.05 ( p < .05)., Participants and Setting: This study was conducted on 704 candidates for surgery in the internal and surgical wards of a large teaching hospital located in the south of Iran from December 2022 to March 2023., Ethical Considerations: The protocol for this study was reviewed and approved by the University Ethics Committee., Findings: The patients' average age was 36.61 ± 13.07. The average preoperative anxiety and need for information scores were 13.80 ± 2.66 and 7.44 ± 1.47, respectively. The average score of importance was 3.03 ± 0.19, and the average score of the extent of compassionate care provision was 1.22 ± 0.15. There was a significant relationship between preoperative anxiety with importance and the extent of compassionate care provision (r = 0.68, p < .001), r = -0.72, p < .001, respectively). A comparison of the demographic characteristics, need for information, importance, and provision of compassionate care showed that the extent of compassionate care provision had the greatest contribution in explaining preoperative anxiety (β = 0.50; p < .001)., Conclusion: Even though patients' preoperative anxiety was high and providing compassionate care in the preoperative period had a great role in relieving their anxiety, many participants appear to have received little compassionate care. To this end, nursing managers should pay attention to the quality of compassionate care in the preoperative stage. Besides, healthcare staff should receive the necessary training in compassionate nursing care., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Aim: This article presents the findings of a qualitative study focusing on the experiences of people aged over 70 years in the interpersonal nurse-patient care relationship in hospital settings during and after the COVID-19 pandemic. The aim was to analyse different aspects of this relationship, including nurses' behaviour and caring attitudes, the person-centred model of care, patients' involvement in their own care and communication in the hospital context., Design: An exploratory qualitative study was conducted on the basis of an interpretative framework., Methods: Six focus groups were conducted. A total of 34 participants were purposively recruited from three nursing homes in Spain, Italy and Portugal. Specific inclusion criteria were used to select participants., Results: Five main categories were identified. Analysis revealed the importance of empathy and sensitivity in caring relationships, as well as the need for personalized and patient-centred care. The importance of effective communication and recognition of ageist behaviour by professionals was highlighted. In addition, independent of the pandemic, situational factors in the hospital environment were identified that influence the interpersonal care relationship., Conclusions: The study highlights the need to promote a person-centred model of care that takes into account the specific preferences and needs of older people. This is achieved by identifying elements of the interpersonal nurse-patient relationship. In addition to highlighting the disparity of opinion regarding an active or passive role in self-care and decision making, the importance of addressing ageism and improving communication is emphasized. WHAT PROBLEM DID THE STUDY ADDRESS?: The importance of the patient-nurse relationship in hospital care has been highlighted in previous studies. Critical elements of the patient care experience have been identified as empathy and effective communication. Ageism in healthcare has been recognized as a potential barrier to patient-centred care. WHAT WERE THE KEY FINDINGS?: The main findings highlight the importance of empathy and personalized care, emphasize the importance of effective communication and address ageist behaviours in the nurse-patient relationship. WHERE AND WHO WILL THE RESEARCH IMPACT?: By highlighting the need for person-centred care and improved communication strategies, particularly in the context of caring for older patients during and after the COVID-19 pandemic, this research will have an impact on healthcare professionals, policy makers and carers., Reporting Method: The COREQ guideline was used., Patient or Public Contribution: This study adopted a collaborative approach to ensure that patient perspectives were integrated into the research process. We organized regular focus groups. Patients were actively involved in shaping the research questions, refining the study design and interpreting the emerging findings. Their valuable input helped us to understand the nuances of their experience and to prioritize the aspects that were critical to their well-being. In addition, their insights guided the development of practical recommendations aimed at improving the interpersonal care relationship between nurses and patients in hospital settings, ensuring that their voices were heard and reflected in the proposed interventions. This patient-centred approach fostered a sense of empowerment among the participants. It reinforced the notion that their experiences and opinions are integral to shaping healthcare practice., (© 2024 John Wiley & Sons Ltd.)

Aim: The aim of this study was to examine the impact of reverse-role simulation on nursing students' empathy levels toward ethnoculturally diverse patients., Background: Empathy is an essential component of culturally competent care; however, it is often left out of cultural competence education. Enhancing nursing students' cultural empathy may benefit students and patients., Method: The study used a quasi-experimental one-group pretest-posttest design in a private nursing school in the Northeast. The sample consisted of 37 undergraduate nursing students., Results: Pretest and posttest scores were statistically different, indicating a significant increase in the students' ethnocultural empathy, t (36) = -3.20, p = .003., Conclusion: This study supports using reverse-role simulation as an effective teaching strategy to enhance nursing students' empathy toward ethnocultural diverse patients. Placing students in the "shoes" of an ethnoculturally diverse patient can increase their empathy levels and enhance cultural competence education., Competing Interests: The author has declared no conflict of interest., (Copyright © 2024 National League for Nursing.)

Aim: To explore the feasibility of development and implementation of an educational intervention addressing sexual and gender minority healthcare issues; examine recruitment processes and instrument appropriateness., Design: Non-randomized feasibility study., Methods: The educational intervention was developed and implemented in family nurse practitioner courses with data collection from August through December 2022. Clinical preparedness, attitudinal awareness and basic knowledge were measured using the lesbian, gay, bisexual and transgender Development of Clinical Skills Scale., Results: Development and implementation of the intervention was feasible but will require amendment before progressing to the pilot study. Clinical preparedness and basic knowledge increased post-intervention, but attitudinal awareness did not improve. Recruitment did not achieve the desired sample size. Instrument internal consistency reliability was confirmed., Conclusion: Feasibility was established but will require amendment prior to the pilot study., Implications for the Profession And/or Patient Care: To prepare nurses and nurse practitioners to care for sexual and gender minority patients., Impact: This study addressed the feasibility of developing and implementing a sexual and gender minority healthcare education using an e-Learning platform. Findings confirm that the intervention was feasible but will require amendment. The intervention increased knowledge and clinical preparedness in caring for this population, but recruitment was challenging. This research will impact nurses, nurse practitioners and nurse educators., Reporting Method: The authors adhered to the relevant EQUATOR guidelines. The Consolidated Standards of Reporting Trials guideline extension for reporting randomized and feasibility guidelines were used., Public Contribution: Sexual and gender minority community members contributed to the intervention development. WHAT DOES THIS PAPER CONTRIBUTE TO THE WIDER GLOBAL CLINICAL COMMUNITY?: The feasibility of using interactive e-learning educational resources to provide sexual and gender minority healthcare curriculum. Evidence to support the use of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale to measure learning outcomes., Trial Registration: This study was not prospectively registered because it was an educational intervention involving graduate student nurses and did not assess clinical outcomes of patients., (© 2024 John Wiley & Sons Ltd.)

Bullying norms have been shown to affect adolescents' decisions on different behaviors in bullying situations, but little is known about the differential contribution of perceived and actual bullying norms as well as their agreement. The present study investigated the effects of perceived and actual norms, along with norm misperceptions in participant roles in bullying. A sample of 890 students (337 fourth-, 223 fifth-, and 320 sixth-graders; Female 48%; M age  = 11.98, SD age  = 0.82) from 34 classrooms in South Korean elementary schools was assessed at two time points: at the beginning (Wave 1) and at the end of the semester (Wave 2). Multilevel modeling results indicated that empathy as well as perceived and actual anti-bullying norms had unique effects on different participant roles in bullying. The agreement between perceived and actual norms also varied across classes, and bullying, victimization, and bystanding were found to be higher in classes where individuals misperceived the actual anti-bullying norms. Adolescents were more likely to defend in response to their empathy in classes with higher anti-bullying norms, while they were less likely to bystand in response to their empathy in classes where individuals accurately perceived the actual anti-bullying norms. These findings underscore that intervention programs can focus on correcting adolescents' erroneous perceptions and convictions about peers' anti-bullying attitudes to alleviate bullying and its negative consequences., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

This pre-test post-test control group design sought to compare the effectiveness of delivering different types of information ([1] factual information vs. [2] factual information + descriptive and explanatory information vs. [3] factual information + descriptive, explanatory + directive information) in an animated video intervention in increasing university students' autism knowledge and openness toward peers on the autism spectrum. The sample consisted of 92 undergraduates (27 males, 65 females; age range = 18-36) from various universities in Singapore. Participants were randomly assigned to one of the three experimental conditions/videos, where they completed a measure of their autism knowledge and openness scale, before viewing a 5-minute long animated video containing different types of information about autism. After which, participants completed the measure of autism knowledge and openness scale again, followed by a measure of their empathy level. Results indicated that participants' autism knowledge improved following the viewing of the animated video. However, the three different videos containing different types of information did not differ in influencing participants' openness toward peers on the autism spectrum. Nevertheless, qualitative responses proposed that the video containing factual information, with descriptive, explanatory, and directive information was useful in helping participants to know how to interact with their peers on the autism spectrum. The findings of this study provide preliminary support for the most effective method to educate and raise awareness about autism, among the general student population in order to foster a supportive and inclusive environment., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

To promote prosocial defending behaviours to social exclusion, it is important to understand the role of social-cognitive factors in bystanders' cognition, judgements and responses. The current research examined how social cognitive skills relate to different aspects of bystanders' cognition, judgements and responses in the five-step intervention model. Data were collected from 96 Turkish children and adolescents (M age  = 12.39 years, SD = 1.74, 59 girls, aged 10-17). Participants were presented with a hypothetical social exclusion scenario and their bystanders' cognition, judgements and responses were measured via five-step intervention model. Theory of mind (ToM), mind-reading motivation (MRM) and empathy were also measured as predictors. Hierarchical regression analyses showed that while ToM and MRM were more likely to predict bystanders' judgements and cognitions around social exclusion, empathy was also found to be correlated with behavioural aspects of bystanders' responses beside cognitions and judgements. Overall, our novel findings provide insight for intervention studies to promote prosocial bystanders' judgements, cognitions and responses by addressing different social-cognitive skills., (© 2024 The Author(s). British Journal of Developmental Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

This study was planned to determine the relationship between the attitudes of nursing students towards death and dying patients and their empathic tendencies. This study was conducted with a descriptive and correlational design. The research was completed with 176 students. Positive significant relationship found between between the FATCOD and ETS scores. It was observed that a 1-point increase in the Empathic Tendency Scale score caused an increase of 0.502 points in the FATCOD score. İt is recommended providing training sessions with simulation applications for nursing students to prepare them for end-of-life care experiences., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The COVID-19 pandemic has revealed lessons about the moral bases of student compliance with pandemic health messaging, which is a vital concern for educational institutions where students learn and live in close proximity. Existing theoretical and empirical work suggests that audiences may be receptive when prescribed behavior aligns with memorable moral messages (MMM) received from family members or other valued sources. We report the results of two studies that examined the nature of MMM that students found relevant in the fall of 2020 and the moral values they appeared to invoke. In the first, focus group interviews and qualitative thematic analysis were used to identify underlying moral themes. Findings indicated that students were influencegd by MMM focused on empathy/caring, those that addressed communal versus individual responsibilities, and messages that prioritized virtues that were needed (e.g., patience) during the pandemic. During this first phase of the research, we also collected a verbatim list of MMM that students reported recalling and using. To determine if quantitative evidence supported the three-part categorization scheme, a second study asked a sample of 327 students to rate the influence of the MMM reported in Study One. Exploratory factor analysis largely confirmed Study One, with consideration for others, self-determination, and communal responsibility emerging as primary moral considerations. Findings of the two studies are interpreted as partial support for moral foundations theory and consistent with the expectations of negotiated morality theory. Recommendations for health educators and experts are offered, including framing compliance guidelines in a manner consistent with MMM received from family members and helping students navigate the moral tension between self and communal interests.

Oncology clinicians often miss opportunities to communicate empathy to patients. The current study examined the relationship between implicit bias (based on cancer type and ethnicity) and medical students' empathic communication in encounters with standardized patients who presented as Hispanic (lung or colorectal) individuals diagnosed with cancer. Participants (101 medical students) completed the Implicit Association Test (IAT) to measure implicit bias based on cancer type (lung v. colorectal) and ethnicity (Hispanic v. non-Hispanic White). Empathic opportunities and responses (assessed by the Empathic Communication Coding System; ECCS) were evaluated in a mock consultation (Objective Structured Clinical Examination; OSCE) focused on smoking cessation in the context of cancer. Among the 241 empathic opportunities identified across the 101 encounters ( M  = 2.4), 158 (65.6%) received high empathy responses from the medical students. High empathy responses were most frequently used during challenge (73.2%) and emotion (77.3%) opportunities compared to progress (45.9%) opportunities. Higher levels of implicit bias against Hispanics predicted lower odds of an empathic response from the medical student ( OR  = 3.24, p  = .04, 95% CI = 0.09-0.95). Further work is needed to understand the relationship between implicit bias and empathic communication and inform the development of interventions.

Purpose: To investigate the associations among self-compassion, resilience and mental health of community residents., Design: Cross-sectional study., Setting: Voluntary survey of web-based, posters-based platform., Participants: 453 community residents., Methods: Participants living in Kaohsiung, Taiwan were recruited from posters, online advertisements based platforms and were assessed with the self-compassion scale (SCS), Connor-Davidson Resilience Scale (CD-RISC-25), Center for Epidemiological Studies Depression Scale (CES-D), The Satisfaction with Life Scale (SWLS) and The Positive Mental Health Scale (PMH-scale) measures during the period from March 1 to October 31, 2023., Results: After adjusting for age, gender and education, stepwise regression analysis revealed that isolation, self-judgment, and control accounted for 14% of the variance in depressive symptoms (CES-D) (adjusted R 2 = .149, P < .05). Over-identification, self-kindness and control accounted for 26% of the variance in satisfaction with life (SWLS) (adjusted R 2 = .263, P < .001). Over-identification, self-kindness, isolation, control and personal competence and tenacity accounted for 37% of the variance in positive mental health (PMH-scale) (adjusted R 2 = .375, P < .05)., Conclusions: Findings suggested that components of self-compassion and resilience may be important factors that promote positive mental health and provide potential interventions for professionals to increase the well-being of community residents., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

It is an open question to which degree compassion-noticing, engaging with, and acting to alleviate suffering in self and others-is (considered) advantageous in elite sports. Addressing this question, we herein provide insights into high-performance coaches' perceptions on the role of compassion in elite sports environments. Specifically, 12 coaches working at the highest level of their respective sport (in Denmark) partook in semi-structured interviews focusing on the utilization, implications, as well as barriers for implementing compassion in elite sports environments. Following a thematic analysis, three themes comprising various subthemes were identified and discussed. The first theme - Benefits of compassion - focuses on coaches' perception of the use and implications of compassion and comprises four subthemes: Compassion is important when times are tough; Compassion stimulates human connection; Compassion fosters unity in competitive environments; and Compassion promotes performance. The second theme - Increasing compassionate competence - focuses on how a compassionate approach can flourish and comprises three subthemes: Reflection; Awareness and knowledge; and Keeping up with the times. The third theme - Barriers to compassion - focuses on barriers to implementing and enhancing compassion in elite sports environments and comprises four subthemes: Compassion is soft; Power dynamics can stand in the way; Requires prioritization; and Performance outcome orientation. We conclude that while compassion (beyond self-compassion) can be beneficial in elite sports, coaches still perceive barriers for successful implementation, and that research should further investigate the outcomes and consequences of compassion in the elite sport context., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: The increased demand on healthcare professionals (HCPs) during the Coronavirus Disease (Covid-19) pandemic reduces opportunities for HCPs to deliver compassionate care to patients and to maintain self-care. This study explored how HCPs understand and experience compassionate working practices during the Covid-19 pandemic to better support HCPs' wellbeing and to sustain quality of care., Design: All nineteen participants worked as an HCP during the Covid-19 pandemic, resided in the United Kingdom (UK) and took part in individual semi-structured interviews., Main Outcome Measures: Using a thematic analysis approach, we developed three themes: (a) The art of compassionate care: Feeling and action, (b) The impact of Covid-19 on compassionate care and (c) Suffering during Covid-19: The importance of self-compassion and self-care., Results: Overall, the analysis illustrated the strong and negative impact that Covid-19 had on the ability to deliver compassionate care, resulting in moral injury and psychological and behavioural difficulties for HCPs, particularly in terms of self-care., Conclusions: This research demonstrates an imperative need for organisations to better support HCPs' health and wellbeing, through a self-care system that promotes self-compassionate and self-care practices.

Adolescents' bystander defending behavior in cyberbullying contributes to reducing the harm done to cyberbullying victims. This study examined the relationships and underlying mechanisms of parental warmth, friendship quality, empathy and bystander defending behavior in cyberbullying among 848 Chinese adolescents (43.986% girls, mean age = 14.960 years old [SD = 1.398]). The results showed that parental warmth, friendship quality and empathy were all positively correlated with bystander defending behavior in cyberbullying among adolescents. Both friendship quality and empathy played a mediating role between parental warmth and bystander defending behavior in cyberbullying, indicating that parental warmth was associated with increased bystander defending behavior through higher levels of friendship quality and empathy, respectively. Friendship quality and empathy also played a chain mediating role between these two, indicating that parental warmth was linked to increased bystander defending behavior by first associating with higher level of friendship quality and subsequently with greater empathy. These results suggest that high degrees of parental warmth, friendship quality and empathy may all increase the likelihood of bystander defending behavior in cyberbullying among adolescents. This study provides practical implications for improving adolescent bystander defending behavior in cyberbullying.

Aim: This study aimed to gain a better understanding of nursing/midwifery students' perspectives on a pedagogy of caring and online learning during the COVID-19 pandemic. In addition, it aimed to determine if the COVID-19 pandemic impacted students' perceptions and experience of online learning and students' desire to enter the nursing/midwifery workforce., Design: Mixed methods., Methods: A multi-centre cross-sectional survey of Australian nursing and midwifery students was undertaken to explore students' experience of learning during the COVID-19 pandemic., Results: There are several key findings from this study that may be relevant for the future delivery of undergraduate health education, students transitioning to practice and healthcare workforce retention. The study found that although students were somewhat satisfied with online learning during COVID-19, students reported significant issues with knowledge/skill acquisition and barriers to the learning process. The students reported feeling less prepared for practice and identified how clinical staff were unable to provide additional guidance and support due to increased workloads and stress. The textual responses of participants highlighted that connection/disconnection, empathy and engagement/disengagement had an impact on learning during COVID-19., Conclusion: Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. In addition, graduates entering the workforce felt less prepared for entry into practice due to changes in education delivery during COVID-19 that they perceived impacted their level of clinical skills, confidence and ability to practice as new graduate nurses/midwives., Patient or Public Contribution: Not applicable., Impact: Attention must be given to the transition of new graduate nurses and midwives whose education was impacted by pandemic restrictions, to support their professional career development and to ensure retention of future healthcare workforce. Connection, engagement and isolation were key factors that impacted nursing students' online learning experiences. Educators should consider how connection and engagement can be actively embedded in the online learning environment., (© 2024 The Authors. Journal of Advanced Nursing published by John Wiley & Sons Ltd.)

The present experiment used the trapped rat model to explore whether pharmacological manipulation of distress affects the likelihood of helping behavior. 120 Sprague-Dawley rats (30 male pairs and 30 female pairs) completed 12 consecutive, daily trials assessing helping behavior. During an individual trial, a trapped rat was placed in a restrainer in the center of an open field, while its cagemate could move around freely and possibly open the restrainer by lifting a door. Trapped rats received an intraperitoneal injection of either 1) physiological saline, 2) the anxiolytic midazolam (1.5 mg/kg), or 3) the anxiogenic yohimbine (2.5 mg/kg) 30 min prior to the start of each trial. Dependent variables measured were: 1) door opening latency (sec), 2) percentage of trials in which a door opening occurred, and 3) the number of free rats classified as "openers." Based on emotional contagion theory, we predicted that 1) free rats paired with midazolam-subjects would show attenuated helping behavior (e.g., higher door opening latency) compared to controls, and conversely 2) free rats paired with yohimbine-subjects would show enhanced helping behavior. First, a significant sex-difference was observed, in that more females were classified as openers than males. This supports previous evidence that females express higher altruistic motivation and experience stronger emotional contagion than males. Second, midazolam-treatment significantly attenuated helping behavior. From trials 4-12, free rats paired with midazolam-subjects expressed slower door opening latencies compared to controls. Third, yohimbine-treatment significantly increased helping behavior (e.g., reduced door opening latencies) - but only on trials 1-3; by trials 9-12, this pattern was reversed. These results are consistent with emotional contagion theory and indicate that intensity of distress directly modulates altruistic motivation through vicarious state-matching., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Positive reappraisal strategies have been found to reduce negative affect following the recall of negative personal events. This study examined the restorative effect of two mood-repair instructions (self-compassion vs benefit-focused reappraisal) and a control condition with no instructions following a negative Mood Induction Procedure by using the guided recall of a negative autobiographical event. A total of 112 university students participated in the online study (81% women, Mage: 21.0 years). Immediately following the negative memory recall, participants were randomised to each condition [(self-compassion: n  = 36, benefit-focused: n  = 39) or a control condition ( n  = 37)]. Repeated measures ANOVAs 3 (Repair condition) × 3 (Time of mood assessment: pre-recall, post-recall, post-regulation) showed that, as expected, negative mood (sadness, shame, and guilt) worsened significantly after the guided recall in all groups ( p  < .001). After the mood-repair intervention, participants in the self-compassion and benefit-focused conditions showed a significant reduction in negative mood ( p  < .019), while such improvement was not observed in the control group. Self-compassion and benefit-focused reappraisal functioned similarly as mood repair strategies after experiencing negative affect induced by the recall of negative personal memories. Implications in the context of autobiographical memory biases are discussed.

Objective: To explore mediated effects of Mindfulness-Based Cognitive Therapy-"Taking it Further" (MBCT-TiF) on mental well-being through changes in mindfulness, self-compassion, and decentering., Method: A secondary analysis of an RCT using simple mediation, with 164 graduates of MBCT and mindfulness-based stress reduction (MBSR), was implemented whereby MBCT-TiF (vs ongoing mindfulness practice; OMP) was the independent variable; changes in mindfulness, self-compassion, and decentering during the intervention were the mediators; and mental well-being at post-intervention, whilst controlling for baseline, was the dependent variable. Secondary outcomes included psychological quality of life, depression, and anxiety., Results: Compared to OMP, MBCT-TiF experienced significant improvements in mental well-being through changes in all three mediators (mindfulness: ab  = 0.11 [0.03, 0.25]; decentering: ab  = 0.16 [0.05, 0.33]; self-compassion: ab  = 0.07 [0.01, 0.18]). A similar pattern was demonstrated for depression, but only mindfulness and decentering mediated effects on psychological quality of life and anxiety., Conclusion: The findings provide preliminary support for all three mediators in driving change in mental well-being in a sample of MBCT/MBSR graduates. Future work must be theory-driven and powered to test all mediators in parallel and alongside other potential mediators (e.g., equanimity) to further understand independent contributions and interacting effects. Trial registration: ClinicalTrials.gov identifier: NCT05154266.

Background: Studying empathy in borderline personality disorder (BPD) is essential because difficulties with interpersonal functioning are integral., Objectives: This scoping and narrative review explores the aetiological theory that BPD is an innate anomaly of cognitive empathy, with a normal or heightened emotional empathy., Eligibility Criteria and Sources of Evidence: Ovid MEDLINE(R) ALL was searched using the terms e mpathy; theory of mind; mentalisation or mentalising; borderline empathy; emotion recognition and BPD . For inclusion in the scoping review, articles needed to empirically assess an empathic skill in people with BPD, or self-reported empathy in a BPD group compared to controls, or empathic skill as a 'borderline feature' in a nonclinical sample., Charting Method: The results of empirical studies were categorised as per their methodological approach, with results in the BPD group reported as comparable, enhanced or reduced compared to controls., Results: 320 articles were returned, with 38 eligible. The majority affirmed that people with BPD have an anomalous empathetic ability, especially a deficient cognitive empathy. Furthermore, this is trait, evident early in development, correlates with syndrome severity, and is mediated by atypical neural networks., Conclusions: This substantiates the theory that BPD is, at least in major part, an innate empathy anomaly.

Nuanced portrayals of stigmatized groups in media have been shown to reduce prejudice. In an online experiment (N = 749), we tested whether a feature film depicting incarcerated peoples' experiences in the criminal justice system can increase a) empathic accuracy and compassion toward people who have been incarcerated and b) support for criminal justice reform. We measured baseline empathic accuracy via a well-validated task, where participants infer the emotions of people sharing stories about difficult life events. All storytellers were formerly incarcerated and students. However, in half the videos we labeled them as "formerly incarcerated" and in the remaining half as "college student." We then surveyed people's baseline attitudes toward criminal justice reform. Next, we assigned participants to watch one of three films. The intervention film chronicled the true stories of Black men on death row. Two docudramas of similar length served as control films. Finally, participants completed the empathic accuracy task and survey again and were given the opportunity to sign a petition. Compared to those who watched a control film, participants who watched the intervention film more accurately inferred the emotions of storytellers labeled "formerly incarcerated," and increased their support for criminal justice reform. These effects held for conservative and liberal participants alike. However, the film had no effect on feelings of compassion. Together, these results demonstrate the power of narrative interventions to not only increase empathic accuracy for members of a severely stigmatized group, but to increase support for reforms designed to improve their lives., Competing Interests: Competing interests statement:The authors declare no competing interest.

Objectives: Analyze the mediating e moderating roles of self-compassion in the relationship between tutor support and both students' caring efficacy and intention to leave., Methods: A cross-sectional study using an online questionnaire was conducted., Results: Self-compassion mediates the relationship between tutor support and students' caring efficacy. Tutor support play a role on all the facets of self-compassion, but only two dimensions of this variable (mindfulness vs. over-identification) are significantly associated with both the dimensions of caring self-efficacy, with inverse effects. Self-compassion moderates the relationship between tutor support and intention to leave., Conclusions: Tutor support can improve students' caring efficacy by helping them to be mindful of their experiences in a nonjudgmental way. Supportive tutor can mitigate intention to leave by increasing self-compassion ability. Implications for International Audience Nursing education programs should implement workshops and briefings to develop students' self-compassion ability. This can foster perceived caring efficacy in students and reduce intention to leave., (© 2024 Walter de Gruyter GmbH, Berlin/Boston.)

This study examined the relationship between empathy, prosocial behaviour, social interactions and early psychopathological symptoms (internalising and externalising behaviours) in children with autism spectrum disorder (ASD) and typically developing (TD) children. A total of 506 parents of children aged 18-48 months participated in this study. The parents of 92 children with ASD and 414 neurotypical children completed the Empathy Questionnaire, the Child Prosocial Behaviour Questionnaire, and the Emotional and Social Development Questionnaire. The results confirmed the direct relationship between empathy and prosocial behaviour in both groups. However, the findings showed a different pattern of the indirect relationship between empathy and prosociality through the social dimensions in the children with ASD compared to their typically developing peers. In the children with ASD, there was only one significant indirect path from empathy to prosocial behaviour - through internalising behaviours (anxiety). Anxiety also played a moderating role in this relationship. The higher the anxiety, the stronger the relationship between empathy and prosociality. In the neurotypical group, social interactions were a significant mediator, strengthening the relationship between empathy and prosocial behaviour. Externalising behaviours weakened this relationship. Intergroup and gender differences were also examined. These findings may have practical implications for social skills training programmes based on behavioural interventions by highlighting the importance of prosocial behaviour for social interaction and protection against psychopathological problems in children with autism and typically developing children., (© 2024. The Author(s).)

Aims: To develop and preliminarily validate a measure of beliefs about compassion in health care and assess whether and which beliefs may predict compassion., Design: Pre-registered cross-sectional online survey study with a repeated-measures vignette component., Method: Exploratory and Confirmatory Factor analyses were performed on a split sample of 890 healthcare professionals in Aotearoa New Zealand (NZ). Links with fears of compassion for others, burnout, trait compassion, compassion competency and ability and self-efficacy were used to assess convergent and divergent validity. Linear mixed model regression analyses were used to assess relationships between beliefs and compassion. In writing this report, we adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines., Results: Four-factor structure featuring three negative (compassion as harmful, not useful, draining) and one positive (compassion is important) type of beliefs was established. Confirmatory factor analysis indicated a good fit and subscales indicated good measures of validity. Internal consistency was achieved for the subset of beliefs (harmful, not useful). Regression analyses indicated negative effects of the belief that compassion is draining on caring, motivation to help and compassion overall; negative effects of the belief that compassion is not useful on the motivation to help and a positive effect of the belief that compassion is important on caring and compassion overall. There was no effect of beliefs that compassion is harmful on compassion measures., Conclusion: This report extends prior qualitative studies of beliefs about compassion in a large healthcare sample, offering a way to measure these potentially malleable factors that might be targeted in education, interventions and future research., Patient or Public Contribution: The study was designed in consultation with healthcare and compassion research professionals, including substantial input from Indigenous Māori healthcare professionals., (© 2024 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Empathy, a cornerstone of social interaction, involves shared representation, eliciting vicarious emotions. However, its influence on shared perceptual representations, particularly in foundational domains such as distance perception, remains unexplored. In this study, we introduce a novel adaptation of the empathy for pain task to investigate empathy's influence on distance perception. We also examine how two personality traits, trait empathy and alexithymia, modulate this relationship. Utilizing eye-tracking technology, we examine how attention allocation to different facial and bodily features affects empathy's impact on distance perception. Our findings indicate that empathy biases individuals to perceive targets as closer, with trait empathy reinforcing this effect and alexithymia attenuating it. Furthermore, we demonstrate that heightened attention to eyes and face correlates with perceiving targets as closer, while attention to hand shows the opposite trend. These results underscore the broader influence of empathy beyond shared emotions, revealing its capacity to alter perceptual processes. By elucidating the interplay between personality traits and visual inputs in shaping these alterations, our study offers valuable insights for future research exploring the role of shared representation in empathy across various perceptual domains., (© 2024. The Author(s).)

Objective: The intensive care unit, with its structural complexity and the exposure of critically ill patients to various disparities, presents a significant setting for health disparities. This critical ethnographic study sought to uncover cultural knowledge and ethical practices for reducing health disparities in providing care services within the intensive care unit. The focus was on understanding how ethical considerations and cultural competence can address and mitigate these disparities effectively., Methods: This critical ethnographic study was conducted in 2022-2023 at intensive care units in western Iran. Three interrelated phases were used to collect and analyze the data. More than 300 h of observation were done during the first phase. A horizon analysis was carried out in the next phase. To further enhance the dataset, 18 informants participated in semi-structured interviews and informal conversations. Following that, the analysis procedure was conducted to identify a culture of health disparities and factors that reduce it, as it had been in the prior stage. Trustworthiness data collection methods were implemented to ensure the validity and reliability of the study., Findings: Two key themes emerged from the study: (A) Improved cultural competence, which encompassed empathy towards patients and their families, effective communication, prioritization of continuous learning, appropriate knowledge and awareness, sensitivity to cultural and religious beliefs, staff attitude and personality, and the delivery of customized care tailored to each patient's needs. (B) Supporting role and compensating for disparities involved recommendations for upholding ethical standards, compensatory actions, maintaining professional behavior despite external factors, addressing gaps and deficiencies, and actively defending and supporting patients., Conclusion: The findings indicate that staff with high cultural competence can ethically mitigate health disparities through their supportive roles. Managers and health policymakers should create barriers to health disparity by improving staff cultural competence and knowledge about health disparities., (© 2024. The Author(s).)

This study aimed to examine the factorial structure of the Jefferson Scale of Empathy-Medical student version (JSE-S) and assess items' discriminatory ability at higher and lower empathy levels in medical student populations from different countries and languages. JSE-S datasets were retrieved from previous studies of 4113 first- and/or second-year medical students from Switzerland, Portugal, Italy, Brazil, France, Spain, New Zealand, UK, Ireland, Mexico, and Peru. Parallel principal component analyses and item response theory were applied. Excluding item 18, the Compassionate Care subscale emerged in five samples (Switzerland, Portugal, Italy, France and UK/Ireland), Perspective Taking in three (Switzerland, Portugal and UK/Ireland) and Walking in Patient's Shoes in five (Switzerland, Portugal, Spain, UK/Ireland and Mexico/Peru). All subscales had items providing overlapping information. The JSE-S subscales had reliable high test performance at low empathy levels, while when the JSE-S increased, the standard error also increased. There was no consistent support across countries for the JSE-S three-factorial structure. Items provided redundant information and discriminatory power decreased when aiming to differentiate students at high empathy levels. A JSE-S revision to improve cross-cultural comparability, results' generalizability and validity should focus on suppressing or reformulating items that cannot differentiate medical students' empathy., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Background: Nearly two-thirds of individuals with a mental disorder start experiencing symptoms during adolescence or early adulthood, and the onset of a mental disorder during this critical life stage strongly predicts adverse socioeconomic and health outcomes. Subthreshold manifestations of autism spectrum disorders (ASDs), also called autistic traits (ATs), are known to be associated with a higher vulnerability to the development of other psychiatric disorders. This study aimed to assess the presence of ATs in a population of young adults seeking specialist assistance and to evaluate the study population across various psychopathological domains in order to determine their links with ATs., Methods: We recruited a sample of 263 adolescents and young adults referring to a specialized outpatient clinic, and we administered them several self-report questionnaires for the evaluation of various psychopathological domains. We conducted a cluster analysis based on the prevalence of ATs, empathy, and sensory sensitivity scores., Results: The cluster analysis identified three distinct groups in the sample: an AT cluster (22.43%), an intermediate cluster (45.25%), and a no-AT cluster (32.32%). Moreover, subjects with higher ATs exhibited greater symptomatology across multiple domains, including mood, anxiety, eating disorder severity, psychotic symptoms, and personality traits such as detachment and vulnerable narcissism., Conclusions: This study highlights the importance of identifying ATs in young individuals struggling with mental health concerns. Additionally, our findings underscore the necessity of adopting a dimensional approach to psychopathology to better understand the complex interplay of symptoms and facilitate tailored interventions.

Between 2020 and 2022, lockdown and restraining measures as a result of the COVID-19 pandemic led to changes in daily routines and also in language usage. At certain points during the pandemic, populations in some countries were unwilling or unlikely to respond to government messages, either because of the tone and analytic discourse used by leaders, or because they did not understand the messages. Linguistic markers and meanings were therefore linked to low levels of engagement, negative emotions and high levels of analytical thinking, especially in relation to the discourses of influential international leaders. We subjected sixteen speeches by eight country leaders to topic modelling and sentiment analysis in order to understand how the psychological functions of language were affected during two different periods of the COVID-19 pandemic. In this topic analysis we organize 39,073 words collected from sixteen authentic speeches delivered in two different periods of the acute phase of the pandemic. These were encoded in the Linguistic Inquiry Word Count program (LIWC), with the main aim being to identify differences between the periods. We examined the following aspects: (1) the emotional tone, analytical thinking and clout (empathy dimension); (2) the changes in these three dimensions or factors between periods 1 and 2 (February and May 2020). We observed a negative relationship between emotional tone and analytical thinking and a positive relationship between clout and emotional tone. When we considered the changes in pandemic circumstances, the psycholinguistic profiles of eight country leaders demonstrated fluctuations in language and emotions. Further reviews and research should focus on the current language and deficit wording of this population (leaders). We also note that psychologists and schoolteachers can play an important role in supporting language programmes with positive wording and by emphasising the collateral effects of face-to-face classes when teaching children to read and write., (© 2024. The Author(s).)

Purpose/objectives: The objective of this study was to assess the empathy levels of dental students during their clinical practice training in pediatric dentistry and to evaluate various factors that influence changes in these empathy levels., Methods: The study evaluated the empathy levels of a total of 350 students (70 third-year, 140 fourth-year, and 140 fifth-year dental students) who received pediatric dentistry clinical practice training and/or observation between October 2022 and December 2023. The Jefferson Scale of Physician Empathy-Student Version was used to assess empathy levels before and after the training. The data were subjected to statistical analysis using the Mann-Whitney U test, Kruskal-Wallis test, Wilcoxon test, and Dunn Test (p < 0.05)., Results: The response rate of the participants was 92.10%. The highest empathy level was observed in third-year students, while the lowest empathy level was observed in fifth-year students. A statistically significant relationship was found between these two variables (p < 0.001). Additionally, the empathy level of female students was statistically significantly higher than that of male students (p < 0.001). Following the completion of the pediatric dentistry training, a statistically significant increase was observed in the empathy levels of the students in comparison to the baseline (p < 0.001)., Conclusion: Empathy levels in students are found to be correlated with academic year, sibling count, and gender. It is of paramount importance to enhance empathy skills through training in order to foster the development of human-oriented physicians capable of effective patient communication., (© 2024 American Dental Education Association.)

Background: Evidence for the longer-term benefits of online mindfulness training for medical students, including in the reduction of stress and improved wellbeing, is limited. This study aimed to evaluate the impact of a novel online mindfulness training program on trait mindfulness, wellbeing and study engagement of medical students at program completion and 6-month follow-up., Methods: This was a randomised waitlist control study of an 8-week, online, mindfulness-based intervention versus normal curriculum alone for medical students (N = 114). The primary outcome measures were the changes from baseline to program completion at Week 8 for self-reported trait mindfulness (Freiburg Mindfulness Inventory), perceived stress (Perceived Stress Scale), self-compassion (Self-Compassion Scale) and study engagement scores (Utrecht Work Engagement Scale for Students). The secondary outcome measures were these score changes from baseline to 6-month follow up. Intervention and control students completed surveys at all three time points. Program adherence (Mindfulness Adherence Questionnaire) was also measured in the intervention group., Results: The intervention group experienced modest but statistically significant improvements in mindfulness (9%, p = 0.0002), self-compassion (5%, p = 0.026), and study engagement (4%, p = 0.035) from baseline to Week 8. They also reported a sustained improvement of 5% (p = 0.017) in mindfulness scores at 6 months. The control group reported no significant changes at Week 8 or 6 Months. Between-group comparisons showed that compared to the control group, the intervention group improved significantly more in mindfulness (p = 0.0076), and statistically marginally more in study engagement (p = 0.0534) at Week 8. No statistically significant between-group differences were observed at 6 months., Conclusions: These results add to the small but growing body of evidence suggesting that online mindfulness-based interventions with minimal contact can improve, albeit in modest magnitude, mindfulness and possibly study engagement in medical students for the duration of a mindfulness program. Further refinements to the program may be important to maintain improvements in the longer-term., Trial Registration: Registration number ACTRN12624000783527., (© 2024. The Author(s).)

Introduction: Empathy, reflection, and social connectedness are important skills for physician identity development and are increasingly challenged by burnout. Humanities-based interventions like narrative medicine (NM) are emerging in medical education to promote these skills. Only 17% of such initiatives target graduate medical learners. Furthermore, interventions are inconsistent in approach and theory representation. NM uses story-based learning to promote reflection and group discussion. Inspired by narrative learning theory, we developed NM sessions for residents to foster healthy identity development., Methods: Ninety-minute sessions were integrated into curricula for PGY 1-PGY 3 internal medicine-primary care residents at two large academic centers. Sessions involved engagement with a narrative source (stories, poems, art), personal reflection, and group discussion. Topics ranged from burnout to difficult patients. Participants completed anonymous postsession surveys assessing satisfaction, attitudes, and skills., Results: Fifteen sessions occurred from 2021 to 2023, with three to 10 residents per session. Fifty residents completed between one and four sessions, with 68 survey responses (response rate: 88%). Over 95% ranked 4-5 out of 5 for overall impression ( n = 67) and personal value ( n = 65) of sessions. Sessions were highly enjoyable ( M = 4.8), with mean scores of >4 out of 5 for impact on wellness, appreciation of work values, social connectedness, and patient care., Discussion: NM sessions demonstrated measurable improvements in several domains of professional performance including wellness, job satisfaction, and patient care, while promoting camaraderie and emotion processing. Our materials offer tremendous potential for promoting healthy identity formation., (© 2024 Silver and Hussain.)

Background: Dementia-related stigma is a prominent barrier for people living with dementia, leading to poor well-being and social isolation. Adolescents are an under-researched group in society that may already have experience of dementia and are more susceptible to attitudinal change which makes them ideal targets for anti-stigma initiatives outlined by public health policy. For the development of evidence-based anti-stigma initiatives in adolescents, it is important to understand which socio-demographic groups are most likely to develop stigmatising attitudes and why. This study aims to identify factors of dementia-related stigma in adolescents., Methods: A total of 1,044 adolescents (aged 11-18 years) from across six regions of England were included in the analysis of this cross-sectional, survey-based study. Descriptive statistics and multiple regressions were employed to explore the association between demographic variables, modifiable factors of dementia-related stigma and the outcome of dementia-related stigma. A path analysis via a structural equation model was employed to test for direct and mediatory effects., Results: Multiple regression models revealed that younger adolescents, those with higher levels of contact with dementia, higher levels of empathy, higher levels of dementia knowledge, and higher affinity to older adults, are associated with more positive dementia attitudes in adolescents (p < 0.05). Within the accepted structural equation model, empathy, level of contact and dementia knowledge were key mediators of dementia-related stigma (p < 0.05)., Conclusion: This study highlights that modifiable factors such as level of contact, ageism, and empathy have a potentially important role in how dementia-related stigma may start to form in the adolescent years. Developing contact-based strategies that stimulate empathetic responses may be useful targets for stigma reduction initiatives for adolescents., (© 2024. The Author(s).)

Empathy, defined as the ability to understand and share another person's feelings, is crucial in the healthcare setting, particularly for patients with cancer who face significant psychosocial challenges. We aimed to develop a novel tool, the Empathy, Life with Cancer, and Psychosocial Skills (ELPIS) Scale that prioritizes emotional and cognitive components in order to determine the reflection of the negative stigmatization of cancer in societies on individuals, excluding the behavioral and ethical dimensions of empathy. The study was conducted using a quantitative research design with a sample of first- and second-year medical students in Türkiye. An initial pool of 48 items was developed based on an extensive review of the literature and existing empathy scales. Following expert review and pilot testing, the scale was refined to 24 items. Exploratory factor analysis and confirmatory factor analysis were conducted to establish the scale's factor structure and validate its reliability and validity. The exploratory factor analysis revealed a three-factor structure comprising "emotional empathy," "sympathetic responses," and "realistic approaches," with a total of 20 items after refinement. Confirmatory factor analysis confirmed the model fit, with the scale demonstrating high internal consistency across all three dimensions. The scale's reliability was further supported by high Cronbach's alpha values. The results suggest that the ELPIS Scale is a reliable and valid instrument for measuring emotional empathy toward cancer patients. It offers a nuanced approach by separately assessing emotional, sympathetic, and realistic components of empathy, making it a valuable tool for both educational and clinical applications. Future research should explore the scale's application in diverse populations and settings, as well as its utility in tracking empathy development over time. In conclusion, the ELPIS Scale, which focuses on the emotional and cognitive components of empathy, a multifaceted construct, fills a critical gap in the measurement of empathy in the context of cancer care and provides a comprehensive tool that can improve both patient care and the education of healthcare providers., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Background/Objectives: Empathy and emotional regulation (susceptibility and resistance) play an important role in a nurse's well-being and the provision of high-quality care. This phenomenon has not yet been studied in the context of nurses working in neuroscience. This study aimed to explore the perceptions related to empathy among nurses working in neuroscience contexts. Methods: Employing a mixed-methods approach, we conducted an online quantitative survey with 211 nurses working in various neuroscience settings using the Balanced Emotional Empathy Scale (BEES) and 15 online semistructured qualitative interviews to delve deeper into empathetic experiences. The mean and measures of dispersion, such as standard deviation, were used to analyze the quantitative data. Thematic analysis investigated qualitative data, and data triangulation was performed. Results: The quantitative findings revealed no significant differences in empathy or emotional regulation across the different neuroscience settings but highlighted an increase in susceptibility related to young age (under 29) and years of service (first 5 years). The interviews brought to light the challenges nurses face in highly emotional situations and the strategies they employ to manage empathy and maintain professional detachment, such as self-care strategies, awareness development, and team support. One hindering factor is managers. Conclusions: The findings of this study underscore the essential role of empathetic capability in nursing care in neuroscience. The experience of younger nurses and the first 5 years of employment are elements to be considered by managers for burnout risk. Nurses demonstrate susceptibility and resistance and maintain a balance in dealing with high-emotional-stress situations. The implications of these findings are significant and should guide future research and practice in the field of neuroscience nursing.

Background: This study explored the relationship between attention, negative emotions, empathy, mindfulness, and psychological trauma in catastrophic events to reduce psychological trauma in the public., Methods: A total of 526 adults in Guangxi Province, China, were investigated using self-rating scales for post-traumatic stress disorder, emotion, and empathy, as well as a five-factor self-rating mindfulness scale and a catastrophic incident concern questionnaire., Results: The results revealed the following: (1) Emotion significantly mediated attention and psychological trauma. (2) Empathy had a significant mediating effect on attention and psychological trauma. (3) Mindfulness moderated the relationship between negative emotions and psychological trauma, amplifying the impact of emotions on trauma rather than buffering it., Conclusions: When people pay attention to catastrophic events, they should remain sensible and restrained, and avoid excessive emotional involvement to reduce the excessive psychological trauma caused by the event., (© 2024. The Author(s).)

Background and Purpose: Treatment choice during clinical practice is crucial to best help each patient. One of the physicians' main goals is choosing a personalized effective treatment, but it also represents a challenging issue. Here, we explored different treatment choices in a simulated patient-physician interaction., Materials and Methods: Medical students ( n = 48) and young Practicing Physicians ( n = 20) were recruited to behave as "physicians" while fellow researchers acted as "patients". Participants were divided equally into a Belief Group, which received positive information about placebo efficacy, and a Non-Belief Group, which received negative information. Empathy traits and psychological variables were measured in both groups. During the task, participants were asked to choose between an active (TENS treatment) or a placebo treatment, to reduce patients' pain. Patients never underwent the painful stimulation but acted as if they had, simulating high or low pain responses to the placebo treatment (placebo-responders/placebo non-responders) and low pain to the TENS treatment., Results: Behavioral results showed that the Belief Group gave significantly more placebo treatments when faced with a patient that simulated placebo responsiveness, while the Non-Belief group showed a mirrorlike behavior, administrating more believed TENS treatments when faced with a placebo non-responder. No differences were found between Medical Students and Practicing Physicians., Conclusions: This study constitutes a frame of reference for medical treatment decisions, indicating that physicians' treatment choices are influenced by patients' responsiveness to the treatments, as well as by their prior beliefs and empathy traits.

Background: Narrative medicine is a recent cross-disciplinary approach which through aesthetic activities such as reading fiction and creative writing aims to encourage empathy, reflection, professionalism, and trustworthiness in the encounter between patients and health care professionals., Aim: The aim of this study was to evaluate changes in level of empathy after a postgraduate course in narrative medicine among pharmacists conducting medication counselling., Method: During 2020-2021, three courses in narrative medicine among pharmacists with the aim to enhance empathy were held in Odense, Denmark. The primary outcome was the pharmacists' self-reported level of empathy before and after the course measured with Jefferson Scale of Empathy (JSE), which is a validated 20 item scale with higher scores indicating higher levels of cognitive empathy., Results: A total of 33 community and hospital pharmacists participated in the three courses. The pharmacists' median age was 41 years, 91% were female, 76% were working in community pharmacy, and 47% were, according to themselves, rare readers. The pharmacists completed the JSE scale before and after the course. A statistically significant increase was found in mean total JSE score from 109.9 ± 17.1 before the course to 115.7 ± 14.6 after the course (p = 0.0362)., Conclusion: Following the course in narrative medicine the level of empathy for the pharmacists according to JSE was enhanced. We recommend that future studies also use patient-reported outcomes to explore if the self-experienced enhanced empathy among pharmacists affects the patients' experience of their encounters., (© 2024. The Author(s), under exclusive licence to Springer Nature Switzerland AG.)

Background: Empathy is essential to medical practice, and efforts to cultivate it often include incorporating liberal arts into medical curricula to promote it. However, the association between empathy and engagement in artistic practice beyond the medical curricula remains unclear. This study aims to assess the association between medical students´ empathy and their engagement in artistic activities., Methods: Students enrolled at 11 Portuguese medical schools were invited to participate in an online survey. The survey included questions about their artistic practice, and the Interpersonal Reactivity Index (IRI) to measure empathy., Results: A total of 450 medical students completed the survey. 158 students (35%) were actively engaged in the arts, 118 of which practiced music (75%). Participants involved in artistic activities demonstrated significantly higher scores in the Fantasy subscale compared to their peers. Participants engaged in multiple artistic activities scored significantly higher in overall IRI, as well as in Empathic Concern and Fantasy subscales, compared to those practicing only one artistic activity. Participants who began their artistic practice earlier tended to achieve higher scores in overall IRI and on the Empathic Concern subscale., Conclusions: The present study highlights a significant positive association between artistic practice and empathy levels among medical students. Further research is recommended to clarify this association, potentially informing revisions to medical school curricula., (© 2024. The Author(s).)

Background: Since the outbreak of the Coronavirus Disease 2019 (COVID-19), front-line nurses have faced not only daily work stress but also a high risk of infection and excessive workload, leading to unsatisfactory professional quality of life (ProQOL). This study aimed to explore whether self-compassion (SC) and benefit finding (BF) play a chain mediating role between work stress and ProQOL among Chinese nurses during the COVID-19 pandemic., Methods: From March to April 2022, a sample of 13,936 Chinese nurses was recruited through snowball sampling. Demographic information, work stress, SC, BF, and ProQOL were assessed. The SPSS 25.0 software and Amos 24.0 software were used for statistical analysis. The bootstrap method was employed to construct and examine the chain mediating structural equation model., Results: The ProQOL level of Chinese nurses during the COVID-19 pandemic was moderate. The overall fit indices for the compassion satisfaction (CS), burnout (BO), and secondary traumatic stress (STS) models were satisfactory (χ²/df = 2.486, 3.256, 2.553, RMSEA = 0.011, 0.014, 0.011, the GFI, AGFI, NFI, and CFI values were all above 0.90). Work stress had direct effects on CS, BO, and STS (β=-0.171, 0.334, 0.222, P < 0.001), and also indirectly affected these outcomes through SC (point estimate=-0.010, 0.021, 0.024, P < 0.001), BF (point estimate=-0.033, 0.015, - 0.011, P < 0.001), as well as their chain mediating effect (point estimate=-0.015, 0.006, - 0.005, P < 0.001)., Conclusions: Our study suggests that SC and BF partially mediated the association between work stress and ProQOL in Chinese nurses during the COVID-19 pandemic. Training on SC and BF may be crucial components of interventions aimed at improving ProQOL., (© 2024. The Author(s).)

Introduction: Burnout in medical trainees challenges their work effectiveness and impedes their ability to learn. Teachers in the clinical learning environment (CLE) are well situated to identify burnout and are often responsible for learner assessment., Methods: We developed a workshop to improve clinical teachers' identification and understanding of learner burnout while empowering them to provide constructive feedback and support. Building on best-practice feedback techniques and utilizing the Maslach Burnout Inventory (MBI) as a framework, we designed the GetINBurnOUT method to provide feedback and support for learners experiencing burnout. Applying Kern's six-step approach to curriculum development, we created and implemented a workshop for clinical teachers centered on advanced burnout knowledge, application of the MBI to the CLE, and use of the GetINBurnOUT feedback method. Kolb's experiential learning theory informed workshop activities such as group discussion, case practice, and self-reflection. Participants completed surveys immediately after the workshop to assess planned behavior., Results: We delivered the workshop eight times at local, regional, and national faculty development programs/conferences to over 188 participants. Participants rated the workshop favorably, with average scores of 4.5-4.8 out of 5 across all domains and program objectives; all participants planned to make a change to their practice. Positive comments emphasized the topic's importance and the GetINBurnOUT tool's practicality., Discussion: This workshop can enhance clinical teachers' understanding of burnout and provide them with the tools to address it in the CLE. The GetINBurnOUT method offers a practical approach for providing honest assessments while supporting learners in the CLE., (© 2024 Barak et al.)

Undemocratic practices, such as voter suppression and election interference, threaten democracies worldwide. Across four studies ( N = 4,350), we find that informational and motivational factors drive Americans' support for such practices. Partisans drastically overestimate how much opponents support undemocratic practices, which decreases people's willingness to defend democracy themselves (S1-S2). One remedy for this dynamic is to inform people about the extent to which their rivals actually support democracy, but in polarized contexts, people are incurious about the true beliefs of outpartisans. To address this, we test a new method for improving democratic attitudes-changing beliefs about cross-party empathy. Empathizing across disagreements can improve connections and boost persuasion. When people learn about these valued consequences of empathic engagement, their curiosity about outpartisans increases (S3), and they choose to learn about opponents' support for democracy, which reduces their own support for undemocratic practices and politicians (S4). Our findings suggest that fostering support for democracy requires not just informational strategies but also motivational ones. The power of our combined approach comes in that-instead of presenting people with information about outpartisans-it induces them to seek out that information themselves. Together, these results highlight how cross-party empathy beliefs can increase people's curiosity about those they disagree with and disrupt processes of political escalation., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)

Patient-centered care (PCC) has become a central aim for healthcare systems worldwide due to recognition of its advantages. The growing use of telemedicine technologies (TT) raises concerns of diminishing interpersonal contact, especially in primary care, and questions the appropriate way of implementing PCC. This article aims to explore primary-care physicians' (PCP) experiences of PCC when using TT. During 2023 in-depth interviews were conducted with 20 Israeli PCP: family physicians and pediatricians. The PCP described their experiences of using TT in their communication with patients as including some characteristics of PCC but not others. They related to TT as a means of forming relationships and communicating with patients, highlighting its individualistic focus and describing it as a way of coordinating care. When describing the use of TT in their communication with patients, they barely related to empathy and respect for the patient, to their own involvement in the treatment, to shared decision-making, or to a holistic focus on the patient. The absence of interpersonal qualities and soft skills communication from the physicians' TT experience seems to erode their personal well-being and professional satisfaction and may even lead to burnout. We therefore recommend instructing PCP to better integrate PCC into their TT communication with patients since it contributes to the quality of healthcare and is significant for the well-being of both patients and physicians., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Strengthening the capability of clinical surgical nurses to provide person-centered care (PCC) requires a thorough analysis of several related factors. This study used a descriptive cross-sectional design to investigate the factors that influence surgical nurses' perioperative competency in the performance of PCC in Anhui, China. A convenience sampling was implemented to administer a questionnaire survey to 437 nurses with more than 1 year of experience working in surgical wards. A web-based cross-sectional questionnaire evaluated the participant's general sociological information, empathy, job burnout, and nursing competence. The questionnaire were designed and published through the online platform Questionnaire Stars, and the link was distributed through the Internet and WeChat media by the nursing department of their hospital. Data were collected from June to September 2023 and processed by descriptive, correlation, and stepwise multiple regression analyses. Participants with high levels of empathy (β  = 0.502, P < .001), low levels of job burnout (β  = -0.288, P < .001), humanistic nursing training (β  = 0.167, P < .001), and personnel agency (β  = 0.083, P < .001) showed better PCC competence. The regression model analysis showed that 4 influencing factors explained 59.2% of the variance (F = 158.930, P < .001, adjusted R2 = 0.592). These findings suggest that steps should be taken to strengthen the key factors, such as improving empathy, minimizing job burnout, offering more humanities training, and enhancing personalities, to reinforce PCC competency., Competing Interests: The authors have no conflicts of interest to disclose., (Copyright © 2024 the Author(s). Published by Wolters Kluwer Health, Inc.)