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국 문 요 약

간호대학생을 위한 공감교육 프로그램이
공감, 대인관계 능력 및 돌봄에 미치는 효과

본 연구의 목적은 간호대학생들을 대상으로 다차원적인 공감개념에 입각하여 공감교육 프로그램을 개발하고, 이를 적용하여 공감, 대인관계 능력 및 돌봄에 미치는 효과를 평가하고자 하는 것이다
본 연구는 ADDIE 모델의 개발방법에 따라 인지적, 정서적, 의사소통적 공감요소를 포함한 다차원적 공감교육 프로그램을 개발하고, 이를 간호학생에게 적용한 후 공감, 대인관계 능력 및 돌봄에 미치는 효과를 평가하기 위한 실험군 대조군 전후 유사실험설계이다.
연구대상자는 I시 K여자대학교의 간호학과에 재학 중인 4학년 총 46명으로 실험군 23명, 대조군 23명이며, 2016년 4월 19일에서 5월 6일 까지 실험군에게 1회 2시간 30분씩, 주 2회, 3주간의 프로그램으로 총 6회에 걸쳐 15시간으로 구성된 프로그램을 적용하였다. 프로그램의 각 회기의 주제는 마음열기, 마음으로 경청하기, 서로 다름을 이해하기, 자신과 타인의 감정을 알아채기, 공감 표현하기, 공감과 돌봄이라는 6가지 주제로 강의, 발표, 개인활동, 그룹 활동, 집단토의, ...

국 문 요 약

간호대학생을 위한 공감교육 프로그램이
공감, 대인관계 능력 및 돌봄에 미치는 효과

본 연구의 목적은 간호대학생들을 대상으로 다차원적인 공감개념에 입각하여 공감교육 프로그램을 개발하고, 이를 적용하여 공감, 대인관계 능력 및 돌봄에 미치는 효과를 평가하고자 하는 것이다
본 연구는 ADDIE 모델의 개발방법에 따라 인지적, 정서적, 의사소통적 공감요소를 포함한 다차원적 공감교육 프로그램을 개발하고, 이를 간호학생에게 적용한 후 공감, 대인관계 능력 및 돌봄에 미치는 효과를 평가하기 위한 실험군 대조군 전후 유사실험설계이다.
연구대상자는 I시 K여자대학교의 간호학과에 재학 중인 4학년 총 46명으로 실험군 23명, 대조군 23명이며, 2016년 4월 19일에서 5월 6일 까지 실험군에게 1회 2시간 30분씩, 주 2회, 3주간의 프로그램으로 총 6회에 걸쳐 15시간으로 구성된 프로그램을 적용하였다. 프로그램의 각 회기의 주제는 마음열기, 마음으로 경청하기, 서로 다름을 이해하기, 자신과 타인의 감정을 알아채기, 공감 표현하기, 공감과 돌봄이라는 6가지 주제로 강의, 발표, 개인활동, 그룹 활동, 집단토의, 모델링, 역할극, 과제, 성찰일지 등의 교육방법과 비디오, 그림과 사진, 음악, 유인물, 경청검사지, Ego-gram 검사 등의 교육자료를 활용하였다. 자료수집은 2016년 4월 15일에서 6월 8일까지 진행했으며 양적 자료는 자가보고식 설문지를 이용하여 프로그램 전, 후(3주 후) 및 프로그램 종료 후 4주 후(7주 후)에 공감, 대인관계 능력 및 돌봄에 대한 자료를 수집하였고, 질적 자료는 매 회기별 성찰일지와 소감문을 통해 수집하였다.

수집된 자료는 IBM SPSS Statistics 18.0을 이용하여 일반적 특성 및 종속변수는 실수, 백분율, 평균과 표준편차로 분석하였고, 실험군과 대조군의 사전 동질성 검정은 independent t-test와 x²-test, Fisher’s exact test로, 종속변수의 정규분포 검정은 shapiro-wilk test로 검정하였다. 가설은 Repeated measure ANOVA, 각 군간 사전 사후 비교는 paired t –test로 검정하였다. 또한 매 회기별 성찰일지와 프로그램 종료 후 소감문의 내용분석을 통해 의사소통적 공감을 확인하였다. 분석을 통해 확인된 본 연구의 결과는 다음과 같다.

1. 대상자의 일반적 특성인 연령, 종교, 자신이나 가족의 입원 경험, 전공 만족도, 실습에 대한 만족도, 성격특성 및 스트레스 강도와 연구변수인 공감의 하위변수 4가지 즉 관점 취하기, 상상하기, 공감적 관심, 개인적 고통 및 대인관계 능력과 돌봄에 대한 사전 동질성 검정 결과 실험군과 대조군 간에 통계적으로 유의한 차이가 없어 두 군은 동질한 것으로 확인되었다.

2. 간호대학생을 대상으로 한 공감교육 프로그램의 공감변수에 대한 효과를 검정하기 위해 인지적 공감의 2개 하위변수인 관점취하기와 상상하기, 정서적 공감의 2개 하위변수인 공감적 관심과 개인적 고통에 대한 효과를 각각 확인하기 위한 가설검정 결과는 다음과 같다.

가설 1-1. ‘간호학생을 대상으로 한 공감교육 프로그램에 참석한 실험군과 참석하지 않은 대조군은 시간경과에 따른 인지적 공감 중 관점취하기 정도에 차이가 있을 것이다’라는 가설은 집단 간(F=7.06, p=.011)와 집단 내(F=9.031, p <.001), 집단과 시간의 교호작용(F=7.239, p=.001) 모두 통계적으로 유의하게 차이가 있는 것으로 나타나 가설 1-1은 지지되었다. 또한 실험군의 사전 사후 변화를 확인하기위한 분석결과 프로그램 중재 전에 비해 프로그램 중재 종료 4주 후 관점취하기 점수가 향상된 것으로 나타났다(t=-4.665, p<.001).
가설 1-2. ‘간호학생을 대상으로 한 공감교육 프로그램을 실시한 실험군과 대조군은 시간경과에 따른 인지적 공감 중 상상하기 정도에 차이가 있을 것이다’라는 가설은 집단 간(F=6.537, p=.014)에는 유의한 차이를 보였으나 집단 내(F=3.358, p= .817)와 집단 및 시간의 교호작용(F=2.073, p= .132)에는 통계적으로 유의하게 차이가 없는 것으로 나타나 가설 1-2은 기각되었다
가설 1-3‘간호학생을 대상으로 한 공감교육 프로그램을 실시한 실험군과 대조군은 시간경과에 따른 정서적 공감 중 공감적 관심 정도에 차이가 있을 것이다’가설은 집단 간(F=3.601, p=.064)에는 유의한 차이가 없었으나 집단 내(F=4.742, p=.011)와 집단과 시간의 교호작용(F=4.719, p=.011)에는 통계적으로 유의한 차이가 나타나 가설 1-3은 지지되었다. 또한 실험군의 사전 사후 변화를 확인하기위한 분석결과 프로그램 중재 전에 비해 프로그램 중재 종료 4주 후 공감적 관심 점수가 향상된 것으로 나타났다(t=-3.525, p=.002).
가설 1-4 ‘간호학생을 대상으로 한 공감교육 프로그램을 실시한 실험군과 대조군은 시간경과에 따른 정서적 공감 중 개인적 고통 정도에 차이가 있을 것이다’라는 가설은 집단 간(F=4.878, p=.032), 집단 내 (F=9.909, p< 0.001) 및 집단과 시간의 교호작용(F=3.904, p=.024) 모두 통계적으로 유의한 차이가 나타나 가설 1-4는 지지 되었다. 또한 실험군의 사전 사후 변화를 확인하기위한 분석결과 프로그램 중재 전에 비해 프로그램 중재 종료 4주 후 개인적 고통 점수가 감소된 것으로 나타났다(t=3.238, p=.004).

3. 참석자들의 공감교육 프로그램 참석 후 의사소통 공감의 변화를 확인하기 위한 내용분석 결과‘공감적 표현의 향상’, ‘위안과 치유를 경험’, ‘대인관계 향상’, ‘갈등해결을 경험’등의 4가지 주제가 도출되어 의사소통적 공감의 변화가 있었음을 알 수 있었다.

4.‘간호학생을 대상으로 한 공감교육 프로그램에 참여한 실험군과 대조군은 시간경과에 따른 대인관계 능력 정도에 차이가 있을 것이다’라는 가설은 집단 간(F=7.623, p=.008), 집단 내(F=17.752 p<0.001) 및 집단과 시간의 교호작용(F=14.064, p<0.001) 모두 통계적으로 유의한 차이가 나타나 가설 3은 지지 되었다. 또한 실험군의 사전 사후 변화를 확인하기위한 분석결과 프로그램 중재 전에 비해 프로그램 중재 종료 4주 후 대인관계 능력이 향상된 것으로 나타났다(t=-7.741, p<.001).
5.‘간호학생을 대상으로 한 공감교육 프로그램에 참여한 실험군과 대조군은 시간경과에 따른 돌봄 정도에 차이가 있을 것이다.’라는 가설은 집단 간(F=11.637, p=.001), 집단 내(F=16.853, p<0.001), 집단과 시간의 교호작용(F=9.595, p<0.001) 모두 통계적으로 유의한 차이가 나타나 가설 2는 지지 되었다. 또한 실험군의 사전 사후 변화를 확인하기위한 분석결과 프로그램 중재 전에 비해 프로그램 중재 종료 4주 후 돌봄 점수가 향상된 것으로 나타났다(t=-9.256, p<.001).

이상의 연구결과를 종합해 볼 때 연구 참여자들은 인지적, 정서적, 의사소통적 공감요소가 모두 포함된 다차원적 개념의 공감개념에 입각하여 개발된 공감교육 프로그램을 통해 공감에 있어서 인지적 공감의 관점취하기와 정서적 공감 중 공감적 관심이 향상되고, 정서적 공감 중 개인적 고통이 감소되었으며, 대인관계 능력 및 돌봄이 향상되는 것으로 나타났다. 또한 성찰일지와 소감문 분석결과 의사소통적 공감도 향상되었다. 이는 본 공감교육 프로그램이 개인내적 공감인 인지적, 정서적 공감을 부분적으로 향상시킴으로써 내적 공감을 표현하는 의사소통적 공감에 변화를 가져와 대인관계 능력과 간호사로써 필요한 자질인 돌봄을 향상시켰음을 보여준 결과로 해석할 수 있다. 본 공감교육 프로그램은 단순한 기술로써의 공감이 아닌 내면의 공감을 회복하고 향상시켜 대인관계 능력을 키움으로써 간호대학생들의 대학생활 적응을 돕고 임상현장에서 환자의 마음을 이해하고 그 요구를 해결하는 돌봄을 향상시켜 간호의 질을 높이는데 유용한 기초 자료로 활용될 수 있을 것이다.



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핵심어: 공감, 공감교육 프로그램, 대인관계 능력, 돌봄

Abstract ▼ AI-Helper

ABSTRACT

The Effect of an Empathy Education Program on Nursing Students’ Empathy, Interpersonal ability, and Caring

Jeong, Jin Ok
Dept. of Nursing
The Graduate School
Yonsei University

1. Introduction

Feeling empathy is an understanding of others, to a...

ABSTRACT

The Effect of an Empathy Education Program on Nursing Students’ Empathy, Interpersonal ability, and Caring

Jeong, Jin Ok
Dept. of Nursing
The Graduate School
Yonsei University

1. Introduction

Feeling empathy is an understanding of others, to accept them, forming inner empathy by sharing, and helping others feel that they are not alone but understood (Gallese, 2007; Cunico et al, 2006). Empathy can be understood in the social and emotional aspects which are the basis of interactions and relationships. To have good social relationships, one should share another person’s feeling as well as be aware of another person’s thoughts and behaviors. Furthermore, one should be able to appropriately respond to them and to accurately express one’s feelings or another person’s feeling (Kim & Kim, 2009). In other words, the ability of inner empathy, which is cognitive and affective empathy, is expressed verbally and is connected to altruistic behaviors (Davis, 1994), which makes him or her experience positive interpersonal relationships by promoting the formation of social support networks (Koo, 2006)
Empathy is a key element in supportive relationships (Alligood, 2005). In the relationship with patients, nurses communicate through interactions by becoming a therapeutic tool (Kasch, 1986). Here, the nurse’s empathy can affect the process and result of the illness process by influencing on the quality of relationship between nurse and patient (Alligood, 2005).
However, although empathy is a term that is commonly used in nursing literature, due to its importance the empathy that patients feel in the course of nurses’ provision of care appears to be insufficient (Kunyk & Olson, 2001).
Therefore, nursing students need to improve their interpersonal ability by learning empathic attitudes and skills that can be the foundation of interpersonal relationships while in college. This is necessary not only for adaptation to college life but also for preparation for building interpersonal relationships patients and other professionals as well as enhance care ability as a future nurse.
From the aspect of Erikson’s theory of psychosocial development (1959), the time in college is a critical development period in which students have to establish a mature interpersonal relationship in the early adulthood (Lee et al., 2011). Recently, the Korean nursing field has made efforts to develop interpersonal ability by paying greater attention to the importance of communication and educating communication skills in the nursing curriculum. Currently, in the certification criteria of Korea Accreditation Board of Nursing for bachelor’s degree, communication theory and human relations are classified as major basic courses in the field of humanities and social sciences (Korea Accreditation Board of Nursing, 2015), and most nursing colleges open classes related to communication and human relationship as a basic subject for lower-grade students (Kim, Park, and Lee, 2004). However, in order to practice interpersonal relationship and care that is a nature of nursing through communication based on empathic ability, an educational approach that only provides theories of communication and skills has limitations in enhancing the inner empathic ability for nursing students. In Kim and colleagues’ (2004) study of a group program in combination with lectures, for nursing sophomore students they pointed out the limitations of the current lecture-oriented classes.
Nursing educators have suggested the possibility of improving empathy skills and various results through empathy education (Cunico, Sartori, Marognolli & Meneghini, 2012). Looking at empathy education programs in Korea and other countries, a systematic literature review on empathy training programs for nursing students and nurses (Brunero et al., 2010) showed that only 7 out of 17 studies were for nursing students, of which 4 studies considered the course in the curriculum as an intervention, 2 studies used a short-term communication skill program, and one study used meditation training. In Korea, a study employing an empathy education program, (Choi, 1988) only dealt with communicational empathy. Education and training programs or studies including an empathy element or having empathy ability as an outcome variable included those using bibliotherapy, multicultural education program and and Enneagram group counseling program (Yoo, 2015; Pick & Park, 2013; Lee, 2011), an emotional intelligence improvement program focusing on affective empathy (Lee & Koo, 2014) and those focusing on behavioral elements of communication skill oriented empathy (Choi, 1988; Won & Shin, 2008; Shin & Lee, 2011; Song, 2006; Kim, Park, and Lee, 2004). However, there is no study to date that developed and applied an empathy education program based on an multidimensional empathy model that encompasses cognitive, affective, and communicational empathy elements.
Currently, empathy theorists and researchers have reached a consensus that understanding on empathy can be enhanced when a person has clear knowledge of cognitive and affective elements for the empathic response (Park, 2004). In other words, having empathic thinking and emotion is a prerequisite for being able to express empathy. Although communication skills are one of the behavioral elements of empathy (Williams & Stickley, 2010), empathy education based on a multidimensional empathy model that encompasses cognitive and affective factors is required,in addition to communication skills as an expressive element (Park, 2004).
Therefore, this study aimed to develop an empathy education program for nursing students based on the multidimensional empathy concepts including cognitive, affective, and communicational factors of empathy, and to evaluate its effects on empathy, interpersonal ability, and caring.

2. Objectives
The study aimed to develop and evaluate the effects of an empathy education program for undergraduate nursing students. Specific purposes are as follows:

(1) To develop an empathy education program for undergraduate nursing students.
(2) To verify the effects of the empathy education program on empathy, interpersonal ability, and caring.

3. Conceptual framework
The conceptual framework of this study was based on the Empathy Organizational model (Davis, 1994) that is a multidimensional empathy model including cognitive and affective empathy. This framework is composed of antecedents, process, and outcome concepts. The antecedents include personal and situational characteristics known to affect cognitive and affective empathy, the process is an empathy education program including cognitive, affective and communicational empathy elements. Additionally, the outcomes include cognitive and affective empathy as intrapersonal outcomes, as well as communicational empathy, interpersonal ability and caring as interpersonal outcomes (figure 1).

Figure 1. Conceptual framework of this study


4. Methods

1) Program development
In this study, a multidimensional empathy education program including cognitive, affective, and communicational empathy elements was developed according to the phases of the ADDIE model. The development process is as follows.

(1) Analysis phase
An extensive review of the literature was conducted using the keywords empathy, empathy education, empathy training, empathy education program, empathy training program in nursing, effects of empathy education/training program, and teaching –learning methods in the analysis phase. Analysis of empathy-related curriculum in a college of nursing and interview with nurse and nursing student for case development and need assessment were also included.

(2) Design phase
This phase focused on composition of program contents, i.e., developing the purpose of the program for nursing students, understanding of empathy components, connecting the intervention to relevant outcomes, sequencing the intervention, developing evaluation methods, and making decisions of teaching strategies and learning methods.

(3) Development phase
This phase focused on development of the pilot program, setting the goal and theme for each session, and describing the contents, activities, and teaching methods for each session.

(4) Implementation phase
At this phase verification of program validity with face validity (composition validity and content validity) was done and the pilot program was implemented with four junior nursing students.


(5) Evaluation phase
Finally, the program was refined after analyzing and revising based on pre-test results with consideration of face validity.


Phase
Content
1. Analysis
. Literature review
- Literature review of empathy, empathy education, empathy
training, empathy education program, empathy training
program in nursing
- Review of effects of empathy education/training program.
- Review of education program of empathy improvement and
teaching –learning methods
. Analysis of the curriculum related empathy in a college of
nursing.
. Interview for case development and need assessment
(nursing student, nurse)
2. Design
. Composition of program contents
- Development of Program purpose for nursing students
- Understanding of empathy components
- Connection of intervention and outcome
- Sequencing of intervention
- Development of evaluating method
- Decision of teaching strategies and learning methods
3. Development
. Development of pilot program
- Setting the goal for each session
- Setting theme for each session
- Describing contents, activities and teaching methods for each
session
4. Implementation
. Pilot program implementation
- Verification of program validity (Face validity)
- Implementation of pre-test
5. Evaluation
. Confirmation of program after analyzing and revising pre-test
results with consideration of face validity
Table 1. Development of the empathy education program based on the ADDIE model
2) Evaluation of Program effectiveness

⑴ Hypotheses
① To test the effects of the empathy education program on empathy variables, including two sub-variables of cognitive empathy (perspective taking and fantasy), and two sub-variables of affective empathy (empathic concern and personal distress), the following sub-hypotheses were established:
Hypothesis 1-1 There will be a difference in the degree of perspective taking empathy over time between the experimental group and the control group.
Hypothesis 1-2 There will be a difference in the degree of fantasy empathy over time between the experimental group and the control group.
Hypothesis 1-3 There will be a difference in the degree of empathic concern over time between the experimental group and the control group.
Hypothesis 1-4 There will be a difference in the degree of personal distress over time between the experimental group and the control group.
② Hypothesis 2. There will be a difference in the degree of interpersonal ability over time between the experimental group and the control group.
③ Hypothesis 3. There will be a difference in the degree of caring over time between the experimental group and the control group.
④ Furthermore, communicationa l empathy will be explored through content analysis of a reflective journal written in each session along with a final evaluative write-up upon completion of the program.

⑵ Research Design
In this study, a quasi-experimental research method was used with a nonequivalent control group pre-post design.

Figure 2. Research design


Pre-test
Intervention
Post- test 1
(Immediately after)
Post-test 2
(After 4 weeks)
Exp.
E1
X
E2
E3
Cont.
C1

C2
C3

. Exp.= Experimental group; Cont= Control group
. E1, C1 : General Characteristics, Empathy (Cognitive, Emotional),
Interpersonal ability, Caring
. X : Empathy Education Program
(150 min at a time, Twice a week, A total of 6 times)
Writing a reflective journal after each session and final evaluative
write-up
. E2, E3, C2, C3 : Empathy (Cognitive, Emotional), Interpersonal ability,
Caring

⑶ Sample and Sampling
A total of 46 nursing students were recruited by convenience sampling from senior nursing students of the nursing department of K college in I city, Korea. Participants were divided into two groups, an experimental group of 23 and a control group of 23.

⑷ Data Collection
Quantitative data were collected from April 15 to June 8, 2016, using a self reported survey at baseline (pre test), immediately following the program (post test1), and 4 weeks later (post test2). Qualitative data was collected by students’ reflective journals on each session and their records of their own final impression upon completing the program.
⑸ Measures
This study used a self-administered questionnaire consisting of a total of 154 items including 28 items on empathy, 31 items on interpersonal ability, 30 items of on caring, and additional items on general characteristics (demographic characteristics, stress level, and personality traits). Approval of the developers was obtained for all of the following instruments used for this study.
For empathy, the Korean version of Interpersonal Reactivity Index (IRI) was used, which was developed by Davis (1983) and translated into Korean by Kang et al. (2009). Reliability and validity have been verified. In this study, the overall Cronbach's ɑ was .77, and as for subscales, the Cronbach's ɑ was .69 for perspective taking, .71 for fantasy, .72 for empathic concern, and .73 for personal distress.
For interpersonal ability, the scale developed by Buhrmester et al. (1988) was used, which has been translated into Korean and modified as the Korean Interpersonal Competency Scale by Han and Lee (2010). Validity has been established for college students and in this study, the overall Cronbach's ɑ was .85.
For caring, the Caring Efficacy Scale (Form B) (Coates, 1997) was used after translation under the permission of the developer. The Cronbach's ɑ upon development was .88, while it was .92 in this study.
As part of general characteristics, stress level and personality traits were also measured. For the stress level, the Korean version of the Perceived Stress Scale (PSS-10), originally developed by Cohen, Kamarck and Mermelatein (1983), was used. The PSS-10 was translated into Korean and its reliability and validity were verified by Lee (2012) In the study of Lee (2012), Cronbach's ɑ was .74, while it was .75 in this study.
For personality traits, the Korean version of the International Personality Item Pool (IPIP) was used, which was made by Goldberg (1993) and translated by Guay et al. (2013). In this study, the Cronbach's ɑ for its subdomains was as follows: .91 for extroversion, .75 for amiability/friendliness, .86 for integrity, .92 for emotional stability, and .81 for intelligence/imagination.

⑹ Intervention
The experimental intervention (Empathy education program) was carried out from April 19 to May 6, 2016 for 150 minutes a session, twice a week, for 3 weeks and a total of 15 hours. The topic of each session is as follows: opening up mind, listening with one’s heart, understanding each other’s difference, knowing feelings of oneself and others, expressing empathy, empathy and caring. Various training methods such as lecture, presentation, personal activity, group activity, group discussion, modeling, role-play, homework, and writing a reflective journal were used, and as for training materials, videos, pictures, music, printed material, listening test sheet, and Ego-gram were employed.

⑺ Analytic strategy
The quantitative data was analyzed with SPSS/WIN 18.0. For the analysis of general characteristics, empathy, interpersonal ability, and caring, descriptive statistics were used. Independent two samples t-test, x²-test, Fisher’s, exact test were performed for the preliminary homogeneity test, and Shapiro-wilk test was performed for the test of normal distributed dependent variables, Repeated measure ANOVA and paired t-test were used for hypothesis testing. To explore communicational empathy, the qualitative data were analyzed using content analysis method.

⑻ Ethical Considerations
This study was conducted after obtaining an approval from the Institutional Review Board (IRB) of Y University (IRB Approval No. 2016-0005-4) to protect the human rights of the participants. Before the study, an independent research assistant provided explanation about the purpose and background of the study, methods and procedures, potential risks and benefits to study participants, personal information protection, and explanation about confidentiality. Also students were informed of provision of incentives for participation and assured that they could quit at any time without risk. Following explanations willing participants signed the consent form as well as a separate consent form on use of personal information (mobile phone number), which was to encourage continuous study participation and provide the incentive.
The collected questionnaires were kept in a cabinet with a lock, the results were saved and managed in the computer after encoding, and personal information (mobile phone number) was deleted after delivering the incentive. In addition, participants were informed that the study related data will be retained for 3 years after study completion and thereafter destroyed by incineration.

5. Results

1) The empathic education program

The final composition of the empathic education program is as follows (table 2): The program’s six sessions are composed of three parts: introduction, understanding of empathy, and integral application. The introduction phase is to understand the objective of the program and shape mutual affinities through opening up each other’s mind. The understanding of empathy phase consists of cognitive, affective, and communicational empathy. The integral application phase consists of role play to apply the attitude and skills of empathy in conflict situations of everyday life and clinical nursing.
The flow of each session followed introduction, deployment, and termination phases. In the introduction participants got to know each other and learning objectives were introduced. In the deployment phase, theory and practice were employed. The termination phase is composed of summary, introduction of the next session, and writing a reflective journal.
Table 2. The empathy education program

2) Evaluatin program effectiveness

⑴ Homogeneity Test of General Characteristics between Experimental and
Control Group
The result of homogeneity test on general characteristics such as age, religion, experience of hospitalization, satisfaction of their major, and the satisfaction of clinical practicum, personality trait and stress level found no significant differences between the experimental and control group (Table 4).

Table 4. Homogeneity Test of General Characteristics between the Experimental and
Control Group (N=46)
Characteristics
Categories
Exp.
(n=23)
Cont.
(n=23)
t or x²
p
n(%) or
Mean±SD
n(%) or
Mean±SD
Age (yrs)

22.57±0.99
22.35±1.11
0.70
.48
Religion
Yes
11(47.8)
7(30.4)
1.46
.37
No
12(52.2)
16(69.9)
Experience of hospitalization
(Family/Self)
Yes
20(87.0)
20(87.0)
0.015
1.00*
No
3(13.0)
3(13.0)
Satisfaction
of major
Satisfied
17(73.9)
15(65.2)
0.41
.75
Not satisfaction
6(26.1)
8(34.8)
Satisfaction of practicum
Satisfied
17(73.9)
16(69.9)
0.11
1.00
Not satisfaction
6(26.1)
7(30.4)
Personality trait
Extraversion
28.60± 8.14
29.831± 7.78
-0.52
.61
Agreeableness
36.87± 4.78
37.52± 4.63
-0.47
.64
Conscientiousness
32.47± 7.80
31.22± 6.91
0.58
.57
Neuroticism
26.39± 9.10
27.30± 8.47
-0.35
.73
Openness to experience
31.91± 6.16
29.65± 5.85
1.28
.21
Stress level

20.09±4 .79
19.91± 5.57
0.11
.91
* Fisher’s exact test
Exp.= Experimental group; Cont.= Control group


⑵ Homogeneity Test of Dependent variable between Experimental and Control
Group
The result of homogeneity test on the dependent variables (empathy, interpersonal ability and caring) showed that there was no significant difference between the control group and the experimental group at baseline (Table 5).

Table 5. Homogeneity Test of Dependent Variables between Experimental and
Control Group (N=46)

Variables
Range
Exp.
(n=23)
Cont.
(n=23)
t
p
Mean±SD
Mean±SD
Cognitive empathy
Perspective taking
0-28
18.26±3.65
18.13±4.20
0.112
.911
Fantasy
0-28
17.74±3.03
16.30±3.95
1.382
.174
Affective
empathy
Empathic concern
0-28
19.00±4.21
18.83±3.79
0.147
.884
Personal distress
0-28
16.74±2.58
16.52±3.63
0.492
.625
Interpersonal ability
1-5
3.19±0.52
3.30±0.38
-.773
.444
Caring
1-6
4.07±0.53
3.98±0.69
0.455
.651


⑶ The Result of Hypothesis testing
① The empathy education program was effective in increasing the perspective taking empathy score of the experimental group compared to the control group (F=4.87, p=.012).
② There were no significant differences in the fantasy score between the experimental group and control group (F=3.358, p= .701).
③ The empathy education program was effective in increasing the empathic concern score of the experimental group compared to the control group (F=3.272, p=.048).
④ The empathy education program resulted in decrease of the personal distress score of experimental group compared to the control group (F=2.268, p=.022).
⑤ Through content analysis of students’ reflective journals and their final records of this program, four theme clusters were derived; ‘Improvement of empathic expression,’ ‘Experiencing comfort and healing,’ ‘Improvement of interpersonal relationships,’ and ‘ Experiencing conflict resolution'. This suggests that the empathy education program was influential for enhancing communicational empathy.
⑥ The empathy education program was effective in increasing the interpersonal ability score of the experimental group compared to the control group (F=9.595, p<0.001).
⑦ Lastly, the empathy education program was effective in increasing the caring score of the experimental group compared to the control group (F=9.595, p<0.001)

6. Discussion
This study aimed to confirm the effects on empathy, interpersonal ability, and caring, after developing and applying an empathy education program for nursing students based on multidimensional empathy concepts that encompass cognitive, affective, and communicational empathy elements.
Looking at the effect of cognitive empathy of this empathy education program, the score of perspective taking, one of the sub-dimensions of cognitive empathy, was improved in the participants, but there was no change in the score of fantasy. Therefore, the effect of cognitive empathy of this education program can be considered to be improved partially. However, since the primary objective of cognitive empathy was perspective taking when the empathy education program was developed, in such aspect, this program can be considered effective. This program showed its effect on perspective taking of cognitive empathy with a short intervention time of 15 hours, which was shorter than the 21 hours in Shin’s study (1997), thus can be a practical merit in its implementation for nursing students. Examining the effect of affective empathy, the score of empathic concern increased, but the score of personal distress decreased. Park (2004) stated that formation of affective empathy and the direction to which the emotion actually functions must be separated, and suggested that the empathic concern or personal distress mentioned by Davis (1994) refers to a mediation process. According to Park, empathic concern leads people to act for the other’s welfare, while personal distress refers to the process mediating another person to be away from the pain that the person suffers from. In this aspect, if personal pain is reduced through the empathy education program, people will be able to act more empathically. In the future, for empathy education programs, strategies to help people actively intervene with empathy and the will to care must be developed, not just objectively being aware of and watching the other’s empathy through cognitive empathy. In addition, the result of investigation on the change of communicational empathy through content analysis on reflective journal and final impressions writings showed that this empathy education program was effective on communicational empathy as well. This can be interpreted that the ability to communicate, which is expressive empathy, can be influenced through partial improvement of cognitive and affective empathy.
This study’s finding on effectiveness of the intervention on interpersonal ability, is consistent with the outcomes of many studies revealing that communication programs composed of various methods, including discussions, demonstrations, role plays, etc., as well as lectures targeting small groups, are effective in improving interpersonal abilities (Shin & Lee, 2011; Won & Shin, 2008; Kim, Park, & Lee, 2004). Additionally, interpersonal ability and caring both increased after provision of the program.
When taking into account the fact that empathic concern acts as a parameter connecting part of affective empathy or the awareness of affective empathy with prosocial behaviors (Park, 2004), the effect of the increase of empathic concern seems to contribute to the increase of actual interpersonal ability and caring in nursing students.
In conclusion, the Empathy Education Program positively influenced growth of intrapersonal empathy, such as cognitive and affective empathy, and was also conductive in increasing expressive empathy in the form of empathy. The program was also influential in increasing interpersonal ability and caring of nursing students. In this respect, this Empathy Educational Program can contribute to enhance nursing students’ability to connect with clients and other healthcare professionals, form a good relationship, and possibly improve the quality of nursing in clinical fields.




______________________________________________________________________ Key words; Empathy, Empathy Education Program, Interpersonal ability, Caring

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