RESEARCH

RELATIONSHIP BETWEEN EMPATHY AND

WELL-BEING AMONG EMERGENCY NURSES
Authors: Patricia Bourgault, PhD, RN, Stephan Lavoie, PhD, RN, Emilie Paul-Savoie, PhD(c), Maryse Grégoire, MA, RN,
Cécile Michaud, PhD, RN, Emilie Gosselin, MSc, RN, and Celeste C. Johnston, PhD, RN, Québec, Canada

Introduction: A large number of patients who are in pain upon Results: Emergency nurses appear to have low levels of
arriving at the emergency department are still in pain when they empathy. High levels of psychological distress and low levels of
are discharged. It is suggested that nurses’ personal traits and well-being were also observed in our sample. Among these
their level of empathy can explain in part this issue in pain variables, only empathy and well-being appear to be related,
management. The purpose of this study was to better understand because we found higher empathy scores in nurses with higher
the shortfalls in pain management provided by emergency nurses well-being.
by considering nurses’ characteristics.
Discussion: The poor mental health we found among
Methods: A cross-sectional descriptive correlational design was emergency nurses is alarming. A clear need exists for
used for this pilot study. French validated self-administrated supportive interventions for nurses. Finally, well-being was
questionnaires (sociodemographic characteristics, empathy, psycho- the only variable related to empathy. To our knowledge, this is
logical distress, and well-being) were presented to 40 emergency the first study to report this relationship in nurses.
nurses. Thirty emergency nurses completed all questionnaires
during work hours. Descriptive statistics, group comparisons, and Key words: Empathy; Well-being; Distress; Pain management;
correlation analyses were used for the data analysis. Emergency nurse

n recent years, the prevalence of pain has been high in a study showed that 78% of ED patients have severe pain

I the emergency department, but unfortunately its

management does not seem to be optimal. Indeed,
(7-10 on a scale of 10), yet only 27% receive analgesia. 1 A
more recent study noted gaps in pain management. 2
Clearly, at a time when multiple analgesics are available and
postanalgesia monitoring can be performed via heart-
Patricia Bourgault is Professor, École des sciences infirmières, Faculté de médecine
et des sciences de la santé, Université de Sherbrooke, Québec, Canada. monitoring devices, this lack of pain relief calls for
Stephan Lavoie is Assistant Professor, École des sciences infirmières, Faculté de exploration. The Fosnocht team 3 has provided one
médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada. explanation: the main goal of ED care is to identify the
Emilie Paul-Savoie is PhD Student, École des sciences infirmières, Faculté de cause of pain, overshadowing the management of that pain.
médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada. Yet even after the cause has been identified, pain seems to
Maryse Grégoire is Faculty Lecturer, École des sciences infirmières, Faculté de be allowed to persist, as one study showed that 82% of
médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada, patients who were in pain upon arriving at the emergency
and Clinical Nurse Specialist, Direction interdisciplinaire des services cliniques du
department were still in pain when they were discharged. 1
Centre hospitalier Universitaire de Sherbrooke, Québec, Canada.
This percentage is alarming because nurses have an ethical
Cécile Michaud is Professor, École des sciences infirmières, Faculté de médecine
et des sciences de la santé, Université de Sherbrooke, Québec, Canada. and legal responsibility to address the experience of the person
Emilie Gosselin is PhD Student, École des sciences infirmières, Faculté de suffering from pain by assessing the presence of pain and
médecine et des sciences de la santé, Université de Sherbrooke, Québec, Canada. intervening on behalf of that person’s interest in accordance
Celeste C. Johnston is Emeritus Professor, post-retirement, School of Nursing, with the guidelines of the institution. 4
McGill University, Québec, Canada. A second possible explanation is that nurses’ attitudes
For correspondence, write: Patricia Bourgault, PhD, RN, École des sciences toward pain evaluation and relief, and how they perceive
infirmières, Faculté de médecine et des sciences de la santé, Université de their patients’ pain, may be obstacles to optimal pain
Sherbrooke; 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada, J1H 5N4;
management. 5 Indeed, a lack of correlation has been
E-mail: Patricia.Bourgault@USherbrooke.ca.
observed between pain intensity in the postoperative
J Emerg Nurs ■.
0099-1767 period as documented by nurses and their patients. 6 A real
Copyright © 2015 Emergency Nurses Association. Published by Elsevier Inc. difference appears to exist between the level of pain felt by
All rights reserved. patients and the level of pain perceived by their nurses. It
http://dx.doi.org/10.1016/j.jen.2014.10.001 is suggested that whether pain is treated or allowed to

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RESEARCH/Bourgault et al

persist could be explained by nurses’ knowledge about

pain management, their personal traits, and their level of Methods
empathy as suggested by the model of Patiraki-Kourbani STUDY DESIGN AND SETTING
et al, 7 who demonstrate, after a qualitative study conducted
with 46 nurses, that nurses need theoretical knowledge A cross-sectional descriptive correlational design was used
to treat pain, along with personal and professional for this pilot study conducted with a French-speaking
experiences. That knowledge is influenced by patient population. Recruiting was conducted through convenience
characteristics and by their own personal characteristics, sampling in a university hospital center located in the
including their empathy level. This last hypothesis needs to Province of Québec, Canada. The hospital center has 2
be explored. emergency departments at separate sites, employing 125
Recent studies have revealed significant gaps in nurses’ nurses. The 2 emergency departments combined treat close
knowledge about pain, particularly those working in to 100,000 patients a year.
surgery 8,9 and emergency departments. 10,11 This situation
seems to have been the case for years, because such knowledge PARTICIPANTS
gaps were observed more than 20 years ago with regard to
both pain evaluation 12,13 and administration of analge- After obtaining approval from the Ethics Committee of the
sics. 14,15 Concerning the personal traits of nurses, it is local hospital, 2 researchers (PB and SL) presented the study
proposed that nurses underestimate pain levels because of to the nurses in both emergency departments. A sample size
professional detachment, a protective mechanism they have of 37 nurses was calculated from the formula for an
developed as a way of dealing with other people’s pain. 16 association between 2 continuous variables (empathy and
Other evidence points to mental health as an explanation— well-being). We wanted to be able to detect any correlation
that is, psychological distress could erode the empathy of greater than 0.40 with 80% power and a 5% α level. A total
medical residents 17,18 and with it the quality of care they of 40 nurses volunteered, representing all 3 work shifts.
provide. 18 In contrast, residents with better psychological Interested nurses signed a consent form, which explained the
well-being were found to be more compassionate and to study variables and confidentiality rules. Self-administered
provide better quality care, 19 while also displaying more questionnaires were completed and returned during work
empathy. 20 Empathy and sympathy are 2 distinct concepts hours with manager permission. To ensure their anonymous
that involve sharing, but whereas empathic caregivers share status, nurses deposited their completed questionnaires and
their understanding, sympathetic caregivers share their signed consent forms in separate boxes.
emotions with their patients. 21 Sympathy would be involved
in the burnout of caregivers. 22 However, only a handful of INSTRUMENTS
studies have examined the influence of psychological distress
and well-being on empathy in the context of nursing. In this study, the French validated versions of all instruments
A study of nurses working in postoperative acute care were used. Sociodemographic data based on Patiraki-Kourbani
found that they were moderately empathetic 23 but that et al. model were collected on the participants’ age, nursing
their empathy had no bearing on the quality of their pain experience, years of ED work, and education level (college,
management. Other research has found that empathy in university, and graduate studies). 7
nursing students diminishes over the course of their In health care, empathy is defined as a cognitive
studies. 24 On the other hand, a qualitative study has attribute involving an understanding of the patient’s
suggested that empathy is a key component of optimal experience and perspective, as a separate individual,
pain management. 25 In the same vein, other researchers combined with an ability to communicate that understand-
have observed a positive relationship between empathy ing to the patient. 27 For this study, empathy was measured
and pain relief. 26 In view of this lack of consensus, more using the Jefferson Scale of Physician Empathy (JSPE). 28
research is needed to shed light on the relationships among This self-administrated questionnaire consists of 20 items
these variables. divided into 4 dimensions: (1) adopting the patient’s
The goal of our pilot study was to better understand the perspective; (2) understanding the patient’s experiences,
shortfalls in pain management provided by ED nurses. Our feelings, and signals; (3) ignoring the patient’s perspective;
primary objective was to assess a group of ED nurses for their and (4) adopting the patient’s way of thinking. The JSPE
levels of psychological distress and well-being and their also includes one orphan item: the value placed on empathy.
empathy. Our secondary objective was to explore associations Participants respond to items on a 7-point Likert scale. The
among these variables. total score ranges from 20 to 140. The JSPE has good

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normality, we studied possible associations between

TABLE 1
empathy and other variables using Spearman correlation
Empathy and health mental scores
analyses. We then looked for differences between groups of
Variables Mean ± SD nurses by using Mann-Whitney nonparametric tests, with
JSPE 92.88 ± 6.99 the group as the independent variable and empathy and
EMMDP 24.03 ± 6.78 psychological distress as dependent variables. The statistical
EMMBEP 77.00 ± 9.34 significance threshold for all analyses was set to α b 0.05.
Data analysis was performed using PASW Statistics 18
EMMBEP, Échelle de mesure des manifestations de bien-être psychologique (Psychological Well-Being (SPSS Inc, Chicago, IL).
Manifestation Scale); EMMDP, Échelle de mesure des manifestations de la détresse psychologique
(Psychological Distress Manifestation Scale); JSPE, Jefferson Scale of Physician Empathy.

Results
internal consistency (Cronbach α = 0.77 to 0.89) good test-
retest reliability and construct validity. 27–29 For the French SOCIODEMOGRAPHIC CHARACTERISTICS
version, the instrument was adapted to apply to nurses Of the 40 nurses who volunteered, 30 were interested in the
instead of physicians, then translated into French and research and decided to take part in the study, and 29
validated by our team. 30 The stages of the validation of completed all questionnaires. Our sample was mostly
cross-cultural translation of Hebert were followed, includ- women (90%) and fairly young: 20% of participants were
ing reverse translation, submission to an expert committee, 20 to 25 years of age, 23.3% were 26 to 30 years, 23.3%
pre-test and test-retest reliability. 31 were 31 to 35 years, and 33.3 were older than 36 years. A
Mental health is defined as the ability to adapt to slight majority worked the day shift (53.3%), whereas
various pleasant and unpleasant situations; to maintain 33.3% worked evenings, 10% worked nights, and 3.3%
satisfying relationships with others; and to find a balance were on rotation through all 3 shifts. For 43.3% of
among all facets of life, be they physical, psychological, participants, the highest level of education completed was a
spiritual, social, or economic. 32 It has 2 sides: distress and college diploma, while for the remaining 56.7%, it was
well-being. 33 Distress has 4 dimensions (self-depreciation, university. The college diploma in nursing allows practice as
anxiety/depression, social disengagement, and irritability/ a general nurse (3-year program). The bachelor’s degree in
aggressiveness), 34 whereas well-being has 6 dimensions nursing prepares students to practice as a clinical nurse, and
(self-esteem, balance, social engagement, sociability, control this program is spread over 2 to 3 years. Most of the nurses
over self/events, and happiness). 35 Masse’s team 32 has in our sample had been working in the emergency
developed 2 measurement scales for distress and well-being: department for 1 to 5 years (44.8%); 34.5% had done so
the Échelle de mesure des manifestations de la détresse for 6 to 10 years; and 20.7% had more than 10 years of ED
psychologique (EMMDP; Psychological Distress Manifesta- experience. As for receiving ongoing training (credited or
tion Scale); and the Échelle de mesure des manifestations de accredited) specifically on pain management, 65.5% of our
bien-être psychologique (EMMBEP; Psychological Well- participants had done so as part of their jobs, and 34.6%
Being Manifestation Scale). Both are in French and were had done so by choice.
developed in Québec. The short versions consist of 43 items
for distress and 47 items for well-being. A 4-point Likert ASSOCIATIONS BETWEEN EMPATHY AND MENTAL
scale is used to respond to each statement. The total well- HEALTH
being score ranges from 47 to 188, and the total distress score
ranges from 0 to 129. The EMMDP and EMMBEP have Table 1 shows the average scores and standard deviations for
excellent internal consistency (Cronbach α = 0.93), and their empathy and mental health. No statistically significant
content and construct validity have been demonstrated with correlation was found between scores for empathy and
French-speaking adults. Their test-retest reliability has also psychological distress, but a negative correlation between
been demonstrated, confirming their temporal stability. age and psychological distress was observed (r = –0.38; P b
.05). However, as shown in Table 2, we observed a trend for
STATISTICAL ANALYSIS a moderate association between empathy level and
psychological well-being (r = 0.36; P = .08). We then used
Descriptive statistics regarding the characteristics of the the measure of psychological well-being (as determined by
sample are expressed in percentages, averages, and standard the EMMBEP) to split our sample into an above-average
deviations. Taking into account the sample size and data group and a below-average group, that is, (1) nurses with a

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TABLE 2 TABLE 3
Correlations between empathy and mental health Comparisons of empathy and psychological distress
Variables r P value according to well-being
EMMDP –0.06 .77 Nurses with a Nurses with a P value
high level of low level of
EMMBEP 0.36 .08 well-being (n =11) well-being (n =18)

EMMBEP, Échelle de mesure des manifestations de bien-être psychologique (Psychological Well- JSPE 96.40 ± 5.97 90.69 ± 6.84 .049
Being Manifestation Scale); EMMDP, Échelle de mesure des manifestations de la détresse EMMDP 23.64 ± 3.44 24.31 ± 8.38 .766
psychologique (Psychological Distress Manifestation Scale).

EMMDP, Échelle de mesure des manifestations de bien-être psychologique (Psychological Distress

Manifestation Scale); JSPE, Jefferson Scale of Physician Empathy.
high level of well-being and (2) nurses with a low level of well-
being. We found that the first group had significantly higher
levels of empathy than did the second group (P = .049). psychological well-being. Although the literature suggests
However, there was no difference in the 2 groups’ levels of that empathy declines with psychological distress, 17 we did
psychological distress. These results are presented in Table 3. not observe a statistically significant association between
these variables. However, we did identify a trend for an
association between empathy and psychological well-being.
Discussion This finding is consistent with studies of medical residents,
in which it was found that residents who had high levels of
In terms of average age, ratio of men to women, and years of well-being paid more attention to their patients’ experience
experience, our sample was comparable with what is found and showed more empathy. 46,47 The lack of correlation
among the nurses in our center’s emergency departments. 36 It between psychological distress and well-being can be
was therefore representative of the accessible population. The explained by our small sample size. To capture the essence
first objective of our study was to assess empathy, psychological of potential associations, we divided our sample of nurses
distress, and well-being in ED nurses. For empathy, our results into 2 groups as determined by their level of psychological
suggest that our sample was less empathetic than other groups well-being and found significantly higher average empathy
of nurses 37 or health professionals, such as physicians 28 and scores in the group with higher well-being (N 80). Again,
pharmacists. 38 This finding runs counter to the popular belief another team of researchers found similar results in a
that nurses are the most empathetic health professionals. 39 population of medical residents. 20
Those results must be taken with precaution considering
that our group of nurses simultaneously displayed a higher LIMITATIONS
level of psychological distress than the general population of
Canada, 40 together with a lower level of psychological well- This study has strengths and limitations. First, it touched on
being. Most studies of mental health in nurses focus on topics that can be sensitive in the health care professions,
psychological distress, 20,41 but few consider psychological that is, empathy and mental health. All the instruments
well-being. During the past few years, numerous studies have used for measuring these concepts were valid and suited to
documented the strong prevalence of psychological distress, the population being studied. Anonymous data collection
depression, and burnout among health professionals, 18,42 probably helped our participants express their true feelings,
including nurses. 43,44 The high levels of psychological distress reducing the risk of social desirability bias. However, the
observed in our study may be partially explained by the youth small number of participants and the fact that all were from
of the nurses in our sample, as also noted by the Lavoie- a single environment restricts the extent to which the results
Tremblay team. 44 We found a negative correlation between can be generalized. Also, because empathy has a behavioral
age and psychological distress (r = –0.38; P b .05), suggesting aspect, evaluating it with a self-administered questionnaire
that younger nurses have more psychological distress cannot provide a complete portrait. It would be better to
than their older colleagues. Similar results were found by combine multiple assessment approaches. 48
another recent study on ED nurses, showing a positive
IMPLICATIONS FOR EMERGENCY NURSES
association between young age and symptoms of posttrau-
matic stress. 45 To our knowledge, our study is the first to explore the
The second objective of our study was to look for relation between psychological well-being and empathy in
associations among empathy, psychological distress, and emergency nurses based on the model of Patiraki-Kourbani

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et al. 7 The literature contains several articles supporting the 7. Patiraki-Kourbani E, Tafas CA, Dillon McDonald D, Papathanassoglou
positive clinical benefits of empathy, such as better patient EDE, Katsaragasis S, Lemonidou C. Personal and professional pain
compliance and greater patient satisfaction. 49 However, our experiences and pain management knowledge among Greek nurses. Int J
results suggest that empathy can be eroded by poor mental Nurs Stud. 2004;41:345-354.
health, including a low level of well-being. Interestingly, a 8. Botti M, Bucknall T, Manias E. The problem of postoperative pain:
recent study describes an intervention to promote well-being issues for future research. Int J Nurs Pract. 2004;10:257-263.
that uses self-awareness exercises and clinical practice. 50 This 9. Lapré J, Bolduc N, Bourgault P. Implantation d’une Ligne directrice des
study showed that physicians who took part in the pratiques exemplaires en évaluation de la douleur en postopératoire. Inf
Clin. 2011;8:19-29.
intervention developed higher levels of empathy and
10. Melby V, McBride C, McAfee A. Acute pain relief in children: use of
psychological well-being. It would be interesting to explore
rating scales and analgesia. Emerg Nurs. 2011;19:32-37.
the impact of similar training with emergency nurses. Formal
training could also have an effect on empathy, because the 11. Tsai FC, Tsai YF, Chien CC, Lin CC. Emergency nurses’ knowledge of
perceived barriers in pain management in Taiwan. J Clin Nurs.
literature suggests that empathy levels decline during the
2007;16:2088-2095.
training of nursing 51 and medical 52 students.
12. McCaffery M, Ferrell BR. Nurses’ assessment of pain intensity and
choice of analgesic dose. Contemp Nurs. 1994;3:68-74.
13. McCaffery M, Ferrell RB. Nurses’ knowledge of pain assessment and
Conclusions management-how much progress have we made?. J Pain Symptom
Manage. 1997;14:175-188.
In conclusion, our results provide preliminary evidence that 14. Heath D. Nurses’ knowledge and attitudes concerning pain manage-
psychological well-being could play a key role in empathy in ment in an Australian Hospital. Aust J Adv Nurs. 1998;16:15-18.
ED nurses. Of the variables studied—psychological distress 15. McCaffery M, Ferrell RB. Opiod analgesics. Nurses’ knowledge of doses
and psychological well-being—only the latter seems to be and psychological dependence. J Nurs Staff Dev. 1992;77–84.
associated with empathy. Therefore, there is reason to 16. Campbell-Yeo M, Latimer M, Johnson C. The empathetic response in
believe that improving psychological well-being would lead nurses who treat pain: concept analysis. J Adv Nurs. 2008;61:711-719.
to higher levels of empathy. Our results also highlight the 17. Bellini LM, Baime M, Shea JA. Variation of mood and empathy during
presence of psychological distress in ED nurses, particularly internship. JAMA. 2002;287:3143-3146.
those who are younger. Further research is needed to 18. Shanafelt TD, Bradley KA, Wipf JE, Back AL. Burnout and self-
replicate these results with other populations of nurses and reported patient care in an internal medicine residency program. Ann
to determine if low levels of empathy are primary or Intern Med. 2002;136:358-367.
secondary to low levels of psychological well-being. 19. Shanafelt TD, Sloan JA, Habermann TM. The well-being of physicians.
Am J Med. 2003;114:513-519.
20. Shanafelt TD, West C, Zhao X, et al. Relationship between increased
REFERENCES personal well-being and enhanced empathy among internal medicine
1. Karwowski-Souilé F, Lessenot-Tcherny S, Lamarche-Vadel A, et al. Pain in residents. J Gen Intern Med. 2005;20:559-564.
an emergency department: an audit. Eur J Med. 2006;13:218-224. 21. Ninghtingale SD, Yarnold PR, Greenberg MS. Sympathy, empathy, and
2. Finn JC, Rae A, Gibson N, Swift R, Watters T, Jacobs IG. Reducing time to physician resource utilization. J Gen Intern Med. 1991;6:420-423.
analgesia in the emergency department using a nurse-initiated pain 22. Black S, Weinreich P. An exploration of counselling identity in
protocol: a before-and-after study. Contemp Nurs. 2012;43:29-37. counsellors who deal with trauma. In: Weinreich P, Saunderson W,
3. Fosnocht DE, Swanson ER, Barton ED. Changing attitudes about pain (eds.), Analysing Identity: Cross Cultural, Societal and Clinical Contexts
and pain control in emergency medicine. Emerg Med Clin North Am. London: Routledge & Kegan Paul; 2003:339-360.
2005;23:297-306. 23. Reynolds WJ, Scott B. Do nurses and other professional helpers
4. Registered Nurses’ Association of Ontario. Assessment and Management normally display much empathy? J Adv Nurs. 2000;31:226-234.
of Pain. 3rd ed. Toronto, Canada: Registered Nurses’ Association of 24. Watt-Watson J. Relationship Between Nurses’ Empathic Responses and
Ontario; 2013. Pain Management in Acute Care [thesis], Toronto: University of
5. Shaban RZ, Holzhauser K, Gillespie K, Huckson S, Bennett S. Toronto; 1997.
Characteristics of effective interventions supporting quality pain 25. Watt-Watson J, Stevens B, Garfinkel P, Streiner D, Gallop R. Relationship
management in Australian emergency departments: an exploratory between nurses’ pain knowledge and pain management outcomes for their
study. Australas Emerg Nurs J. 2012;15:23-30. postoperative cardiac patients. J Adv Nurs. 2001;36:535-545.
6. Bergeron DA, Leduc G, Marchand S, Bourgault P. Étude descriptive du 26. Bolduc N, Bourgault P, Michaud C, Lapré J. Questionnaire de Toronto
processus d’évaluation et de documentation de la douleur postopératoire sur la gestion de la douleur. IVe Congrès mondial des infirmières et
dans un hôpital universitaire. Pain Res Manag. 2011;16:81-86. infirmiers. 8 juin 2008; Marrakech (Maroc).

■ ■ • ■ WWW.JENONLINE.ORG 5

Master Proof ymen2663.pdf

RESEARCH/Bourgault et al

27. Hojat M, Gonnella JS, Nasca TJ, Mangione S, Vergare M, Magee M. 38. Fjortoft N, Van Winkle LJ, Hojat M. Measuring empathy in pharmacy
Physician empathy: definition, components, measurement and relationship student. Am J Pharm Educ. 2011;75:109.
to gender and specialty. Am J Psychiatry. 2002;159:1563-1569. 39. Ozcan CT, Oflaz F, Sutcu Cicek H. Empathy: the effects of undergraduate
28. Hojat M, Mangione S, Nasca TJ, et al. The Jefferson scale of physician nursing education in Turkey. Int Nurs Rev. 2010;57:493-499.
empathy: development and primary psychometrics. Educ Psychol Meas. 40. Statistiques Canada. Taux d’absence du travail 2004 (Vol. 71-211-XIF),
2001;61:349-365. Ottawa: Ministre de l’industrie; 2005.
29. Hojat M, Gonnella JS, Mangione S, Nasca TJ, Magee M. Physician 41. Myers MF. The well-being of physician relationships. West J Med.
empathy in medical education and practice: experience with the Jefferson 2001;174:30-33.
Scale of Physician Empathy. Semin Integr Med. 2003;1:25-41. 42. Boudreau RA, Grieco RL, Cahoon SL, Robertson RC, Wedel RJ. The
30. Bourgault P, Michaud C, Bolduc N, Lapré J. Validation culturelle et pandemic from within: two surveys of physician burnout in Canada.
application de questionnaires sur les connaissances en gestion de la douleur et Can J Commun Ment Health. 2006;25:71-88.
l’empathie. Séance parallèle. IV e Congrès mondial des infirmières et 43. Bourbonnais R, Brisson C, Malenfant R, Vézina M. Health care
infirmiers. Secrétariat international des infirmières et infirmiers de
restructuring, work environment, and health of nurses. Am J Ind Med.
l’espace francophone. June 8, 2009; Marrakech (Maroc). 2005;47:54-64.
31. Hébert R, Bravo G, Voyer L. Measuring instrument’s translation for 44. Lavoie-Tremblay M, Sounan C, Lavigne GL, et al. The psychosocial
gerontologic research in French: methodological criteria and inventory.
work environment and evidence utilization by health professionals. Can
Rev Can Vieillissement. 1994;13:392-405. J Nurs Res. 2008;40:112-128.
32. World Health Organisation. Promoting mental health. www.who.int/ 45. Lavoie S, Talbot LR, Mathieu L. Post-traumatic stress disorder
mental_health/evidence/MH_Promotion_Book.pdf. Published 2005.
symptoms among emergency nurses: their perspective and a “tailor-
Accessed October 16, 2014. made” solution. J Adv Nurs. 2011;67:1514-1522.
33. Massé R, Poulin C, Dassa C, Lambert J, Bélair S, Battaglini MA. 46. Novack DH, Suchman AL, Clark W, Epstein R. Calibrating the physician.
Élaboration et validation d’un outil de mesure de la santé mentale,
Personal awareness and effective patient care. JAMA. 1997;278:502-509.
Montréal, Canada: Régie régionale de la santé et des services sociaux de
47. Novack DH, Epstein RM, Paulsen RH. Toward creating physician-
Montréal-Centre; 1998.
healers: fostering medical students’ self-awareness, personal growth, and
34. Massé R, Poulin C, Dassa C, Lambert J, Bélair S, Battaglini MA. well-being. Acad Med. 1999;74:516-520.
Élaboration et validation d’un outil de mesure de la détresse
48. Teherani A, Hauer KE, O’Sullivan P. Can simulations measure
psychologique dans une population non clinique de Québécois
empathy? Considerations on how to assess behavioural empathy via
francophones. Can J Public Health. 1998;89:183-187.
simulations. Patient Educ Couns. 2008;71:148-152.
35. Massé R, Poulin C, Dassa C, Lambert J, Bélair S, Battaglini A.
49. Hojat M. Empathy in Patient Care: Antecedents, Development, Measure-
Élaboration et validation d'un outil de mesure du bien-être
ment, and Outcomes, New York, NY: Springer; 2007.
psychologique: L'ÉMMDEP. Rev Can Sante Publique. 1998;89:
352-357. 50. Krasner MS, Epstein RM, Beckman H, et al. Association of an educational
program in mindful communication with burnout, empathy, and attitudes
36. Lavoie S, Bourgault P, Grégoire M. Empathy, psychological distress
among primary care physicians. JAMA. 2011;302:1284-1293.
among ER nurses and pain management: nurses’ perceptions, Atlanta,
GA: International Society of Traumatic Stress Studies; 2009. 51. Ward J, Cody J, Schaal M, Hojat M. The empathy enigma: an empirical
study of decline in empathy among undergraduate nursing students.
37. Fields SK, Mahan P, Tillman P, Harris J, Maxwell K, Hojat M.
J Prof Nurs. 2012;28:34-40.
Measuring empathy in healthcare profession students using the Jefferson
Scale of Physician Empathy: health provider–student version. J Interprof 52. Pedersen R. Empathy development in medical education—a critical
Care. 2011;25:287-293. review. Med Teach. 2010;32:593-600.

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