Perceptualand Motor Skills, 1991, 72, 743-747.
63 Perceprual and Motor Skills 1991
EMPATHY, OTHERS-CONCEPT, A N D PROSOCIAL ORIENTATION CAROLYN FAKOURI School of Nursing KARL B. ZUCKER AND M. EBRAHIM FAKOURI Department of Edtrcational and School Psychology Indiana State Uniuersio Summary.-The relationship between 56 nursing students' empathy and their others-concept was investigated to establish ties to a broader construct, prosocial odentation. The female Caucasian nursing students were rated for empathy by two clinical instructors. They were also given the Paired Hands Test to assess their others-concept. The students with the higher empathy ratings had more positive others-concepts. The responses of the low empathy group to the Paired Hands Test indicated a much stronger tendency to perceive and interpret social interactions negatively. Besides practical implications for nurses and other helping professionals, these findings have theoretical ramifications as well. Others-concept has been shown previously to be related to a cluster of variables such as positive social behavior and moral judgment. Evidence of the relationship to empathy helps to tie this cluster to the prosocial orientation construct as a base for further research.
The construct of empathy, which has been considered to be important for the helping professions (e.g., Gladstein, 1986; Rogers, 1965), also figures prominently in the theoretical literature on "prosocial orientation" (e.g., Staub, 1988). A person who has a prosocial orientation, as we view it, is a caring individual who is empathic, has moral sensitivities, and is motivated to interact positively with others. Prosocial orientation is a more inclusive concept than prosocial behavior because it includes cognitive, affective, and behavioral components. Based on these assumptions, a person with a prosocial orientation would be expected to view other people from a positive perspective, other things being equal. We have described such a perspective elsewhere as having a positive others-concept (Barnett & Zucker, 1975). Empirical evidence indicates that people who have positive others-concepts, when compared to people who have negative others-concepts, tend to engage in more positive social interactions (Barnett & Zucker, 1973, 1975, 1977, 1980a, 1980b) and more principled moral reasoning (Hanlin & Zucker, 1986; Whiteman, Zucker, & Grirnley, 1978). They also are more likely to be accommodating, sensitive, 'The support of Indiana State University's Research Committee is acknowledged and appreciyed. Address correspondence to C. Fakouri, School of Nursing, Indiana State University, Terre Haute. I N 47809.
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C. FAKOURI, ETAL.
conscientious, forthright, spontaneous, and self-disciplined (L. Cohen, 1981). From this information on variables associated with a positive others-concept, one would anticipate that were an acceptable measure of empathy obtained, people with positive others-concepts would also be empathic. If that could be established, we would have identified empirically a cluster of interrelated and assessible variables that mav be important components for the study of a prosocial orientation. The availability of a sample of student nurses provided an opportunity to explore this hypothesis. The importance of empathy for the nursing profession is well documented (see, for example, S. Cohen, 1983; Forsyth, Kubesh, Maloney, Story, & Delaney, 1989; LaMonica, Carew, Winder, Haase, & Blanchard, 1976). I n this particular program, each student nurse works closely with two different clinical nursing instructors for at least one semester, offering an opportunity for obtaining relatively consistent ratings of empathy. Given the importance of empathy for a prosocial orientation and the demonstrated relationship between others-concept and other variables important for a prosocial orientation, we wished to see if a tie between empathy and others-concept could be established empirically. The purpose of this study, therefore, was to investigate the relationship between nursing students' empathy, as perceived by clinical nursing instructors, and the others-concept of the students. We hypothesized that high empathy would be associated with a positive others-concept. Although empathy has been defined and studied from both affective and cognitive perspectives, we chose Iannotti's (1975) affective definition (responsiveness of an individual to the feelings of another person) for our research for reasons explained later in this article; see the Results and Discussion section below.
Subjects Subjects were 56 students enrolled in a nursing program at a midwestern university. The students were Caucasian women; their mean age was 23 years.
Procedure Assessments of the student nurses' others-concepts were obtained from the Paired Hands Test (Zucker & Barnett, 1977), which was administered to the student nurses during the beginning of their program. The Paired Hands Test is a short projective technique comprised of a series of 20 photographs of two hands interacting, to which the examinee responds in terms of what the hands might be doing. Responses are scored along a seven-point positive-negative continuum, depending upon how the people whose hands are represented in the photographs are perceived to be interacting and feeling
EMPATHY, OTHERS-CONCEPT, PROSOCIAL ORIENTATION
745
about each other. A response implying a very warm feeling is scored 7, perceptions of very negative interactions are scored 1, and other responses are scored along a continuum between these two points. The highest possible score is 140. Therefore, the higher a person's score, the higher is that person's others-concept assumed to be, i.e., the more that person is assumed to view people and social interactions from a positive perspective. The test can be administered individually or in a group. Likewise, it can be administered using an open-ended or a multiple-choice format. For this study it was administered individually, and open-ended responses were recorded verbatim. Interscorer agreement when the Paired Hands Test is administered in this manner was found in another study to be 74.25% among three raters who scored 400 responses; a difference of more than one point was found on only 5.5% of the responses (Fetz & Zucker, 1985). Numerous published reports offer support for validity of the Paired Hands Test as a measure of a person's others-concept, viewed as one's general expectancies or perceptions of other people along a positive-negative continuum (Barnett & Zucker, 1973, 1975, 1977, 1980a, 1980b). The empathy ratings were obtained some time later, after the students had completed a clinical nursing course. Two instructors of nursing, who had worked closely with the students in a supervisory relationship for at least one semester, independently rated each student. The instructors were told to consider empathy as "the ability to feel the same as someone else feels." They rated each student on a 5-point scale, and the average of the ratings from the two instructors was used as the student's index of empathy for the purposes of this research. The interrater correlation for 16 randomly chosen subjects was .90.
RESULTSAND DISCUSSION Analysis indicated that the student nurses as a whole could be described as having high ratings in empathy and relatively positive perceptions of others. The mean ernpathy rating for the entire sample of student nurses was 3.8. Their mean score and standard deviation on the Paired Hands Test were 95.6 and 7.91, respectively. The mean of normative data based on a sample of 512 female freshman college students is 93.0 (Barnett & Zucker, 1977). Although these findings indicate that the sample of student nurses had high empathy ratings and, compared with normative data, had more positive others-concepts, intragroup variation existed on both dimensions. Based on their average empathy ratings, students were divided into two groups, those who were rated 4 or above (ranged from 4 to 5) and those who were rated below 4 (ranged from 1.5 to 3.5), and the Paired Hands Test scores of the two groups were compared. The means and standard deviations of Paired Hands Test scores for the group showing higher empathy were 97.3 and 6.3 and for the group showing lower empathy were 93.3 and 9.33, respectively.
746
C. FAKOURI, ET AL.
The difference between the two means was statistically significant (t = 1.85,
p < ,031. Although instructors' ratings are not a highly refined measure of empathy, they appeared adequate for distinguishing relative differences in empathy among students in a group who were basically rated high and for whose scores the range was narrow. Further comparisons of the two groups showed other differences. When the number of high scores (6 or 7) on Paired Hands Test photographs given by the high empathy group was compared to the number given by the low empathy group, it indicated no significant difference. However, the comparison of the number of low Paired Hands Test scores (1 or 2) of the two groups showed that the low empathy group gave significantly more 1 and 2 responses to Paired Hands Test photographs than did the high empathy group (X2= 5.67, p
63 Perceprual and Motor Skills 1991
EMPATHY, OTHERS-CONCEPT, A N D PROSOCIAL ORIENTATION CAROLYN FAKOURI School of Nursing KARL B. ZUCKER AND M. EBRAHIM FAKOURI Department of Edtrcational and School Psychology Indiana State Uniuersio Summary.-The relationship between 56 nursing students' empathy and their others-concept was investigated to establish ties to a broader construct, prosocial odentation. The female Caucasian nursing students were rated for empathy by two clinical instructors. They were also given the Paired Hands Test to assess their others-concept. The students with the higher empathy ratings had more positive others-concepts. The responses of the low empathy group to the Paired Hands Test indicated a much stronger tendency to perceive and interpret social interactions negatively. Besides practical implications for nurses and other helping professionals, these findings have theoretical ramifications as well. Others-concept has been shown previously to be related to a cluster of variables such as positive social behavior and moral judgment. Evidence of the relationship to empathy helps to tie this cluster to the prosocial orientation construct as a base for further research.
The construct of empathy, which has been considered to be important for the helping professions (e.g., Gladstein, 1986; Rogers, 1965), also figures prominently in the theoretical literature on "prosocial orientation" (e.g., Staub, 1988). A person who has a prosocial orientation, as we view it, is a caring individual who is empathic, has moral sensitivities, and is motivated to interact positively with others. Prosocial orientation is a more inclusive concept than prosocial behavior because it includes cognitive, affective, and behavioral components. Based on these assumptions, a person with a prosocial orientation would be expected to view other people from a positive perspective, other things being equal. We have described such a perspective elsewhere as having a positive others-concept (Barnett & Zucker, 1975). Empirical evidence indicates that people who have positive others-concepts, when compared to people who have negative others-concepts, tend to engage in more positive social interactions (Barnett & Zucker, 1973, 1975, 1977, 1980a, 1980b) and more principled moral reasoning (Hanlin & Zucker, 1986; Whiteman, Zucker, & Grirnley, 1978). They also are more likely to be accommodating, sensitive, 'The support of Indiana State University's Research Committee is acknowledged and appreciyed. Address correspondence to C. Fakouri, School of Nursing, Indiana State University, Terre Haute. I N 47809.
744
C. FAKOURI, ETAL.
conscientious, forthright, spontaneous, and self-disciplined (L. Cohen, 1981). From this information on variables associated with a positive others-concept, one would anticipate that were an acceptable measure of empathy obtained, people with positive others-concepts would also be empathic. If that could be established, we would have identified empirically a cluster of interrelated and assessible variables that mav be important components for the study of a prosocial orientation. The availability of a sample of student nurses provided an opportunity to explore this hypothesis. The importance of empathy for the nursing profession is well documented (see, for example, S. Cohen, 1983; Forsyth, Kubesh, Maloney, Story, & Delaney, 1989; LaMonica, Carew, Winder, Haase, & Blanchard, 1976). I n this particular program, each student nurse works closely with two different clinical nursing instructors for at least one semester, offering an opportunity for obtaining relatively consistent ratings of empathy. Given the importance of empathy for a prosocial orientation and the demonstrated relationship between others-concept and other variables important for a prosocial orientation, we wished to see if a tie between empathy and others-concept could be established empirically. The purpose of this study, therefore, was to investigate the relationship between nursing students' empathy, as perceived by clinical nursing instructors, and the others-concept of the students. We hypothesized that high empathy would be associated with a positive others-concept. Although empathy has been defined and studied from both affective and cognitive perspectives, we chose Iannotti's (1975) affective definition (responsiveness of an individual to the feelings of another person) for our research for reasons explained later in this article; see the Results and Discussion section below.
Subjects Subjects were 56 students enrolled in a nursing program at a midwestern university. The students were Caucasian women; their mean age was 23 years.
Procedure Assessments of the student nurses' others-concepts were obtained from the Paired Hands Test (Zucker & Barnett, 1977), which was administered to the student nurses during the beginning of their program. The Paired Hands Test is a short projective technique comprised of a series of 20 photographs of two hands interacting, to which the examinee responds in terms of what the hands might be doing. Responses are scored along a seven-point positive-negative continuum, depending upon how the people whose hands are represented in the photographs are perceived to be interacting and feeling
EMPATHY, OTHERS-CONCEPT, PROSOCIAL ORIENTATION
745
about each other. A response implying a very warm feeling is scored 7, perceptions of very negative interactions are scored 1, and other responses are scored along a continuum between these two points. The highest possible score is 140. Therefore, the higher a person's score, the higher is that person's others-concept assumed to be, i.e., the more that person is assumed to view people and social interactions from a positive perspective. The test can be administered individually or in a group. Likewise, it can be administered using an open-ended or a multiple-choice format. For this study it was administered individually, and open-ended responses were recorded verbatim. Interscorer agreement when the Paired Hands Test is administered in this manner was found in another study to be 74.25% among three raters who scored 400 responses; a difference of more than one point was found on only 5.5% of the responses (Fetz & Zucker, 1985). Numerous published reports offer support for validity of the Paired Hands Test as a measure of a person's others-concept, viewed as one's general expectancies or perceptions of other people along a positive-negative continuum (Barnett & Zucker, 1973, 1975, 1977, 1980a, 1980b). The empathy ratings were obtained some time later, after the students had completed a clinical nursing course. Two instructors of nursing, who had worked closely with the students in a supervisory relationship for at least one semester, independently rated each student. The instructors were told to consider empathy as "the ability to feel the same as someone else feels." They rated each student on a 5-point scale, and the average of the ratings from the two instructors was used as the student's index of empathy for the purposes of this research. The interrater correlation for 16 randomly chosen subjects was .90.
RESULTSAND DISCUSSION Analysis indicated that the student nurses as a whole could be described as having high ratings in empathy and relatively positive perceptions of others. The mean ernpathy rating for the entire sample of student nurses was 3.8. Their mean score and standard deviation on the Paired Hands Test were 95.6 and 7.91, respectively. The mean of normative data based on a sample of 512 female freshman college students is 93.0 (Barnett & Zucker, 1977). Although these findings indicate that the sample of student nurses had high empathy ratings and, compared with normative data, had more positive others-concepts, intragroup variation existed on both dimensions. Based on their average empathy ratings, students were divided into two groups, those who were rated 4 or above (ranged from 4 to 5) and those who were rated below 4 (ranged from 1.5 to 3.5), and the Paired Hands Test scores of the two groups were compared. The means and standard deviations of Paired Hands Test scores for the group showing higher empathy were 97.3 and 6.3 and for the group showing lower empathy were 93.3 and 9.33, respectively.
746
C. FAKOURI, ET AL.
The difference between the two means was statistically significant (t = 1.85,
p < ,031. Although instructors' ratings are not a highly refined measure of empathy, they appeared adequate for distinguishing relative differences in empathy among students in a group who were basically rated high and for whose scores the range was narrow. Further comparisons of the two groups showed other differences. When the number of high scores (6 or 7) on Paired Hands Test photographs given by the high empathy group was compared to the number given by the low empathy group, it indicated no significant difference. However, the comparison of the number of low Paired Hands Test scores (1 or 2) of the two groups showed that the low empathy group gave significantly more 1 and 2 responses to Paired Hands Test photographs than did the high empathy group (X2= 5.67, p
