The Relationship Among Attachment, Empathy, and Caring in Baccalaureate Nursing Students

Abstract

Empathy and caring are the foundations upon which the fundamentals and principles of nursing practice are grounded, and help to delicately balance scientific knowledge and humanistic behaviours. Three nursing organizations in Canada: 1) the Canadian Nurses Association (CNA), 2) College of Nurses of Ontario (CNO), and 3) Registered Nurses Association of Ontario (RNAO), through a code of ethics, professional practice standards, and best practice guidelines, advocate for the delivery of safe, ethical and empathetic nursing care. Caring relationships in nursing, based on trust, respect, professional intimacy, and evidence contribute to therapeutic nurse-patient relationships. Unfortunately, many nursing students are unable to develop therapeutic relationships based upon their internal working models (IWM) formed in childhood. Depending on the consistency of care received in childhood especially during times of stress a relatively stable pattern of low attachment avoidance and low attachment anxiety develops. Whereas, inconsistent care can lead to high attachment avoidance where individuals present as uncaring, emotionally distant, and self-reliant, while individuals with high attachment anxiety fear rejection, abandonment, and worry others will be unavailable or unresponsive to them. The purpose of this study was the testing of a theoretical model linking attachment avoidance and attachment anxiety to empathy, the mediator variable, and caring. This cross-sectional survey of 192 baccalaureate nursing students in a collaborative nursing program in Ontario were sampled and a theoretical model was tested using latent variable structural equation modeling (SEM) techniques. The final analysis revealed a relatively good fit of the data to the hypothesized model (X2 =129.30; p <.01; df = 57; X2/df = 2.26), high GFI (.92), high TLI (.92), high CFI (.94), and an acceptable RMSEA (.07). Higher caring was significantly correlated with empathy while attachment avoidance was negatively correlated with empathy. The model demonstrated there was no direct effect between attachment avoidance and caring while empathy fully mediated the relationship between these constructs. These findings suggest new evidence in understanding attachment avoidance indirectly affects nursing students’ caring abilities through empathy. From these results, nurse educators’ empathy and caring toward nursing students may have an impact on students’ IWM, empathy, caring and therapeutic relationships.