The nurse-patient relationship is an interaction between two people who have different personal interests. ¹ From a clinical and human perspective it has been stablished that this relationship contributes to the recovery process of the patient's health. This has forced medical sciences to incorporate theories of psycho-dynamic and bio-psycho-social analysis, not only in the explanation of the genesis, maintenance and resolution of diseases, ² but also in the patient's general care process. ³ As a consequence, it is necessary for nurses to develop empathic communication with their patients. ⁴

Empathy in health care is understood as a cognitive and behavioral attribute that implies the ability to understand how the patient's experiences and feelings influence and are influenced by the disease and its symptoms. ^5-7 Review of literature indicates that empathy relates to a number of other attributes, such as pro-social behavior, ability to obtain a medical history, increased patient and physician satisfaction, improved therapeutic relationships, and good clinical outcomes. ⁶ The objective of the present study was to estimate the levels of empathy in general (and that of each of its components or dimensions) of nursing students.

Exploratory and cross-sectional study. The population consists of students enrolled in the Nursing Program of the Faculty of Health Sciences at the University of Tolima, Colombia (N = 312, n = 253, 81.08% of the population). The gender factor was the following: female = 123 and male = 130. The information was collected in February 2018. Participants were given the JMSE, (Version-S), validated and adapted for nursing students in Colombia. It was submitted to judges (five) for the purpose of verifying cultural and content validity®. The application was confidential and students' understanding of the culturally adapted scale was performed through a pilot test.

The authors tested the data for normality (Kolmogorov-Smirnov) and homoscedasticity (Le-vene). The internal reliability was estimated using the general Cronbach's alpha and interclass correlation coefficient. It was estimated Hotelling's T², Tukey's non-additivity test, mean and standard deviation. Analysis of variance (ANOVA) and the SPSS 25.0 program were applied. The Total Possible Growth Potential (TPGP) was considered as the quotient between two magnitudes: a) the actual difference between the observed scores of fifth-year students minus the score of first-year students (D1) with respect to b) the difference between the highest value of empathy allowed by the instrument (140) and the effective value of the empathy of first-year students (D2): TPGP=D1/D2. This indicator allows evaluating the magnitude of advancement, regression, or stagnation of empathy. The components operate in the same way, the maximum values were considered specifically for each one of them. The significance level used was a < 0.05 and P <0.20, based on the bioethical standards of Helsinki (2013).

The Kolmogorov-Smirnov and Levene tests were not significant (p> 0.05). Cronbach's alpha was satisfactory (not typified = 0.891 and typified = 0.886). The interclass correlation coefficient was 0.891; IC [0.87; 0.909] (F=9.15; p=0.005). The T² test of Hotelling (F=448.8; p=0.0001) and Tukey non-additive (F = 14.19; p = 0.001). The results of the estimates of descriptive statisticians are shown in Table 1.

Table 1

Table 2 shows the results of the ANOVA. It was observed that in Empathy (E), were highly significant in the three factors; the eta-square value was satisfactory and the power observed was high; the average for women was 101.0, and that for men was 92.89. The "Compassionate Care"(CC) component behaved in the same way as "Empathy." The women's average was of 32.87 and of the men of 27.48 (of a maximum of 49 points). In the component of "Taking the Patient's Perspective"(TPP), it was observed that academic year (AY) and gender factors were highly significant; Eta-square values were low and satisfactory power for both factors; the average for women was 57.46 and for men it was 52.27 (from a maximum of 70 points). Finally, in the component of "Ability to Understand Others"(AUO), it was found only that the factor AY and AY * Gender were significant and with values of eta-square and satisfactory power. The women achieved an average of 10.32 and the men 10.17 (of a maximum of 21 points).

Table 2

Table 3 presents the results of the multiple comparisons of the means in the factor AY in "Empathy" and each of the components. In empathy, the formation of three groups (with ascending values) is observed: the first year is the one with the lowest value, then increases in the second, fourth, and fifth year, but the highest value is recorded in the third year. If we consider that the potential growth of first-year students was 61.51 (140-78.49) then the difference between the empathy of the fifth and first-year students (95.7-78.49) was 17.21 points, which means that only was covered 27.98% of the total potential growth of empathy.

Table 3

In the "CC" component, found a situation analogous to the behavior of empathy. Three well-defined groups are formed: the first formed by the first, fifth, and fourth years, the next group formed by the second year, and the last by the third year students. If we consider that the growth potential of first year students was 23.96 (49-25.04); then the difference between the empathy of the fifth and first-year students (26.4-25.04) was 1.36 points, that is, 5.67% of the potential growth possible of this component.

Concerning the "TPP," also three groups are formed (with ascending values). The first-year group has the lowest values, followed by the second, ifth and third, and inally, the fourth year is the highest value. The potential growth of empathy in this component is 27.58 points; then, the difference between the first and fifth year was 18.09; consequently, the growth potential in this component was 65.58%.

We observed in the component "AUO" that data produced two groups: the first formed by the fourth, fifth, and third-year students and, secondly, by the first and second years students. The potential growth of this component of empathy was -22.46%. By comparing the real growth between the fifth and irst year to the maximum possible growth and the irst year, there is a decrease in this component.

Finally, Figure 1 (1a through 1d) shows the means at AY and Gender levels. Women were found to behave differently between the second, fourth and fifth years; these values of empathy in general are higher in the female gender, but in the first year and third tend to equalize (1a). Regarding the component of "CC" (1b), we found that the differences found are similar to the behavior of "Empathy." However, in the two remaining components of the behavior of gender in different years does not follow the patterns noted, but it is always in favor of women. In the "TPP," gender differences are deepened in the fifth year and are entirely upward in females and upward in males up to the fourth year (1c). Finally, in the component the "AUO," the feminine gender surpasses the masculine in almost every academic year (with the exception of the second year that is greater in the women) and undergoes a process of decrement in the values of this component.

The behavior of the levels of empathy observed in this study agrees with the concept of empathic erosion, especially when analyzing empathic behavior in the male gender. This is no further evidence that empathic erosion is a general case, but that this process is one more case of several types of distributions. The empathy levels in the students examined are relatively low. Results such as these strongly suggest to the authorities of any university the need to take measures, both in the curriculum as in teaching-learning methodologies, which must be implemented in the teaching processes in nursing.