Why Empathy Matters in HIV Nursing Education: Building Student Nurses’ Willingness to Care

Article information

Shi, C., & Cleofas, J. V. (2022). Professional commitment and willingness to care for people living with HIV among undergraduate nursing students: The mediating role of empathy. Nurse Education Today, 119(105610), 105610. https://doi.org/10.1016/j.nedt.2022.105610 

What this study is about

People living with HIV need respectful, competent, and compassionate healthcare. Nurses play a major role in this because they are often the largest group of healthcare providers and are deeply involved in prevention, treatment, education, monitoring, and everyday patient care. But HIV-related stigma remains a problem in many healthcare settings. Some students and professionals may feel fear, discomfort, or reluctance when asked to care for people living with HIV. 

This study asks an important education question: What makes nursing students more willing to care for people living with HIV?

Specifically, the authors examined three concepts:

1. Professional commitment — how strongly students identify with nursing, value the profession, and are willing to make an effort as future nurses.
2. Empathy — the ability to understand patients’ perspectives, needs, and suffering.
3. Willingness to care — students’ readiness to perform nursing care activities for people living with HIV. 

The central idea is that students who are more committed to nursing may be more willing to care for people living with HIV—but this relationship may partly work through empathy.

Why this matters

HIV care is not only a technical issue. It is also an ethical and relational issue.

A student may know how HIV is transmitted, but still feel afraid. A student may understand infection control, but still hold stigma. A student may believe nursing is important, but still hesitate when the patient is someone living with HIV.

That is why this study matters. It suggests that nursing education should not focus only on HIV facts. It should also develop students’ professional identity and empathic capacity. In other words: students must learn not only what HIV is, but how to care for people living with HIV as persons deserving dignity, safety, and respect. 

What the researchers did

This was a quantitative cross-sectional study involving 747 undergraduate nursing students from nursing schools in five provinces of China: Hunan, Jiangxi, Guangxi, Henan, and Hebei. The participants were full-time undergraduate students currently engaged in clinical practice. 

The researchers collected data through an online survey distributed via WeChat. They used three main instruments:

• Nurse Willingness Questionnaire — to measure willingness to care for people living with HIV.
• Nursing Professional Commitment Scale — to measure students’ commitment to the nursing profession.
• Jefferson Scale of Empathy–Health Professionals — to measure empathy. 

They then used structural equation modeling, a statistical method that tests how variables are connected in a proposed model. The conceptual model is shown in Figure 1 on page 3: professional commitment is expected to influence willingness to care directly, and also indirectly through empathy. 

What the study found

1) Students were willing to care—but not at the highest level

Overall, nursing students showed a relatively high but still “not optimal” willingness to care for people living with HIV. Only 13.25% expressed very strong willingness to care. 

Students were most willing to perform tasks such as taking vital signs, while they were least willing to perform more intimate or potentially unpleasant care activities such as cleaning stool or vomit. This suggests that willingness may vary depending on the type of nursing task, especially when care involves close bodily contact. 

2) Professional commitment was linked to willingness to care

Students with higher professional commitment also tended to report higher willingness to care for people living with HIV. 

This makes sense. If students strongly value nursing, see it as socially meaningful, and feel committed to the profession, they may be more willing to care for patients even when the situation feels challenging, stigmatized, or emotionally difficult.

In plain language: when students deeply identify with nursing as a caring profession, they may be more prepared to care for people living with HIV.

3) Empathy was also linked to willingness to care

Empathy was positively associated with willingness to care. Students who were better able to understand patients’ perspectives and needs showed greater willingness to provide HIV-related care. 

Among the empathy dimensions, perspective taking scored highest, while standing in the patient’s shoes scored lowest. This suggests that students may cognitively understand patients’ perspectives but still find it harder to emotionally imagine themselves in the patient’s situation. 

This is an important teaching insight: empathy is not automatic. It can be uneven. Students may need structured learning experiences that help them move from “I understand the patient has needs” to “I can imagine what this experience feels like and respond with care.”

4) Empathy partially explained the professional commitment–willingness link

The most important finding is the mediation result.

The study found that professional commitment had both:

• a direct effect on willingness to care, and
• an indirect effect through empathy. 

Empathy accounted for 21.14% of the effect of professional commitment on willingness to care. The mediation model is shown in Figure 2 on page 5, where professional commitment predicts empathy, and both professional commitment and empathy predict willingness to care for people living with HIV. 

In everyday terms: professional commitment matters, but it becomes more powerful when paired with empathy.

A student may say, “I am committed to being a nurse.” But empathy helps translate that commitment into willingness to care for a stigmatized patient group.

What this means for nursing education

This study supports a clear educational message: HIV nursing education should develop both commitment and compassion.

Knowledge is necessary, but not enough. Students need accurate HIV education to reduce fear and misinformation. They also need opportunities to strengthen their professional values, reflect on stigma, and practice empathic communication.

The authors suggest educational strategies such as guided clinical exposure, case studies, high-fidelity simulation, narrative medicine education, and reflective processing. These approaches can help students encounter the human realities of HIV care, not only the biomedical facts. 

Bottom line

This study shows that nursing students’ willingness to care for people living with HIV is shaped by both professional identity and empathy. If nurse educators want future nurses to provide respectful and non-discriminatory HIV care, they need to teach more than infection control. They need to cultivate professional commitment, reduce stigma, and build empathy through meaningful, guided, reflective learning. 

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Policy/practice recommendations

1. Integrate empathy-building into HIV nursing education
   Use simulation, patient narratives, case-based discussion, reflective writing, and debriefing to help students understand the lived experiences of people living with HIV. 
2. Strengthen professional commitment throughout training
   Nursing programs should support students’ professional identity through role modeling, mentoring, career planning, supportive clinical environments, and discussions of nursing’s ethical obligations. 
3. Move beyond HIV knowledge-only teaching
   HIV education should include stigma reduction, communication, ethics, patient dignity, confidentiality, and person-centered care.
4. Use guided clinical exposure carefully
   Students may become more willing to care when they encounter HIV care in safe, supervised, well-supported clinical settings where fear and stigma can be discussed openly.
5. Assess willingness to care as an educational outcome
   Nursing schools can evaluate not only students’ HIV knowledge, but also their attitudes, empathy, and readiness to provide care.
6. Create anti-stigma learning environments
   Faculty should address homophobia, fear of infection, moral judgment, and discriminatory language as part of professional formation in nursing.

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Glossary of key terms

• People living with HIV / PLHIV — People who have human immunodeficiency virus and may require ongoing care, treatment, support, and protection from stigma.
• Willingness to care — A student or nurse’s readiness to provide nursing care to a specific patient group. In this study, it refers to willingness to perform nursing care activities for people living with HIV. 
• Professional commitment — A person’s positive attachment to, identification with, and willingness to contribute to the nursing profession. 
• Empathy — The ability to understand a patient’s perspective, needs, suffering, and situation in a way that supports compassionate care. 
• Mediation — A statistical relationship where one variable helps explain how or why another variable affects an outcome. Here, empathy partly explains how professional commitment influences willingness to care. 
• Structural equation modeling / SEM — A statistical method used to test complex relationships among variables, including direct and indirect effects. 
• Nurse Willingness Questionnaire — A scale measuring willingness to perform nursing activities for people with HIV/AIDS. 
• Nursing Professional Commitment Scale — A tool measuring students’ commitment to nursing, including effort, membership, and belief in nursing goals and values. 
• Jefferson Scale of Empathy–Health Professionals — A scale measuring empathy among healthcare professionals or students.
• Perspective taking — An empathy skill involving the ability to understand another person’s viewpoint.
• Compassionate care — Care that is emotionally responsive, respectful, and sensitive to patient suffering.
• HIV stigma — Negative beliefs, attitudes, or behaviors directed toward people living with HIV, which can reduce care quality and discourage help-seeking.
• Cross-sectional study — A study that collects data at one point in time. It can show associations but cannot prove cause and effect.