The belief in a just world and empathy in nursing students: the role of self-esteem

BACKGROUND: Empathy, as a cornerstone of holistic clinical practice, is crucial for fostering positive patient–provider relationships and ultimately influencing patient outcomes. While belief in a just world (BJW), self-esteem (SE), and physician empathy (PE) are known to be interrelated, the specific mechanisms through which BJW and SE influence PE remain unclear. OBJECTIVES: The aim of this study was to examine the relationship among the BJW, SE and PE, and the role of SE as a mediator. METHODS: This study employed a cross-sectional design, which was conducted among nursing students from three medical colleges in Liaoning Province, China, between November and December 2021. A survey that included the Just World Belief Scale, the Rosenberg Self-Esteem Scale, and the Jefferson Scale of Physician Empathy was administered to nursing students through the Wenjuanxing online platform. A total of 1162 nursing students were recruited for the study via a convenience sampling method, and 1035 participants returned effective questionnaires. Descriptive tests, Pearson correlation, and the PROCESS macro were used to test the proposed mediation model. RESULTS: The total scores of PE, BJW, and SE were 102.41 ± 15.93, 57.59 ± 11.03 and 27.69 ± 3.98. The data of this study fits well with the hypothesized mediated model. The BJW was significantly correlated with SE and PE (P < 0.05). The SE also positively affects PE (P < 0.05). The total effect of Belief in a Just World (BJW) on Professional Empathy (PE) was 0.35, with a direct effect of 0.22. Additionally, the indirect effect of BJW on PE through Self-Esteem (SE) was 0.12, indicating that SE mediated 35.65% of the relationship between BJW and PE. CONCLUSIONS: Belief in a just world (BJW) can directly influence professional empathy (PE), and it can also affect PE indirectly through the mediating role of self-esteem (SE). This framework holds important implications for understanding moral development, promoting prosocial behavior, and informing clinical interventions aimed at enhancing empathy among nursing students. Educators should establish a fair learning and assessment environment for nursing students, incorporating practices such as mindfulness training, scenario-based simulations, and role-playing into the curriculum to enhance their capacity for empathy.