Advice and development

Beyond empathy: when students 'develop' their patients' illness

Students who believe they have the same disease as their patients need support and mentoring to prevent this false perception from damaging their quality of life.

Students who believe they have the same disease as their patients need support and mentoring to prevent this false perception from damaging their quality of life

Picture: iStock

Nursing students are actively encouraged to place compassion at the centre of practice, with empathy often considered a crucial component of quality care. But can this be taken too far? 

To explore the impact that identifying with patients’ symptoms can have on nursing students’ quality of life, researcher Agni Nakou surveyed 200 students at the Technological Educational Institute (TEI) of Epirus in Greece, as part of her master’s degree. 

Ms Nakou, a nurse for 20 years, found that more than half the students taking part thought they showed similar symptoms to their patients.  

‘For students, empathy lies in their ability to enter the patient’s position, perceive their symptoms and situation, and then try to help them,’ says Ms Nakou, who also teaches at the TEI’s nursing school.  

‘During practice placements, nursing students are often influenced by what they see and the care they give,’ she says. ‘But in some cases, this can go beyond empathising with the patient to the point that students exhibit similar symptoms, sometimes believing they suffer from the same illness as their patients.’

Debrief and reflect

The research found that some students developed false perceptions of illness, even experiencing bodily pain and other physical and mental health symptoms. This damaged their social functioning and led to a negative impact on their well-being and quality of life. 

‘For these students, their daily lives can be adversely affected,’ says Ms Nakou. ‘Stress and fear of their supposed illness can rise, creating problems in their workplace.’ For example, relationships with colleagues may be affected and there can be a reluctance to carry out some tasks.

‘The intense mental discomfort recorded in the study is clinically significant,’ adds Ms Nakou. ‘Behavioural variations range from moderate irritability to extreme avoidance or dependency behaviours, unavoidably affecting their learning potential and perceptions about the nursing profession.’ 

Increasing supportive mechanisms, such as mentoring and debriefing, could help prevent potentially damaging situations from arising, suggests Ms Nakou. 

‘Reflective sessions at the end of each week could help maintain students’ well-being, increasing levels of learning and creating a sense of satisfaction in being part of the nursing profession.’ 

An RCN toolkit to help nursing students get the best from their practice placement outlines the responsibilities of their peers, higher education institutions, personal tutors, mentors and service providers, and includes information on how to manage stress. 

The RCN counselling service also provides free, confidential short-term counselling on work-related or personal issues. 


Lynne Pearce is a freelance health journalist 


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