Understanding the boundaries of Empathy: a qualitative exploration in pediatric oncology nursing

Abstract

Empathy is a fundamental component of pediatric oncology nursing. This study aims to examine in depth how nurses working in pediatric oncology define empathy, experience it in clinical practice, and manage emotional and professional boundaries in the empathetic care process. Methods: A qualitative research design was used. Semi-structured individual interviews were conducted with 17 nurses with at least 2 years of experience in pediatric hematology-oncology units. The interviews were conducted via Zoom. Data were analyzed using Braun and Clarke’s thematic analysis, and data collection continued until thematic saturation was achieved. Results: Three main themes were identified: Understanding Empathy, The Journey of Empathy, and The Cost of Empathy. Nurses defined empathy as an indispensable part of high-quality pediatric oncology care; however, they reported conceptual uncertainty in distinguishing empathy from sympathy and indecision regarding appropriate emotional boundaries. Empathy was perceived as a dynamic process shaped more by clinical experience than formal education. Early professional experiences were often characterized by emotional distress, while increasing experience enabled nurses to regulate their emotions and adopt more sustainable empathic practices. Despite this adaptation, prolonged exposure to children’s suffering and death was associated with compassion fatigue and emotional exhaustion. The absence of structured empathy training and formal emotional support systems further intensified these challenges. Conclusions: In pediatric oncology nursing, empathy is a complex, evolving professional competency that demands continuous emotional regulation and boundary management. Structured empathy training, reflective supervision, and strengthening institutional support mechanisms are essential to promote sustainable empathic care while protecting nurses’ emotional well-being.