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

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. The aim of this study was to examine the relationship among the BJW, SE and PE, and the role of SE as a mediator. 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. 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. 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.