{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T15:05:17Z","timestamp":1784905517792,"version":"3.55.0"},"reference-count":39,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T00:00:00Z","timestamp":1784851200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background\/Objectives: 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\u2019s 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\u2019s 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\u2019 emotional well-being.<\/jats:p>","DOI":"10.3390\/children13080984","type":"journal-article","created":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T13:53:26Z","timestamp":1784901206000},"page":"984","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Understanding the Boundaries of Empathy: A Qualitative Exploration in Pediatric Oncology Nursing"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2995-361X","authenticated-orcid":false,"given":"Ayfer","family":"Ayd\u0131n","sequence":"first","affiliation":[{"name":"Department of Nursing, Faculty of Health Sciences, Istanbul Atlas University, Istanbul 34408, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4969-0885","authenticated-orcid":false,"given":"Merve","family":"Ertun\u00e7 Soycan","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nursing, School of Nursing, Istanbul University, Istanbul 34116, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7709-7021","authenticated-orcid":false,"given":"\u00d6zlem","family":"\u015eensoy","sequence":"additional","affiliation":[{"name":"Department of Pediatric Nursing, School of Nursing, Istanbul University, Istanbul 34116, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"H\u00fclya","family":"Dalk\u0131l\u0131\u00e7 Bing\u00f6l","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology-Oncology, Institute of Oncology, Istanbul University, Istanbul 34093, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rejin","family":"Kebudi","sequence":"additional","affiliation":[{"name":"Department of Pediatric Hematology-Oncology, VKV Amerikan Hospital, School of Medicine, Ko\u00e7 University, Istanbul 34365, T\u00fcrkiye"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,7,24]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1016\/j.apnr.2017.02.006","article-title":"Empathy and feelings of guilt experienced by nurses: A cross-sectional study of their role in burnout and compassion fatigue symptoms","volume":"35","author":"Duarte","year":"2017","journal-title":"Appl. Nurs. Res."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1016\/j.ejon.2017.04.002","article-title":"The role of psychological factors in oncology nurses\u2019 burnout and compassion fatigue symptoms","volume":"28","author":"Duarte","year":"2017","journal-title":"Eur. J. Oncol. Nurs."},{"key":"ref_3","first-page":"e13124","article-title":"Running on empathy: Relationship of empathy to compassion satisfaction and compassion fatigue in cancer healthcare professionals","volume":"28","author":"Hunt","year":"2019","journal-title":"Eur. J. Cancer Care"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1177\/0269216316663499","article-title":"Sympathy, empathy, and compassion: A grounded theory study of palliative care patients\u2019 understandings, experiences, and preferences","volume":"31","author":"Sinclair","year":"2017","journal-title":"Palliat. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e26727","DOI":"10.1002\/pbc.26727","article-title":"Communication in pediatric oncology: State of the field and research agenda","volume":"65","author":"Sisk","year":"2018","journal-title":"Pediatr. Blood Cancer"},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Hojat, M. (2016). The Jefferson Scale of Empathy. Empathy in Health Professions Education and Patient Care, Springer.","DOI":"10.1007\/978-3-319-27625-0"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.ijnurstu.2016.02.015","article-title":"Relationships between nurses\u2019 empathy, self-compassion and dimensions of professional quality of life: A cross-sectional study","volume":"60","author":"Duarte","year":"2016","journal-title":"Int. J. Nurs. Stud."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1111\/1475-6773.14016","article-title":"A systematic review of research on empathy in health care","volume":"58","author":"Nembhard","year":"2023","journal-title":"Health Serv. Res."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Yu, C.C., Tan, L., Le, M.K., Tang, B., Liaw, S.Y., Tierney, T., Ho, Y.Y., Lim, B.E.E., Lim, D., and Ng, R. (2022). The development of empathy in the healthcare setting: A qualitative approach. BMC Med. Educ., 22.","DOI":"10.1186\/s12909-022-03312-y"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"573","DOI":"10.1007\/s11019-021-10033-4","article-title":"Empathy in patient care: From \u2018Clinical Empathy\u2019 to \u2018Empathic Concern\u2019","volume":"24","author":"Guidi","year":"2021","journal-title":"Med. Health Care Philos."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/j.chb.2016.11.024","article-title":"Situational determinants of cognitive, affective, and compassionate empathy in naturalistic digital interactions","volume":"68","author":"Powell","year":"2017","journal-title":"Comput. Hum. Behav."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s40639-017-0036-0","article-title":"Empathy from the perspective of oncology nurses","volume":"4","author":"Kesbakhi","year":"2017","journal-title":"J. Compassionate Health Care"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1007\/s11019-018-9872-8","article-title":"Clinical sympathy: The important role of affectivity in clinical practice","volume":"22","author":"Hardy","year":"2019","journal-title":"Med. Health Care Philos."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1177\/0141076816680120","article-title":"Empathy, sympathy and compassion in healthcare: Is there a problem? Is there a difference? Does it matter?","volume":"109","author":"Jeffrey","year":"2016","journal-title":"J. R. Soc. Med."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"862","DOI":"10.1111\/scs.13163","article-title":"Empathy, sympathy, and altruism-An evident triad based on compassion. A theoretical model for caring","volume":"37","author":"Arman","year":"2023","journal-title":"Scand. J. Caring Sci."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Malenfant, S., Jaggi, P., Hayden, K.A., and Sinclair, S. (2022). Compassion in healthcare: An updated scoping review of the literature. BMC Palliat. Care, 21.","DOI":"10.1186\/s12904-022-00942-3"},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Gleichgerrcht, E., and Decety, J. (2013). Empathy in Clinical Practice: How Individual Dispositions, Gender, and Experience Moderate Empathic Concern, Burnout, and Emotional Distress in Physicians. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0061526"},{"key":"ref_18","first-page":"338","article-title":"Reducing Compassion Fatigue in Inpatient Pediatric Oncology Nurses","volume":"46","author":"Sullivan","year":"2019","journal-title":"Oncol. Nurs. Forum"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"151840","DOI":"10.1016\/j.soncn.2025.151840","article-title":"\u201cI Put a Wall Between Me and My Emotions, but That Wall Was Coming Towards Me\u201d: A Descriptive Qualitative Study on Determining Emotion Regulation Experiences of Oncology Nurses","volume":"41","author":"Kayalar","year":"2025","journal-title":"Semin. Oncol. Nurs."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"104260","DOI":"10.1016\/j.nedt.2019.104260","article-title":"Effectiveness of empathy clinical education for children\u2019s nursing students: A quasi-experimental study","volume":"85","author":"Ding","year":"2020","journal-title":"Nurse Educ. Today"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1016\/j.ecns.2018.07.003","article-title":"Simulation-Based Empathy Training Improves the Communication Skills of Neonatal Nurses","volume":"22","author":"Shao","year":"2018","journal-title":"Clin. Simul. Nurs."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"104296","DOI":"10.1016\/j.nedt.2019.104296","article-title":"The effect of structured empathy education on empathy competency of undergraduate nursing interns: A quasi-experimental study","volume":"85","author":"Yang","year":"2020","journal-title":"Nurse Educ. Today"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"102739","DOI":"10.1016\/j.nepr.2020.102739","article-title":"Empathy training in health sciences: A systematic review","volume":"44","year":"2020","journal-title":"Nurse Educ. Pract."},{"key":"ref_24","first-page":"408","article-title":"Overcoming Compassion Fatigue and Burnout in Pediatric Oncology Nurses: Implementation of a Staff Well-Being Program","volume":"41","author":"Blackwell","year":"2024","journal-title":"J. Pediatr. Hematol. Oncol. Nurs."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Alodhialah, A.M., Almutairi, A.A., and Almutairi, M. (2024). Exploring Nurses\u2019 Emotional Resilience and Coping Strategies in Palliative and End-of-Life Care Settings in Saudi Arabia: A Qualitative Study. Healthcare, 12.","DOI":"10.3390\/healthcare12161647"},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Ghaljeh, M., Mardani-Hamooleh, M., and Pezaro, S. (2024). Nurses\u2019 perceptions of compassionate care in pediatric oncology: A qualitative interview study. BMC Health Serv. Res., 24.","DOI":"10.1186\/s12913-024-11661-1"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology","volume":"3","author":"Braun","year":"2006","journal-title":"Qual. Res. Psychol."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Lincoln, Y.S., and Guba, E.G. (1985). Naturalistic Inquiry, Sage.","DOI":"10.1016\/0147-1767(85)90062-8"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): A 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int. J. Qual. Health Care"},{"key":"ref_30","first-page":"S124","article-title":"Empathy Experiences: Perspective of Pediatric Oncology Nurses","volume":"Volume 72","author":"Aydin","year":"2025","journal-title":"Proceedings of the 57th Congress of the International Society of Paediatric Oncology (SIOP), Pediatric Blood & Cancer"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1728","DOI":"10.1002\/pon.5737","article-title":"Compassion in pediatric oncology: A patient, parent and healthcare provider empirical model","volume":"30","author":"Sinclair","year":"2021","journal-title":"Psychooncology"},{"key":"ref_32","first-page":"e107179","article-title":"Changes in the Level of Nursing Students\u2019 Empathy During Four Years Education","volume":"19","author":"Kesbakhi","year":"2020","journal-title":"J. Med. Educ."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"41","DOI":"10.4103\/ijnmr.IJNMR_66_16","article-title":"Empathy, Burnout, Demographic Variables and their Relationships in Oncology Nurses","volume":"22","author":"Ashouri","year":"2017","journal-title":"Iran. J. Nurs. Midwifery Res."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Moudatsou, M., Stavropoulou, A., Philalithis, A., and Koukouli, S. (2020). The Role of Empathy in Health and Social Care Professionals. Healthcare, 8.","DOI":"10.3390\/healthcare8010026"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1177\/1043659616689290","article-title":"Secondary Traumatic Stress and Burnout Among Muslim Nurses Caring for Chronically Ill Children in a Turkish Hospital","volume":"29","author":"Wilson","year":"2018","journal-title":"J. Transcult. Nurs."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1177\/17449871231177164","article-title":"The mediating role of empathy in the impact of compassion fatigue on burnout among nurses","volume":"28","author":"Akbolat","year":"2023","journal-title":"J. Res. Nurs."},{"key":"ref_37","first-page":"959","article-title":"Effects of Working at the Pediatric Oncology Unit on Personal and Professional Lives of Nurses","volume":"12","author":"Konukbay","year":"2019","journal-title":"Int. J. Caring Sci."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Paro, H.B.M.S., Silveira, P.S.P., Perotta, B., Gannam, S., Enns, S.C., Giaxa, R.R.B., Bonito, R.F., Martins, M.A., and Tempski, P.Z. (2014). Empathy among Medical Students: Is There a Relation with Quality of Life and Burnout?. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0094133"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1093\/sw\/swv014","article-title":"The Role of Empathy in Burnout, Compassion Satisfaction, and Secondary Traumatic Stress among Social Workers","volume":"60","author":"Wagaman","year":"2015","journal-title":"Soc. Work."}],"container-title":["Children"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/984\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T14:15:26Z","timestamp":1784902526000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2227-9067\/13\/8\/984"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,24]]},"references-count":39,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["children13080984"],"URL":"https:\/\/doi.org\/10.3390\/children13080984","relation":{},"ISSN":["2227-9067"],"issn-type":[{"value":"2227-9067","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,24]]}}}