{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T17:25:12Z","timestamp":1787073912388,"version":"build-2736575974"},"reference-count":40,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T00:00:00Z","timestamp":1787011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Eur. J. Investig. Health Psychol. Educ.","EJIHPE"],"abstract":"<jats:p>Empathy is essential to humanized nursing care, yet its relationship with emotional competence before professional entry remains insufficiently specified. This single-school cross-sectional study examined whether distinct dimensions of emotional competence were differentially associated with emotional empathy among 337 secondary-level vocational nursing students enrolled in a five-year Croatian program for general care nurses\/medical technicians. Students completed the Emotional Skills and Competence Questionnaire (ESCQ-45) and the Emotional Empathy Scale from the E-Questionnaire, which primarily captures affective responsiveness to others\u2019 distress and other negative-valence states. Spearman correlations, Kruskal\u2013Wallis tests with Dunn\u2013Holm post hoc comparisons, Welch tests, and hierarchical linear regression with heteroscedasticity-consistent type 3 robust standard errors were used. Emotional empathy correlated with emotion perception and understanding (\u03c1 = 0.35, p &lt; 0.001) and emotion management (\u03c1 = 0.28, p &lt; 0.001), but not with emotion expression and naming (\u03c1 = 0.10, p = 0.070). In the fully adjusted regression model, emotion perception and understanding (\u03b2 = 0.254, p &lt; 0.001), emotion management (\u03b2 = 0.254, p = 0.003), and female versus male reported sex (\u03b2 = 0.277, p &lt; 0.001) were statistically significant predictors, whereas clinical exposure was not (p = 0.429). Emotion expression and naming had a negative adjusted coefficient (\u03b2 = \u22120.158, p = 0.040) after simultaneous control for the remaining predictors. The findings support a dimensional interpretation of emotional competence and indicate that negative-valence emotional empathy is more closely associated with recognizing, understanding, and managing emotions than with expressive emotional skills considered in isolation.<\/jats:p>","DOI":"10.3390\/ejihpe16080119","type":"journal-article","created":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:12:11Z","timestamp":1787069531000},"page":"119","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Associations Between Emotional Competence and Emotional Empathy in Secondary-Level Vocational Nursing Students at One Croatian School: A Cross-Sectional Study"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7407-5473","authenticated-orcid":false,"given":"Martina","family":"Trn\u010devi\u0107","sequence":"first","affiliation":[{"name":"Vinogradska Nursing School, Vinogradska Cesta 29, 10000 Zagreb, Croatia"},{"name":"Faculty of Medicine, University of Rijeka, Ul. Bra\u0107e Branchetta 20, 51000 Rijeka, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivana","family":"Pi\u0161\u0107enec","sequence":"additional","affiliation":[{"name":"Vinogradska Nursing School, Vinogradska Cesta 29, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vi\u0161nja","family":"Pranji\u0107","sequence":"additional","affiliation":[{"name":"Vinogradska Nursing School, Vinogradska Cesta 29, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0267-3167","authenticated-orcid":false,"given":"Ljerka","family":"Armano","sequence":"additional","affiliation":[{"name":"University Hospital Centre Sestre Milosrdnice, Vinogradska Cesta 29, 10000 Zagreb, Croatia"},{"name":"Faculty of Health Studies, University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia"},{"name":"Faculty of Health Studies, University of Zagreb, Mlinarska Cesta 38, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3118-2623","authenticated-orcid":false,"given":"Aleksandar","family":"Racz","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, University of Rijeka, Ul. Bra\u0107e Branchetta 20, 51000 Rijeka, Croatia"},{"name":"Faculty of Health Studies, University of Rijeka, Ul. Viktora Cara Emina 5, 51000 Rijeka, Croatia"},{"name":"Faculty of Health Studies, University of Zagreb, Mlinarska Cesta 38, 10000 Zagreb, Croatia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1140","DOI":"10.1177\/10731911221086987","article-title":"The psychometric assessment of empathy: Development and validation of the perth empathy scale","volume":"30","author":"Brett","year":"2023","journal-title":"Assessment"},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Budler, L. C., Gosak, L., Vrbnjak, D., Pajnkihar, M., and \u0160tiglic, G. (2022). Emotional intelligence among nursing students: Findings from a longitudinal study. Healthcare, 10, (10).","DOI":"10.3390\/healthcare10102032"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Cho, M. K., and Kim, M. Y. (2024). Effectiveness of simulation-based interventions on empathy enhancement among nursing students: A systematic literature review and meta-analysis. BMC Nursing, 23.","DOI":"10.1186\/s12912-024-01944-7"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.1017\/sjp.2016.33","article-title":"Cross-cultural invariance of the emotional skills and competence questionnaire between Portugal and Croatia","volume":"19","author":"Costa","year":"2016","journal-title":"Spanish Journal of Psychology"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1007\/BF02310555","article-title":"Coefficient alpha and the internal structure of tests","volume":"16","author":"Cronbach","year":"1951","journal-title":"Psychometrika"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1037\/0022-3514.44.1.113","article-title":"Measuring individual differences in empathy: Evidence for a multidimensional approach","volume":"44","author":"Davis","year":"1983","journal-title":"Journal of Personality and Social Psychology"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1146","DOI":"10.1100\/tsw.2006.221","article-title":"Human empathy through the lens of social neuroscience","volume":"6","author":"Decety","year":"2006","journal-title":"The Scientific World Journal"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"241","DOI":"10.1080\/00401706.1964.10490181","article-title":"Multiple comparisons using rank sums","volume":"6","author":"Dunn","year":"1964","journal-title":"Technometrics"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1016\/j.nedt.2017.05.008","article-title":"Emotional intelligence increases over time: A longitudinal study of Australian pre-registration nursing students","volume":"55","author":"Foster","year":"2017","journal-title":"Nurse Education Today"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1080\/00273171.2019.1707061","article-title":"Extrinsic convergent validity evidence to prevent jingle and jangle fallacies","volume":"56","author":"Gonzalez","year":"2021","journal-title":"Multivariate Behavioral Research"},{"key":"ref_11","unstructured":"Harman, H. H. (1976). Modern factor analysis, University of Chicago Press. [3rd ed.]."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"300","DOI":"10.1016\/j.pec.2020.08.022","article-title":"Toward a consensus on the nature of empathy: A review of reviews","volume":"104","author":"Meranius","year":"2021","journal-title":"Patient Education and Counseling"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"107","DOI":"10.3102\/10769986006002107","article-title":"Distribution theory for glass\u2019s estimator of effect size and related estimators","volume":"6","author":"Hedges","year":"1981","journal-title":"Journal of Educational Statistics"},{"key":"ref_14","first-page":"65","article-title":"A simple sequentially rejective multiple test procedure","volume":"6","author":"Holm","year":"1979","journal-title":"Scandinavian Journal of Statistics"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e30017","DOI":"10.1097\/MD.0000000000030017","article-title":"Empathy ability of nursing students: A systematic review and meta-analysis","volume":"101","author":"Jiao","year":"2022","journal-title":"Medicine"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"S59","DOI":"10.1177\/08980101231163966","article-title":"Empathy in nursing students: A scoping review","volume":"42","author":"Juniarta","year":"2024","journal-title":"Journal of Holistic Nursing"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"104364","DOI":"10.1016\/j.nepr.2025.104364","article-title":"The impact of an empathy education programme on empathy, communication skills and emotional competency in nursing students: A quasi-experimental study","volume":"85","author":"Ko","year":"2025","journal-title":"Nurse Education in Practice"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"583","DOI":"10.1080\/01621459.1952.10483441","article-title":"Use of ranks in one-criterion variance analysis","volume":"47","author":"Kruskal","year":"1952","journal-title":"Journal of the American Statistical Association"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2492","DOI":"10.1016\/j.neuroimage.2010.10.014","article-title":"Meta-analytic evidence for common and distinct neural networks associated with directly experienced pain and empathy for pain","volume":"54","author":"Lamm","year":"2011","journal-title":"NeuroImage"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.nedt.2019.01.006","article-title":"A systematic review of the effectiveness of empathy education for undergraduate nursing students","volume":"75","author":"Cant","year":"2019","journal-title":"Nurse Education Today"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1080\/00031305.2000.10474549","article-title":"Using heteroscedasticity-consistent standard errors in the linear regression model","volume":"54","author":"Long","year":"2000","journal-title":"The American Statistician"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1207\/s15327965pli1503_02","article-title":"Emotional intelligence: Theory, findings, and implications","volume":"15","author":"Mayer","year":"2004","journal-title":"Psychological Inquiry"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.jmir.2023.02.014","article-title":"Empathy, emotional intelligence, and interprofessional skills in healthcare education","volume":"54","author":"McNulty","year":"2023","journal-title":"Journal of Medical Imaging and Radiation Sciences"},{"key":"ref_24","unstructured":"Ministry of Science, Education and Sports of the Republic of Croatia (2013). Strukovni kurikulum za stjecanje kvalifikacije medicinska sestra op\u0107e njege\/medicinski tehni\u010dar op\u0107e njege."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/spc3.12157","article-title":"The emerging study of positive empathy","volume":"9","author":"Morelli","year":"2015","journal-title":"Social and Personality Psychology Compass"},{"key":"ref_26","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, (1).","DOI":"10.3390\/healthcare8010026"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1007\/s11135-006-9018-6","article-title":"A caution regarding rules of thumb for variance inflation factors","volume":"41","year":"2007","journal-title":"Quality & Quantity"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"879","DOI":"10.1037\/0021-9010.88.5.879","article-title":"Common method biases in behavioral research: A critical review of the literature and recommended remedies","volume":"88","author":"Podsakoff","year":"2003","journal-title":"Journal of Applied Psychology"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1146\/annurev-orgpsych-110721-040030","article-title":"Common method bias: It\u2019s bad, it\u2019s complex, it\u2019s widespread, and it\u2019s not easy to fix","volume":"11","author":"Podsakoff","year":"2024","journal-title":"Annual Review of Organizational Psychology and Organizational Behavior"},{"key":"ref_30","unstructured":"Lackovi\u0107-Grgin, K., Prorokovi\u0107, A., \u0106ubela, V., and Penezi\u0107, Z. (2002). E-upitnik: Skala emocionalne empatije i skala ma\u0161te. Zbirka psihologijskih skala i upitnika, Sveu\u010dili\u0161te u Zadru."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"591","DOI":"10.1093\/biomet\/52.3-4.591","article-title":"An analysis of variance test for normality (complete samples)","volume":"52","author":"Shapiro","year":"1965","journal-title":"Biometrika"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"421","DOI":"10.1016\/j.childyouth.2018.07.027","article-title":"Factors influencing the development of empathy and prosocial behavior among adolescents: A systematic review","volume":"94","author":"Silke","year":"2018","journal-title":"Children and Youth Services Review"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"72","DOI":"10.2307\/1412159","article-title":"The proof and measurement of association between two things","volume":"15","author":"Spearman","year":"1904","journal-title":"The American Journal of Psychology"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1080\/00224545.2021.1985417","article-title":"What is your empathy scale not measuring? The convergent, discriminant, and predictive validity of five empathy scales","volume":"162","author":"Stosic","year":"2022","journal-title":"Journal of Social Psychology"},{"key":"ref_35","first-page":"7","article-title":"Emotional skills and competence questionnaire (ESCQ) as a self-report measure of emotional intelligence","volume":"18","author":"Duran","year":"2009","journal-title":"Horizons of Psychology"},{"key":"ref_36","first-page":"729","article-title":"Emotional intelligence: Theory, operationalization, implementation and relationship with positive psychology","volume":"15","author":"Munjas","year":"2006","journal-title":"Dru\u0161tvena Istra\u017eivanja"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1016\/bs.pbr.2019.03.024","article-title":"Empathy and emotion regulation: An integrative account","volume":"247","author":"Thompson","year":"2019","journal-title":"Progress in Brain Research"},{"key":"ref_38","first-page":"28","article-title":"The generalization of student\u2019s problem when several different population variances are involved","volume":"34","author":"Welch","year":"1947","journal-title":"Biometrika"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1037\/bul0000426","article-title":"Empathy, sympathy, and emotion regulation: A meta-analytic review","volume":"150","author":"Yavuz","year":"2024","journal-title":"Psychological Bulletin"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"517","DOI":"10.1146\/annurev-psych-010419-050830","article-title":"Integrating empathy and interpersonal emotion regulation","volume":"71","author":"Zaki","year":"2020","journal-title":"Annual Review of Psychology"}],"container-title":["European Journal of Investigation in Health, Psychology and Education"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2254-9625\/16\/8\/119\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T16:28:16Z","timestamp":1787070496000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2254-9625\/16\/8\/119"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,18]]},"references-count":40,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["ejihpe16080119"],"URL":"https:\/\/doi.org\/10.3390\/ejihpe16080119","relation":{},"ISSN":["2254-9625"],"issn-type":[{"value":"2254-9625","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,18]]}}}