Award Date

December 2023

Degree Type


Degree Name

Doctor of Philosophy (PhD)



First Committee Member

Karyn Holt

Second Committee Member

Andrew Reyes

Third Committee Member

Clariana Ramos de Oliveira

Fourth Committee Member

Stephen Benning

Number of Pages



Background: Compassion is a core competency and the philosophical foundation of nursing. Previous studies demonstrated that uncompassionate nursing care was associated with increased patient morbidity and mortality, prolonged illness and recovery, and missed care opportunities. However, it is unknown whether prelicensure nursing education contributes to greater compassion levels among prelicensure nursing students (PNSs). Aims: These studies addressed three research aims: (1) Describe and compare levels of compassion in first-term and last-term PNSs, (2) Determine the effects of a compassion-inducing simulation event on compassion in PNSs, as measured through a survey and biological measurement, and lastly, (3) Investigate the relationship between self-reported levels of compassion and salivary oxytocin (sOXT) levels in PNSs.

Methods: Two studies were used to address the research aims: (a) Study 1 assessed and compared trait-compassion levels among first- and last-term nursing students in prelicensure programs in Nevada and Washington via the administration of a self-report survey, and (b) Study 2 examined the difference in state-compassion levels before and after a compassion-inducing simulation event in PNSs at the University of Nevada, Las Vegas. State-compassion levels were measured using the Sinclair Compassion Questionnaire – Learner, while trait-compassion was measured using the Compassion Scale. In Study 2, participants were asked to provide a 4 ml passive drool saliva sample into a polyethylene tube four times—before and after a control activity and before and after a compassion-inducing event. These saliva samples were analyzed for levels of oxytocin (OXT). An independent samples t-test compared compassion levels between first- and last-term PNSs. A repeated measures analysis of variance (ANOVA) was performed to compare state-compassion and sOXT levels over time, before and after the control and simulation events. In addition, Pearson’s correlation analysis was used to test whether any change in state-compassion levels was associated with any change in OXT levels.

Results: Data for Study 1 indicated no significant difference between trait-compassion in first- and last-term PNSs. There was a significant difference between male and female participants, with females having statistically higher compassion than males (p<.05). Study 2 revealed a statistically significant inverse correlation between sOXT and SCQ-L over four time points. Additionally, SCQ-L significantly increased over time, while sOXT significantly decreased.

Discussion: Findings from this research will enhance understanding of compassion levels among PNSs and whether nursing education and a compassion-inducing simulation event improve compassion levels. Considering the necessity of compassion for providing quality patient care and that nursing education is the pathway for individuals to become nurses, these studies inform future research evaluating compassion-promoting programs or simulations in prelicensure nursing education programs.

Conclusion: Compassion did not change during prelicensure nursing education when comparing first- and last-term PNSs. Nurse educators must work to develop, implement, and evaluate means to positively impact compassion among PNSs. Such methods should include robust study design, incorporate events or interventions explicitly aimed at the experience of compassion, and facilitate compassion development in new nurses. Such efforts and activities will improve the quality of life for nurses and patients and increase longevity and compassionate nursing care for the public.


Compassion; Nursing education; Nursing student; Oxytocin; Simulation


Education | Nursing

File Format


File Size

1550 KB

Degree Grantor

University of Nevada, Las Vegas




IN COPYRIGHT. For more information about this rights statement, please visit

Available for download on Thursday, May 15, 2025