Roses by other names? Empathy, sympathy, and compassion in mental health nursing

The Mediating Effect of Professional Values on the Relationship Between Self-Leadership and Compassion Competence of Community Mental Health Nurses

BACKGROUND

Compassion competence is a core nursing skill that is significant in understanding and alleviating the physical and mental distress of individuals. Self-leadership and nursing professional values are also reported as important factors in improving the clinical care practices of nurses and may have a positive effect on improving the compassion competence of nurses. However, there are few studies examining the relationship between these variables in community mental health nurses.

AIM

This study investigated the mediating effect of professional values on the relationship between self-leadership and compassion competence of community mental health nurses.

METHODS

A cross-sectional correlational study was conducted with 121 community mental health nurses from 30 mental health welfare centers in South Korea. Participants completed self-report scales on self-leadership, nursing professional values, and compassion competence. Baron and Kenny's regression method and the Sobel test revealed significant mediating effects of nursing professional values on the relationship between self-leadership and compassion competence.

FINDINGS

Participants' mean compassion competence scores were 3.57 (SD = 0.45) on a 5-point scale. Compassion competence positively correlated with self-leadership (r = 0.67, P < .001) and nursing professional values (r = 0.60, P < .001). Nursing professional values played a partial mediating role in the relationship between self-leadership and compassion competence (Z = 3.23, P = .001).

CONCLUSION

Compassion competence of community mental health nurses can be improved by promoting self-leadership and nursing professional values.

Exploring levels of empathy and assertiveness in final year physiotherapy students during clinical placements

Empathy and assertiveness are two essential soft skills for any healthcare professional's competence and ethical development. It has been shown that empathy can be influenced throughout the training of a future healthcare professional, particularly during the clinical placement period. This research aims to assess fourth-year physiotherapy students' empathic and assertive development before and after clinical placement. A longitudinal observational study was conducted with fourth-year physiotherapy students during the academic year 2022/2023. A preliminary assessment of empathy and assertiveness levels was carried out before the start of the clinical placement and at the end of the placement using the Individual Reactivity Index to assess empathy and the Rathus Test to assess assertiveness. The results show a statistically significant difference (p ≤ 0.05) in both the empathy subscales of perspective-taking and empathic-concern between the pre- and postassessment, as well as an inverse correlation between the empathy subscale of personal distress and assertiveness. It is concluded that students show adequate results in empathy and assertiveness. However, there is some influence of clinical practice on the development of empathy, and future intervention studies need to be considered. Furthermore, students with higher levels of assertiveness have lower levels of personal distress, suggesting that assertiveness is closely related to empathy.

Validity and reliability evaluation of the Turkish version of the Clinical Interpersonal Reactivity Index

AIM

This study was conducted to evaluate the validity and reliability of the Turkish version of the Clinical Interpersonal Reactivity Index, an instrument to assess nurses' empathy.

BACKGROUND

A practical empathic approach is valuable for planning nursing interventions suitable for the patient's conditions and needs and increasing patient satisfaction.

DESIGN

This is a methodological study.

METHODS

The study was carried out at Muğla Sıtkı Koçman University Training and Research Hospital, recruiting a total of 358 nurses between January and February 2023. Exploratory and confirmatory factor analyses were used to determine and validate the factor structure of the Clinical Interpersonal Reactivity Index.

RESULTS

The exploratory factor analysis extracted three factors. According to the confirmatory factor analysis, all goodness of fit measures were within acceptable limits. Cronbach's α values were 0.89 for the total scale with 17 items and between 0.73 and 0.81 for the factors. In test-retest analyses, all intra-class correlation coefficients were higher than 0.7, and the correlations between the first and second applications of the scale were between 0.61 and 0.73.

CONCLUSION

The Turkish version of the Clinical Interpersonal Reactivity Index can be applied as a valid and reliable measurement tool to evaluate empathy in Turkish nurses.

The experiences of intensive care nurses coping with ethical conflict: a qualitative descriptive study

BACKGROUND

The critical conditions and life risk scenarios make intensive care nurses susceptible to ethical conflict. Negative consequences were recognized at both the individual level and the professional level which highly compromised the patient care and nurses' well-being. Therefore, ethical conflict has become a major concern in nursing practice. However, the experience of coping with ethical conflict among intensive care nurses remains unclear.

AIMS

This study aims to explore the experience of intensive care nurses coping with ethical conflict in China.

METHODS

From December 2021 to February 2022, in- depth interviews with 15 intensive care nurses from five intensive care units in a tertiary general hospital in China was performed using purposive sampling. An inductive thematic analysis approach was used to analyze the data. We applied the consolidated criteria for reporting qualitative research for this study.

RESULTS

Two distinctive themes were found: detachment and engagement, which contained four subthemes: ignoring ethical problems in the workplace, seeking ways to express emotions, perspective-taking, and identifying positive assets. Theses coping strategies demonstrated an ongoing process with different essential features.

CONCLUSION

This study provides a new insight into the experience of intensive care nurses coping with ethical conflict in clinical nursing. Intensive care nurses demonstrated differential experience of coping with ethical conflict including problem-focused, emotion-focused and meaning-making strategies. These findings have implications for policymakers and nursing administrators to develop ethical education and training and supportive environment for intensive care nurses to tackle this issue.

Effect of moral sensitivity on professional values of undergraduate nursing students: Mediating effect of empathic tendency

BACKGROUND

The development of professional values in nursing students is an important issue for the nursing profession. However, the research on nursing students' professional values and its related factors is very limited.

PURPOSE

This cross-sectional and correlational study aimed to examine the mediating effect of empathy between moral sensitivity and professional values.

METHODS

This study was conducted with 328 second, third and fourth-year students. The participants completed an online survey consisting of the student information form, Modified Moral Sensitivity Questionnaire for Student Nurses, Empathic Tendency Scale and Nursing Professional Values Scale.

RESULTS

The results showed that moral sensitivity affected undergraduate nursing students' professional values not only directly but also indirectly through empathic tendency.

CONCLUSIONS

The results of the study show that moral sensitivity and empathic tendency support the acquisition of professional values in undergraduate nursing students. Nurse educators needs to realize that can be improved professional values by integrating moral sensitivity and empathic tendency in their curriculum.

The validation of a Mandarin version of the Empathy Components Questionnaire (ECQ-Chinese) in Chinese samples

Empathy involves both empathic ability and empathic motivation. An important topic has been how to measure empathic ability and motivation simultaneously in both clinical and non-clinical samples and across different cultures. The Empathy Components Questionnaire (ECQ) is a self-report questionnaire that measures empathic ability and motivation in a questionnaire. The current study aimed to validate the Mandarin Chinese version of the ECQ (ECQ-Chinese) in three Chinese samples. In study 1, a total of 538 Chinese participants (Sample 1) completed the ECQ-Chinese via an online survey, and existing measures of empathy and related constructs which were used for criterion validity. In study 2, a total of 104 participants (Sample 2) were recruited again from sample 1 and completed the ECQ-Chinese three weeks later to investigate test-retest reliability. In study 3, a further 324 participants (Sample 3) completed the ECQ-Chinese for confirmatory factor analysis. The results showed that the ECQ-Chinese has a good internal consistency reliability, split-half reliability, and criterion validity (Study 1), and a good test-retest reliability (Study 2). Further, Study 3 found that a 22-item ECQ-Chinese consisting of five subscales had a good construct validity, convergence validity and discriminate validity, demonstrating it to be a suitable tool for the measurement of empathic ability and motivation in Chinese samples and to carry out cross-cultural studies of empathy and its components.

Mental health nurses' constructions of compassion: A discourse analysis

Compassion is an important element of contemporary nursing work. Compassion has been recognized as necessary for improving health outcomes. However, very little is known about how compassion is understood in the mental health practice setting. We conducted interviews with seven mental health nurses to explore their perspectives on compassion and views on compassion policy. Analysis of the data revealed that compassion was identified and discussed as Compassion as part of the person (and the profession); Compassion: Fundamental to the nursing role; Barriers to compassion; Perspectives on compassion policy. In addition, findings demonstrated ethical constraints on compassion in the mental health context, as well as the administrative burden on nurses more broadly, which was also a reported barrier to compassion. Mental health nurses identified compassion as fundamental to their clinical practice, yet compassion was impeded owing to practical and emotional constraints upon nurses. System-wide action must be taken to increase and support the mental health nursing workforce to strengthen the practice of compassion. This will be fundamental to improving health outcomes that are claimed to be enhanced by compassion. This study is reported according to the COREQ guidelines.

Empathy education in post-graduate nurses: An integrative review

AIM

This study reviews the outcomes of programmes teaching empathy to post-graduate nurses.

BACKGROUND

Nurses who are able to empathise with their patients, place themselves within a preferred position to deliver better patient outcomes. There have been substantial efforts to improve the empathy skill level of undergraduate nursing students, with success but understanding this skill level at the post graduate level is limited.

DESIGN

An integrated literature review of the qualitative and quantitative literature on nurse post graduate education programmes over the last 10 years was conducted.

DATA SOURCES

CINAHL, Medline, Psych-Info, Google Scholar and hand searching of reference lists of relevant papers were used.

REVIEW METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Mixed Methods Appraisal Tool (MMAT) was used for quality appraisal.

RESULTS

The review includes nine quantitative non randomised studies and one qualitative study. The findings suggest that empathy skills in post graduate nurses can be improved, but given the variation in the operational definition of empathy used, range in frequency and length of training and speciality specific requirements further work is needed to understand the use of 'empathy' in the post graduate nurse.

CONCLUSION

Future non university based or 'in house' empathy education in nursing should focus on the post graduate nurse and the needs of their clinical specialties.

'Walking in the shoes of our patients': a scoping review of healthcare professionals learning from the simulation of patient illness experiences

BACKGROUND

Health professionals who have experienced ill-health appear to demonstrate greater empathy towards their patients. Simulation can afford learners opportunities to experience aspects of illness, but to date, there has been no overarching review of the extent of this practice or the impact on empathic skills.

OBJECTIVE

To determine from the evidence-what is known about simulation-based learning methods of creating illness experiences for health professions and the impact on their empathic skills.

STUDY SELECTION

Arksey and O'Malley's methodological framework informed our scoping review of articles relevant to our research question. Three databases (MEDLINE, Embase and Web of Science) were searched, and a sample of 516 citations was screened. Following review and application of our exclusion criteria, 77 articles were selected to be included in this review.

FINDINGS

Of the 77 articles, 52 (68%) originated from the USA, 37 (48%) of studies were qualitative based and 17 (22%) used a mixed-methods model. Of all the articles in our scope, the majority (87%) reported a positive impact and range of emotions evoked on learners. However, some studies observed more negative effects and additional debriefing was required post-simulation. Learners were noted to internalise perceived experiences of illness and to critically reflect on their empathic role as healthcare providers.

CONCLUSIONS

A diverse range of simulation methods and techniques, evoking an emotional and embodied experience, appear to have a positive impact on empathy and could be argued as offering a complementary approach in healthcare education; however, the long-term impact remains largely unknown.

Development of the Clinical Interpersonal Reactivity Index to evaluate nurses' empathy

We determined the validity and reliability of the Clinical Interpersonal Reactivity Index in a sample of Japanese nurses. Participants were registered nurses at national university hospitals and nursing researchers in Japan. A postal questionnaire was conducted. Construct validity was analyzed by exploratory and confirmatory factor analysis, and convergent validity demonstrated using the Interpersonal Reactivity Index. The Clinical Interpersonal Reactivity Index has an 18-item, two-factor structure with Cronbach's alpha values of 0.87 and 0.73. Confirmatory factor analysis showed a goodness-of-fit index of 0.917, an adjusted goodness-of-fit of 0.894, a root mean square error of approximation of 0.60, and a comparative fit index of 0.911. Correlation analysis between the Clinical Interpersonal Reactivity Index and Interpersonal Reactivity Index indicated the factors were significantly correlated for empathic concern and perspective taking (r = 0.439-0.401). Test-retest assessment showed reliability coefficients for the first factor as r = 0.859 and the second factor as r = 0.709. The Clinical Interpersonal Reactivity Index demonstrated validity and reliability for Japanese nurses. The two factors evaluated perspective taking and unconditional positive regard.

Hospital nurses' empathy and moral sensitivity toward elderly care: A cross-sectional study

AIM

The aim of this study is to explore factors that influence elderly caring attitudes, with a focus on empathy and moral sensitivity.

BACKGROUND

Medical and nursing needs of the elderly have escalated as a consequence of changes induced by aging and the associated diseases and disabilities.

METHOD

A cross-sectional study involving 229 nurses from four general hospitals in South Korea was conducted. Questionnaires assessing demographic and work experience information, empathy (Empathy Construct Rating Scale), moral sensitivity (Korean version of the Moral Sensitivity Questionnaire) and elderly caring (Elderly Caring Attitude Scale) were used. Data were analysed using multiple regression analysis.

RESULTS

The factors influencing the caring attitudes of nurses were empathy, moral sensitivity, preference for geriatric nursing and experience with continuing education in geriatric nursing. The explanatory power of this regression model was 59.4%.

CONCLUSIONS

Strategies to enhance empathy and moral sensitivity of nurses and education related to geriatric nursing might help improve elderly caring attitudes.

IMPLICATIONS FOR NURSING MANAGEMENT

Continued education in geriatric nursing should be provided for nurses caring for the elderly. In terms of nursing management and education, it is necessary to consider and develop strategies to improve the empathy and moral sensitivity of nurses toward elderly patients.

Clinical sympathy - A mixed method study of the relationship between the clinical nurse educator and the graduate nurse

AIM/OBJECTIVE

This paper sought to investigate the influence of the supernumerary clinical nurse educator role on the newly qualified graduate nurses' professional development and successful transition to competent and confident practitioners in the acute care hospital environment.

BACKGROUND

The novice nurses learning in the inpatient clinical environment is affected by increasing patient acuity, complex conditions and organisational expectations. The supernumerary clinical nurse educator is uniquely positioned to prioritise these nurses' education through protected and available time to support adaption in the workplace culture and retention in the organisation.

DESIGN

A convergent mixed methods design was used to investigate the relationship between the supernumerary clinical nurse educator role through the opinions and experiences of the graduate nurse.

METHODS

Data were collected in February - July 2015 from graduate nurses from three hospital sites in a healthcare organisation in Western Australia. The research used online questionnaires (n = 39) and face to face interviews (n = 10). Analysis of quantitative data used descriptive statistics and qualitative data used thematic analysis.

RESULTS

Four main themes were identified. These were: acknowledges new and challenging experiences, available to provide constructive responses, sympathises with anxiety and missing in action.

CONCLUSION

The graduate registered nurses perceived that clinical sympathy provided by the clinical nurse educator was essential to their new role of frontline nurses influencing their delivery of quality patient care and as a practical solution to champion the graduate nurses' longevity in the future nursing workforce.

The association between empathy and the nurse-patient therapeutic relationship in mental health units: a cross-sectional study

WHAT IS KNOWN ON THE SUBJECT?: Empathy is one of the main attributes for establishing the nurse-patient therapeutic relationship. Davis (1983) identified four components on an empathic response: perspective taking, fantasy, empathetic concern and personal distress. It is essential to deepen our knowledge on the influence of the dimensions of empathy for the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: A significant association exists between the dimensions of empathy and the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship between nurses and patients in mental health units. This study shows that the nurses' perspective on the patient's situation improves the bond, and therefore, this skill is especially useful in the first phase or orientation phase of the therapeutic relationship. However, for the second phase or working phase of the therapeutic relationship, a greater empathic concern among nurses, together with less personal distress, improves collaborative goal setting with patients. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: It is important for mental health nurses to be aware of the importance of personal self-awareness and the emotional management of empathy for the construction and development of therapeutic relationships of quality with patients. Knowledge of the relationship between each of the dimensions of empathy in the different stages of the therapeutic relationship is useful for the design of educational programmes, by including training on empathic strategies. ABSTRACT: Introduction Empathy and its dimensions (perspective taking, empathic concern, personal distress and fantasy) are essential for establishing the nurse-patient therapeutic relationship. It is important to know how this influences the construction and development of the therapeutic alliance during the different phases of the therapeutic relationship. Aim To examine whether the dimensions of empathy influence the nurse-patient therapeutic relationship within mental health units. Method A cross-sectional design was used to collect data to measure the therapeutic alliance and the different dimensions of empathy via an online form completed by nurses working at 18 mental health units. Linear regressions were used in the analysis. Results A total of 198 participants completed the questionnaires. Nurses established a greater therapeutic alliance with patients when they were able to adopt their patient's perspective and experience concern. Discussion Nurses' perspective taking is an influential factor impacting the nurse-patient bond in the orientation phase, whereas experiencing greater concern and decreased emotional distress were associated with improved therapeutic alliance in the working phase. Implications for practice These findings may help gain awareness among nurses of the importance of empathy in the nurse-patient relationships, as well as inform educational programmes, by including training in empathic strategies and emotional management.

The impact of a participatory intervention on the therapeutic relationship in mental health nurses: A multicentre study

AIMS

To evaluate the effects of an intervention aimed at improving the therapeutic relationship, using the participatory-action research method, in terms of improving the quality of the nurse-patient therapeutic relationship.

DESIGN

A single-group pre-post research design.

METHODS

Quantitative data were collected between January 2018 and June 2019 using an online form completed by nurses from 18 mental health units (N = 95). Data were collected before and after the intervention, which consisted of the design, implementation and evaluation of strategies to improve the therapeutic relationship through participatory-action research involving nurses. The Working Alliance Inventory-Short, Interpersonal Reactivity Index, Evidence-Based Practice Questionnaire and Practice Environment Scale of the Nursing Work Index were used. The Wilcoxon rank-sum test was used together with the Spearman's correlation coefficient. Two multiple linear regressions models were constructed.

RESULTS

Overall, the intervention improved the nurse-patient therapeutic relationship. In addition, the results revealed that, above all, the improvement in evidence-based practice along with a decrease in nurses' personal distress were the factors associated with the improvement of the nurse-patient therapeutic relationship.

CONCLUSION

In mental health units, the therapeutic nurse-patient relationship can be improved through participatory interventions that include the implementation of evidence-based practices.

IMPACT

This research examined the effects of an intervention aimed at improving the therapeutic relationship among nurses working at mental health units using participatory action research. The results show that the therapeutic relationship can be improved through participatory methods where evidence-based practice is implemented and enhanced among nurses, since a better therapeutic relationship along with reduced staff discomfort are determining factors that influence the quality of the therapeutic relationship. Institutional managers should promote participatory group interventions to enable nurses to develop evidence-based aspects of the therapeutic relationship together with expanding personal aspects and self-knowledge.

Understanding the concept of compassion from the perspectives of nurses

BACKGROUND

The high level of satisfaction of users of a health service is largely due to the fact that they receive excellent care from healthcare professionals. Compassionate care is an essential component of excellent care. But what do nurses understand compassion to be?

RESEARCH OBJECTIVES

To analyse the concept of compassion from the perspective of nurses in the Andalusian Public Health System, Spain.

RESEARCH DESIGN

This is a qualitative study following the grounded theory model. Four focus groups and 25 in-depth interviews were conducted.

PARTICIPANTS AND RESEARCH CONTEXT

A total of 68 nursing professionals working in the Andalusian Public Health System (Spain) participated. Theoretical sampling was used, with participants being recruited using the snowball technique.

ETHICAL CONSIDERATIONS

This research was approved by the Research Ethics Committee of the Centro-Almería Health District (CEICA 27/9/17).

FINDINGS

From the analysis of the data, four themes emerged that helped to understand the concept of compassion according to nurses: 'Negative perception of the term compassion', 'Compassion and empathy as synonyms', 'Beyond empathy', and 'Effects of having a compassionate attitude'.

DISCUSSION

Nurses perceive the concept of compassion differently to each other and even contradictorily. This concept is imbued with cultural elements, which adds confusion to understanding it, and is even perceived as something negative similar to pity.

CONCLUSION

Nurses confuse the concepts of empathy and compassion as if they were synonymous. Before considering training in compassion for healthcare professionals, it is essential to clarify the concept of compassion through educational interventions.

Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time

Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.