Empathy: a review of the literature with suggestions for an alternative research strategy

Family Caregivers’ Perspectives on Hospice Nursing Care

In hospice nursing, dying persons and their families are the unit of care and the focus of nursing interventions which are provided within the context of interdisciplinary care. The key component of hospice nursing is the interaction between the nurse, the terminally ill person, and the family. This naturalistic study was designed to describe the family caregiver's relationships between the hospice patient, the nurse, and themselves. The intent was to determine if family caregivers would develop empathic relationships with the hospice nurses. Nine bereaved family caregivers participated in the study. All were bereaved at least six months prior to being interviewed. The major finding of the study was that family caregivers perceived the hospice nurses as part of the family. The hospice nurses were characterized as respectful, kind, caring, clinical experts whose presence and interventions helped meet the needs of the family experiencing death.

Medical students' understanding of empathy: a phenomenological study

CONTEXT

Empathy towards patients is associated with improved health outcomes. However, quantitative studies using self-reported data have not provided an in-depth opportunity to explore the lived experiences of medical students concerning empathy.

OBJECTIVES

This study was designed to investigate undergraduate medical students' experiences of the phenomenon of empathy during the course of their medical education and to explore the essence of their empathy.

METHODS

This was a descriptive, phenomenological study of medical student interviews conducted using the method of Colaizzi and Giorgi. The sample (n = 10) was drawn from medical students in Years 4 and 5. In-depth interviews were used to obtain a clear understanding of their experiences of empathy in the context of patient care. Interviews continued until no new information could be identified from transcripts.

RESULTS

Five themes were identified from analysis: the meaning of empathy; willingness to empathise; innate empathic ability; empathy decline or enhancement, and empathy education. Empathic ability was manifested through two factors: innate capacity for empathy, and barriers to displaying empathy. Different experiences and explanations concerning the decline or enhancement of empathy during medical education were explored.

CONCLUSIONS

Empathic ability was identified as an important innate attribute which nevertheless can be enhanced by educational interventions. Barriers to the expression of empathy with patients were identified. Role-modelling by clinical teachers was seen as the most important influence on empathy education for students engaged in experiential learning.

Psychometric Analysis of the JSPE Nursing Student Version R: Comparison of Senior BSN Students and Medical Students Attitudes toward Empathy in Patient Care

Background. Empathic communication skills are critical to providing high-quality nursing care to holistically understand the patient's perspective. A survey research design was used to address the research questions discussed in this study. Data consisted of responses from nursing students attending accredited programs in the southeastern United Sates using the Jefferson Scale of Physician Empathy Nursing Student Version R (JSPE-R). Findings. Comparisons of the total scores from JSPE Versions S and R yielded similar means and standard deviations with 115 and 114.57, respectively, and standard deviations of 10 and 10.94, respectively. The results of a one-sample t-test failed to render statistical significance (t = −1.22, P = .224), indicating that the overall attitudes of nursing students and medical students are similar. The 25th, 50th, and 75th percentiles and overall instrument reliability were also comparable. Conclusions. This paper supports the emergence of alternative factor analysis structures as applied to nursing students through statistical progression from exploratory factor analysis to confirmatory structures. Implications for practice explore the utility of empathy instruments in nurse education, such as empathy progression through curriculum. As nursing educators, the utility of development of instruments to measure effectiveness of teaching strategies and pedagogy for empathy enhancement in practice is important.

Naming of depression: nursing, social and personal descriptors

This paper explores descriptors of depression and begins by exploring nursing descriptors including the nature of assessment and nursing diagnosis and progresses to underpin these major processes by considering social descriptors such as cultural and spiritual constructs. The role and influence of stigma is discussed and an examination of gender influences and experiences is undertaken. The paper concludes by examining personal descriptors in the literature. The overall aim of the paper is (1) to add to nursing knowledge by depicting the grounded realities of the experience of depression and (2) stimulate discussion on the need to provide holistic care pathways that are responsive to the uniqueness of this lived experience and finally to (3) encourage further research on key psycho-social factors associated with depression and the concurring advancement of nursing care. This paper has been completed in the context of an ongoing study into the grounded experience of 'Depression' and the development of a psychiatric nursing theory of connectivity.

Nursing in a postemotional society

Globalization is often seen as the final stage in the transition towards a market economy. It is argued that a side-effect of globalization is cultural homogeneity and loss of life world, or 'McDonaldization'. McDonaldization represents the rationalization of society in the quest for extreme efficiency. More recently, Mestrović has argued that the rationalization of emotions has also occurred and that Western societies are entering a postemotional phase. In postemotional societies there has been a separation of emotion from action. The result is synthetic, manufactured emotions manipulated and standardized for mass consumption. In this paper I explore what it means to nurse in a 'postemotional society' and what impact this dulling of the emotions has had on a profession that locates 'care' as its central defining concept. My aim is to generate critical discussion of the shape and direction of contemporary society and the role of nursing within it.

Nurse-patient communication: an exploration of patients' experiences

BACKGROUND

Patient-centred communication is a basic component of nursing and facilitates the development of a positive nurse-patient relationship which, along with other organizational factors, results in the delivery of quality nursing care. Nurses are frequently described in the literature as poor communicators, however, very few studies have examined patients' experiences of how nurses communicate.

AIMS AND OBJECTIVES

The aim of the study was to explore and produce statements relating to patients' experiences of how nurses communicate.

DESIGN

A qualitative perspective using an hermeneutic phenomenological approach was considered to be the most appropriate methodology for this study.

METHODS

Using purposeful sampling, eight patients in a general teaching hospital in the Republic of Ireland were interviewed. Data were collected using unstructured interviews. Data analysis was a reflective process and the findings were presented through the description and interpretation of themes and sub-themes.

RESULTS

Following data analysis four themes emerged. These were, 'lack of communication', 'attending', empathy' and 'friendly nurses'.

CONCLUSIONS

The findings of this study indicate that, in contrast to the literature that suggests that nurses are not good at communicating with patients, nurses can communicate well with patients when they use a patient-centred approach. However, health care organizations do not appear to value or recognize the importance of nurses using a patient-centred approach when communicating with patients to ensure the delivery of quality patient care.

RELEVANCE TO CLINICAL PRACTICE

The implication of these findings for clinical practice is that the task-centred approach to patient care that is associated with nursing in the past, appears to be alive and well. If health care management want to ensure that patients receive quality nursing care, they will need to consider patient-centred communication to be essential to encourage and support nurses to communicate in this manner.

Enhancing creativity to improve palliative care: the role of an experiental self-care workshop

Creativity plays an important part in all aspects of life. Although the nature of creativity is hypothesized in a variety of ways, there is no common agreement as to how or why it manifests. In the USA and UK, creative ability is often restricted by education, and nursing education programmes appear to be no exception. This article discusses the development of a weekend workshop programme for health professionals working with older people and in palliative care, using Alligood's (1991) hypotheses, that there are positive correlations between creativity, self-actualization and empathy. Actualization and creativity are closely related to self-care and there is evidence that 'selfishness' is an essential ingredient in the actualizing process. There is also evidence that an empathic relationship between health workers and their patients has a significant positive impact on interpersonal care processes. If the creative potential of nurses and carers can be enhanced through self-care, their ability to empathize may be increased. The focus of the workshops is on creative methods of self-care, using experiential exercises in relaxation, music, touch, massage and silence. Evaluation of the workshops revealed that the potential of using this method to develop care practices is worthy of investigation and development.

Developing empathy to improve patient care: a pilot study of cancer nurses

Empathy has been identified as an important communication skill that can improve psychological outcomes for patients with cancer and palliative care patients; as such there is a need for cancer nurses to be empathic. The majority of research that has been carried out has been concerned with the definition and measurement of empathy. Exploration into the concept of empathy has shown that there is a need to examine the nature of it and to identify exactly where it succeeds and fails. The questions of how empathy is nurtured and sustained and under what conditions it flourishes and diminishes need to be addressed. This study aimed to investigate how cancer nurses interpret and acquire empathy, and to identify the conditions that influence it. It was also important to establish what cancer nurses considered to be the benefits and disadvantages of expressing empathy. The findings demonstrated that nurses are aware of the concept of empathy and do use their empathic skills; however, there are barriers that could inhibit the expression of empathy, including lack of time, poor environment and communication difficulties. This study highlights the recognition of empathy as a discrete communication skill and the need for more structured courses.

On the phenomenology of empathy in nursing: empathy or sympathy?

In her recent phenomenological study Baillie attempted to describe the essential structure of empathy in surgical nursing. The study is important in that it utilizes a qualitative research method to investigate the phenomena of empathy, in contrast to previous quantitative studies. Although the phenomenological approach is clearly identified and ascribed to Husserl as the founder of the phenomenological movement, as well as utilizing the peculiarly Husserlian notion of bracketing, or epoché, in an attempt to describe the essence (another Husserlian objective) of the phenomenon under investigation (empathy), the research method does not reflect Husserl's philosophy. The results reflect nurses' subjective views on empathy, an exercise consistent with the nurse-phenomenologists quoted, who without exception, all believe Husserlian phenomenology concerns itself with subjective experience. However, in seeking the essence of phenomena unclouded by subjective opinion, Husserl stands in contrast to nursing interpretations of phenomenology's famous catch phrase, 'back to the things themselves' (zu den Sachen selbst). Nurse-phenomenologists have misunderstood the intention of Husserlian phenomenology, and despite their opposition to traditional scientific methods, are still mired in the Kantian notion of science as a reality independent of mind. A theme consistent with the 'things-in-themselves', not the things themselves. As such, nursing's use of the phenomenological method is questionable, and therefore the research findings on the phenomenon of empathy need to be reformulated. Interestingly, the phenomenon of empathy challenges us to question such underlying assumptions on how we view the world.

Students' expectations of postregistration degree programmes

The needs of postregistration students pursuing degree-linked clinical courses have received little attention and there are few insights concerning their aspirations when they enrol on such courses. Thus the aim of this study was to explore postregistration students' perceptions of the specific needs of their patient/client group and to examine how they envisaged the course on which they had just enrolled might help them to meet these needs in addition to their own requirements for professional and personal development. Data were collected by group interview from 62 students enrolling on eight different postregistration courses, all employed in an acute hospital trust. The results were analysed inductively. They indicated that students had internalized the state of the healthcare market and were keenly aware of the need to fulfil the expectations of employers and the public, while fulfilling their own needs for education and pursuing their own professional and career trajectories. They appeared ambitious and yet appeared to demonstrate empathy for patients and their families and felt a tremendous desire to provide care of a high quality through the optimal development of technical expertise. Students' emphasis on the importance of keeping abreast of technological developments should not be lightly dismissed considering its prominent position within the acute areas where they were employed, especially as it did not replace their desire to promote the caring aspects of their work.

Exploring empathy as a variable in the evaluation of professional development programs for palliative care nurses

Research indicates that empathy, a quality regarded as fundamentally important to nursing practice, is a teachable skill. Because empathic nurse-patient relationships are particularly important in the care of the terminally ill, this has direct relevance to the professional development of palliative care nurses. This article discusses the place of empathy as a criterion variable in the evaluation of a professional development program for palliative care nurses introduced at the Centre for Mental Health Nursing Research at Queensland University of Technology, Brisbane, Australia. A modified version of the Staff-Patient Interaction Response Scale (SPIRS) was used as a pre- and postintervention measure to assess the expressed empathy of the participating nurses. The modifications to SPIR and its coding system to make it suitable for palliative care nursing, and the mechanisms for improving and evaluating the reliability of this instrument will be discussed. The full description of this particular modification of SPIRS for palliative care research is provided as an example of how this instrument could be used in projects for which nurses undertake the difficult task of providing compassionate care to the terminally ill.

What's it all about, empathy?

This paper investigates the concept of empathy, a core element of all helping relationships. A discussion of its prevalence in the nursing literature is traced, before a discussion ensues as to whether it is a naturally acquired ability which develops with maturity, or whether it is a skill that can be taught and learnt. It is concluded that empathy remains a poorly defined, multidimensional concept which still remains not fully identified.

A phenomenological study of the nature of empathy

The purpose of this study was to gain an understanding of the nature of empathy, as perceived and experienced by registered nurses. A phenomenological approach was selected, with nine experienced staff nurses working in surgical settings being interviewed using an open, unstructured approach. Empathy was evidently felt to be beneficial, displayed both nonverbally and through the nurse's actions, and therefore the ability to empathize, and to feel empathy with the individual patient, needs supporting and promoting in nurses. The importance of learning from experience (both personal and professional), and the ability to communicate effectively, are both highlighted by this study. The nature of empathy is evidently multi-faceted, and the presence of empathy is influenced by a complex relationship between the individual nurse, patient and the environment. It should be recognized that environmental issues, such as high workload and stress, also affect ability to empathize.

Levels of empathy of critical care nurses

Empathy represents an essential element for effective caring and therefore enhances the goals and rationale of nursing care. The focus of this study was the level of empathy possessed by critical care nurses, in relation to their gender, years of experience in critical care nursing, level of formal education and their current position. This descriptive correlational study utilised the Empathy Construct Rating Scale (ECRS) in order to measure empathy. The study revealed that critical care nurses possess moderately well-developed levels of empathy. No statistically significant relationships were found between gender, years of experience in critical care, level of formal education and current position and levels of empathy. The conclusion of the study was that further research is required to explore the concept of empathy within the context of critical care nursing, and in particular the meaning and significance of empathy to critical care nurses.

Towards further clarification of the concept 'dignity'

The word dignity is used frequently in nursing and is deemed important to maintain or promote in patients. Its meaning, however, remains unclear. This paper uses the model of concept analysis described by Chinn and Kramer to further clarify the concept and develop the ideas of Mairis. A tentative definition and indicators are suggested to ascertain if dignity is present in a given interaction and context. Dignity is found to be connected to the shared humanity of patient and nurse, whilst acknowledging the uniqueness of individuals. It emerges through the analysis that, in order to effectively promote the dignity of patients, the nurse should also possess dignity.

The role of empathy in the care of dementia

The concept of empathy in relation to caring is reviewed. A variety of definitions of empathy are considered to show how empathy has been used within general nursing practice. A wide range of literature is drawn on to gain insights into the multifaceted and diverse information on this topic. The differing perceptions that arise from various professional viewpoints are explored. A set of attributes are identified for empathy and these are considered in relation to clinical practice in elderly mental health. Three examples of care are discussed to show how emotive empathy can be employed to give an improved direction to care of dementia clients. The concept is reviewed in relation to the particular needs of caring for dementia. It is suggested that it should be included in mental health training. It is concluded that emotive empathy has a vital part to play in the delivery of care for the elderly mentally ill.

Teaching With Entertainment Films: An Empathetic Focus

In an effort to bridge the gap in learning in the affective domain, nurse educators must understand and develop meaningful teaching strategies. Specific strategies designed to facilitate cognitive understanding of the affective response can be found in entertainment films. The findings of this study suggest that the use of entertainment films with guidance is effective in teaching empathetic responses. The continued study of the complex phenomenon in developing an understanding of the many variables that comprise not only the experience of empathy, but also the transference of the experience into helping interventions.

Empathic nurse-patient relationships in hospice nursing

This naturalistic study explored the development of empathic nurse-patient relationships between 10 terminally ill adult hospice patients and their hospice nurses. The data were collected and analyzed from the hospice patient's perspective. Content analysis and the constant comparative method were used to analyze the transcripts of the audio taped interviews. The findings suggest that the development of empathic relationships between hospice nurses and patients was a process that occurred most often over time and involved a reciprocal sharing. Specific patient needs, nurses' functions, attributes, and the patient's reciprocity contributed to the development of the empathic relationship.