The experiences of patients, family caregivers, healthcare providers, and health service leaders with compassionate care following hospitalization with COVID-19: a qualitative study

PURPOSE

This study explored the experiences of patients, caregivers, healthcare providers, and health service leaders of compassion in the care of people hospitalized with COVID-19.

MATERIALS AND METHODS

This study is a secondary analysis of qualitative data deriving from primary research data on recommendations for healthcare organizations providing care to people hospitalized with COVID-19. Participants comprised patients with COVID-19 (n = 10), family caregivers (n = 5) and HCPs in COVID-19 units (n = 12). Primary research data were analyzed deductively under the "lens" of compassion, as defined by Goetz.

RESULTS

Four interacting themes were found: (1) COVID-19 - to care or not to care? The importance of feeling safe, (2) A lonely illness - suffering in isolation with COVID-19, (3) Compassionate care for people with COVID-19 across the hospital continuum, and (4) Sustaining compassionate care for people hospitalized with COVID-19 - healthcare provider compassion fatigue and burnout.

CONCLUSIONS

Compassionate care is not a given for people hospitalized with COVID-19. Healthcare providers must feel safe to provide care before responding compassionately. People hospitalized with COVID-19 experience additional suffering through isolation. Compassionate care for people hospitalized with COVID-19 is more readily identifiable in the rehabilitation setting. However, compassion fatigue and burnout in this context threaten healthcare sustainability.IMPLICATIONS FOR REHABILITATIONHealthcare providers need to feel physically and psychologically safe to provide compassionate care for people hospitalized with COVID-19.People hospitalized with COVID-19 infection experience added suffering through the socially isolating effects of physical distancing.Compassion and virtuous behaviours displayed by healthcare providers are expected and valued by patients and caregivers, including during the COVID-19 pandemic.High levels of compassion fatigue and burnout threaten the sustainability of hospital-based care for people with COVID-19.

(Not) part of the team: Racial empathy bias in a South African minimal group study

Minimal Group Paradigm (MGP) research suggests that recategorization with an arbitrarily defined group may be sufficient to override empathy biases among salient social categories like race. However, most studies utilizing MGPs do not consider sufficiently the socio-historical contexts of social groups. Here we investigated whether the recategorization of White participants into arbitrarily defined mixed-race teams using a non-competitive MGP would ameliorate racial empathy biases towards ingroup team members in the South African context. Sixty participants rated their empathic and counter-empathic (Schadenfreude, Glückschmerz) responses to ingroup and outgroup team members in physically painful, emotionally distressing, and positive situations. As anticipated, results indicated significant ingroup team biases in empathic and counter-empathic responses. However, mixed-race minimal teams were unable to override ingroup racial empathy biases, which persisted across events. Interestingly, a manipulation highlighting purported political ideological differences between White and Black African team members did not exacerbate racial empathy bias, suggesting that such perceptions were already salient. Across conditions, an internal motivation to respond without prejudice was most strongly associated with empathy for Black African target individuals, regardless of their team status. Together, these results suggest that racial identity continues to provide a salient motivational guide in addition to more arbitrary group memberships, even at an explicit level, for empathic responding in contexts characterized by historical power asymmetry. These data further problematize the continued official use of race-based categories in such contexts.

Empathy moderates the relationship between cognitive load and prosocial behaviour

Cognitive load reduces both empathy and prosocial behaviour. However, studies demonstrating these effects have induced cognitive load in a temporally limited, artificial manner that fails to capture real-world cognitive load. Drawing from cognitive load theory, we investigated whether naturally occurring cognitive load from the ongoing COVID-19 pandemic moderated the relationship between empathy and prosocial behaviour (operationalised as support for public health measures). This large study in an Australian sample (N = 600) identified negative relationships between pandemic fatigue, empathy for people vulnerable to COVID-19, and prosocial behaviour, and a positive relationship between empathy and prosocial behaviour. Additionally, we found that the negative effect of the pandemic on prosocial behaviour depended on empathy for vulnerable others, with pandemic fatigue's effects lowest for those with the highest empathy. These findings highlight the interrelationships of cognitive load and empathy, and the potential value of eliciting empathy to ease the impact of real-world cognitive load on prosocial behaviour.

The development of empathy in the healthcare setting: a qualitative approach

BACKGROUND

Healthcare professionals' empathetic behaviors have been known to lead to higher satisfaction levels and produce better health outcomes for patients. However, empathy could decrease over time especially during training and clinical practice. This study explored factors that contributed to the development of empathy in the healthcare setting. Findings could be used to improve the effectiveness and sustainability of empathy training.

METHOD

A qualitative approach, informed by aspects of grounded theory, was utilized to identify factors that enabled the development of empathy from the perspectives of doctors, nurses, allied healthcare workers and students. Twelve sessions of focus group discussions were conducted with 60 participants from two hospitals, a medical school, and a nursing school. Data was analyzed independently by three investigators who later corroborated to refine the codes, subthemes, and themes. Factors which influence the development of empathy were identified and categorized. This formed the basis of the creation of a tentative theory of empathy development for the healthcare setting.

RESULTS

The authors identified various personal (e.g. inherent characteristics, physiological and mental states, professional identity) and external (e.g. work environment, life experience, situational stressors) factors that affected the development of empathy. These could be further categorized into three groups based on the stability of their impact on the individuals' empathy state, contributed by high, medium, or low stability factors. Findings suggest empathy is more trait-like and stable in nature but is also susceptible to fluctuation depending on the circumstances faced by healthcare professionals. Interventions targeting medium and low stability factors could potentially promote the development of empathy in the clinical setting.

CONCLUSIONS

Understanding factors that impact the development of empathy allows us to develop measures that could be implemented during training or at the workplace leading to improve the quality of care and higher clinical work satisfaction.

I Can But I Shall Not Always Be Empathic

Empathy, a core process for social interactions, is the capacity to understand and share others' mental states and emotions. Each individual is thought to have a maximum level of empathy (empathic ability) and a spontaneous tendency to express it (empathic propensity), which can be affected by multiple factors. Two within-subject studies were conducted to assess the malleability of empathy by modulating contextual factors and measuring their interaction with psychological characteristics. In Study 1, 59 healthy adults evaluated their empathy for people showing facial expressions of pain following different instructions: Passive Observation and Instruction to Actively Empathize. In Study 2, 56 healthy adults performed a similar task under two conditions: Passive Observation and Observation under a Cognitive Load. The results revealed that empathy was significantly increased in the actively empathizing condition (Study 1) and under a cognitive load, but more importantly for men (Study 2). The level of change between the two conditions was associated with self-reported empathy, autistic, alexithymia and psychopathic traits (Study 1), as well as with working memory capacities and the level of empathy reported in the passive observation condition (Study 2). These findings suggest that an instruction to actively empathize and, surprisingly, a cognitive load can both increase empathy, but not for the same individuals. An instruction to actively empathize seems to increase empathy for individuals with good empathic dispositions, while a cognitive load enhances empathy in people for which empathic propensity is sub-optimal.

Pain and social decision-making: New insights from the social framing effect

This paper focuses on the social function of painful experience as revealed by recent studies on social decision-making. Observing others suffering from physical pain evokes empathic reactions that can lead to prosocial behavior (e.g., helping others at a cost to oneself), which might be regarded as the social value of pain derived from evolution. Feelings of guilt may also be elicited when one takes responsibility for another’s pain. These social emotions play a significant role in various cognitive processes and may affect behavioral preferences. In addition, the influence of others’ pain on decision-making is highly sensitive to social context. Combining neuroimaging techniques with a novel decision paradigm, we found that when asking participants to trade-off personal benefits against providing help to other people, verbally describing the causal relationship between their decision and other people’s pain (i.e., framing) significantly changed participants’ preferences. This social framing effect was associated with neural activation in the temporoparietal junction (TPJ), which is a brain area that is important in social cognition and in social emotions. Further, transcranial direct current stimulation (tDCS) on this region successfully modulated the magnitude of the social framing effect. These findings add to the knowledge about the role of perception of others’ pain in our social life.

Dispositional Perspective-Taking and Empathic Concern Modulate the Impact of Cognitive Load on Empathy for Facial Emotions

Meeting other people involves the importance to share their experiences and to understand their perspectives or, more simply, to empathize with them. Empathy research distinguishes two main dimensions of empathy, the affective sharing and the cognitive understanding. In the present study, we focus on the impact of cognitive load on empathy to pain, fear, happiness, and neutral facial emotions. Participants had to judge the intensity of the emotion when looking to facial expressions (empathize group), or with an additional eight-digit memory task (cognitive load group). While we assumed that cognitive load would reduce empathy, inconsistently with previous findings, our results did not show any significant effect of group. Interestingly, regression analyses showed that perspective-taking and empathic concern were positively related to pain, fear, and happiness ratings within the cognitive load group. These results reveal that when judging empathy under high cognitive load, dispositional empathic concern and perspective-taking could allow individuals to override the supposed deleterious cognitive load effect on empathy.

The Influence of Cognitive Load on Empathy and Intention in Response to Infant Crying

Many studies have explored risk factors for child maltreatment, but little research has focused on situational risk factors such as cognitive load, which involves within-individual fluctuation. The current study sought to determine whether cognitive load led to within-individual changes in intention in response to infant crying. The study also sought to ascertain whether state empathy, empathic concern (EC), and personal distress mediated or moderated this relationship. Sixty-six participants completed a memory task (remembering meaningless, two- or eight-letter, English alphabet string), during which they were required to keep these letters in mind while hearing infant crying (or a tone). Subsequently, participants rated questions concerning state empathy and intention in response to the crying (i.e., intentions involving caregiving, neglect, or physical abuse). Results showed that cognitive load reduced caregiving intention and increased intention to perpetrate neglect. In addition, EC mediated the relationship between cognitive load and intention to provide care or perpetrate neglect. Moreover, cognitive load interacted with state empathy to predict intention to provide care or perpetrate neglect. These findings highlighted the importance of focusing on situational cognitive risk factors for child maltreatment and elucidated the role of state empathy as a mediator or moderator in child maltreatment research.