Towards a relational conceptualization of empathy

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter‐related understandings of empathy: (a) A co‐creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other‐oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships.

Encountering Ambivalence - A Qualitative Study of Mental Health Nurses' Experiences with Dual Relationships

Nurses are obliged to set professional boundaries in nurse-patient relationships. Relationships with patients that are pursued outside of working hours (dual relationships) are commonly prohibited by legislation and professional codes of ethics, but some nurses still engage in them. A thematic analysis of qualitative interviews revealed that the nurses experienced ambivalence regarding how they see the patients, their assessment of the dual relationships and how people around the nurses react to the relationships. Ambivalence was characterized by contradictory and indeterminate thoughts and attitudes toward patients and dual relationships. Results indicated that dual relationship decisions were complex and highly contextually dependent.

The ambiguity of altruism in nursing: A qualitative study

BACKGROUND:

For a long time, altruism was the basis for caring. Today, when society is more individualized, it is of interest to explore the meaning of altruism in nursing.

METHODS:

In all, 13 nurses from a Swedish acute care setting participated in two focus group interviews performed as Socratic dialogues. Data were analyzed using a phenomenological hermeneutical method.

ETHICAL CONSIDERATIONS:

Ethical issues were considered throughout the process according to established ethical principles. Informed consent was obtained from all participants, confidentiality regarding the data was guaranteed and quotations anonymized.

FINDINGS:

Altruism created a sense of ambivalence and ambiguity, described as a rise of sovereign expressions of life caused by "the other's" need, but also unwillingness to take unconditional responsibility for "the other."

CONCLUSION:

Society's expectations of altruism and nurses' perception of their work as a salaried job collide in modern healthcare. Nurses are not willing to fully respond to the ethical demand of the patients. In case of a disaster, when nurses personal safety, life and health may be at risk, there might be reasons to question whether the healthcare organization would be able to fulfill its obligations of providing healthcare to an entire population.

Against dichotomies: On mature care and self-sacrifice in care ethics

INTRODUCTION

In previous issues of this journal, Carol Gilligan's original concept of mature care has been conceptualized by several (especially Norwegian) contributors. This has resulted in a dichotomous view of self and other, and of self-care and altruism, in which any form of self-sacrifice is rejected. Although this interpretation of Gilligan seems to be quite persistent in care-ethical theory, it does not seem to do justice to either Gilligan's original work or the tensions experienced in contemporary nursing practice.

DISCUSSION

A close reading of Gilligan's concept of mature care leads to a view that differs radically from any dichotomy of self-care and altruism. Instead of a dichotomous view, a dialectical view on self and other is proposed that builds upon connectedness and might support a care-ethical view of nursing that is more consistent with Gilligan's own critical insights such as relationality and a practice-based ethics. A concrete case taken from nursing practice shows the interconnectedness of professional and personal responsibility. This underpins a multilayered, complex view of self-realization that encompasses sacrifices as well.

CONCLUSION

When mature care is characterized as a practice of a multilayered connectedness, caregivers can be acknowledged for their relational identity and nursing practices can be recognized as multilayered and interconnected. This view is better able to capture the tensions that are related to today's nursing as a practice, which inevitably includes sacrifices of self. In conclusion, a further discussion on normative conceptualizations of care is proposed that starts with a non-normative scrutiny of caring practices.

The nursing discipline and self-realization

BACKGROUND

It is obvious from literature within the nursing discipline that nursing is related to moral or moral-philosophical related ideas which are other-oriented. The socio-cultural process of change in modern society implies that more self-oriented ideas have been found to be significant.

AIM

The overall aim of this article is to highlight self-oriented moral or moral-philosophical related ideas as an important part of the nursing discipline. This is achieved by (a) exploring self-realization as a significant self-oriented moral or moral-philosophical related idea based on a philosophical anthropological perspective, (b) demonstrating how moral or moral-philosophical related ideas are expressed by nurses, (c) discussing the relevance of self-realization for the nursing discipline, and (d) pointing out possible consequences for the future development of the discipline of nursing.

RESEARCH DESIGN

This theoretical study draws empirical examples from interviews.

PARTICIPANTS AND RESEARCH CONTEXT

Data consisted of interviews with 13 nurses with varying work experience within the primary and secondary somatic and psychiatric health service, from inside as well as outside institutions.

ETHICAL CONSIDERATIONS

The empirical study was approved by the Norwegian Social Science Data Services. Information was given and consent was obtained from the study participants.

FINDINGS

Findings are presented in two themes: (a) other-oriented ideas and (b) self-oriented ideas. More concretely, the findings show that nurses hope to make life as good as possible for the patient and they have a wish to improve themselves as human beings, to become better persons.

DISCUSSION

The relevance of self-realization for the nursing discipline is discussed along two lines, first, by connecting nurses' self-understanding to a horizon of identity and second, by considering what self-realization could offer.

CONCLUSION

It is of ultimate concern for the nursing discipline to highlight self-realization connected to the positive view of freedom understood as an exercise-concept. Further identifying and articulating the contribution of self-realization to nurses and nursing practice is of particular importance.