Empathy as one reason nurses are so widely trusted.
Last December, nurses were named the most honest and trusted profession in the U.S. for the 17th year in a row. In order to build trusting nurse-patient relationships that can help improve health, nurses must understand the needs and circumstances of patients, families, and communities. One way nurses arrive at an understanding of these needs is through practicing empathy. This may explain why nurse empathy has been found to be a major factor in hospitalized patients’ satisfaction with their care.
photo credit: EKGTechnicianSalary
The word empathy is not very old, as words go. It appears to have been a translation into English, using a combination of Greek roots meaning ‘in’ and ‘feeling,’ of an early 20th century German psychological term, Einfűhlung (‘feeling-in’).
In health care, we generally define empathy as the ability to enter a patient’s frame of reference (thoughts, emotions, circumstances, etc.) and sense the meaning in her or his inner world, as the concept was described by Carl Rogers, one of the founders of humanistic psychology.
Are we becoming less empathetic?
These days, empathy can often seem to be in short supply. Much-publicized study findings suggest that younger generations may have lower levels of empathy than older generations. At the same time, some people have drawn attention to a ‘dark side’ of empathy, arguing that empathy can become distorted, self-serving, or even polarizing in certain situations and proposing that empathy be used in a controlled way to prevent ’empathy burnout.’
Empathy as practice.
by nosha/flickr creative commons
While we may think of empathy as an innate, natural behavior, recent findings have been interpreted to mean that practicing empathy does not just happen but takes a conscious effort—given the choice, many people avoid practicing empathy due simply to the mental effort it takes. The idea that empathy takes effort is true in nursing as well—it is a skill that nurses must actively practice.
Practicing empathy in the context of providing health care is a complex process that, according to writer Lou Agosta, involves:
- being present
- truly listening to the patient’s story to gather relevant information
- understanding the patient’s context
- and reflecting on one’s own reaction in order to fine-tune empathy up or down depending on the situation—for example, in an emergency situation a nurse may need to tune down their focus on empathy to better focus on providing lifesaving measures
Empathy as a rich and useful concept when teaching nursing students.
As nursing faculty teaching clinical groups in a large, urban, community-based integrated care setting, we have had the opportunity to emphasize the deliberate practice of empathy, combined with critical thinking and reflection, as our students assess, plan, implement, and evaluate care processes for people with chronic mental illness and, in many cases, experiencing homelessness.
For example, during a clinical rotation, a support group participant shared that the car he also lived in had been impounded. At the end of the group session, the students were shaken by his story and expressed strong empathy for this individual. At the same time, we discussed with the students the need to keep their empathy in perspective in order to focus on thinking critically about how to help this individual. As a group, they were able to determine an action plan to assist the client in question.
In another clinical rotation, students learned about needs related to social determinants of health that exist for clients with diabetes who are also homeless. The students worked with clinic staff and consulted research to create a tool that would help assess client needs related to diabetes. The students can be said to have exhibited a kind of empathy—putting themselves in the place of the patients—in coming up with questions that focused on such practical issues as how clients are able to store their insulin, whether they have access to blood sugar testing supplies, and where they regularly obtain food.
Keeping empathy at the forefront despite ever more advanced technology.
Empathy remains an essential, if often intangible, ingredient in providing quality health care. As the majority of nursing students entering the profession are under 30 and must increasingly use advanced technology in providing care, we must guard against missing opportunities of teaching and practicing empathy in interactions at the bedside and community-based settings. As nursing faculty teaching our students to use empathy in their nursing process, we provide them with opportunities to practice an important skill needed for them to go out and change the world.
Mallory Bejster, DNP, RN, is the RN-BS coordinator and an instructor of nursing at the University of Central Missouri, a community health nursing clinical instructor at Rush University, and a Public Voices Fellow through the OpEd Project.
Olimpia Paun, PhD, PMHCNS-BC, FGSA. is an associate professor in the College of Nursing at Rush University and the Rush Nurses Alumni Association Chair in Health and Aging Process. She is also a geropsychiatric clinical nurse specialist, a researcher, and a Public Voices Fellow through the OpEd Project.
When I had students I did a pair of postconferences that shook my students pretty deeply, but they thanked me for it. For the first, I went to the hardware store and bought several pairs of thick work gloves. I got a bunch of unclaimed eyeglasses from the lost and found and smeared some of the lenses with a nearly-invisible coating of petroleum jelly, and blacked out some. I got some unneeded knee braces and AFOs (ankle-foot orthoses) from PT. Finally, I enlisted the participation of a staffer who was well-known to the students, put him in a patient gown and pants, snaked a tube out of the fly and hung a urine bag off his wheelchair, and had him be very convincingly hemiplegic and dysarthric. The students put on gloves (some on dominant hands, some on both) and spectacles, some had to put one hand in a pocket, and we all had our lunch as usual in the conference room. They were most disturbed by the man in the wheelchair– because they knew him well, and saw beyond the embarrassing appurtenances of illness and disability, how he must have felt as they fed him his lunch, and realized what a change this was for THIS human. And of course, eating your own food when you can’t feel or hold the utensils well or see to pick up the food or cup without spilling was something they never really thought of.
The next week we did a guided imagery thing. They were all in their twenties, so we started there. “You’re 25. What did you do when you got up today? What will you do after class? What do you do at home and work, and with whom? Think about it for a few minutes.” And I gave them three full minutes by the clock — which is a pretty long time, if you have to sit quietly with your eyes closed. Then, “OK, now you’re thirty five.” Three minutes. “Forty-five.” And so on until they were all 85. Then, after a minute to gather themselves, they talked about their “lives.” Some shared happy future lives, surrounded by caring family; others, not so much, with sickness and fear predominant, about being alone and unable to enjoy life.
My goal was to get them to really empathize with the people they were learning to care for– we all know how much students focus on tasks and lab check-off “skills” without realizing that the irreplaceable nursing “skill” has nothing to do with psychomotor capability. I noticed a real difference in their interactions with the residents afterwards. Later when they were on to other rotations I’d still hear from them now and then about how those two exercises changed their way of thinking like a nurse.