Empathy In Health Care and Nursing

Afza.Malik GDA

Concept of Empathy and Nursing Care

Empathy In Health Care and Nursing

What is Empathy,Empathy as a Component of Health Care,Empathy as an Integral Component of Human Psychology ,Empath And Nursing Research,Empathy Evidence in Nursing Literature,Quasi-Experimental Research on Empathy,Empathy Past and Present.

What is Empathy

    Empathy is a dimension of nursing that is central to caring competence, and it is often referred to as the essence and art of nursing. 

    Empathy in nursing is the ability of nurses to penetrate the covert thoughts and feelings of the client, to accurately interpret the client's thoughts and feelings as if they were their own, and to verbally and non verbally convey that interpretation back to the client in forming a positive nurse-client relationship. 

    When empathy is appropriately expressed it is in the form of sincerity, genuine positive regard, and sensitive understanding of the client's private world. Empathic nursing care has been shown to improve physiological and psychological outcomes for clients (Hope-Stone & Mills, 2001).

Empathy as a Component of Health Care

    Carl Rogers (1961) believed that empathy is the ability to perceive the internal frame of reference of another with such exactness as to be one with the other person's frame of reference. Carper (1978) correlated empathy with aesthetic knowing in her description of fundamental patterns of knowing in nursing. 

    From a historical perspective, the roots of morality are found in empathy. Being able to empathize with potential victims encourages people to act and help others. Empathy underlies many facets of moral judgment and action.     

    An instance when empathy leads to moral action is when a bystander is moved to intervene on behalf of a victim; the more empathy a bystander feels for the victim the more likely it is that the bystander will intervene (Goldman, 1998)

    The level of empathy felt towards another will shape one's moral judgments and empathic attitudes. Putting oneself in another's place leads people to follow certain moral principles.

Empathy as an Integral Component of Human Psychology 

    Developmentally, there is a natural progression of empathy from infancy onward. At 1 year, children feel distress and will start to cry when they see another child cry. After 1 year, the child will try to soothe another. child that is crying. 

    The most advanced level. of empathy emerges in late childhood when children begin to feel empathy for the plight of an entire group, such as the poor or the oppressed. 

    During adolescence, empathic understanding can reinforce moral convictions developed earlier in life that center on a desire to alleviate misfortune and injustice (Goldman, 1998).

Empath And Nursing Research

    Early nursing research on empathy indicated that empathy development programs had little to no effect on empathy. However, later studies have shown that by including strategies such as art, nurse educators can enhance basic empathy among nursing students, which may have implications for nurses.

Empathy Evidence in Nursing Literature

    Kunyk and Olson (2001) described the concept of empathy found in the nursing literature between 1992 and 2000. They found five conceptualizations of empathy: 

(a) empathy as a human trait

(b) empathy as a professional state

(c) empathy as communication process

(d) empathy as caring

(e) empathy as a special relationship

    Nurse authors are approaching empathy from a variety of perspectives, time frames, measurements, and outcomes indicating advancement of the science regarding empathy in nursing. 

    G. Evans, Wilt, Alligood, and O'Neil (1998) addressed empathy as a multidimensional phenomenon and stressed the importance of understanding two types of empathy: basic and trained. They liked basic empathy to natural, raw, or ordinary feelings for others, such as the innate tendency of a child to cry when recognizing distress in another human. 

    They liked trained empathy to increased empathy as a result of knowledge and education. They used the Layton Empathy Test and the Hogan Empathy Scale to measure trained and basic empathy in 106 nursing students and found that trained empathy was not sustained over time, causing the researchers to call into question attempts by nursing faculties to teach empathy to students . 

    They emphasized the importance of obtaining a measurement of students' base-line empathy as a way of monitoring changes in basic empathy after exposure to various empathy learning modalities. 

    G. Evans and colleagues (1998) suggested new approaches to facilitate students' discovery of their basic empathy and emphasized that basic empathy can be identified, reinforced, and refined in order to develop expertise in the expression of empathy.

Quasi-Experimental Research on Empathy

    Oz (2001) conducted a quasi-experimental investigation of empathy with 260 nurses who were randomly assigned to intervention and control groups. They used Dokmen's Scale of Empathic Skills, and the Empathic Tendency Scale to measure empathic communication skills and empathic tendency levels. 

    Their intervention consisted of education about empathic communication. Results indicated that nurses gained empathic communication skills as a result of empathy training. However, this training did not significantly change the nurses' basic empathic tendency levels.

    Wikstrom (2001) investigated the effect of an intervention program on student nurses' engagement in learning about empathy. The investigator assigned participants to intervention and control groups. 

    The intervention group received empathy exercises involving the use of a reproduction of Edvard Munch's painting, "The Sick Girl," to stimulate discussion and account making regarding interpretations of empathy depicted in the painting. 

    There was a significant improvement in the intervention group members' levels of empathy as compared to the matched control group. The research findings supported the use of art as a complementary strategy to theoretical knowledge on empathy to stimulate nurses' basic empathy.

    Kunyk and Olson (2001) found evidence that the concept of empathy is being advanced conceptually and empirically with more depth and breadth in the nursing literature. They, however, insisted that a more mature concept of empathy must emerge before empathy can be fully useful in nursing practice, research, and education.

    Alligood (2001) and the Empathy Research Team at the University of Tennessee, Knoxville, developed an implicit middle range theory of empathy to explain how the concept of empathy operates within the context of King's general systems framework of personal, interpersonal, and social systems. 

    A middle range theory of empathy conceptualized within this established nursing framework provides new understandings of basic empathy for nursing. According to Alligood, empathy has been viewed from a behavioral (state) approach; however, the more current view of empathy emanates from a developmental (trait) perspective. 

    Viewing empathy as a state rather than a trait of individuals represents a perspective shift and opens avenues for research in nursing related to empathy and emphasizes the importance that nurses have to develop and understand their own empathy as a basis for clinical practice ( Alligood).

Empathy Past and Present 

    In the past 20 years, empathy has been conceptually and empirically advanced in the nursing literature. Studies have raised critical questions about the nature of empathy and how empathy may or may not be teachable using various educational and experiential strategies. 

    Research findings suggest that baseline measurements of empathy in nurses and nursing students can be a starting point for developing strategies to enhance empathic response to clients. 

    Nursing as a profession needs more replication of studies to identify basic empathy skills and to discern the different impact of empathy education versus empathy education combined with experiential exercises in empathic understanding such as art, film, and literature. 

    With continued research and growth in the understanding of empathy, the art of nursing can be enhanced.

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