Different authors have varying definitions of empathy and have described its nature and applications to different fields such as nursing, medicine, research and education. Empathy is an important characteristic that should be reflected in medical practice for the benefit of both the patient and the medical professional. The difficulty lies on the elusive nature of the concept, the various interpretations that arise from the use of the term in different fields, the presence of various levels and forms of empathy, and its multi faceted nature (Kunyk and Olsen, 2001; Morse et al.
1992; Wiseman, 1996; Wiseman, 2007).
This paper aims to identify the different perceptions of empathy, summarize some definitions of the concept in the literature and aims to consolidate these in order to obtain a functional concept from different perspectives that can be acceptable for the field of nursing. By concretizing this general idea of empathy, this paper aims to strengthen the importance of empathy in the care of patients and inculcate to the students the different levels of patient-nurse interaction including personal association with the patient.
Through this research, strengthening this characteristic can be achieved and should, hopefully, elicit the best form of care to the patient and inspire growth and self-improvement on the side of medical practitioner as opposed to a prescriptive one on how to interact with patients. More than any other field, the concept of empathy should be well understood by medical practitioners because of the sensitivity and significance of the object that they are handling, that of human life and emotions.
In fact, the American Association of Medical Colleges have stressed the value of learning empathy by students rearing for the field of health and medical care as this is a vital criteria for showing one’s recognition and awareness of a patient’s feelings and sentiments, as well as a tool for understanding a patient’s coping mechanisms. However, as the technical learning process advances, a few innate and behavioral characteristics can be overlooked and as the treatment processes become routine, some concepts can remain disregarded.
Thus, studying about the theory of behavior, e. g. empathy, in nursing practice is also important in providing the best care possible for the patients. According to a recent review by Stepien and Baernstein (2006), empathy is an important factor that can affect a patient’s approval and satisfaction. In fact, in a study by Swahnberg et al. (2006), a patient who does not experience empathy from the doctor or the nurse feels neglected and this event is categorized as abuse in health care.
On the other hand, a patient who experiences empathy from nurses, physician or other personnel feels important and special. This reaction can trigger a series of events that affects the medical institution as a whole. Empathy reflects quality in nursing and medical care which, in turn, mirrors a patient’s compliance to the doctor or nurses’ advice regarding his condition. More often, it follows that clinical results are expected to be positive, thus, satisfying patients and their families, as well as the personal well being of the medical staff or the physician.
This brings about a series of interactions that elicits positive and encouraging atmosphere in a hospital, clinic or nursing home. Wiseman (1996) stressed that patient-focused care is enhanced and patient morale, as well as nursing performance, is improved. Although empathy may not be a key determinant in the recovery of a patient, Bulger (1997) notes that empathy is an essential component of healing and should be coupled with appropriate patient-physician communication, interaction and understanding.
This illustrates a hospital situation that brings about the element of mercy from the people around the patient in order to show support and facilitate healing. The latter creates a thin line between sympathy and empathy. Although some reports mention that similarity is an essential characteristic of empathy, it also is a route to sympathy (Wiseman, 2007). These two concepts are oftentimes associated with each other and some authors have clarified the differences between the two (Wiseman, 1996). Empathy: definitions and usage in different fields
Empathy originated from a Greek word empatheia, meaning passion, and has been defined in the Merriam-Webster’s Online Dictionary as the action of understanding, being aware of, being sensitive to, and vicariously experiencing the feelings, thoughts, and experience of another of either the past or present without having the feelings, thoughts, and experience fully communicated in an objectively explicit manner. It has also been referred to as an imaginative projection of the empathetic individual so that the object appears to be infused with it.
Similarly, in the field of clinical practice, Larson and Yao (2005) stressed that empathy is characterized by exerting emotional effort on the part of a medical practitioner. This is important in understanding the patient and this emotional labor may even result in the alteration of his current emotions to fully comprehend and show genuine concern, even enthusiasm, in caring effectively for the patient. Empathy is also conceptualized as a knowledge tool that can be developed and practiced.
Because of this characteristic, it becomes a skill which can be developed and assessed, which is why it has to be measured through questionnaires and surveys. If empathy is a skill then it must be taught and quantified to gain measure of the teaching programs effectively (Wiseman, 1996). Applications and usage in different areas and diverse cases add to the various definitions and analyses already present in literature.
For example, Wiseman (2007) analyzes its levels of practice specifically in an oncology ward and Swahnberg et al. 2007) show its relations to abusive health care from the point of view of women. Empathy is also viewed as a skill in clinical practice that can be taught to students. Teachers have become creative in incorporating into the lesson the concept of empathy in order to impart it to their students effectively. Stepien and Baernstein (2006) mention such methods as utilizing arts, theater, literature and writing. The tasks achieve the objective of engrossing the students in emotional effects of illnesses to patients and allow students to develop sensitivity to these clinical accounts, an aspect of cognitive empathy.
In the business field, empathy is treated differently but is also viewed as an essential characteristic of both employees and bosses alike in order to serve their clientele better. Freemantle (2003) refers to it as adding emotional value (AEV) to service and ensuring empathy measures (EM) by creating a warm atmosphere in the workplace. According to his article, empathy can be measured by the satisfaction of a client and can be achieved through the congenial and helpful nature of employees which the author refers to as smiles and courtesy.
Creating empathy in the business is seen as synonymous with humility, courtesy and ability to relate to people, may they be employees, clients or suppliers. Developing the concepts of AEV and EM and coupling it with efficiency boosts profits and interpersonal relationships in this field. In psychology, the concept of empathy is similar to what has been described by Wiseman (2007) of empathy as an incident. This is an initial phase of empathy that is observed during counseling or the listening phase from the model of Barrett-Lennard (1962)¬. In this model, communication is initiated due to random associations.
King (1981) also notes the need to understand human behavior in order to allow room for detachment and create a sensitive but self-aware perception of another’s experiences. But aside from mentally comprehending a situation and event, Stepien and Baernstein (2006) reviews several studies stressing that the emotional component is extremely important in expressing empathy. Contrastingly, Duan and Hill (1996) distinctly characterize and classify the concept as being cognitive empathy, the initial response or affective empathy, which results in a poignant response to the situation.
The concept of empathy is also associated with social behavior and development. In fact, it is seen as a hereditary influence where, based on twin studies, females are observed to exhibit more empathetic behavior than male children (Volbrecht et al. , 2007). In contrast, surveys on medical students indicate that the ability to empathize is not dependent on gender but is directly associated with the personal well being, quality of life and disposition of the student (Thomas et al. , 2007). Defining attributes of the concept of empathy
Wiseman (1996) reviewed the studies on the concept of empathy based on the method by Walker and Avant (1988) and itemized defining attributes which has to be present in an empathetic situation. When one mirrors another’s view of the world, perceives another’s present emotions, remains objective despite a situation, event or character, is tolerant or non-judgmental, and most importantly, communicates the understanding of the situation in question, he or she exhibits empathy to another person or object.
These are characteristics of empathy according to Wiseman’s review and are among the attributes that are universally present in most or all of 53 studies evaluated. In addition, empathy as a state or a trait was not considered an attribute in this study due to the varying tendencies of different people to react to a situation. However, it was also mentioned that in most reports, empathy is considered to be partly trait and also a state. In clinical practice, Stepien and Baernstein (2007) indicate different characteristics of empathy that should be met.
These include the emotive aspects which refer to the ability to visualize another’s feelings and perspectives; the moral aspects which refer to the self-conscious nature of the physician or nurse to empathize; the cognitive aspect is the dimension which allows one to understand the patient’s situation; and the behavioral dimension which refers to the reaction of the medical personnel conveyed to the patient. Antecedents and consequences
In nursing practice, Wiseman (1996) notes that the following antecedents are required for empathy to take place; it takes communication of the experience or condition from the patient to the nurse, the ability of the nurse to listen and perceive the details of the condition and, finally, the reaction must be sent across to the patient in order to reaffirm to the patient that the condition is understood. Budding from the idea of hierarchy levels in empathy development, Wiseman (2007) combines the idea that both mental and social skills advance the practice of empathy in nursing care.
Thus, it also results in a dynamic and progressive form of practice. Based on this framework, empathy starts out as an incident but evolves to include experience. The latter is termed by Wiseman (2007) as empathy as a way of knowing and empathy as a process. This process includes totally imbibing the concept and transforming it into empathy as a way of being by building and strengthening relationships. These qualifications of empathy in psychology are also referred to by Barrett-Lennard (1962) as the listening phase, the reasoning phase and the understanding phase.
In these two models, all three phases and levels are required for the experience to be referred to as empathy. Tyner (1985), on the other hand, mentions that the nurse should go through an identification phase first in order to relate to a patient’s experiences especially if the means for relating to the experience is very low. That is, there is little similarity on the experience of the nurse that allows him to relate to the condition or if the condition is new to him.
An important consequence of empathy is also its ability to reflect confidence, self-awareness and broadness of experience of the nurse. The capability to empathize also shows both the sensitivity and security of the nurse since it takes a high amount of self-understanding and awareness in order for one to understand and relate to the feelings of another person especially the patient (Wiseman, 2007). Borderline, related, and contrary cases presented in literature indicate that the object’s response defines an empathetic episode.
Borderline cases may satisfy the communication and listening phase but not the reaction phase whereas related cases may be characterized from an interpretation using the object’s point of view and not of the patient. Unsurprisingly, contrary cases do not satisfy any of the defining attributes of empathy or only comprise the communication phase where the object reacts in a totally different perspective as the patient (White, 1997; Wiseman, 1996).
Personal concept of empathy Based on the defining attributes and antecedents present in literature empathy can be defined as an interactive episode where a condition is conveyed and touches the object’s heart and causes him to react and feel the same way another person would and eventually verbalizing his reaction. It allows him to mirror the emotions that are being felt by another and are triggered by the same stimulus, may they be positive or negative.
It may occur from different perspectives but arrive at the same end result of emotional outcomes due to the similarities in responses that are being triggered by the same event. It should require association and produce a driving force to change an adverse condition or celebrate in opposite cases as empathy should not only be exclusive for distressing situations but joyful experiences as well. Finally, it should bring about enrichment on the part of the nurse as it allows a process of immersion to another person’s experience or facet of life.