Empathy and suffering
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Transcript of Empathy and suffering
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Empathy and SufferingR. Pardoe & I. Yeung
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Objectives – points to take away
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The Empathic Process and Its Mediators – A Heuristic Model (Gallop, Lancee, & Garfinkel, 1990)Objective: to create a stepwise model that
can be used in practiceIn this study empathy is examined as a tri-
phasal processWithin each of these phases there are different
mediators that can either hinder or advance the empathic process
It determines the influence of mediators on the empathic process
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The Empathic Process... (cont’d)Implications
Guideline for nurses to reflect on their dialogues
In using this process, it becomes easier to distinguish between empathy and other similar concepts
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Inducement phase
Matching phase
Disinterest
Participatory-Helping phase
Overwhelmed
Engaged
Match
Perplexed
Overidentification
No action
Nonspecific emotional support
Instrumental problem
solving
Understanding
THE EMPATHIC PROCESS
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OutcomesDisinterested – observer proceeds to next
event.Overwhelmed – observer only focuses on
his/her affective response to event. Observer may assume that the other person experiences similar feelings and feel pity for the other but not as an expression of desire to understand the world of the other.
Engaged – observer attends to observed and wishes to proceed to next phase.
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OutcomesPerplexed – generated hypotheses do not
contain observed content and affect. No match made.
Overidentification – Observer experiences loss of self due to associated distress. Cannot help the observed.
No action – does not mean a lack of empathy!Nonspecific emotional support – observer
wants to “make person feel better”.Instrumental problem solving – attempt to
solve patient’s problems
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The Usefulness of the Staff-Patient Interaction Response Scale for Palliative Care Nursing for Measuring the Empathetic Capacity of Nursing Students (Adriaansen, van Achterberg, & Borm, 2008)
Objective: To determine the reliability and validity of the SPIRS-PCN as a measure of empathy in palliative care
How was it measured? Known-groups technique: analyzing the degree
the instrument separates groups predicted to differ based on known characteristics
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The Usefulness of Staff-Patient Interaction... (cont’d)Major findings: Validity partially supported – SPIRS also
measures maturity (or the ability to place oneself in another’s shoes)
Reliability supportedSecular students scored lower on the SPIRS-
PC than religious studentsStudents with experience scored higher than
students with no experience
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ActivityPair upPick one of the two examples from the next
slide and come up with one response for each of categories listed below:Likely to cause defensivenessLikely to terminate interactionLikely to engage in interactionLikely to keep discussion going
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Examples1. Frank is a patient
in his mid-60s. He was admitted to the hospital 4 days ago for chemotherapy for advance prostate cancer.
He says: “I don’t want to be a burden to you”
2. Anne is a patient in her mid-20s with a hx of intravenous drug use who was admitted to hospital 2 days ago for a liver biopsy. She is positive for Hepatitis B and HIV
She says: “I just want to stay in bed – please”
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Likely to cause defensiveness Confronting Strong negative response Denial of responsibility
Likely to terminate interaction Generalization Cliches Use of flattering statements Focused on oneself Accepting flattery of patient Looking for reassurance Irrelevant opinion Giving presumptuous advice Giving presumptuous solution
Likely to engage in interaction Trying to empower the pt Giving an explanation Asking superficially on the well-being of
the patient Asking for clarification Reflective listening attitude Expressing interest Acknowledging fears Explanation of the situation Giving advice Expressing a relevant opinion
Likely to keep discussion going Inviting the patient to continue the
dialogue Inviting the patient to explore the situation Trying to recognize feelings of the patient Recognizing the reality of the situation Investigating profoundly the feelings of the
pt
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The Impact of Nurses’ Empathic Responses on Patients’ Pain Management in Acute Care (Watt-Watson, Garfinkel, Gallop, Stevens & Streiner, 2000)o Objective: To look at the relationship between nurses’
empathic responses and patients’ pain rating and analgesia after surgery
o Methods: o 225 post-operative bypass patients were interviewed on:
o Pain intensity and qualityo Perception of the nurse as a resource for pain
o 94 nurses were asked to fill out a questionnaire to determine their o Level of empathyo Knowledge and beliefs on pain
o 80 nurse-patient pairso Patient data grouped and matched with their nurse to form nurse-
patient pairs
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Finding #1o Level of empathy does not correlate with level
of pain o Level of empathy does not amount of analgesiao However, patients with more empathic nurses
perceived themselves as receiving analgesia when neededFinding #2
o Nurses’ level of empathy varied directly with nurses’ level of knowledge and beliefs about pain assessment and management (nurses agreeing with and believing patients statements of pain)
o More empathic nurses give opioids for pain
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Finding #3 Level of empathy did not vary nurse
characteristics such as years of unit/nursing experience, level of in-service education
Levels of empathy did not vary in relation to patients’ age
Finding #4
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Psychiatric Comorbidity following Traumatic Brain Injury (Rogers & Read, 2007)Objective: to determine the probability of
developing certain psychiatric conditions after TBI using the Hill’s criteria to establish causation
Implications: Referral for psychiatric servicesScreening in the communityMedical history assessments
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Psychiatric Comorbidity... (cont’d)ResultsDisorder Relationship with TBI
Major Depression
Maladaptive psychosocial factors related to TBI increases risk/premorbid psychosocial factors
Bipolar Affective Disorder
No relationship
Schizophrenia Increased risk with genetic predisposition
Substance Abuse (SA)
Premorbid SA/hx of psychiatric condition – short term increased risk post-injury
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Disorder Relationship to TBI
Generalized Anxiety Disorder
No relationship/Cultural differences may increase risk
Panic Disorder Increased risk with latency period of 10+ years
PTSD Hx of psychiatric disorder/location of TBI
OCD Mixed results
Psychiatric Comorbidity... (cont’d)Results
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The Experience of Living with Stroke: A Qualitative Meta-synthesisObjective: use qualitative literature to
enhance understanding of living with strokeThemes
ChangeTransition and transformationLossUncertaintySocial Isolation
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Major findings