Empathy and SufferingR. Pardoe & I. Yeung

Objectives – points to take away

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

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

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

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.

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

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

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

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

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”

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

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

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

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

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

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

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

The Experience of Living with Stroke: A Qualitative Meta-synthesisObjective: use qualitative literature to

enhance understanding of living with strokeThemes

ChangeTransition and transformationLossUncertaintySocial Isolation

Major findings