Empathy: a study of two types

"Walking in Their Shoes": The effects of an immersive digital story intervention on empathy in nursing students

Aim

To evaluate the effects of a novel, immersive digital story intervention on empathy.

Design

A randomized trial with three phases.

Results

A total of 238 2nd year nursing students were recruited between May 2018 and December 2019. At baseline, no significant differences in empathy between the groups were found (p = .760). However, at post‐test, empathy was significantly higher in the intervention group (M: 118.76, SD: 10.65) than it was in the control group (M: 114.60, SD: 15.40) (p = .012). At follow‐up, there were no significant differences in empathy between the groups (p = .364).

Conclusion

The intervention resulted in an immediate increase in empathy in nursing students. However, further development of effective intervention delivery modes and fundamental redesign of the intervention itself would be needed to sustain this improvement over the long term.

Effect of a 2-day communication skills training on nursing and midwifery students' empathy: a randomised controlled trial

INTRODUCTION

Empathy is crucial to the fundamental aim and achievement of nursing and midwifery goals. Researchers agree on the positive role empathy plays in interpersonal relationships when providing healthcare. Models of good communication have been developed to assist nurses, midwives and doctors to improve their ability to communicate with patients. This study investigated the effect of a 2-day communication skills training (CST) on nursing and midwifery students' empathy in a randomised controlled trial.

METHODS

The two groups had a baseline data collection at the same time. The intervention group had a CST, followed by post-test on day 3. The control group had post-test on day 4 just before their CST. The empathy outcome was measured with Jefferson Scales of Empathy-Health Professions Student version. Both groups had a follow-up test at the same time 6 months after the CST.

RESULTS

In this study, there was no statistically significant difference in the scores of empathy between the groups F(1, 171)=0.18, p=0.675. The intervention group had baseline T1 (M=109.8, SD=9.8, d=0.160), and post-test T2 (M=111.9, SD=9.0, d=0.201), whereas the control group had baseline T1 (M=107.9, SD=11.46, d=0.160), and post-test T2 (M=110.0, SD=11.0, d=0.201). Baseline data were collected on 15 June 2013.

CONCLUSIONS

This study has shown that empathy may not be enhanced within a short period after CST.

HOW TO MEASURE THE EMPATHY LEVEL OF UNDERGRADUATE NURSING STUDENTS? AN INTEGRATIVE REVIEW

ABSTRACT Objective: analyze available evidence in the literature on the measuring of empathy levels in nursing undergraduates. Method: integrative literature review developed in the databases PubMed, Web of Science, CINAHL and LILACS in September 2017. Results: among the 40 primary studies analyzed, 21 questionnaires were identified to measure the empathy levels of nursing undergraduates. Conclusion: different tools exist that are considered reliable to analyze the empathy level among nursing undergraduates.

Evaluation of empathy measurement tools in nursing: systematic review

AIM

This paper is a report of a systematic review conducted to analyse, evaluate and synthesize the rigour of measures used in nursing research to assess empathy, in order to identify a 'gold standard' for application in future studies.

BACKGROUND

Empathy is considered essential to the provision of quality care. We identified 20 different empathy measures used in nursing research. There are inconsistencies between tools, indicating both the inherent complexity of measuring empathy and the need to evaluate the rigour of the measures themselves.

DATA SOURCES

An extensive search was conducted for the period 1987 and 2007 using the Medline, CINAHL and PsycINFO databases and the keywords 'empathy', 'tool', 'scale', 'measure', 'nurse' and 'nursing'. Twenty-nine studies were identified as relevant, in which 20 different empathy measurement tools were used. Twelve tools met the inclusion criteria for this review.

METHOD

Twelve measures were critically reviewed and analysed. A 7-criterion framework was developed to appraise the rigour of the empathy measures, with a score range of 0-14 for each measure.

RESULTS

Quality scores obtained were low (2-8 of 14). Validity and reliability of data were commonly reported, but responsiveness to change was tested in only three measures. None of the measures were psychometrically robust or covered all the domains of empathy. User involvement was limited and only five were developed in nursing settings.

CONCLUSION

Most measures have undergone rigorous development and psychometric testing, although none is both psychometrically and conceptually satisfactory. Empathy measures need to cover all relevant domains reflecting users' own perspectives and be tested with appropriate populations in relevant care settings.

Measurement of empathy in nursing research: systematic review

AIM

This paper is a report of a systematic review to identify, critique and synthesize nursing studies of the measurement of empathy in nursing research.

BACKGROUND

The profound impact of empathy on quality nursing care has been recognized. Reported empathy levels among nurses range from low to well-developed and there is clearly debate about what constitutes empathy and how it can be measured and improved.

DATA SOURCES

Searches were made of the CINAHL, MEDLINE and PsycINFO databases, using the terms 'empathy', 'tool', 'scale', 'measure', 'nurse', and 'nursing', singly or in combination to identify literature published in the English language between 1987 and 2007.

METHODS

A systematic review was carried out. The included papers were critically reviewed, relevant data were extracted, and a narrative synthesis was conducted.

RESULTS

Thirty papers representing 29 studies met the inclusion criteria. Three types of studies were identified: descriptive studies (n = 12), studies of empathy and patient outcomes (n = 6), and evaluational studies (n = 11). Twenty scales were used, with more than one tool being applied in some studies, suggesting the need for a systematic review of empathy measures in nursing research. A range of settings were studied but some, such as genetic healthcare, have been neglected.

CONCLUSION

Despite numerous tools being used in nursing research to assess empathy, there appears to be no consistency, suggesting the need to evaluate the rigour of empathy tools appropriately, either to inform education or for application in clinical settings.

Deferred empathy: a construct with implications for the mental health of older adults

Deferred empathy occurs when an experience provokes a memory that after reflection allows people to say, "Now I understand." Heretofore, the concept was explored only in quantitative research; therefore, the purpose of this phenomenological study was to elicit a more detailed description of the construct of deferred empathy. For most of the participants (n = 20) triggering events involved personal challenges such as loss, loss of control, or interpersonal conflict that reminded them of, and changed, their perception of earlier relationships. Development of empathy involved reflection on past and present events, making choices, changing expectations, and learning acceptance. The process resulted in appreciative understanding of others as well as personal benefits. Findings have implications for mental health promotion in older adults in which life review promotes gerotranscendence.

A systematic review of tests of empathy in medicine

BACKGROUND

Empathy is frequently cited as an important attribute in physicians and some groups have expressed a desire to measure empathy either at selection for medical school or during medical (or postgraduate) training. In order to do this, a reliable and valid test of empathy is required. The purpose of this systematic review is to determine the reliability and validity of existing tests for the assessment of medical empathy.

METHODS

A systematic review of research papers relating to the reliability and validity of tests of empathy in medical students and doctors. Journal databases (Medline, EMBASE, and PsycINFO) were searched for English-language articles relating to the assessment of empathy and related constructs in applicants to medical school, medical students, and doctors.

RESULTS

From 1147 citations, we identified 50 relevant papers describing 36 different instruments of empathy measurement. As some papers assessed more than one instrument, there were 59 instrument assessments. 20 of these involved only medical students, 30 involved only practising clinicians, and three involved only medical school applicants. Four assessments involved both medical students and practising clinicians, and two studies involved both medical school applicants and students. Eight instruments demonstrated evidence of reliability, internal consistency, and validity. Of these, six were self-rated measures, one was a patient-rated measure, and one was an observer-rated measure.

CONCLUSION

A number of empathy measures available have been psychometrically assessed for research use among medical students and practising medical doctors. No empathy measures were found with sufficient evidence of predictive validity for use as selection measures for medical school. However, measures with a sufficient evidential base to support their use as tools for investigating the role of empathy in medical training and clinical care are available.

Does Mindfulness Decrease Stress and Foster Empathy Among Nursing Students?

This pilot study of baccalaureate nursing students explored the effects of an 8-week mindfulness-based stress reduction (MBSR) course on stress and empathy. The course was intended to provide students with tools to cope with personal and professional stress and to foster empathy through intrapersonal knowing. A convenience sample of 16 students participated in the course, used guided meditation audiotapes at home, and completed journal assignments. Stress and empathy were measured using paired sample t tests. Participation in the intervention significantly reduced students' anxiety (p > .05). Favorable trends were observed in a number of stress dimensions including attitude, time pressure, and total stress. Two dimensions of empathy--personal distress and fantasy--also demonstrated favorable downward trends. Regular home meditation was correlated with additional benefit. Participants reported using meditation in daily life and experiencing greater well-being and improved coping skills as a result of the program. Findings suggest that being mindful may also decrease tendencies to take on others' negative emotions. Coping with stress and fostering the affective domain are important facets of nursing education that may be facilitated by mindfulness training.

Enhancing creativity to improve palliative care: the role of an experiental self-care workshop

Creativity plays an important part in all aspects of life. Although the nature of creativity is hypothesized in a variety of ways, there is no common agreement as to how or why it manifests. In the USA and UK, creative ability is often restricted by education, and nursing education programmes appear to be no exception. This article discusses the development of a weekend workshop programme for health professionals working with older people and in palliative care, using Alligood's (1991) hypotheses, that there are positive correlations between creativity, self-actualization and empathy. Actualization and creativity are closely related to self-care and there is evidence that 'selfishness' is an essential ingredient in the actualizing process. There is also evidence that an empathic relationship between health workers and their patients has a significant positive impact on interpersonal care processes. If the creative potential of nurses and carers can be enhanced through self-care, their ability to empathize may be increased. The focus of the workshops is on creative methods of self-care, using experiential exercises in relaxation, music, touch, massage and silence. Evaluation of the workshops revealed that the potential of using this method to develop care practices is worthy of investigation and development.

Clarification of conceptualizations of empathy

BACKGROUND

If understanding our clients needs, emotions, and circumstances is fundamental to nursing practice, and empathy is the foundation of that understanding, then a conceptualization of empathy that can be used by nurses is of utmost importance to the profession. In 1992, Morse, Anderson, Bottorff, Yonge, O'Brien, Solberg and McIlveen analysed the concept of empathy in the psychological and nursing literature, and suggested the conceptualization of empathy was incomplete. Since that time, nurse authors have continued to publish conceptualizations and research on empathy.

PURPOSE

The purpose of our analysis was to describe empathy as presented in the nursing literature between 1992 and 2000.

METHOD

A concept clarification methodology of concept analysis was used because of the many definitions, the rich descriptions, and the application of empathy as a research variable in the reviewed literature.

FINDINGS

Five conceptualizations of empathy were revealed: empathy as human trait, empathy as a professional state, empathy as a communication process, empathy as caring, and empathy as a special relationship.

CONCLUSIONS

The literature reviewed contained evidence that the concept is developing more depth and breadth. Nurse authors are approaching empathy from a variety of perspectives, time frames, measurements, and outcomes. While all are important to the development of the concept, further enrichment of the conceptual work on empathy is needed before a fully mature concept emerges that is fully useful in nursing practice, research, and education.

Work of art dialogues: an educational technique by which students discover personal knowledge of empathy

The visual art programme was an approach used to facilitate students' discovery of personal knowledge of empathy. The research programme constituted the first phase of an existing theory course in empathy. It involved a visual-verbal-writing process in which a reproduction of Edvard Munch's The Sick Child was studied and interpreted with a focus on personal knowledge of empathy. Data were collected from two university colleges of health sciences in Sweden during a period of 4 years (1995-1998). Student nurses (n = 428) in the undergraduate programme served as the study population. In the first stage, the students worked alone on written reports. Then, in small-groups, they discussed whether the picture facilitated the discovery of a personal knowledge of empathy. The results showed that the visual art programme stimulated the students to discuss and write about empathy. The ambiguity in the painting and the relaxed study situation was favourable to the students' discovery of their personal knowledge of empathy.