Beyond empathy: expanding expressions of caring

College students' perceptions of anticipated career burnout

Objective: Although burnout has been studied in-depth among working professionals, less is known about college students' perceptions of burnout in their future careers. In this study, we explored the prevalence and correlates of anticipated career burnout and engagement among students. Participants: Participants were 351 undergraduate students. Methods: Students completed an online survey. Results: Students planning to enter both helping and non-helping professions were worried about burnout in their chosen careers. They expected more burnout and less engagement 10 years into their career when compared to two or three years. However, students who perceived their future work as a good fit to their personal skills and abilities expected less burnout and more engagement. Conclusions: These findings can be applied to career assessment and planning so that students are able to move into careers that align with their goals, career orientation, and expectations to maximize their experience of engagement in their future work.

Trusting the Dentist—Expecting a Leap of Faith vs. a Well-Defined Strategy for Anxious Patients

This article aimed to set into perspective the unique aspects of trust within the dentist–patient relationship by exploring the literature as well as historical aspects of dentistry in the association between trust/distrust and patient anxiety. In order to characterise this uniqueness, the assumptions for trusting in dentistry are compared and contrasted with other professions using a conceptual analysis. The professions of medicine, sociology, psychology, nursing and dentistry were check listed according to the tenets of a concept analytical approach reported by Hupcey et al., in 2001. Recommendations for patient/person-centred care, as opposed to dentist-centred care, that would improve trust are specified according to the literature. These include empowering patients, practicing active listening, empathy and relationship building that might benefit dental patients in relation to the perceived risks of anxiety or induced pain. It was concluded that global distrust of dominating dentists must give way to person-centred professional strategies so that dentists and patients can tackle their dental anxiety-trust challenges, both in the public’s image of the dental profession and in clinical relationships. Future directions would be to explore incentives for dentists to change to patient/person-centred care.

Structural Equation Modeling of Person-Centered Nursing in Hospital Nurses

Background: This study aimed to develop and test a model of person-centered nursing (PCN) for hospital nurses using Structural Equation Modeling (SEM). Methods: This was a cross-sectional descriptive study. The subjects of this study were 340 clinical nurses in South Korea. A survey was conducted using an online questionnaire. Data were analyzed using SPSS 18.0 and AMOS 21.0. Results: Results of the validity test of the hypothesized model showed that goodness-of-fit indices satisfied the criteria (χ2 = 573.767 (df = 257, p < 0.001), TLI = 0.92, CFI = 0.93, SRMR = 0.02, RMSEA = 0.06), and 10 of the 15 paths established in the hypothesized model were statistically supported. The model’s explanatory power was 82%, which showed that empathy directly and indirectly affected PCN, and that nursing competency directly affected clinical nurse performance of PCN. In addition, nursing competency, interpersonal relationship ability, and moral sensitivity indirectly influenced PCN through empathy. Conclusions: In order to promote PCN for clinical nurses, it is desirable to develop in-hospital education programs that can improve nursing competency, interpersonal relationship ability, and moral sensitivities, emphasizing elements of empathy. Empathy was an important mediating factor that influenced the relationships between PCN and related variables.

Demonstrating empathy when communicating with older people

Empathy is an integral aspect of communication with older people and is central to person-centred care. As part of the provision of person-centred care, empathy supports effective communication, producing positive effects such as increased emotional well-being, increased adherence to treatment plans, reduced pain levels and improved wound healing. Empathy involves attempting to understand the other person's perspective and feelings and communicate that understanding back to them. Empathic communication can help older people feel that they are being listened to and valued as partners in healthcare relationships. This article focuses on why it is important to demonstrate empathy when communicating with older people and how this can be achieved. It explains the origin of the concept of empathy in nursing and provides different ways of characterising empathy. It explores barriers to empathic communication in older people nursing and identifies verbal and non-verbal communication skills that nurses can use to enhance their empathy. Finally, it explains the importance for nurses to develop self-awareness and undertake self-care to preserve their capacity to demonstrate empathy towards older people.

Socially-Assistive Robots Using Empathy to Reduce Pain and Distress during Peripheral IV Placement in Children

Objectives

Socially-assistive robots (SAR) have been used to reduce pain and distress in children in medical settings. Patients who perceive empathic treatment have increased satisfaction and improved outcomes. We sought to determine if an empathic SAR could be developed and used to decrease pain and fear associated with peripheral IV placement in children.

Methods

We conducted a pilot study of children receiving IV placement. Participating children were randomized to interact with (1) no robot, or a commercially available 3D printed humanoid SAR robot programmed with (2) empathy or (3) distraction conditions. Children and parents completed demographic surveys, and children used an adapted validated questionnaire to rate the robot's empathy on an 8-point Likert scale. Survey scores were compared by the t-test or chi-square test. Pain and fear were measured by self-report using the FACES and FEAR scales, and video tapes were coded using the CHEOPS and FLACC. Scores were compared using repeated measures 2-way ANOVA. This trial is registered with NCT02840942.

Results

Thirty-one children with an average age of 9.6 years completed the study. For all measures, mean pain and fear scores were lowest in the empathy group immediately before and after IV placement. Children were more likely to attribute characteristics of empathy to the empathic condition (Likert score 7.24 v. 4.70; p=0.012) and to report that having the empathic vs. distraction robot made the IV hurt less (7.45 vs. 4.88; p=0.026).

Conclusions

Children were able to identify SAR designed to display empathic characteristics and reported it helped with IV insertion pain and fear. Mean scores of self-reported or objective pain and fear scales were the lowest in the empathy group and the highest in the distraction condition before and after IV insertion. This result suggests empathy improves SAR functionality when used for painful medical procedures and informs future research into SAR for pain management.

Patient participation in municipal elderly care from the perspective of nurses and occupational therapists

AIM

The aim of this study was to describe how nurses and occupational therapists in municipal care of older people define and implement patient participation in their daily work.

DESIGN

This study had a cross-sectional design. Data were collected using an online questionnaire.

METHODS

The questionnaire had both closed and open-ended questions. One-hundred and fourteen nurses and occupational therapists responded. Data were analysed with descriptive statistics and thematic analysis.

RESULTS

Two main themes were identified as follows: "The professionals' perspective at the centre - Patient participation to enhance compliance" and "The patients' perspective at the centre - Patient participation as an ongoing process." The themes covered a continuum. On one extreme, patient participation was equated with making the patient comply with what the professionals wanted to do. On the other extreme, all power was transferred to the patient. The first theme was restricted to the decision-making process. The second theme covered the entire care or, rehabilitation, process.

Empathy in the nurse–patient relationship in geriatric care: An integrative review

Introduction:

Empathy is a complex human experience that involves the subjective intersection of different individuals. In the context of nursing care in the geriatric setting, the benefits of empathetic relationships are directly related to the quality of the practice of nursing.

Objective:

Analyze scientific production on the benefits of empathy in the nurse–patient relationship in the geriatric care setting.

Methods:

An integrative review of the literature was performed using the PubMed, Cochrane, CINAHL, Scopus, PsycINFO, and Web of Science databases. The articles retrieved were organized, evaluated, and classified based on the level of scientific evidence.

Results:

Relationships of empathy between nurses and older people were analyzed in quasi-experimental studies using different assessment tools, the majority of which had moderate levels of validity and reliability. Studies with a qualitative approach discussed the meaning of empathy in terms of the quality of care offered, compassion, and vulnerability.

Discussion:

Levels of empathy increase when activities are developed with the aim of teaching, sensitization, and training for relational care between nursing staff and older people. The analysis of empathetic relationships is important to the evaluation of the quality of care provided to older people.

Conclusion:

Empathy in the nurse–patient relationship in the geriatric care setting is an important ethical aspect that contributes to the quality of the practice of nursing. The present findings indicate the need for more robust assessment tools with adequate psychometric properties and the descriptive analysis of empathy.

The use of supportive communication when responding to older people's emotional distress in home care - An observational study

Background

Responding to older people’s distress by acknowledging or encouraging further discussion of emotions is central to supportive, person-centred communication, and may enhance home care outcomes and thereby promote healthy aging. This observational study describes nursing staff’s responses to older people’s emotional distress, and identify factors that encourage further emotional disclosure.

Methods

Audio-recorded home care visits in Norway (n = 196), including 48 older people and 33 nursing staff, were analysed with the Verona Coding Definitions of Emotional Sequences, identifying expressions of emotional distress and subsequent provider responses. The inter-rater reliability (two coders), Cohen’s kappa, was >0.6. Sum categories of emotional distress were constructed: a) verbal and non-verbal expressions referring to emotion, b) references to unpleasant states/circumstances, and c) contextual hints of emotion. A binary variable was constructed based on the VR response codes, differentiating between emotion-focused responses and responses that distanced emotion. Fisher’s exact test was used to analyse group differences and determined variables included in a multivariate logistic regression analysis to identify factors promoting emotion-focused responses.

Results

Older people’s expressions of emotional distress (n = 635) comprised 63 explicit concerns and 572 cues. Forty-eight per cent of nursing staff responses (n = 638) were emotion-focused. Emotion-focused responses were observed more frequently when nursing staff elicited the expression of emotional distress from the patients (54%) than when patients expressed their emotional distress on their own initiative (39%). Expressions with reference to emotion most often received emotion-focused responses (60%), whereas references to unpleasant states or circumstances and contextual hints of emotion most often received non-emotion-focused responses (59%). In a multivariate logistic model, nursing staff’s elicitation of the emotional expression (vs patients initiating it) and patients’ expression with a reference to an emotion (vs reference to unpleasant states or contextual hints) were both explanatory variables for emotion-focused responses.

Conclusions

Emotion-focused responses were promoted when nursing staff elicited the emotional expression, and when the patient expression referred to an emotion. Staff responded most often by acknowledging the distress and using moderately person-centred supportive communication. More research is needed to establish generalizability of the findings and whether older people deem such responses supportive.

The Interpersonal Competence Instrument for Nurses

A new tool, the Interpersonal Competence Instrument for Nurses, was evaluated for content validity and readability. Evaluators consisted of a panel of 10 nursing experts. The instrument measures four categories of the patient-nurse interaction: translating, getting to know you, establishing trust, and going the extra mile. The content validity indexes (CVI) for 14 of 15 behaviors within the four categories rangedfrom .8 to 1.0 and are considered to have content validity. The CVIfor the 15th behavior, clicking, was calculated as. 7, and, thus, was modified. The CVIfor the entire instrument of 111 items was determined to be .84. Readability analyzed with the SMOGformula established a grade level of 8.09. Additional psychometric testing of the tool is in progress. Internal consistency reliability is being evaluated through the use of coefficient alpha and item analysis. Construct validity is being estimated through the experimental approach. The internal structure of the instrument is being assessed throughfactor analysis. Presuming that this instrument continues to demonstrate validity and reliability with future testing, it will facilitate the evaluation of nurse-patient interaction and promote focused education for nurses in the career development continuum.

Examining the role of personal traumas in a nurse's work life

In this monthly column, Aysha Mendes discusses the impact a nurse's personal traumas can have on his or her nursing practice, professional and personal experience of caring, and on patients and their families.

Awaiting diagnosis of breast cancer: strategies of enduring for preserving self

PURPOSE/OBJECTIVES

To explicate the emotional experiences of women undergoing breast cancer diagnosis who are waiting for the results of breast biopsy.

RESEARCH APPROACH

Glaserian Grounded Theory.

SETTING

Urban area in western Canada.

PARTICIPANTS

37 women aged 32-76 years. The breast cancer diagnosis was positive for 11 women, negative for 24 women, and two results were unclear.

METHODOLOGIC APPROACH

Unstructured, recorded telephone interviews.

FINDINGS

Undergoing breast cancer diagnosis is a profoundly distressing experience dictated by diagnostic processes and procedures. Women rapidly transitioned from wellness to frightening phases of facing cancer to continuing terror during the testing phase. While waiting to hear results, women controlled their emotions, which enabled them to get through the experience and highlighted the protective function of enduring and its necessity for survival. The basic social psychological process, preserving self, is the outcome of enduring.

CONCLUSIONS

A mid-range theory, Awaiting Diagnosis: Enduring for Preserving Self, was developed. This theory explicates the emotional responses of women who were undergoing diagnosis for breast cancer and provides a theoretical behavioral basis for responding to cues and signals of suffering.

INTERPRETATION

The Praxis Theory of Suffering enables nurses to recognize and respond according to the behaviors of suffering, and to endure with healthy, adaptive, and normalizing behaviors that enable preserving self.

Empathy problematic in psychological aspects of professional medical care (review)

The article covers summary report of the main aspects of empathy research in medical care. Data of an empathy level diagnostics depending on social aspects is pre¬sented, as well as an issue of empathy consideration as a stable personal characteristic, its dependency on experience and doctor's specialization, context of medical activity (necessary pain infliction, emergency aid assistance) is discussed. Aspects of empathic communication for medical workers of various specialties, inter alia psychiatrists and oncologists, as well as communication strategies, developed for coping with cocurrent negative emotions are analyzed. An example of a medical interview facilitating the quality of interpersonal relationship in the pair patient-doctor alliance" is given. In conclusion there are presented actual scientific contra¬dictions and set the possible main lines of future researches.

Parents' experiences of communication with neonatal intensive-care unit staff: an interview study

Background

An infant’s admission to a neonatal intensive-care unit (NICU) inevitably causes the parents emotional stress. Communication between parents and NICU staff is an essential part of the support offered to the parents and can reduce their emotional stress. The aim of this study was to describe parents’ experiences of communication with NICU staff.

Methods

A hermeneutic lifeworld interview study was performed with 18 families whose children were treated in the level III NICU at a university hospital in Sweden. The interviews were analysed to gain an interpretation of the phenomenon of how parents in the NICU experienced their communication with the staff, in order to find new ways to understand their experience.

Results

Parents’ experience of communication with the staff during their infant’s stay at the NICU can be described by the main theme ‘being given attention or ignored in their emotional situation’. The main theme derives from three themes; (1) meeting a fellow human being, (2) being included or excluded as a parent and (3) bearing unwanted responsibility.

Conclusions

This study shows that parents experienced communication with the NICU staff as essential to their management of their situation. Attentive communication gives the parents relief in their trying circumstances. In contrast, lack of communication contributes to feelings of loneliness, abandonment and unwanted responsibility, which adds to the burden of an already difficult situation. The level of communication in meetings with staff can have a decisive influence on parents’ experiences of the NICU.

The staff should thus be reminded of their unique position to help parents handle their emotional difficulties. The organization should facilitate opportunities for good communication between parents and staff through training, staffing and the physical health care environment.

Experiences of everyday life in men with alcohol dependency--a qualitative study

The aim of the present study is to describe and understand the meaning of living with alcohol dependency (AD) as a man. Studies point out a high prevalence of AD in men and the reasons for, and consequences of, that are complex. However, today there is a lack of knowledge about men's lived experiences of having AD. In-depth interviews were conducted with 15 alcohol dependent men and analyzed using a phenomenological-hermeneutic approach. In the comprehensive understanding, findings from the naïve understanding and the structural analysis were interpreted with help from both gender and caring theoretical perspectives. "A Fallible Man" and "A Man with Powerfulness" were disclosed as two main gender formations influencing senses of well-being. A Fallible Man involved varying experiences of restrictions, being in control, and meaninglessness. Being in control promoted a sense of well-being. A Man with Powerfulness involved energetic activity, and the development and maintaining of interests as well as risk-taking. Being powerful diminished feelings of meaninglessness, cravings, and social alienation. The results show, among other things, that the men live an incompatible life and, because of that, need support and guidance to find a more meaningful life. This can be accomplished if caregivers allow men to be in focus and involved in planning their own care. To avoid limiting the men while they are in treatment, the health care professionals also need to focus on the men's everyday life. This focus involves acknowledging the men's individual experiences of what enriches and limits their everyday lives.

Mindfulness, self-compassion, and empathy among health care professionals: a review of the literature

The relationship between mindfulness and self-compassion is explored in the health care literature, with a corollary emphasis on reducing stress in health care workers and providing compassionate patient care. Health care professionals are particularly vulnerable to stress overload and compassion fatigue due to an emotionally exhausting environment. Compassion fatigue among caregivers in turn has been associated with less effective delivery of care. Having compassion for others entails self-compassion. In Kristin Neff's research, self-compassion includes self-kindness, a sense of common humanity, and mindfulness. Both mindfulness and self-compassion involve promoting an attitude of curiosity and nonjudgment towards one's experiences. Research suggests that mindfulness interventions, particularly those with an added lovingkindness component, have the potential to increase self-compassion among health care workers. Enhancing focus on developing self-compassion using MBSR and other mindfulness interventions for health care workers holds promise for reducing perceived stress and increasing effectiveness of clinical care.

Psychometric properties of a Chinese version of the Jefferson Scale of Empathy-Health Profession Students

Empathy is central to a therapeutic nurse-patient relationship. Valid and reliable Chinese instruments to assess nursing students' empathy are lacking. The aim of this study was to examine the psychometric properties of a Chinese version of the Jefferson Scale of Empathy-Health Profession Students (C-JSE-HPS) among Taiwanese undergraduate nursing students. A convenience sample of 613 Taiwanese nursing students participated in the study. Content validity, construct validity, internal consistency reliability and test-retest reliability were examined. Content validity was confirmed by a content validity index of 0.89. Factor analysis yielded three components of perspective taking, compassionate care and standing in the patient's shoes, explaining 57.14% of total variance. Women scored higher on empathy than men. Also, students who were enrolled in the 4-year Bachelor of Science in Nursing (BSN) indicated greater empathy degrees than those in the 2-year Registered Nurse to Bachelor of Science in Nursing (RN-to-BSN). Cronbach's alpha coefficient and the test-retest reliability were 0.93 and 0.92 respectively. A C-JSE-HPS demonstrated satisfactory psychometric properties to measure empathy of undergraduate nursing students. Educators may use this instrument to assess empathic qualities among students and design effective empathy-oriented nursing curricula to improve the quality of nursing care.

A risk to himself: attitudes toward psychiatric patients and choice of psychosocial strategies among nurses in medical-surgical units

Psychiatric patients are liable to stereotyping by healthcare providers. We explored attitudes toward caring for psychiatric patients among 13 nurses working in general hospitals in Ireland. Participants thought aloud in response to a simulated patient case and described a critical incident of a patient for whom they had cared. Two attitudinal orientations were identified that correspond to stereotypical depictions of risk and vulnerability. The nurses described psychosocial care strategies that were pragmatic rather than authentically person-centered, with particular associations between risk-oriented attitudes and directive nursing care. Nurses had expectations likely to impede relationship building and collaborative care. Implications arising include the need for improved knowledge about psychiatric conditions and for access to professional development in targeted therapeutic communication skills.

'A caring professional attitude': What service users and carers seek in graduate nurses and the challenge for educators

With the publication of the new NMC standards for pre-registration nursing education, undergraduate curricula are being written in universities across England. There are many drivers for the curricula but one that has until recently received scant attention is the service user's and carer's voice. This paper discusses the findings of a qualitative study that asked 52 service users and carers about the qualities they sought in nurses and their views on nurse education. Eight focus groups were conducted with a broad range of service users and carers from primary and secondary care, and voluntary organisations. Data were analysed using the framework approach facilitated by a qualitative analysis software programme. The sample was diverse, but there were similarities in the qualities they valued in nurses. They sought technical competence, knowledge and willingness to seek information, but overwhelmingly prioritised 'a caring professional attitude'. This was articulated as empathy, communication skills and non-judgmental patient centred care: major themes in the new NMC standards. Our participants also expressed concern about whether the educational preparation of nurses can develop these caring qualities. We discuss this concern, the challenges for nurse educators it presents and how we can engage service users and carers in shaping and delivering our new curricula.

Communication between children and health professionals in a child hospital setting: a Child Transitional Communication Model

AIM

This paper is a report of a further analysis of data from an ethnographic study of the nature of communication between children and health professionals in a child hospital setting.

BACKGROUND

There is a paucity of research on the nature of communication between health professionals and child patients. Additionally, theory has not been developed to any great extent in the communication literature on children.

METHOD

Using an ethnographic approach, fieldwork took place in one specialized children's hospital during 2005. Forty-nine children, aged 6-16 years, with a variety of medical and surgical conditions, participated. Data were collected through semi-participant observations, unstructured interviews, participatory activities and documentary evidence.

FINDINGS

Health professionals positioned children as either passive bystanders or active participants in the communication process. These two positions, passive bystander and active participant, signified the extent of children's inclusion or exclusion in the communication process and the degree to which children's communication needs were met or not. A Child Transitional Communication Model presented in this paper draws on multiple theoretical perspectives to explain why health professionals placed children as either a passive bystander or an active participant in the communication process.

CONCLUSION

Children prefer to oscillate between a passive bystander and active participant position within the communication process, depending on their needs at any given point in time. This challenges the insistence for stronger child participation in all matters that affect them, in isolation of debates surrounding children's need for support/protection and any potential negative consequences of children's active participation.

Ordinary people, extraordinary voices: The emotional labour of lay people caring for and about people with a mental health problem

Many attempts to reduce the stigmatization of people with mental illness have often been predicated, based on the desire to persuade the public that people with mental illness are 'ill' in the same way as people with medical conditions. This paper presents one aspect from the findings of a study that examined the ways in which lay people perceived mental health and illness. Data are drawn from the discussion of the roles and experiences of different non-mental health professionals who cared for and about people they met in their everyday employment. In this paper, we argue that central to these roles is the importance of listening to people in an arena which is non-statutory and without judgment. We demonstrate that people use popular sectors when they are unsure of the problem they have, or they are reluctant to refer themselves to the professional sector. The paper presents narrative extracts illustrating the emotional labour operating in each participant's role and the extent to which they provide support for their client's emotional and psychological well-being. The implications for mental health nursing are discussed in relation to working with and alongside people experiencing mental distress, in relation to 'ordinary human qualities'.

An evaluation of a DVD trigger based assessment of communication and care delivery skills

This article describes the implementation and evaluation of a novel form of assessment of communication skills and knowledge for all branches of nursing students in a multi-campus UK Midlands university. The assessment took the form of a recorded scenario which was presented on DVD and a series of assessment questions inviting students to consider communicative and care delivery aspects of the events depicted. This 'DVD trigger' assessment yielded theoretically informed, practically relevant answers from the students, over 80% of whom passed. Student reactions to the assessment were elicited via a specially designed questionnaire which indicated broad approval for the assessment and yielded a high degree of internal reliability, and suggested that attitudes to the assessment could be grouped into three major factors. The first factor comprised items relating to the practical aspects of the examination, the second to teaching, learning resources and exam support and the final factor represented the perceived relationship between the examination and the skills involved in care delivery and communication in professional practice. This highlights the value of evaluating students' responses to assessment in developing new forms of examination and in harmonising assessments with learning resources, teaching and appropriate preparation for exams. Moreover, we argue that the face validity of assessments is important in ensuring students' engagement with the learning tasks and assessment activities and may contribute to the broader validity of the assessment enterprise in predicting and enhancing skills in subsequent professional practice.

The scholarly work of Janice Morse: synthesis and reflection

The author was afforded opportunity during her doctoral studies to compile and reflect upon the scholarly work of nurse researcher, Dr Janice Morse. Morse's refinement and development of patient-centred, empirically based concepts and theories, and her mastery of a diverse research repertoire, are an indisputable contribution to nursing knowledge. The author delineates four ways by which Morse's work contributes to nursing's disciplinary body of knowledge: (i) the consistent focus on the nurse-patient domain; (ii) the multiplicity of knowledge forms; (iii) the promotion of paradigm integration and methodological pluralism; and (iv) the predominance of prescriptive theories. Additionally, conjecture is put forth regarding the philosophical assumptions underpinning Morse's work. Morse serves as an excellent role model for nurse researchers who strive to ensure that nursing theories are amenable to clinical application, to research investigation and to utilization as a pedagogical tool.

A concept development of 'being sensitive' in nursing

'Being sensitive' in nursing was explored using Schwartz-Barcott and Kim's hybrid model of concept development, producing a tentative definition of the concept. Three phases were employed: theoretical, empirical/fieldwork and analytical. An exploration of the literature identified where the common idea of ;being sensitive' as a nurse was embedded and demonstrated that a theoretical development of this fundamental aspect of nursing was absent. The empirical phase was conducted using semistructured interviews with nine expert palliative care and cancer nurses. This method was particularly useful for the exploration of this concept because of its firm grounding in practical example. A definition of what the concept ;being sensitive' means in nursing, and subsequent clarification of ;being insensitive', have been posed from the research process undertaken. The essential nature of this concept being integral to nursing practice is emphasized. Potential implications for the development of nursing practice through teaching of this concept were identified.

Therapeutic relationships in critical care nursing: a reflection on practice

AIMS

The aim of this paper is to gain a greater understanding of the emotional intelligence required to form therapeutic nurse-patient relationships in the context of critical care nursing.

CONTEXT

There is currently a demand for patient-centred nursing in all aspects of health care to improve both quality of care and consumer satisfaction. Central to patient-centred care is the presence of a therapeutic nurse-patient relationships, but the development of these relationships present a challenge in the acute and technological world of critical care nursing.

THEORETICAL FRAMEWORK

Using Titchen's Skilled Companionship Model as a guide as well as empirical and theoretical knowledge on nurse-patient relationships, this paper presents a reflection on a relationship that the author developed with a patient and his family encountered in her practice as a critical care nurse. REFLECTIVE CONCLUSIONS: Engaging in therapeutic nurse-patient relationships can expose nurses to emotional pain in the context of critical care nursing. The process of reflection can facilitate critical care nurses in the development of the emotional intelligence required to develop and maintain these relationships and this enhances the care of critically ill patients and their families.

Brain death: close relatives' use of imagery as a descriptor of experience

AIM

This paper is a report of a study to explore the use of imagery to describe the experience of confronting brain death in a close relative.

BACKGROUND

The brain death of a loved one has been described as an extremely difficult experience for close relatives, evoking feelings of anger, emotional pain, disbelief, guilt and suffering. It can also be difficult for relatives to distinguish brain death from the state of coma and thus difficult to apprehend information about the diagnosis.

METHODS

Narrative theory and a hermeneutic phenomenological method guided the interpretation of 17 narratives from close relatives of brain dead patients. All narratives were scrutinized for experiences of brain death. Data were primarily collected in 1999. The primary analysis related to close relatives' experience of brain death in a loved one. A secondary analysis of the imagery they used to describe their experience was carried out in 2003.

FINDINGS

Six categories of imagery used to describe the experience of confronting a diagnosis of brain death in a loved one emerged: chaotic unreality; inner collapse; sense of forlornness; clinging to the hope of survival; reconciliation with the reality of death; receiving care which gives comfort. Participants also identified two pairs of dimensions to describe their feelings about the relationship between their brain dead relative's body and personhood: presence-absence and divisibility-indivisibility. Being confronted with brain death meant entering into the anteroom of death, facing a loved one who is 'living-dead', and experiencing a chaotic drama of suffering.

CONCLUSION

It is very important for members of the intensive care unit team to recognize, face and respond to these relatives' chaotic experiences, which cause them to need affirmation, comfort and caring. Relatives' use of imagery could be the starting point for a caring conversation about their experiences, either in conversations at the time of the death or when relatives are contacted in a later follow-up.

Toward a holistic conceptualization of empathy for nursing practice

This article proposes a new holistic conceptualization of empathy for nursing practice that allows different aspects of the literature to be understood. This study is based on the data of a doctoral study exploring the nature of empathy on an oncology ward. The findings revealed that empathy is not a single phenomenon. Four different forms of empathy were identified, namely, empathy as an incident, empathy as a way of knowing, empathy as a process, and empathy as a way of being. These different forms of empathy can be understood in terms of a continuum of empathy development and suggest a new way of conceptualizing empathy that can be depicted diagrammatically.

Lost in translation, or the true text: mental health nursing representations of psychology

One theme of academic discourse and research in mental health nursing is the exploration and application of psychosocial models of nursing practice. Despite this, the influence of disciplinary psychological knowledge on practitioners' talk about nursing practice has not been extensively researched. To address this gap, the authors analyzed talk about psychological work using transcripts of 10 focus groups involving 59 mental health nurses. Nurses identified a psychological domain of practice as central to their work. Given the amount of time spent with clients, nurses are the prime resource for psychological work. Psychological talk was organized into three categories related to the nursing process and organizational context and analyzed through empowerment and critical perspectives on power. Although technical ("formal") and everyday ("informal") discourses were generally well integrated, the authors question the oral basis to this body of knowledge in terms of accountability to service users and as a marker of disempowerment.

Developing empathy in nurses: an inservice training program

The purpose of this study was to determine whether inservice communication training enhanced the empathic skills of 263 nurses employed at Hacettepe University Hospital. Data were collected using a nurse information form, participants' satisfaction form, and the Empathic Communication Skill B (ECS-B) form developed by Dökmen [Dökmen, U. (1988). A new measurement model of the empathy and developing empathy by using psychodrama. Journal of Education Faculty of Ankara University, 21, 155-190]. The ECS-B was used as both a preintervention and a postintervention measure. The data were expressed as means, percentages, and standard deviations, and were analyzed using Pearson's chi-square test and repeated-measures analysis of variance. The posttest scores of nurses increased from 155.6 to 180.5, and training played a role in enhancing nurses' empathic skills with regard to all variables (P < .05). However, a more comprehensive and continuous training should be planned, and its impact on behavior and patient outcomes should be investigated.

“Nobody Understands”: On a Cardinal Phenomenon of Palliative Care

In the clinical practice of palliative medicine, recommended communication models fail to approximate the truth of suffering associated with an impending death. I provide evidence from patients' stories and empiric research alike to support this observation. Rather than attributing this deficiency to inadequate training or communication skills, I examine the epistemological premises of the biomedical language governing the patient-physician communication. I demonstrate that the contemporary biomedicine faces a fundamental aporetic occlusion in attempting to examine death. This review asserts that the occlusion defines, rather than simply complicating, palliative care. Given the defining place of aporia in the care for the dying, I suggest that this finding shape the clinicians' responses to the needs of patients in clinical care and in designing palliative research. Lastly, I briefly signal that a genuinely apophatic voice construing the occlusion as a mystery rather than an aporia may be superior to the present communication and empathy models.

Caring: the socialisation of pre-registration student nurses: a longitudinal qualitative descriptive study

BACKGROUND

This study explores the impact of the process of socialisation on pre-registration student nurses views about care, and their personal ability to cope with becoming a nurse.

OBJECTIVES

It aims to identify the effect time has on participants attitudes and views of care and becoming a nurse, during pre-registration nurse training, by using a descriptive longitudinal qualitative design.

SETTING

Data collection took place within the School of Health or on student's clinical placement areas, using a random sample of 16 pre-registration student nurses obtained from a convenience sample of 52 volunteers.

METHODS

Participants were involved in two semi-structured in depth interviews, the first 6-9 months after entering nurse training and the second 6-9 months prior to completion. Interviews were tape recorded, transcribed verbatim and analysed using Morse and Field's (1996) four stages of analysis.

RESULTS

Identified changes between data collection stages suggest socialisation results in a loss of idealism about care within nursing, as well as the identification of negative aspects of care. Loss of care is linked to increased abilities to cope with the nursing role, although this is not uniform and some participants clearly discriminate and reject negative exposures. In conclusion this study identifies an under recognised dichotomy between the caring ethos of professional nursing and the professional socialisation processes student nurses are subject to, which directly mitigate against the individual nurses abilities to care.

Patient participation in nursing care: an interpretation by Swedish Registered Nurses

AIMS AND OBJECTIVES

The aim of this study was to clarify Registered Nurses' understanding of patient participation in nursing care. Objectives were to investigate ward nurses' interpretation of the elements of patient participation and its implementation.

BACKGROUND

One goal of health care is patient participation. Registered Nurses must encourage the participation of their patients in nursing care situations. A right for patients to make their own informed choices is laid down in Swedish laws and national and local directives. The concept of patient participation can be interpreted differently and is thus difficult to implement and evaluate. Current nursing literature provides little clarity of the elements and processes of patient participation and conceptual definitions differ.

DESIGN AND METHODS

A qualitative approach was applied and the Grounded Theory method used. Thirty-one Registered Swedish Nurses described the meaning of patient participation and its implementation in nursing care. Seven focus group interviews with nurses providing inpatient somatic care were carried out in five hospitals in west Sweden.

RESULTS

Four properties, describing nurses' approaches and procedures, constitute patient participation. The properties are: interpersonal procedure, therapeutic approach, focus on resources, opportunities for influence. These properties were considered crucial for patient participation in a nursing care context.

CONCLUSIONS AND RELEVANCE TO CLINICAL PRACTICE

The results clarify the concept of patient participation from a nursing perspective. A comprehensive description of important factors for patient participation could be made on the basis of nursing experience. This comprehensive description can be used in nursing care practice and its evaluation. The developed categories can be used in nursing care documentation of how patient participation is realized.

Exploring the relationship between caring, love and intimacy in nursing

This article uses the five distinct perspectives on caring proposed by Morse et al (1990) to illustrate the relationship between love, intimacy and caring. Two distinct types of love, namely Agape (altruism/charity) and filia (brother love) are utilized in nursing. Only some caring relationships with patients reach an intimate level, and this is determined by patient characteristics to which the nurse responds. It is concluded that caring as a moral imperative is the most relevant to discussions on caring in nursing and the perspective on which the other four viewpoints hinge.

Emotional intelligence in nursing work

BACKGROUND

Emotional labour has been widely accepted in the literature as part of nursing work, however the contribution of emotional intelligence in the nursing context requires further study.

AIM

This paper aims to present an analysis of the literature on emotional intelligence and emotional labour, and consider the value of emotional intelligence to nursing.

METHOD

A literature search was undertaken using the CINAHL and MEDLINE databases. Search terms used were 'emotions', 'intelligence', 'emotions and intelligence' and 'emotional labour'. A hand-search of relevant journals and significant references added to the data.

RESULTS

Emotional intelligence plays an important part in forming successful human relationships. Emotional labour is important in establishing therapeutic nurse-patient relationships but carries the risk of 'burnout' if prolonged or intense. To prevent this, nurses need to adopt strategies to protect their health. The potential value of emotional intelligence in this emotional work is an issue that still needs to be explored.

CONCLUSIONS

Analysis of the literature suggests that the modern demands of nursing draw on the skills of emotional intelligence to meet the needs of direct patient care and co-operative negotiations with the multidisciplinary team. The significance of this needs to be recognized in nurse education. The link between emotional intelligence and emotional labour is a fruitful area for further research. The potential benefits of gaining a better understanding of how these concepts interact is largely conjecture until we have more evidence. The prospect that there may be advantages to both nurses and patients is a motivating factor for future researchers.

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.