Empathy as an Ethical Imperative

Predictive moral sensitivity in nursing students: The roles of empathy and spiritual health

BACKGROUND

The evidence indicates a phenomenon of ethical erosion in healthcare students. Variables like empathy and spiritual health might affect moral sensitivity in nursing students. The present study is an attempt to predict the moral sensitivity of nursing students based on empathy and spiritual health.

MATERIALS AND METHODS

A cross-sectional and analytical study was carried out at Saveh University of Medical Sciences, Saveh, Iran, in 2023. In total, 110 nursing students were included in the study by census method. Data gathering was done using Ellison and Paloutzian spiritual health inventory, Jefferson's empathy inventory, and Lutzen's moral sensitivity scale. The collected data was analyzed using Pearson's correlation and multiple regression analysis.

RESULTS

The mean scores of empathy, spiritual health, and moral sensitivity in nursing students were equal to 99.8 ± 15.25, 81.32 ± 10.01, and 65.09 ± 12.23 respectively. Empathy and spiritual health were positively and significantly related to moral sensitivity (P < 0.01). In total, 31% of variation in moral sensitivity was attributed to empathy and spiritual health.

CONCLUSION

Empathy and spiritual health were positively and significantly related to moral sensitivity. Taking into account the role of spiritual health and moral sensitivity in nursing students, enhancing this aspect of health through informing individuals and highlighting the positive aspects and potential effects on physical and mental health and professional performance in return is recommended.

Students' perceptions towards the ethical considerations of using artificial intelligence algorithms in clinical decision-making

Aim The present study aimed to explore the perceptions of dental students regarding the ethical considerations associated with the use of artificial intelligence (AI) algorithms in clinical decision-making.Methods All the undergraduate clinical-year dental students were invited to take part in the study. A validated online questionnaire which consisted of 21 closed-ended questions (five-point Likert scales) was distributed to the students to evaluate their perceptions on the topic. Mean perception scores of the students from different years were analysed using a one-way ANOVA test, while independent t-tests were used to compare the scores between sexes.Results In total, 165 students participated in the present study. The mean age of the respondents was 23.3 (± 1.38) years and the majority were female, Chinese students. Respondents showed positive perceptions throughout all three domains. Uniform and comparable perceptions were seen across various academic years and sexes, with female respondents expressing stronger agreement regarding patient consent and privacy prioritisation.Conclusion Undergraduate clinical dental students generally showed positive perceptions regarding the ethical considerations associated with the integration of AI algorithms in clinical decision-making. It is essential to address these ethical considerations to ensure that AI benefits patient outcomes while upholding fundamental ethical principles and patient-centred care.

Empathy and ethical sensitivity among intensive and critical care nurses: A path analysis

BACKGROUND

Intensive and critical care nurses need to demonstrate ethical sensitivity especially in recognizing and dealing with ethical dilemmas particularly as they often care for patients living with life-threatening conditions. Theories suggest that there is a convergence between nurses' empathy and ethical sensitivity. Evidence in the literature indicates that nurses' emotional, demographic, and work characteristics are associated with their level of empathy and ethical sensitivity.

AIM

To investigate the relationship between nurses' empathy and ethical sensitivity, considering their emotional states (depression, anxiety, and stress), demographic and work characteristics, and test an empirical model describing potential predictors of empathy (as a mediator) and ethical sensitivity using path analysis.

RESEARCH DESIGN

Using a cross-sectional design, the philosophical theory of care ethics and empathy was extended and adopted as a conceptual framework for this study and tested by path analysis.

PARTICIPANTS AND RESEARCH CONTEXT

Data were collected from 347 intensive care nurses recruited by ten educational-medical hospitals in Iran using a questionnaire between February and March 2021.

ETHICAL CONSIDERATIONS

The study was reviewed by the Ethical Advisory Board in Iran and conducted according to the Declaration of Helsinki.

FINDINGS

Study participants demonstrated a mild level of stress, anxiety, and depression, alongside a relatively high level of empathy and ethical sensitivity. Nurses with good socioeconomic status had higher empathetic behavior with patients than those with weak status. Nurses aged over 40 who had received ethics training and had higher work experience were associated with higher ethical sensitivity compared to nurses under 20 years of age. Empathy directly affected ethical sensitivity; however, anxiety had an indirect effect on ethical sensitivity through empathy. Among demographic factors, age had a positive direct effect on ethical sensitivity.

CONCLUSIONS

Less anxiety and a high level of empathy contribute to higher levels of ethical sensitivity among intensive and critical care nurses.

Influence of Emotional Skills on Attitudes towards Communication: Nursing Students vs. Nurses

Communication in nursing is essential to the quality of care and patients' satisfaction, and personal variables such as empathy and emotional intelligence (EI) can improve it; however, no studies have to date analyzed these competencies and their relations among nursing students compared with nurses. The aims of this study are, therefore, to analyze the differences between nursing students and nurses in the means for empathy, EI and attitudes towards communication in order to assess the impact of empathy and EI on nurses' and nursing students' attitudes towards communication, and their influence on the behavioral dimension of attitude. A cross-sectional descriptive study was performed on a convenience sample of 961 nursing students and 460 nurses from the Valencian Community, Spain. T-test and hierarchical regression models (HRM) were used. The data was collected in the selected universities in the 2018/2019 academic year. The results showed high levels in all the variables analyzed (i.e., empathy, EI, and attitudes towards communication) in both samples. The HRM results suggested that empathy was a better predictor than EI of the attitudes towards patient communication among both the nursing students and nurses. In the behavioral dimension of the attitude, the cognitive and affective dimensions had greater weight than the emotional component (i.e., empathy and EI). Developing empathy and the cognitive dimension of the attitude in nursing students and nurses could, therefore, help improve EI and attitudes towards communication. These findings are important for developing intervention programs adjusted to real needs.

Stakeholder engagement during COVID-19: evidence from corporate use of Twitter

Purpose

This study aims to investigate how New Zealand companies use Twitter to communicate and engage effectively with stakeholders during the COVID-19 pandemic.

Design/methodology/approach

This study proposes a conceptual framework for effective stakeholder engagement by using social media to analyse the themes and emotion of company tweets during the COVID-19 pandemic in New Zealand. The engagement of stakeholders with these tweets is also examined. This study argues that companies use selected themes and emotive language to connect with their stakeholders.

Findings

The findings show that selective themes and emotions are useful in company COVID-19 tweets to engage with the stakeholders. COVID-19 tweets contained significantly more emotion than non-COVID tweets, with emotions that can convey empathy being the most common. By presenting themselves as real, personable and empathetic towards others through emotive language, companies can engage in more meaningful and ethical way with their stakeholders.

Practical implications

The paper has implications for managing company communications by providing empirical evidence that both the themes and emotion expressed in the messages are important for effective stakeholder engagement in social media.

Originality/value

The conceptual framework for effective stakeholder engagement using social media is novel and can be used to evaluate and investigate stakeholder engagement during a global crisis.

The role of empathy in ethics of radiological protection

Radiological protection is often considered a matter of scientific and technological facts only, not of value judgements. This perception is now gradually changing, especially with ICRP Publication 138, which addressed the ethical foundation of the system of radiological protection. It identified values which have guided the Commission's recommendations over the decades, but have not always been made explicit. Four core values are discussed (beneficence/non-maleficence, prudence, justice, dignity) as well as three procedural values (accountability, transparency, inclusivity). The latter are considered critical to the practical implementation of the system of radiological protection. Here we are exploring empathy as a procedural values complementing the three identified in ICRP Publication 138. Empathy can be defined as the 'capability (or disposition) to immerse oneself in and to reflect upon the experiences, perspectives and contexts of others'. It is often understood as a skill that one either has or has not, but research has shown it can be taught and therefore can be required as an attitude of those working in health care, education, design, and technology. We suggest it is an essential prerequisite to the assessment and management of any radiological situation and the health problems accruing from it. The concerns of people affected, their needs and wishes need to be taken seriously from the very beginning of any decision-making process. Even if they are considered unfounded and exaggerated, the insights they provide will be valuable for the understanding of the overall situation. Without empathy, our practice of beneficence and non-maleficence as well as solidarity would be oddly limited.

Defining and characterising the nurse-patient relationship: A concept analysis

The nurse-patient relationship involves complex attitudes and behaviours with ethical and deontological implications. It has been linked to improvements in patient health outcomes, although there is still no consensus in the scientific literature as to the definition and characterisation of the concept. This article aim to define the concept of the nurse-patient relationship. A concept analysis was conducted using the Walker and Avant method to identify the attributes defining the nurse-patient relationship. An integrative review of the literature was conducted using the PubMed, Web of Science, Scopus, and Cumulative Index to Nursing & Allied Health Literature databases. A review of the grey literature and other minor non-indexed publications on the topic was also conducted. A total of 36 articles were included in the review. A model case, a contrary case, a related case, and empirical references were produced to clarify the concept and identify its essential attributes. The concept is defined as a helping relationship involving interaction between different players. It is the basis of nursing care and is intended to meet the healthcare needs of the individual receiving this care. It is also viewed as an intervention in itself, requiring a specific training process just like any other nursing skill. The essential attributes of the relationship are empathy, presence, contact, authenticity, trust, and reciprocity. In conclusion, the nurse-patient relationship is a helping relationship established with the patient and/or their family based on interaction, communication, respect for ethical values, acceptance, and empathy in order to encourage introspection and behavioural change. Key components include communication, active listening, and respect. Bioethical values and confidentiality must also be present to ensure that the relationship is built on equality and intimacy.

Relationship between emotional intelligence and job well-being in Chinese clinical nurses: multiple mediating effects of empathy and communication satisfaction

BACKGROUND

Nursing work is associated with great pressure, and nurses are often overwhelmed. Therefore, correct emotional regulation is essential to improve nurses' job well-being and promote better engagement in nursing work. The purpose of this study was to establish a structural model to estimate the impact of Chinese clinical nurses' emotional intelligence on job well-being, using multiple intermediaries to explain the internal mechanisms underlying the relationship.

METHODS

This was a cross-sectional study of 1475 registered nurses from a Chinese hospital who provided responses to emotional intelligence, empathy, communication satisfaction, and job well-being scales. Path analysis using a multiple mediation model was performed using AMOS 23.0.

RESULTS

Among all clinical nurses who participated in the survey, 1475 (98.33 %) completed the questionnaire. The nurses' job well-being score was 83.61 ± 12.63. There was a significant positive correlation between job well-being and communication satisfaction, emotional intelligence, and empathy ability (r = 0.346-0.570, P < 0.001). Empathy and communication satisfaction partially mediated the relationship between emotional intelligence and job well-being, with effect sizes of 0.047 and 0.227, respectively. The chain mediating effect of empathy and communication satisfaction had a value of 0.045.

CONCLUSIONS

It is recommended that hospital managers take actions to improve nurses' emotional intelligence level, and conduct professional psychological training to improve nurses' empathy and communication satisfaction, and ultimately improve their job well-being.

Evidenced-based practice of decision-making process in oncofertility care among registered nurses: A qualitative study

AIM

The purpose of our study was to construct the context of the nursing action/role in oncofertility care.

DESIGN

Qualitative research.

METHODS

We applied grounded theory to guide the qualitative study. Data were collected through in-depth interviews with 12 nurses in Taipei. The data were collected from August 2018 to February 2019.

RESULTS

The core theme that described the role of nurses' decision-making in oncofertility care focused on understanding oncofertility from the self to the other. Care roles or actions in oncofertility that involved the process of psychological cognition were divided into four dimensions: perceiving the patient's changes and needs, triggering the self's emotions, empathizing with patient's situations and introspective care roles. Nurses who had experienced the phase of empathizing with the patient's situations developed more diverse roles and had positive actions toward oncofertility care. Based on the psychological changes for oncofertility decision-making process, implementing contextual training in oncofertility could help nurses create more positive actions in oncofertility care.

Nurse-facilitated reflective exercise post patient death in the ICU: a best practice implementation project

INTRODUCTION

ICUs are stressful environments where patient care is complex and demanding; death is not an unusual outcome. Nurses can become emotionally distressed from experiencing multiple, unexpected, or traumatic patient deaths. Performing a reflective exercise immediately post death is one coping strategy which encourages healthcare staff and family to debrief their feelings in a timelier manner.

OBJECTIVES

The aim of this project was to educate the nurses in the ICU with emotional coping skills pertaining to the effects of patient deaths. The objective was to implement a nurse-guided reflective exercise following each patient death in three adult ICUs in a quaternary academic medical center.

METHODS

The current change project used the Joanna Briggs Institute's Getting Research into Practice and Practical Application of Clinical Evidence Systems for auditing and strategy development. After standardizing the reflective exercise procedure, teaching methods were employed to support implementation. One follow-up audit measured compliance with completing a reflective exercise for all deaths occurring in the three ICUs. Contextual data were collected for completed exercises including type of death and words to describe nurses' emotions.

RESULTS

The reflective exercise script was revised and the standard procedure posted to the intranet for easy access. All ICU nurses received education on the use of this reflective exercise. For each of the two ICUs where this practice was new, compliance with nurses initiating and completing a reflective exercise was at a rate of 17 and 2%, respectively. For the ICU where reflective exercise was reintroduced, compliance was 30%. All deaths included in this study were anticipated (e.g., patient on comfort care) and calm, with the exception of one post cardiac arrest death.

CONCLUSION

Despite multipronged teaching for why, when, and how to use reflective exercise, there was minimal success in completing reflective exercises in the two units where the practice was new. This outcome was most likely due to higher than anticipated levels of needed support or the unpredictability of frequency of deaths on each unit. However, the main achievement was having the Minute of Silence procedure with a standardized script readily available at all times for nursing staff. Reimplementation success in the other ICU was attributed to more recently established reflective practices. Further exploration of barriers, such as type of death, and re-education are essential strategies to bolster and sustain practice and to provide support for our nursing staff to prevent emotional distress.

Empathy as an ethical principle for environmental health

PURPOSE

Environmental health ethics is a relatively young field of study, drawing on experience from medical ethics, public health ethics, and the ethics of radiological protection. Fundamental to all of these in one way or another are the four "principles of biomedical ethics", originally proposed by Beauchamp and Childress (1979) as a guide for decision making in clinical practice. Suggestions have been made of various other principles which should be added to address the specifics of the individual disciplines under consideration. Here we are exploring empathy as a principle complementing those hitherto applied in environmental health practice.

RESULTS AND CONCLUSIONS

Empathy can be defined as the "capability (or disposition) to immerse oneself in and to reflect upon the experiences, perspectives and contexts of others". It is often understood as a skill that one either has or has not, but research has shown it can be taught and therefore can be required as an attitude of those working in health care, education, design, and even politics. We suggest to consider it a procedural principle on a par with inclusiveness, accountability, and transparency. It should drive the assessment of any environmental situation and the health problems accruing from it.