Beyond empathy: clinical intimacy in nursing practice

Abstract Understanding, shared meaning, and mutual trust lie at the heart of the therapeutic nurse–patient relationship. This article introduces the concept of clinical intimacy by applying the interpersonal process model of intimacy to the nurse–patient relationship. The distinction between complementary and reciprocal behaviours, and between intimate interactions and intimate relationships, addresses background concerns about the appropriateness of intimacy in nursing relationships. The mutual construction of meaning in the interactive process between nurses and patients is seen to lie at the heart of clinical intimacy as a hermeneutic enterprise. Intimacy is distinguished from empathy based on intentionality and the status and location of meaning. Reasons for continued investigation into clinical intimacy as an explanatory model for nursing as a hermeneutic practice are presented.     

What makes a chronic pelvic pain patient satisfied?

Purpose: Caring for women with chronic pelvic pain (CPP) is challenging. There have been few studies on what factors patients consider to be important when being treated for their pelvic pain. This study sought to identify the key factors of the health care visit that contribute to patient’s overall satisfaction with their care in a CPP clinic.

Materials and methods: Between January 2015 and December 2016, new patients visiting a tertiary care CPP clinic were recruited to complete a patient satisfaction survey. Inductive thematic analysis was performed on response data regarding important factors that impact patient satisfaction with their visit/care.

Results: Five themes of patient satisfaction identified included: providers with a compassionate and caring attitude, being listened to, clear communication with collaboration when needed, quality time spent with patient, and having a plan of care with recommendations. The theme regarding provider’s compassion and listening skills was the most frequently identified. Pain relief was seldom mentioned as a source of patient satisfaction.

Conclusions: The data suggest that a focus on empathic communication may make a meaningful difference in meeting the needs of women with CPP as well as strengthening the provider/patient relationship.     

Discussing health care costs with patients

Escalating health care costs are affecting patients across the country. As employers and insurance companies face higher expenses, they may move to a cost-sharing strategy, which potentially increases financial burdens on patients. In this situation, physicians may find themselves serving as both medical and financial advisors for their patients. Clinical encounters in which patients experience financial hardship can be awkward and frustrating for both parties. Physicians must learn to discuss issues of affordability in a manner that builds, rather than detracts, from a therapeutic alliance. This article describes our experiences using several communication skills that can help in the discussion of health care costs with patients. The primary skill, empathic communication, which includes "we" statements and "I wish ..." statements, serves to create a platform for shared decision-making, negotiation, and a search for alternatives. In addition, it is helpful if physician offices have resource materials available and strategies identified to assist patients facing financial hardship.     

The Importance of Offense Characteristics,Victimization History,Hostility, and Social Desirability in Assessing Empathy of Male Adolescent Sex Offenders

Empathy has been a focus of work with sex offenders; however, there are a limited number of studies supporting this as a deficit. The study investigated the reliability and validity of 3 scales of the Interpersonal Reactivity Index (IRI)—Empathic Concern [EC], Perspective-Taking [PT], and Personal Distress [PD]—within a clinical sample. These scales were also used to examine the differences in empathy among groups of sex offenders. One hundred and twenty-three male adolescent sex offenders (ages 12–19) completed a battery of psychometric measures that included the IRI during a sex-offender-specific assessment. Moderate internal consistency and convergent validity was established for IRI scales. Age and social desirability were related to IRI scores. Victim empathy was not related to IRI scores. Justifications and acceptance of sexual and interpersonal violence were negatively correlated to EC and positively correlated to PD. Those who committed violent offenses reported more EC and PT; however, a generally hostile temperament was negatively related to these scales. Group differences were not found when contrasted with respect to a history of sexual or physical victimization or denial. Researchers using the IRI with male adolescent sex offenders should be cautious of the influence of age and socially desirable responding.     

Sex,Love and Incest

The author shows how Ferenczi's ideas from the 1920s and early 30s are being revived in interpersonal-relational thinking and how they have become integral to her work with a World Trade Center survivor. She specifically looks at Ferenczi's ideas about the importance of reliving, the healing power of new experience, the commingling of suffering, and the shared unconscious in psychoanalysis.     

Emotional contagion, empathic concern and communicative responsiveness as variables affecting nurses'' stress and occupational commitment

Based on data gathered from registered nurses at two hospitals, this research examined the extent to which empathy variables contributed to nursing stress and occupational commitment. The empathy variables examined were emotional contagion (i.e. sharing the emotions of patients), empathic concern (i.e. being concerned for patients) and communicative effectiveness (i.e. effectively communicating with patients and their families). Nursing stress was explored through the variables of depersonalization, reduced personal accomplishment and emotional exhaustion. Multiple regression analyses revealed that the combination of the three emotional communication variables explained significant proportions of the variance in all three of the stress variables, as well as occupational commitment. The analyses further revealed that a lack of empathic concern and poor communicative responsiveness accounted for significant proportions of the variance in depersonalization. Lack of empathic concern, poor communicative responsiveness and high emotional contagion significantly contributed to reduced personal accomplishment. Emotional contagion explained a significant proportion of the variance in emotional exhaustion. Emotional contagion also significantly reduced occupational commitment. The findings are discussed in terms of nursing education and administration.     

Evaluation of empathy measurement tools in nursing: systematic review

Title.  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.     

Empathy Deficits and Cognitive Distortions in Child Molesters

An attempt was made to examine the thesis that the apparent empathy deficits in child molesters are simply another aspect of their self-serving tendency to distort information by, in this case, failing to recognize victim harm. Thirty-four child molesters were compared on a victim empathy measure and a measure of cognitive distortions, with 24 nonsex offenders and 28 nonoffending males. Child molesters displayed greater cognitive distortions than the other subjects and their greatest empathy deficits were toward their own victims. Consistent with the theory being examined it was found that the empathy scores of the child molesters toward their own victims were significantly correlated with the responses to the cognitive distortions scale. The results are discussed in terms of their implications for theory and practice.     

Nurses' personalities,nursing-related qualities and work satisfaction: a 10-year perspective

The personalities and qualities of nursing personnel are considered to be of great importance for their interactions and nursing relationships with patients and may also influence work satisfaction. The aim of the study was to explore the extent to which different personal qualities and personality factors, with a possible effect on motivation, professional conduct and coping with stress and anxiety, are represented in a group of assistant nurses (second level nurses), and how these qualities are related to nursing competence and long-range work satisfaction. A group of 51 female nursing students (mean age 31.8 years) participated in the study. The nursing-related qualities were empathy, sensitivity to non-verbal communication, feelings of discomfort in different nursing situations and work satisfaction. The personality factors were psychogenic needs and defence mechanisms. At a follow-up 2 years later, 43 nurses were interviewed, work satisfaction was assessed and nursing competence was appraised. At a follow-up 10 years after completion of nursing school, 33 of the nurses took part in a telephone interview. Work satisfaction was assessed in 23 of those who were still working as nurses. Cluster analysis performed on baseline data resulted in four groups: empathic, discomfort prone, service-minded and dominant. At the first follow-up, the service-minded had the greatest work satisfaction, with many considered to be 'real jewels'. At the second follow-up 8 years later, there appeared to be an overrepresentation of injuries and long-term sick leave in this group, whose members had apparent difficulties in being dominant and asserting own interests. Work satisfaction diminished in all the groups over time. Long-term work satisfaction was found, however, to be related to degree of empathy and a low degree of sensitivity to aggressiveness.