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Empathy and suffering

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  • SKIT (rachel=patient; irene=nurse)Inducement phase  a patient says “I don’t know if I can get through this all” to his nurse, the observer Disinterest: I’m sure you’ll be fine. Overwhelmed: I couldn’t ever imagine being in your shoes, I mean, it must be really depressing. I’m sorry that you have to go through this. Engaged: What is it that you feel you can’t get through? Matching phase  the patient responds “Well.. Being in the hospital, having cancer, having to take off work, having to take all these medications.. There’s just so much!”Overidentification: I know what you mean. People come in here with an illness, looking to get better. But being in the hospital can often cause more distress. There’s so many medications to know about, and so many things to look out for. It can get so stressful in here that sometimes I can’t take it! Perplexed: Have you spoken to your social worker? Maybe they can suggest other career paths for you. Defensive: You know… we really try our best here, but nurses are severely understaffed. I hate that this is affecting you. Match: The experience of cancer and just being in a hospital can oftentimes be quite overwhelming.Participatory-Helping phase  the patient responds: “EXACTLY! I just wish I had a way to get rid of all this stress”. No action: I know what you mean. Nonspecific emotional support: We all experience stress sometimes, and that’s normal. Instrumental Problem Solving: Well, if you like we can talk about your options for you to have some home-based care and that way you can get home quicker and at least not have to put up with being in the hospital. Understanding: Stress in life is inevitable, and sometimes it can feel like it gets too much. Let’s talk about some coping strategies that work for you.
  • Example of Sympathy:A patient tells his nurse “I don’t know if I can get through this all”. The nurse sympathizing with thepatient would get overwhelmed, saying: “I couldn’t ever imagine being in your shoes, I mean, it must be really depressing. I’m sorry that you have to go through this”. This nurse is focused on their own affective response. The nurse assumes the patient feels the same way. The nurse feels bad for the patient because of how they would feel if it were them, not because they are trying to understand the patient.
  • SKIT GAME – present, and have audience guess what response we are giving. Patient says: “People at home are going to have trouble with this.”Response likely to cause defensiveness: You’re right - they probably will.Response likely to terminate interaction: Family members can be difficult.Response likely to engage in interaction: What would people at home have trouble with? Response to keep discussion going: You seem concerned about how your family members might feel.
  • Literature has shown that TBI survivors are at an increased risk of developing psychiatric disorders. This study aims to tease out the etiologies.
  • Transcript

    • 1. R. Pardoe & I. Yeung
    • 2. The Empathic Process and ItsMediators – A Heuristic Model(Gallop, Lancee, & Garfinkel, 1990)  Objective: describes the model of empathic process  Empathy is a tri-phasal, time-sequenced process:  Inducement phase  Matching phase  Participatory-helping phase  In each phase, different mediators can either hinder or advance the empathic process
    • 3. The Empathic Process... (cont’d)Definition of Empathy:“…there is a general agreement that empathy refersto the ability to “know” the experience of another andthat some degree of matching of emotions isinferred.”
    • 4. Inducement THE EMPATHIC PROCESS phase Disinterest Overwhelmed Matching phase Over identification Engaged Perplexed Participatory- Helping phase Defensive No action State Nonspecific emotional support Match Instrumental problem solving Understanding
    • 5. Inducement Phase Outcomes Disinterested – observer proceeds to next event. Overwhelmed – observer only focuses on his/her affective response to event. Observer may assume that the other person experiences similar feelings and feel pity for the other but not as an expression of desire to understand the world of the other. Engaged – observer attends to observed and wishes to proceed to next phase.
    • 6. Inducement THE EMPATHIC PROCESS phase Disinterest Overwhelmed Matching phase Over identification Engaged Perplexed Participatory- Helping phase Defensive No action State Nonspecific emotional support Match Instrumental problem solving Understanding
    • 7. Matching Phase Outcomes Overidentification – Observer experiences loss of self due to associated distress. Cannot help the observed. Perplexed – generated hypotheses do not contain observed content and affect. No match made. Defensive State – Observer experiences a personal hit and the need to defend oneself is stronger than the desire to help. Match – hypothetical situation matches observed situation
    • 8. Inducement THE EMPATHIC PROCESS phase Disinterest Overwhelmed Matching phase Over identification Engaged Perplexed Participatory- Helping phase Defensive No action State Nonspecific emotional support Match Instrumental problem solving Understanding
    • 9. Participatory-Helping Outcomes No action – does not mean no match! Nonspecific emotional support – observer wants to “make person feel better”. Instrumental problem solving – attempt to solve patient’s problems
    • 10. Inducement THE EMPATHIC PROCESS phase Disinterest Overwhelmed Matching phase Over identification Engaged Perplexed Participatory- Helping phase Defensive No action State Nonspecific emotional support Match Instrumental problem solvingPatient: “I don’t know if I Understandingcan get through this all”
    • 11. The Empathic Process... (cont’d) Implications  Guideline for nurses to…  reflect on previous dialogues and identify which stage and by which mediator an empathic process ended  communicate meaningfully and therapeutically  In using this process, it becomes easier to distinguish between empathy and other similar concepts  Empathy vs. Sympathy
    • 12. Questions to considerDo you think this model for the empathic process is accurate? Why or why not?
    • 13. Questions to considerAre there any ways it could be improved?
    • 14. Questions to considerHow can we go about teaching empathy?
    • 15. Pair up and discuss an example from your clinical experiences in which you followed the trajectory of the empathic process? Where did you end up in the model?
    • 16. The Usefulness of the Staff-Patient InteractionResponse Scale for Palliative Care Nursing forMeasuring the Empathetic Capacity of NursingStudents(Adriaansen, van Achterberg, & Borm, 2008) Objective: To determine the reliability and validity of the SPIRS-PCN as a measure of empathy in palliative care
    • 17. The Usefulness of Staff-Patient Interaction...(cont’d)Definition of Empathy:“…the ability to perceive the meanings and feelings ofanother person and to communicate those feelings tothe other”
    • 18. SPIRS-PCN (Appendix A)Instructions: Please write a short response to thepatients statement as if you were talking to the patient Context: Frank is a patient in his mid-60s. He was admitted to hospital 4 days ago for chemotherapy for advanced prostate cancer. Stimuli: While under your care, this patient says:  “People at home are going to have trouble with this.”
    • 19. Rating Table (Appendix B)Likely to cause defensiveness Likely to engage in interaction  Confronting  Trying to empower the pt  Strong negative response  Giving an explanation  Denial of responsibility  Asking superficially on the well-being of the patient  Asking for clarification Reflective listening attitude Patient : “People at home   Expressing interest are going to have trouble   Acknowledging fears Explanation of the situation with this.”   Giving advice Expressing a relevant opinionLikely to terminate interaction Likely to keep discussion going  Generalization  Inviting the patient to continue the dialogue  Cliches  Inviting the patient to explore the situation  Use of flattering statements  Trying to recognize feelings of the patient  Focused on oneself  Recognizing the reality of the situation  Accepting flattery of patient  Investigating profoundly the feelings of the pt  Looking for reassurance  Irrelevant opinion  Giving presumptuous advice  Giving presumptuous solution
    • 20. The Usefulness of Staff-Patient Interaction...(cont’d)Major findings: Validity partially supported – SPIRS may also measure maturity (or the ability to place oneself in another’s shoes) Reliability supported (interrater reliability) Secular students scored lower on the SPIRS-PC than religious students Students with experience scored higher than students with no experience
    • 21. Activity Form groups of 4 Pick one of the two examples from the next slide and come up with one response for each of categories listed below:  Likely to cause defensiveness  Likely to terminate interaction  Likely to engage in interaction  Likely to keep discussion going Present in Skit Game form!
    • 22. Examples1.Frank is a patient in his 2. Anne is a patient in her mid-60s. He was mid-20s with a hx of admitted to the intravenous drug use hospital 4 days ago for who was admitted to chemotherapy for hospital 2 days ago for advance prostate a liver biopsy. She is cancer. positive for Hepatitis BHe says: “I don’t want to and HIV be a burden to you” She says: “I just want to stay in bed – please”
    • 23. Likely to cause defensiveness Likely to engage in interaction  Confronting  Trying to empower the pt  Strong negative response  Giving an explanation  Denial of responsibility  Asking superficially on the well-being of the patient  Asking for clarification  Reflective listening attitude  Expressing interest  Acknowledging fears  Explanation of the situation  Giving advice  Expressing a relevant opinionLikely to terminate interaction Likely to keep discussion going  Generalization  Inviting the patient to continue the dialogue  Cliches  Inviting the patient to explore the situation  Use of flattering statements  Trying to recognize feelings of the patient  Focused on oneself  Recognizing the reality of the situation  Accepting flattery of patient  Investigating profoundly the feelings of the pt  Looking for reassurance  Irrelevant opinion  Giving presumptuous advice  Giving presumptuous solution
    • 24. The Impact of Nurses’ Empathic Responses onPatients’ Pain Management in Acute Care(Watt-Watson, Garfinkel, Gallop, Stevens & Streiner, 2000) • Objective: To look at the relationship between nurses’ empathic responses and patients’ pain rating and analgesia after surgery • Definition of Empathy: “…an interactive process in which health professionals wish to know and understand the subjective experience of the patient. Empathy is a sensing of another person’s experience, whether simple or complex, and can occur in brief interactions with patients”.
    • 25. Methods• 225 post-operative bypass patients were interviewed on: • Pain intensity and quality • Perception of the nurse as a resource for pain• 94 nurses were asked to fill out a questionnaire to determine their: • Level of empathy • Knowledge and beliefs on pain• 80 nurse-patient pairs • Patient data grouped and matched with their nurse to form nurse-patient pairs
    • 26. Finding #1 • Level of empathy does not correlate with level of pain • Level of empathy does not amount of analgesia • However, patients with more empathic nurses perceived themselves as receiving analgesia when neededFinding #2 • Nurses’ level of empathy varied directly with nurses’ level of knowledge and beliefs about pain assessment and management (nurses agreeing with and believing patients statements of pain) • More empathic nurses give opioids for pain
    • 27. Finding #3  Level of empathy did not vary nurse characteristics such as years of unit/nursing experience, level of in- service educationFinding #4  Levels of empathy did not vary in relation to patients’ age
    • 28. Psychiatric Comorbidity following TraumaticBrain Injury(Rogers & Read, 2007) Objective: to explore the relationships between psychiatric disorders and TBI; to review the evidence for causality using Hill’s criteria Implications:  Referral for psychiatric services  Screening in the community  Medical history assessments
    • 29. Psychiatric Comorbidity... (cont’d)Hill’s Criteria1. Strong association between causative agent and outcome2. Temporal sequence – causative agent precedes outcome of interest3. Biological gradient – greater severity of causative agent = poorer outcome4. Fitting observed causative relationship to accepted biological models... Etc.
    • 30. Psychiatric Comorbidity... (cont’d)ResultsDisorder Relationship with TBIMajor Depression -Maladaptive psychosocial factors related to TBI increases risk -Premorbid psychosocial factorsBipolar Affective -No relationshipDisorderSchizophrenia -Increased risk with genetic predispositionSubstance Abuse -Premorbid SA/hx of psychiatric condition – short term(SA) increased risk post-injury
    • 31. Psychiatric Comorbidity... (cont’d)ResultsDisorder Relationship to TBIGeneralized Anxiety -No relationshipDisorder -Cultural differences may increase riskPanic Disorder -Increased risk with latency period of 10+ yearsPTSD -Hx of psychiatric disorder/location of TBIOCD -Mixed results
    • 32. The Experience of Living with Stroke: AQualitative Meta-synthesisSalter, Hellings, Foley, & Teasell (2008) Objective: to review qualitative literature to enhance understanding of the experience of living with stroke Themes  Change  Loss  Uncertainty  Social Isolation  Adaptation and Reconciliation
    • 33. The Experience of Living with Stroke… (cont’d)  Change, Transition and transformation  A sudden and overwhelming catastrophe  A fundamental life change and profound disruption  Ongoing process of re-interpretation of self
    • 34. The Experience of Living with Stroke… (cont’d)  Loss  Loss of control  Loss of confidence  Loss of independence  Previously taken-for-granted way of being now a conscious effort  A passive role
    • 35. The Experience of Living with Stroke… (cont’d)  Uncertainty  Anxiety or uncertainty about the future  Fears of another stroke  Physical body unreliable and unpredictable
    • 36. The Experience of Living with Stroke… (cont’d)  Social Isolation  Relationships provide support, comfort, consolation  Connections helped to maintain continuity in life  Difficult to explain their experiences to others  Misunderstood or dismissed  Avoidance of being a burden to others
    • 37. The Experience of Living with Stroke… (cont’d)  Adaptation and Reconciliation  Focus on positive aspects of their lives  Regaining control  Mastering new skills  Changing their environment  Getting back to normal  Arrived at a truce with themselves
    • 38. Why Empathy? http://www.youtube.com/watch?v=nRduvwuM-VM
    • 39. What are some strategies toachieve empathy? (Cynthia)

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