Concept Analysis: Empathy, Essay Example

Introduction

The concept of empathy presents a variety of challenges in terms of comprehension, actual definition, and applicability to the field of nursing.  In a very real sense, empathy is typically perceived as so innate a quality, it must defy specificity; generally speaking, it is the process by which human beings understand and relate to the emotional and psychological states of others; consequently, it is inevitably marked by limitless gradation, as well as by a usual expectation that it is so personal a quality, it is within the individual or it is absent.  In the following, analysis will reveal that definition is in fact available. Moreover, mounting evidence suggests that empathic skills may be learned, and research indicates that nurses may attain higher levels of empathic techniques and understanding through training (Brunero, Lamont, & Coates, 2010,  p. 65). Lastly, and after review of the practices and educational models of the subject, it will be seen that empathy is of the utmost importance to the performance of nursing.  The aim of this concept analysis is to discover the meaning of empathy within nursing, as it will also define attributes and present case scenarios.

Literature Review/ Applied Disciplines

As noted, the intrinsic nature of empathy presents difficulties in terms of assessment and definition.  The concept is by no means new; it has traditionally been held that empathic ability and response is a core component of nursing, particularly given the usual relationship between nurse and patient as more intimate than that of the physician and patient. The empathy concept aside, this has been established by modern and ongoing study, which affirms the nurse-patient relationship as defined by degrees of intimacy otherwise experienced by the patient only with family members and romantic partners.  This is due, and to a significant extent, to the physicality of the circumstances, as the nurse must usually engage in intimate physical contact while administering care.  Psychological and/or emotional intimacy is then often generated, as the closeness of the physicality invariably triggers trust, vulnerability, acceptance, and other aspects of reciprocity (Roberts, 2013,  p. 45).  With regard to the empathy concept, then, a kind of foundation typically exists upon which the nurse-patient relationship may be enhanced through greater empathic interaction.

Regarding the concept itself and the uses ascertained by the literature, it must be noted that actual study of empathy is relatively new. This is particularly the case with physician empathy: “There is a dearth of empirical research on physician empathy despite its mediating role in patient-physician relationships and clinical outcomes” (Hojat et al, 2002,  p. 1563), which of itself indicates the interestingly more “close” relationship likely between nurse and patient.  Nonetheless, modern emphasis is increasingly laid on the need for physicians to develop altruistic sensibilities enabling them to better comprehend the patients’ states of being. The use here is irrefutable; ongoing reports from the Association of American Medical Colleges affirm, if not insist, that education for physicians must entail awareness training of patient perspectives (Hojat et al, 2002,  p. 1563).  As the relationship between the caregiver and the patient is established in virtually all research as crucial in care, the use of empathy, variations of definition notwithstanding, is clear.  It may in this regard be viewed, in fact, as an enhanced means of communication, in which information not otherwise attainable is shared through the exponential process of mutual understanding at emotional levels.

Turning to other care relationships, empathy has been consistently evaluated as being of great use in furthering the intrinsically therapeutic processes of the nurse-patient scenario, which often take less definable forms.  The effects of empathy as studied in this regard are in fact impressive, certainly when the use occurs in cases of mental and/or emotional disorders: “An empathetic relationship appears to be more important to the clinical outcome of psychotherapy than the type of therapy itself” (Mercer, Reynolds, 2002).  Since the late 20^th century, the role of empathy as efficacious in therapy has been increasingly emphasized, largely due to research continually supporting its value (Patterson, 1984).  This would seem to affirm the foundational quality of empathy mentioned earlier, in that it provides an emotional “platform” upon which trust facilitates healing.

It is then hardly surprising that other research affirms empathy as a positive force in a variety of social matters, and that it offers distinct and pragmatic benefits in enhancing all relationships.  This then pertains to empathy in terms of basic psychology. In a 2007 study of adolescent conflict, for example, several hundred European high school students self-reported strategies developed and applied by themselves in regard to resolving issues with peers, and these were assessed using Kurdek’s Conflict Resolution Styles Index and Bryant’s Index of Empathy for Children and Adolescents, which gauges levels of affective emotion.  The results uniformly supported that greater degrees of empathy, or efforts to engage in empathy, went to improved conflict resolution skills (de Wied, Branje, & Meeus, 2007,  p. 53).  Behavioral and psychological disciplines are, in plain terms, embracing the value of empathy as a critical skill set in human relation.

At the same time, when empathy is viewed in relation to psychology, a dilemma arises.  The concept, as noted, is lauded by researchers as virtually indispensable in establishing healthy therapeutic relationships.  An immense body of work dating from the early 1970s, in fact, consistently reinforces the value of empathy in any form of psychotherapy. Nonetheless, it is argued that the “results” of the literature supporting this are negligible, or rather too influenced by the impetus in the research to affirm the concept’s value.  Patterson cites literally dozens of psychological studies of empathy supporting its usefulness in therapy and emotional healing, yet he notes as well how the actual measurements are questionable.  Interestingly, he observes as well that a typical signifier of such success is that patients tend to remain in therapy longer when they feel an empathic rapport with their therapist, which certainly suggests a lack of actual utility (Patterson,  1984).  Nonetheless, even this skeptical study concludes the empathic value to psychology is clear, if only by virtue of the sheer preponderance of the affirming conclusions.

With regard to the discipline of management, modern research tends to focus on the emotional intelligence component of empathy as highly relevant.  Management theory tends to focus more on pragmatic and distinct causes and effects; consequently, the individual’s cognitive ability to perceive the states of feeling of others is seen as crucial in effecting business relations ranging from international contract disputes to employee policies.  More specifically, globalization has generated an increased interest in empathy due to the issues raised by multicultural interactions.  An extensive study of management styles as varying by culture reveals profound differences; American leadership, for example, is centered on the individual, while the Japanese is group-oriented (Hofstede, 1993,  p. 84).  Such fundamental differences in management approach then exacerbate conflict bases such as power distance, individualism, masculinity and femininity perceptions, and avoidance.

With empathy in play, however, it is seen that even significant cultural barriers may be overcome, as the individual essentially “sidesteps” them to gain a more true understanding of the other’s intents and state of being.  Management then may employ empathy training as an immensely valuable instrument which effectively negates the negative potentials in cross-cultural interactions (Hofstede, 1993,  p. 88).  This again relies more on a focus on emotional intelligence, which may be said to be a cognitive approach to an emotional level.  The individual chooses to actively seek understanding through an effort at awareness of the other’s feelings and motives.  In management, in fact, empathy may be seen in its most pragmatic form, as specific results of understanding are sought by specific engagement; it is in a sense empathy translated into a practical, or commercial, process, yet this of itself does not lessen the value of the understanding achieved.

Attributes and Concept Definition

Before any relating of the attributes of empathy may be given, it is necessary to comprehend that there is a consistent aspect of vagueness to the concept, and that attributes and definition are then both codependent and subject to interpretation.  The textbook definition of empathy holds that it is: “The feeling that you understand and share another person’s experiences and emotions; the ability to share someone else’s feelings” (Merriam-Webster, 2014). The nature of the concept is such, nonetheless, that it has proven consistently difficult to measure and/or more adequately define, despite its value as acknowledged as highly significant in care (Hojat et al, 2002, p. 1565).  All of this notwithstanding, it is possible to identify certain characteristics and traits of empathy which are consistently affirmed in the literature.  These may be noted as belonging to two groups:

The cognitive domain of empathy involves the ability to understand another person’s inner experiences and feelings and a capability to view the outside world from the other person’s perspective…. The affective domain involves the capacity to enter into or join the experiences and feelings of another person (Hojat et al, 2002,  p. 1564).

Within the cognitive domain, there is the attribute of what may be called focus, or intent. The individual exerts on some level an effort to set aside their own preoccupations, feelings, and perceptions, and seeks to accept those of the other.  This necessarily entails an intellectual process; there is a cognitive commitment to “taking in” the various clues and more overt expressions of the other, as well as an understanding that the process is exponential.  More exactly, determination of the other’s state of being, emotional and psychological, can occur only as the information is fully received.  Connected to this attribute is the intellectual awareness of encountering that which may be at first inexplicable.  Empathy, even in this cognitive sense, demands a surrender of judgment and bias in favor of accepting an unknown reality partially determined through intellectual engagement, as well as a surrender of one’s own feelings and perceptions.

The affective realm is equally important in empathy, in that reciprocity is more present as an attribute here. This is the realm of feeling, which is based on the empathic circumstances of the interactions. What is perceived through feeling is also translated as such in the process, so the empathy exists on a visceral and emotional level. Empathy here is as well highly intuitive; it relies very much on what is not overtly expressed, but rather felt, and felt as an emotional reality of the other. Attributes then include awareness, willingness to enter into the emotional experience of another, sensitivity, and an absence of personal or other bias.  A further attribute may be offered as the actual state of shared feeling, in that the reciprocity process enables a relating of feeling so complete, the feeling of the other essentially becomes the feeling of both.

From this is is possible to define empathy as concept and actual process.  In technical terms, the definition is typically along these lines: “The state of perceiving the internal frame of reference of another person, with accuracy and with emotional components and meanings that pertain to it, as if one were with the other person” (Brunero, Lamont, Coates, 2010,  p. 65). This is valid, but the nature of the concept is intrinsically ineffable to an extent, in that the reciprocity mentioned creates a reality “fusing” the participants.  In comprehending feeling, feeling is translated by the self to a recognizable feeling of its own, so empathy then very is a state of “oneness” achieved by individuals.  It is a coming together of experience as experience infuses the mind and emotions, and in this process boundaries essentially are eliminated as there is a level of absolute understanding.

Cases

A model case of empathy as facilitating care is seen in an instance of a mother of two suffering from ovarian cancer who seeks counseling. Her therapist, an older man, attends to her expressions of anger and fully understands her misdirecting this at her own children, which understanding greatly eases the mother’s anxieties.  The relationship then represents all empathic attributes, particularly as both individuals have such different frames of reference.  Relating at the deepest level is achieved, so empathy assists in the therapeutic processes.  Reciprocity, awareness, cognitive understanding, cognitive effort, and acceptance are all evident here.

A case wherein attributes are missing may be seen in how a doctor responds to a patient’s emotional distress. The doctor comprehends on an intellectual level that there are emotional issues, but they are more inclined to categorize them as symptoms of the actual illness and thus not fully address them.  There is awareness, but no emotional connection, and research supports that physician empathic receptivity is sometimes limited, a factor potentially attributed to male physicians as less active in generating the expression of feeling necessary for empathy (Hojat et al, 2002,  p. 1567).  Put another way, when the attribute of willingness, which facilitates expression and connection, is absent,  there is a lack of the commitment required in empathic interaction.

There are as well cases in which sympathy, rather than empathy, is the core.  A young girl, forbidden to attend a dance, relates her distress to an older female relation.  The latter expresses understanding because she had experienced a similar disappointment.  The girl, however, is only minimally relieved because the older woman maintains her own frame of reference and offers only sympathy from this; she does not enter into the girl’s actual experience as it existed.  An example of a contrary case is one  wherein a woman undergoing emotional trauma informs her nurse that she no longer wishes to live.  The nurse responds by refuting the claim as nonsensical, and affirming that the woman has much to live for.  Clearly, there is no empathy here because the nurse in no way accepts the emotional reality of the woman; on the contrary, she dismisses it as meaningless.  Lastly, another hypothetical case centers on a nurse who senses disturbance in a patient no one else notices.  The nurse attends to the patient daily and maintains an openness, and the patient eventually relates a secret and troubling issue.  In such a case, empathy is both a passive and proactive force; the nurse’s awareness, based on receptivity, finally triggers the response which cannot be offered without a trust in the empathy as present already.

Antecedents and Empirical Referents

Two antecedents dominate, if not fully comprise, the forces going to the concept of empathy.  The first of these is perspective taking, which is the process by which one imagines how the circumstances of the other would translate for them.  This is not empathy; rather, it is a motivation for empathy, when the individual is enabled to substitute themselves in the matter at hand.  The typical consequence of this process is the empathy, or an effort to engage in empathy, because there is an understanding of the other’s reality (Batson et al, 2007).  It must be emphasized that perspective taking is removed from the interaction essential to empathy; it is in effect a transference of issue, rather than a sharing of feeling or understanding.  Nonetheless, it enable empathy, as does valuing the welfare of the other. This too is antecedental in that it is a motive for empathy, even as it may be generated by any number of impulses.  Essentially, once it is established that the other is meaningful in some way, there is incentive to address through empathic interaction the issues affecting the other  (Batson et al, 2007).  As with perspective taking, the consequence is typically an effort at empathy because the concept is motivated.

Measurement of empathy is, as noted, difficult.  Scales exist, but typically rely on individual perceptions, just as the attributes of the concept are inherently marked by gradation.  Then, situational empathy, in which circumstances dictate, is distinct from dispositional empathy, which goes more to innate character.  The Hogan Scale nonetheless remains the primary empirical referent, and its cognitive empathy scale consists of 64 questions selected from a variety of psychological personality tests, such as the Minnesota Multiphasic Personality Inventory (MMPI) and the California Personality Inventory.  There is also  Davis’s Interpersonal Reactivity Index, consisting of 28 questions divided equally among four subscales, including “perspective taking” and “the tendency to spontaneously adopt the psychological view of others in everyday life” (Stanford, 2013).  Other measurement system reflect these strategies, even as all essentially rely on the subjective determinations of those measured.  It is to be hoped that a more comprehensive scale, and one based on correlating interactions, will eventually better measure how empathy is enacted, since the concept is so inextricably linked to interactive processes.

Summary and Conclusion

The concept of empathy very much defies analysis, rooted in human feeling and exchange as it is.  It is also of the utmost importance in human relations, and of particular meaning to the nursing profession.  A literature review reveals that the concept is seen as multifaceted, and with import to anything engaging human effort; empathy impacts as powerfully on management as it does in psychological matters, an inevitability given its nature as reflective of the pinnacle of human understanding.  It is marked by distinct attributes, including bot not limited to awareness, receptivity, engagement, an absence of all bias, and sensitivity, and it operates as both a cognitive and affective force.  Cases illustrate the degree to which empathy may have positive impact, as well as when sympathy exists in its place or when it is utterly absent.  Lastly, that empathy is prompted by antecedents of perspective taking and the valuing of others is eminently logical, even as measurement is still confined to the subjectivity of self-reporting.

These realities and considerations aside, it must be emphasized that empathy is of vital concern to nursing, as it goes to the traditional ideals of the profession itself. The ability to comprehend the feelings of patients is critical simply because, in times of illness, patients are emotionally vulnerable and consequently less able to cope with their own states of being, and this of itself easily impedes healing and/or care (Cadman, Brewer, 2001,  p. 321). Howsoever study continues in empathy, it will always be a chief concern to nurses, who may be said to best embody it in their commitment to their work.

References

Batson, C. D., Eklund, J. H., Chermok, V. L., Hoyt, J. L., & Ortiz, B. G. (2007).  “An additional antecedent of empathic concern: valuing the welfare of the person in need.” Journal of Personality and Social Psychology, 93(1), 65.

Brunero, S., Lamont, S., & Coates, M. (2010).  “A review of empathy education in nursing.” Nursing Inquiry, 17(1), 65-74.

Cadman, C., & Brewer, J. (2001). “Emotional intelligence: a vital prerequisite for recruitment in nursing.” Journal of Nursing Management, 9(6), 321-324.

de Wied, M., Branje, S. J., & Meeus, W. H. (2007). “Empathy and conflict resolution in friendship relations among adolescents.” Aggressive Behavior,33(1), 48-55.

Hojat, M., Gonnella, J. S., Nasca, T. J., Mangione, S., Vergare, M., & Magee, M. (2002). “Physician empathy: definition, components, measurement, and relationship to gender and specialty.” American Journal of Psychiatry, 159(9), 1563-1569.

Hofstede, G. (1993). “Cultural constraints in management theories.” The Academy of Management Executives, 7(1), 81-94.

Mercer, S. W., & Reynolds, W. J. (2002). “Empathy and quality of care.” The British     Journal of General Practice,52(Suppl), S9.

Merriam-Webster Dictionary.  (2014) “Empathy.”  Retrieved from http://www.merriam-webster.com/dictionary/empathy

Patterson, C. H. (1984).  “Empathy, warmth, and genuineness in psychotherapy: A review of reviews.” Psychotherapy: Theory, Research, Practice, Training, 21(4), 431.

Roberts, D.  (2013).  Psychosocial Nursing: A Guide to Nursing The Whole Person. New York: McGraw-Hill International.

Stanford.  Measuring Empathy.  2013.  Web. 2 April 2014.  Retrieved from http://plato.stanford.edu/entries/empathy/measuring.html