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Where is the compassion

In the past decades greater value has been placed upon intellectual focus and skill acquisition in nursing education. But has it been to the detriment of caring?

Although empathy is widely accepted and expected to be a central component of the nurse-patient relationship, patient’s perceptions are that it is frequently lacking.

This is according to Julia Williams and Theodore Stickley from UK’s University of Nottingham School of Nursing.

In an article published in Nurse Education Today, Williams and Stickley explores the concepts and different meanings of empathy and its relevance to nursing practice.

“Historically, nurse education has perhaps focused too much upon behavioural techniques to demonstrate empathy,” they say.

“Nurse educators should emphasise the importance of the genuine human encounter.”
Research into empathy is complicated by the various conceptualisations of it, and its meaning in the nursing context is not universally agreed. Empathy is a contested and complex concept to understand, experience, practice and teach.

“If they choose to do so, nurse educators are able to model empathy to their students. Students are studying to become nurses and they in turn will be required to foster helping relationships with their patients,” the authors say.

“Empathy therefore has relevance to educators in the influence they have as a role-model to foster positive attitudes and behaviours in student nurses that may ultimately impact upon patient care.”

Primary goals of empathy in nursing are the relief of loneliness and isolation, providing comfort and support and meeting the need of patients to be understood and validated.

This need for understanding, says Williams, is particularly potent when facing some of the crises that bring people into contact with nurses; terminal illness, sudden disfigurement or life-altering chronic conditions cause the deepest human feelings of fear, loss, pain and despair.

“At such times, an empathic care-givers approach has been linked to positive health outcomes measured in terms of reduced anxiety, improved pain management, emotional adjustment to chronic illness and maintaining hope and finding meaning in the face of suffering.”

In nurse education, researchers have found empathy is often taught in the context of behaviourally-based micro-skills of listening and responding.

This is regarded of value in increasing interpersonal repertoire and provides a framework for application in difficult situations. However, Williams says behavioural skills alone do not capture the essence of an empathic way of being.

In past studies, researchers have indentified the move of nursing from hospital-based training to higher education as leading to greater value placed upon intellectual focus and skill acquisition to the detriment of caring. At the same time, they argue, the professionalisation of nursing in an attempt to gain status has reduced the value of caring.

Another factor is that the clinical environment itself has become increasingly highly technical requiring greater knowledge of equipment and technical skills. In an effort to deliver safe technical care the focus of skills teaching which could include an interpersonal element loses sight of the patient as students learn and practise the technical procedure.

Some argue that developing an emotionally intelligent practitioner should be an explicit requirement of the nursing curriculum.

A way forward, says Williams, is for education to redress the balance between technical skills and interpersonal skills; and between academic and emotional skills.

“We would argue that this move to higher education has impacted more than the intellectual focus of nursing courses; the actual process between teacher and student has also been affected.

Firstly the focus of personal tutorials has changed from holistic development and pastoral support to outcome achievement. Secondly, the move to larger cohort numbers and the corresponding lecture theatre learning has further altered the dynamic between lecturer and student, de-personalising it.

Thirdly, at busy periods, the increasing use of computers, both in terms of e-learning and as communication devices between student and lecturer, may change the nurse educator’s perception of students from people into faceless tasks.”

Finally, the demands on nurse teachers have changed.

“We have become lecturers within a university culture with different priorities, and the workplace stress induced by the many re-organisations and changes impact personal resources available for giving to others.”

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