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... (contd)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 PROCESSphaseDisinterest Overwhelmed Matchingphase Overidentification EngagedPerplexed Participatory- Helping phaseDefensiveNo actionStateNonspecificemotional supportMatch Instrumentalproblem solvingUnderstanding 5. Inducement Phase Outcomes Disinterested observer proceeds to nextevent. Overwhelmed observer only focuses onhis/her affective response to event. Observermay assume that the other person experiencessimilar feelings and feel pity for the other butnot as an expression of desire to understand theworld of the other. Engaged observer attends to observed andwishes to proceed to next phase. 6. Inducement THE EMPATHIC PROCESSphaseDisinterest Overwhelmed Matchingphase Overidentification EngagedPerplexed Participatory- Helping phaseDefensiveNo actionStateNonspecificemotional supportMatch Instrumentalproblem solvingUnderstanding 7. Matching Phase Outcomes Overidentification Observer experiences lossof self due to associated distress. Cannot help theobserved. Perplexed generated hypotheses do not containobserved content and affect. No match made. Defensive State Observer experiences apersonal hit and the need to defend oneself isstronger than the desire to help. Match hypothetical situation matches observedsituation 8. Inducement THE EMPATHIC PROCESSphaseDisinterest Overwhelmed Matchingphase Overidentification EngagedPerplexed Participatory- Helping phaseDefensiveNo actionStateNonspecificemotional supportMatch Instrumentalproblem solvingUnderstanding 9. Participatory-Helping Outcomes No action does not mean no match! Nonspecific emotional support observerwants to make person feel better. Instrumental problem solving attempt tosolve patients problems 10. Inducement THE EMPATHIC PROCESSphaseDisinterest Overwhelmed Matchingphase Overidentification EngagedPerplexed Participatory- Helping phaseDefensiveNo actionStateNonspecificemotional supportMatch Instrumentalproblem solvingPatient: I dont know if IUnderstandingcan get through this all 11. The Empathic Process... (contd) 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 considerDo you think this model for the empathic process is accurate? Why or why not? 13. Questions to considerAre there any ways it could be improved? 14. Questions to considerHow 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...(contd)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 wasadmitted to hospital 4 days ago for chemotherapy foradvanced 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 defensivenessLikely 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 thepatient Asking for clarificationReflective listening attitude Patient : People at home Expressing interest are going to have troubleAcknowledging fearsExplanation of the situation with this.Giving adviceExpressing 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...(contd)Major findings: Validity partially supported SPIRS may also measurematurity (or the ability to place oneself in anothersshoes) Reliability supported (interrater reliability) Secular students scored lower on the SPIRS-PC thanreligious students Students with experience scored higher than studentswith 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 hermid-60s. He was mid-20s with a hx ofadmitted to the intravenous drug usehospital 4 days ago for who was admitted tochemotherapy forhospital 2 days ago foradvance prostatea liver biopsy. She iscancer. positive for Hepatitis BHe says: I dont want to and HIV be a burden to youShe says: I just want tostay in bed please 23. Likely to cause defensivenessLikely 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 thepatient 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 persons 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 todetermine their: Level of empathy Knowledge and beliefs on pain 80 nurse-patient pairs Patient data grouped and matched with their nurse toform 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 perceivedthemselves as receiving analgesia when neededFinding #2 Nurses level of empathy varied directly with nurseslevel of knowledge and beliefs about pain assessmentand management (nurses agreeing with and believingpatients 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 betweenpsychiatric disorders and TBI; to review the evidencefor causality using Hills criteria Implications: Referral for psychiatric services Screening in the community Medical history assessments 29. Psychiatric Comorbidity... (contd)Hills 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... (contd)ResultsDisorderRelationship with TBIMajor Depression-Maladaptive psychosocial factors related to TBI increasesrisk-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... (contd)ResultsDisorderRelationship 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 (contd) 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 (contd) Loss Loss of control Loss of confidence Loss of independence Previously taken-for-granted way of being now aconscious effort A passive role 35. The Experience of Living with Stroke (contd) Uncertainty Anxiety or uncertainty about the future Fears of another stroke Physical body unreliable and unpredictable 36. The Experience of Living with Stroke (contd) 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 (contd) 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)