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PubMed2005

Measurement of changes in empathy during dental school.

Empathy in the health care setting is the ability to understand a patient's experiences and feelings and the capability to communicate this understanding. Although empathy has been shown to play an important role in the dentist-patient relationship and is a core competence for dentists, no measure of empathy has been validated in the dental setting. Further, little is known about changes in empathy during dental school. We examined the psychometric properties of a measure of empathy applied to the dental school setting and compared levels of empathy in dental students across their four years of training. One hundred and thirty students completed a survey including the Jefferson Scale of Physician Empathy (JSPE). The JSPE was found to be both a reliable and valid empathy measure for dental students with similar psychometric properties to those found in medical students, residents, and physicians. Further, first-year dental students had significantly higher empathy scores than students in any subsequent year. Consistent with the literature in medical settings, the timing of the decline in empathy levels corresponded to increases in patient exposure. We suggest that training students in the interpersonal skills designed to enhance the dentist-patient relationship should continue throughout dental school training.

Adult↗

PubMed1980

Origins, elements, and functions of therapeutic empathy.

Tracing the roots of empathy (within human history) descriptively to aesthetics and psychologically to the earliest mother-infant interactions, it is proposed that the ontogenesis and employment of mature empathy require repeated flexible--and, if necessary, sustained-access to its primitive levels, levels especially important to the analyst in the understanding of severely disturbed patients. Narcissistic disturbance in the analyst, while occasionally accompanied by a beneficial hypertrophy of primitive empathic capacities, tends to be particularly detrimental to the exercise of mature empathy. Countertransference is considered in this regard and in relation to therapeutic empathy evoked or impeded by unconscious fantasy--the latter proposed to be infrequently, if sometimes necessarily, a central element of therapeutic empathy, which more commonly may function inconspicuously at a preconscious level. In the analytic situation, it is suggested, empathy may often be addressed most usefully to focal conflicts (borrowing French's concept but not his precise definition) via the analyst's partial identification with the patient's self-in-depth, an entity which is acknowledged to be ultimately immeasurable and necessarily mysterious. Several aspects of the therapeutic employment of empathy are examined, including failures of empathy attributable to analyst, patient, or both, for worse and--potentially--for better; the role of empathy and empathic failure(real, imagined, and provoked) in the establishment of archaic negative transferences; and the assessment of abstinence as variable inherent in empathic exploration, with the inference that disciplined employment of empathy, rather than frustration per se, is likeliest to abet a therapeutic regression and to promote an enriching unification of the personality.

Adult↗

PubMed1989

Empathy and burnout in male and female helping professionals.

Relationships between empathy and burnout and possible confounding influences of sex and profession were explored in a sample of 492 male and female nurses, social workers, and teachers. Respondents completed Mehrabian's Emotional Empathy Scale, Stotland's Fantasy-Empathy Scale, and the Maslach Burnout Inventory (MBI). There were no main effects of profession on empathy or burnout variables. There was, however, an interaction effect of sex and profession on depersonalization, which was accounted for by subjects in social work and teaching. Women had significantly higher empathy scores than men; however, men had higher scores than male normative groups. Age related negatively to depersonalization and emotional exhaustion for women, whereas percentage of work time spent in direct practice correlated with depersonalization for men. The possibility that empathy and burnout might represent opposite poles of the same underlying construct was examined but not found. Instead, emotional empathy was significantly positively correlated with both emotional exhaustion and personal accomplishment, whereas emotional exhaustion was also positively related to depersonalization. It is hypothesized that high emotional empathy may predispose helping professionals to emotional exhaustion and that emotional exhaustion, if not mediated by personal accomplishment, may lead to the development of depersonalization. This more complex, interactive model of the empathy-burnout relationship needs longitudinal study.

Burnout, Professional↗

PubMed2000

Do nurses and other professional helpers normally display much empathy?

Empathy, the ability to perceive and reason, as well as the ability to communicate understanding of the other person's feelings and their attached meanings, is held to be a core characteristic of a helping relationship. This paper examines some of the observations that motivated the authors' interest in how registered nurses learn how to offer empathy to clients. First, while empathy is crucial to all helping relationships, professional helpers do not normally offer much empathy. Second, while nurses are meant to provide helping relationships, they do not tend to show much empathy to clients. The relevance of empathy to clinical nursing and the potential consequences of low-empathy nursing for clients is considered. It will be shown that, in the past, a low level of empathy has been reported among the helping professions, including nursing, indicating that many professional helpers are not as helpful as they ought to be. While most studies of empathy in professional relationships are more than a decade old, more recent studies report similar results.

Empathy↗

PubMed2002

Assessment of empathy in different years of internal medicine training.

The operational measurement of physician empathy, as well as the question of whether empathy could change at different levels of medical education, is of interest to medical educators. To address this issue, 98 internal medicine residents from all 3 years of training were studied. The Jefferson Scale of Physician Empathy was administered, and residents' empathy scores correlated with ratings on humanistic attributes made by postgraduate program directors. No statistically significant differences in scores were found among residents of different training levels. Empathy scores remained also stable during internship (test-retest reliability = 0.72). Correlation between empathy and ratings on humanism was 0.17. Thus, the findings suggest that empathy is a relatively stable trait that is not easily amenable to change in residency training programs. The issue of whether targeted educational activities for the purpose of cultivating empathy can improve empathy scores awaits empirical scrutiny.

Education, Medical↗

PubMed1990

Empathy, experience of burnout and attitudes towards demented patients among nursing staff in geriatric care.

A non-anonymous questionnaire was distributed to all nursing staff (n = 557) including RNs, LPNs (psychiatric), LPNs (somatic) and nurses' aides, in one nursing home, one somatic long-term care clinic and one psychogeriatric clinic. Scales measuring empathy, burnout experience and attitudes towards demented patients were included in the questionnaire. The aim of the study was to compare levels of empathy, burnout experience and attitudes among different categories of nursing staff and to examine connections between empathy, burnout and attitudes. The nursing staff showed an overall figure of moderately well-developed empathy and the RNs showed the highest empathy. The RNs had a significantly lower degree of burnout compared to the nurses' aides and the LPNs. Of all respondents, 27.4% were assessed at risk from burnout. Overall, the staff showed a moderately positive attitude towards demented patients and the RNs were most positive. No linear correlation was found between empathy, burnout experience and attitudes. However, a weak negative correlation between burnout and empathy is in accordance with other authors who are suggesting that burnout experience leads to lower empathy in the nursing staff. The fact that the RNs showed the most positive attitudes towards demented patients and had the highest level of empathy compared to LPNs and nurses' aides could be related to lower degree of burnout assessed in the RNs. Qualitative and quantitative overload among the LPNs and nurses' aides connected to the growing number of demented patients in the institutions examined are discussed.

Adult↗

PubMed2003

Characterization of empathy deficits following prefrontal brain damage: the role of the right ventromedial prefrontal cortex.

Impaired empathic response has been described in patients following brain injury, suggesting that empathy may be a fundamental aspect of the social behavior disturbed by brain damage. However, the neuroanatomical basis of impaired empathy has not been studied in detail. The empathic response of patients with localized lesions in the prefrontal cortex (n = 25) was compared to responses of patients with posterior (n = 17) and healthy control subjects (n = 19). To examine the cognitive processes that underlie the empathic ability, the relationships between empathy scores and the performance on tasks that assess processes of cognitive flexibility, affect recognition, and theory of mind (TOM) were also examined. Patients with prefrontal lesions, particularly when their damage included the ventromedial prefrontal cortex, were significantly impaired in empathy as compared to patients with posterior lesions and healthy controls. However, among patients with posterior lesions, those with damage to the right hemisphere were impaired, whereas those with left posterior lesions displayed empathy levels similar to healthy controls. Seven of nine patients with the most profound empathy deficit had a right ventromedial lesion. A differential pattern regarding the relationships between empathy and cognitive performance was also found: Whereas among patients with dorsolateral prefrontal damage empathy was related to cognitive flexibility but not to TOM and affect recognition, empathy scores in patients with ventromedial lesions were related to TOM but not to cognitive flexibility. Our findings suggest that prefrontal structures play an important part in a network mediating the empathic response and specifically that the right ventromedial cortex has a unique role in integrating cognition and affect to produce the empathic response.

Adult↗

PubMed2001

Developing empathy to improve patient care: a pilot study of cancer nurses.

Empathy has been identified as an important communication skill that can improve psychological outcomes for patients with cancer and palliative care patients; as such there is a need for cancer nurses to be empathic. The majority of research that has been carried out has been concerned with the definition and measurement of empathy. Exploration into the concept of empathy has shown that there is a need to examine the nature of it and to identify exactly where it succeeds and fails. The questions of how empathy is nurtured and sustained and under what conditions it flourishes and diminishes need to be addressed. This study aimed to investigate how cancer nurses interpret and acquire empathy, and to identify the conditions that influence it. It was also important to establish what cancer nurses considered to be the benefits and disadvantages of expressing empathy. The findings demonstrated that nurses are aware of the concept of empathy and do use their empathic skills; however, there are barriers that could inhibit the expression of empathy, including lack of time, poor environment and communication difficulties. This study highlights the recognition of empathy as a discrete communication skill and the need for more structured courses.

Attitude of Health Personnel↗

PubMed2007

Empathy-related responding and prosocial behaviour.

In this paper I differentiate among empathy, sympathy and personal distress and discuss the central role of empathy-related responding in positive (including moral) development. Empathy-related responding, especially sympathy, is likely an important source of prosocial, other-oriented motivation. In fact, empathy-related responding, especially sympathy, has been associated with prosocial behaviour (voluntary behaviour intended to benefit another, e.g. helping, sharing); this relation has been obtained for both specific instances of empathy-related responding and for dispositional sympathy. In addition, sympathy (or sometimes empathy) has been linked to relatively high levels of moral reasoning and social competence, and to low levels of aggression and antisocial behaviour. In my talk, I will review research on the relation of empathy-related responding to prosocial behaviour, the consistency of costly prosocial behaviour over time and the possible role of sympathy in its consistency, and the relation of empathy-related responding to moral reasoning, antisocial behaviour and social competence. Examples of research, including longitudinal research in our laboratory, are provided to illustrate these relations. Because of its close relations to social and prosocial responding, an understanding of empathy-related responding contributes to efforts to promote children's moral development.

Emotions↗

PubMed2026

Associations Between Short Video Exposure, Empathy and Attitudes Toward End-Of-Life Care Among Nursing Students: A Cross-Sectional Study.

AIM: This cross-sectional study examined the associations between short video exposure, nursing students' empathy, and attitudes toward end-of-life (EOL) care, and tested whether perceived impact is statistically consistent with an indirect pathway in these relationships. DESIGN: A descriptive cross-sectional study. METHODS: In total, 534 undergraduate nursing students were included. Data were collected using a self-designed questionnaire, including the Attitudes Toward Care of the Dying Scale and the Jefferson Scale of Empathy-Health Professions Student version for empathy assessment. Statistical analysis for correlation and mediation analysis (PROCESS macro) was performed. RESULTS: 85.96% of students watch short videos for more than 30 min daily, with more than 60% of them viewing EOL-related content. Students with prior caregiving experience or formal palliative care education showed significantly higher empathy and more positive attitudes (p < 0.05). Exposure to medical and EOL-related short videos was positively correlated with perceived impact, empathy, and positive EOL attitudes, with effect sizes ranging from very weak to modest (r = 0.10 to 0.27). The data were consistent with an indirect pathway between short video exposure and empathy via perceived impact (indirect effect = 0.04; 95% bootstrap CI [0.01, 0.08]). However, for EOL attitudes, short video exposure showed a direct association rather than an indirect pathway via perceived impact (direct effect = 0.09, p < 0.01). CONCLUSION: In this cross-sectional study, short video exposure was modestly associated with nursing students' empathy, with data consistent with an indirect pathway via perceived impact; the observed associations explained only approximately 1% to 7% of the variance in the outcome variables. However, reshaping EOL attitudes may require more systematic education beyond brief video exposure. These findings are hypothesis-generating and await validation through longitudinal and experimental research using standardized video content. IMPLICATIONS FOR NURSING PRACTICE: Nursing educators should consider integrating curated short video content into palliative care curricula to enhance students' empathy and perceived impact of end-of-life education. However, brief video exposure alone may be insufficient to reshape deeper end-of-life attitudes, suggesting the need for comprehensive, multi-modal educational strategies.

Humans↗

PubMed2005

Development and validation of the Basic Empathy Scale.

In developing the Basic Empathy Scale (BES), 40 items measuring affective and cognitive empathy were administered to 363 adolescents in Year 10 (aged about 15). Factor analysis reduced this to a 20-item scale that was administered 1 year later to 357 different adolescents in Year 10 in the same schools. Confirmatory factor analysis verified the two-factor solution. Females scored higher than males on both affective and cognitive empathy. Empathy was positively correlated with intelligence (for females only), extraversion (cognitive empathy only) neuroticism (affective empathy only), agreeableness, conscientiousness (for males only), and openness. Empathy was positively related to parental supervision and socioeconomic status. Adolescents who would help victims of bullying had high empathy.

Adolescent↗

PubMed1996

Levels of empathy of critical care nurses.

Empathy represents an essential element for effective caring and therefore enhances the goals and rationale of nursing care. The focus of this study was the level of empathy possessed by critical care nurses, in relation to their gender, years of experience in critical care nursing, level of formal education and their current position. This descriptive correlational study utilised the Empathy Construct Rating Scale (ECRS) in order to measure empathy. The study revealed that critical care nurses possess moderately well-developed levels of empathy. No statistically significant relationships were found between gender, years of experience in critical care, level of formal education and current position and levels of empathy. The conclusion of the study was that further research is required to explore the concept of empathy within the context of critical care nursing, and in particular the meaning and significance of empathy to critical care nurses.

Critical Care↗

PubMed2000

Evaluating the outcome of communication skill teaching for entry-level medical students: does knowledge of empathy increase?

BACKGROUND: While the literature shows the clinical value for medical practitioners of skill in communicating with patients in an empathetic manner, objective evaluations of methods to teach empathy are few. PURPOSES: This paper describes a method of teaching entry-level medical students the elements of effective communication with patients, in preparation for their first practical exercises. The paper focuses on how the outcomes of the teaching were evaluated with special attention to empathy. METHODS: Student evaluative ratings were collected after training, and students also completed a pencil-and-paper test of empathy, both before and after the training. While all data were anonymous, student pre- and post-training empathy scores could be compared to assess individual changes in knowledge of empathy after training. RESULTS: Most students (81%) felt better prepared to interview after the training. The pencil-and-paper measure of empathy has good reliability, both internal (alpha 0.83 and 0.91) and inter-rater (kappa 0.96). Overall, students made significant gains in their ability to make empathetic responses, although some (30%) showed no gains. CONCLUSIONS: Further research is required to identify students who fail to acquire skill in expressing empathy after undergoing training, and to validate the pencil-and- paper measure of empathy against real-life performance.

Clinical Competence↗

PubMed2002

How do physicians teach empathy in the primary care setting?

To explore how primary care clinician-teachers actually attempt to convey empathy to medical students and residents, the author carried out a qualitative study in 1999-2000 in which 12 primary care physicians reflected on their views of empathy, how they demonstrated empathy to patients, and how they went about teaching empathy to learners. Interview data were triangulated with observations of actual teaching sessions and informal questioning of students and residents who had been taught by the faculty participants. Grounded theory was used to interpret the data. The faculty had clear conceptualizations of what empathy meant in clinical practice, but differed as to whether it was primarily a measurable, behavioral skill or a global attitude. Respondents stressed the centrality of role modeling in teaching, and most used debriefing strategies, as well as both learner- and patient-centered approaches, in instructing learners about empathy. Findings suggest that limiting the teaching of empathy to a skill-based approach does not reflect the richness of what actually occurs in the clinical setting, and that it is important to teach empathy comprehensively, acknowledging both behavioral and attitudinal tools.

Education, Medical, Undergraduate↗

PubMed2002

Automatic mimicry reactions as related to differences in emotional empathy.

The hypotheses of this investigation were derived by conceiving of automatic mimicking as a component of emotional empathy. Differences between subjects high and low in emotional empathy were investigated. The parameters compared were facial mimicry reactions, as represented by electromyographic (EMG) activity when subjects were exposed to pictures of angry or happy faces, and the degree of correspondence between subjects' facial EMG reactions and their self-reported feelings. The comparisons were made at different stimulus exposure times in order to elicit reactions at different levels of information processing. The high-empathy subjects were found to have a higher degree of mimicking behavior than the low-empathy subjects, a difference that emerged at short exposure times (17-40 ms) that represented automatic reactions. The low-empathy subjects tended already at short exposure times (17-40 ms) to show inverse zygomaticus muscle reactions, namely "smiling" when exposed to an angry face. The high-empathy group was characterized by a significantly higher correspondence between facial expressions and self-reported feelings. No differences were found between the high- and low-empathy subjects in their verbally reported feelings when presented a happy or an angry face. Thus, the differences between the groups in emotional empathy appeared to be related to differences in automatic somatic reactions to facial stimuli rather than to differences in their conscious interpretation of the emotional situation.

Adult↗

PubMed2006

Closeness and distance in the nurse-patient relation. The relevance of Edith Stein's concept of empathy.

This paper emanates from the concept of empathy as understood by the German philosopher Edith Stein. It begins by highlighting different interpretations of empathy. According to the German philosopher Martin Buber, empathy cannot be achieved as an act of will. In contrast, the psychologist Carl Rogers believes that empathy is identical with dialogue and is the outcome of a cognitive act of active listening. The empathy concept of Edith Stein, philosopher and follower of Edmund Husserl's phenomenology, goes beyond these conflicting views and offers a more complex interpretation, with relevance for both healthcare and nursing education. When studying Stein's three-level model of empathy, a field of tension between perspectives of closeness and distance becomes apparent. The paper concludes by suggesting Stein's model of empathy as a strategy to overcome the tension and meet the demands of empathy.

Affect↗

PubMed2006

Empathy and viewing the other as a subject.

Empathy and viewing another person as a subject rather than an object are often associated in theoretical contexts, but empirical research of the relation is scarce. The purpose of the present research was to investigate the relationship between subject/object view and empathy. In Study 1, participants watched film clips and indicated their empathy for specific characters in the clips, as well as the extent to which they saw these persons as subjects and objects. The subject/object view explained some, but not all, of the differences in empathy, which raised the question of what else accounts for differences in empathy. A second study was conducted to investigate whether the difficulty of the other's situation also contributes. In Study 2, another group watched the film clips and rated the difficulty of the film character's situations in addition to empathy and subject/object view. The results of Study 2 revealed that subject view/object and perceived difficulty together explain a substantial part of differences in empathy. It was concluded that empathy is evoked primarily when a person in difficulty is viewed as a subject.

Adolescent↗

PubMed1988

Empathy in psychiatric patients.

The definition of empathy is controversial. Here one aspect of it, namely perception of others' feelings and personality, was investigated. Empathy was assessed by comparing self-rating with rating by other persons. Group psychotherapy patients were used. Nineteen patients with a history of schizophrenic psychosis and 20 neurotics were found to have lower empathy than 20 patients with borderline personality disorders whose empathy was as high as the descriptively used scores of four psychotherapists. Empathy was not found to be dependent on similarity of personalities. It correlated negatively with obsessional features, such as emotional constriction or rigidity. The borderline patients' high empathy appeared of particular interest in view of clinical observations that psychotics had high empathy before the development of psychosis. The possible relevance of empathy in the development of psychosis is discussed.

Adult↗