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Empathy and the Great Divide
Annette Keller
Missouri State University
PSY 527/627
October 3, 2011
Empathy and the Great Divide
Definitions:
According to Taber’s Cyclopedic Medical Dictionary, empathy is defined as the “Objective awareness of and insight into the feelings, emotions, and behavior of another person and their meaning and significance. Not the same as sympathy which is usually nonobjective and noncritical.” Lewis, Heitkemper, Dirksen, O'Brien, and Bucher (2007) expand upon this definition by stating that “empathy can be defined as having the courage to enter into the world of another in a manner that does not judge, sympathize, or correct, but in a manner where the goal is creative understanding. Empathy means putting aside one’s own self for a moment and stepping into the shoes of the patient.” These definitions are derived from medical texts. A further review of the literature incorporating research involving empathy and health care professionals would also include the concept that empathy is “well established as the attribute most essential in understanding another person and for promoting the health of that person.” (Ward et al., 2009) With these definitions in mind, it can be correlated that empathy is a lofty goal. Health care professionals must constantly strive to meet this goal by interacting and communicating with patients, family members and significant others. Ward et al. (2009) state that the definition of empathy in the context of the patient-nurse relationship is “predominantly a cognitive (rather than emotional) attribute that involves an understanding (rather than a feeling) of experiences, concerns and perspectives of the patient, combined with a capacity to communicate this understanding.” Alligood (1992) envisions empathy as a learned process; as “cognitive responses learned and developed through basic nursing instruction and clinical practice.” The ability to show empathy to patients, families and colleagues has become a bench-mark in healthcare and litmus test in determining the level of professionalism among nurses.
Measurement:
Historically, the attempts to measure empathy have centered on the cognitive aspect of empathy and have included the completion of questionnaires such as the Jefferson Scale of Physician Empathy (Hojat, Fields, & Gonnella, 2003), a modified version of this scale, the Jefferson Scale of Empathy for Nursing Students (Ward et al., 2009), the Empathy Situation Reaction Scale (Straats, Long, Manulik, & Kelley, 2006) and the Empathy Assessment Index (Gerdes, Lietz, & Segal, 2011). The data obtained from theses scales has universally been qualitative rather than quantitative. Empathy isn’t tangible and measuring empathy has proven to be elusive. The perception of empathy varies universally: how we show empathy, who is capable of showing empathy and to what degree they demonstrate it is not dictated by genetics, race or religion, but by the very qualities that make us unique individuals. This has been the bane in the development of a universally accepted means of measuring empathy. The scales listed above rely upon the responses of subjects who are not static. One of the points discussed in Ward et al. reported test-reliability data that varied due to the time interval (3-4 months) between having the subjects repeat the test (Jefferson Scale of Physician Empathy). This proves that testing completedusing a self-reporting scale is unreliable and is dependent upon the subject’s situation at the time of testing. These types of scales also do not account for the concept of continual growth and professional improvement which are influenced by situational factors at the time of testing. Experiential learning has been shown to greatly impact the development of empathy (Ward et al., 2009) but conversely, those subjects with limited experiences were also able to demonstrate empathetic responses on the measuring tools utilized.
Recently, another avenue has begun to be explored in the quantitative measurement of empathy. Through the use of magnetic resonance imaging (MRI), researchers have begun to collect data regarding empathy that can be empirically observed and quantified (Gerdes et al., 2011). Cost, availability of MRI scanners and the exposure of subjects to magnetic energy are factors that must be weighed against the efficacy of obtaining research data. Essentially, would the information the testing provides impact patient care and outcomes in such a way as to validate the use of MRI scanning? With the cost of health care continually rising, the use of MRI scanning for empathy research may appear irrational to health care consumers.
Agendas and General Discussion:
First, the completion of the questionnaires must be evaluated. The Jefferson Scale of Physician Empathy (JSPE) and the Jefferson Scale of Empathy (JSE) for Nursing Students consists of twenty Likert-type questions. “Playing” 20 questionsto measure the degree of empathy a health care professional exhibits doesn’t quite seem to encompass the concept of empathy considering that the timing of the questionnaire completion would greatly impact the outcomes. For example, if a nurse completes the questionnaire relatively soon after interacting with a patient and family in a death and dying situation, the scores will reflect the emotional aspects of that situation. If the nurse completes the questionnaire after working a stretch in the ICU that was frustrating and physically exhausting due to the patient load, the results of the questionnaire will reflect this frustration. TheEmpathy Situation Reaction Scale (number of questions not stated but was administered in conjunction with “several other scales relating to empathy”) and the Empathy Assessment Index (54 items) results may be skewed due to their length, i.e. subjects hurried through the questions to finish quickly rather than methodically answering each question. This embodies one of the difficulties of survey-type research. The degree to which the subjects take the research seriously greatly affects the research outcome and results. Differences in situation were addressed in the “limitations” of the studies utilizing the JSPE and JSE but were discounted and suggested as an avenue for future research. Staats et al. (2006) acknowledge the situational differences by stating, “Empathy may exist in part as a general personality disposition but is also hypothesized to be partially domain or situation specific….Here, we argue that empathy is contextualized by situations and embedded interpersonal variables such as gender.”
Second, the research completed in three of the four studies reviewed utilized students as the subjects of the study. Utilizing students for research regarding empathy would also skew the results based on the limited amount of experience within the profession they are pursuing. If empathy is contextualized by situations as Staats et al. (2006) postulate, then a limited amount of experiential situations would result in fewer experiences to draw upon by the subjects when answering the questionnaire. Utilizing students as test subjects in research is a time-honored tradition because students are easily accessible. However, the student as a subject for research represents many limitations when attempting to apply test results to a larger population. This is often given a cursory mention in the discussion of a research paper, but is usually negated as a necessary aspect of completing the research.
Lastly, the motivation behind attempts to measure empathy, especially in the health care fields, must be questioned. None of the reviewed research articles linked the completed research to improving patient/subject outcomes. In other words, when the empathy of nursing students, physicians, and nurse practitioners was “measured,” empirical data was obtained but was not applied to patient care modalities. Ward et al. (2009) report that empathy in the clinical environment leads to greater patient satisfaction, but it does not follow that empathy will improve patient outcomes. If “greater patient satisfaction” is the ultimate goal, then by all means, continue in the attempt to measure empathy. However, if measuring empathy is the goal in and of itself, then most health care consumers would agree that the funding needed to support empathy research could be better utilized in providing less stressful health care environments. Healthcare professionals who experience less stress in the workplace will be better able to provide empathetic interactions with their patients which will in turn lead to improved patient satisfaction and outcomes. Research is not needed to prove this….it has been proven day in and day out throughout medical history.
In conclusion, this paper has endeavored to presenta discussion regarding scales used in the measurement of empathy. This is a relatively new area of research. Past research has focused mainly on the cognitive aspect of empathy, but new research seeks to incorporate recent breakthroughs in neuroscience, particularly social cognitive neuroscience (Gerdes, Lietz, & Segal, 2011). The efficacy of using healthcare dollars to research empathy, an entity that we know exists, but have difficulty quantifying may seem superfluous to health care consumers. Although the effects of empathy are evident in patient care, the ability to quantify and qualify the measure of it remains elusive. Future research regarding the measurement of empathy must incorporate not only increased patient satisfaction, but also improvement in patient outcomes to validate the need for continued research in this area.
References
Alligood M R 1192 Empathy: the importance of recognizing two types.Alligood, M. R. (1992). Empathy: the importance of recognizing two types. Journal of Psychosocial Nursing, 30, 14-17.
Gerdes K E Lietz C A Segal E A 2011 Measuring empathy in the 21st century: Development of an empathy index rooted in social cognitive neuroscience and social justice.Gerdes, K. E., Lietz, C. A., & Segal, E. A. (2011). Measuring empathy in the 21st century: Development of an empathy index rooted in social cognitive neuroscience and social justice. Social Work Research, 35(2), 83-93.
Hojat M Fields S K Gonnella J S 2003 Empathy: An NP/MD comparison.Hojat, M., Fields, S. K., & Gonnella, J. S. (2003). Empathy: An NP/MD comparison. The Nurse Practitioner, 28(4), 45-47.
Lewis S L Heitkemper M M Dirksen S R O'Brien P G Bucher L 2007 Medical surgical nursing, Assessment and management of clinical problemsLewis, S. L., Heitkemper, M. M., Dirksen, S. R., O'Brien, P. G., & Bucher, L. (2007). Patient and Family Teaching. In Medical surgical nursing, Assessment and management of clinical problems (7 ed., pp. 53-65). St. Louis, MO: Mosby Elsevier.
Straats S Long L Manulik K Kelley P 2006 Situated empathy: Variations associated with target gender across situations.Staats, S., Long, L., Manulik, K., & Kelley, P. (2006). Situated empathy: Variations associated with target gender across situations. Social Behavior and Personality, 34(4), 431-442.
Thomas C L 1977 Taber's cyclopedic medical dictionaryThomas, C. L. (Ed.). (1977). Taber's cyclopedic medical dictionary (13 ed.). Philadelphia, PA: F. A. Davis Company.
Ward J Schaal M Sullivan J Bowen M Erdmann J Hojat M 2009 Reliability and validity of the Jefferson Scale of Empathy in undergraduate nursing students.Ward, J., Schaal, M., Sullivan, J., Bowen, M., Erdmann, J., & Hojat, M. (2009). Reliability and validity of the Jefferson Scale of Empathy in undergraduate nursing students. Journal of Nursing Measurement, 17(1), 73-88.