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The concept of empathy lies amid much confusion This analysis addresses that confusion using Walker and Avant's model of concept analysis, and looks at what empathy is is it trait or state, is it dynamic or static, and how is it recognized and measured' Implications of these findings are discussed, limitations of the study are acknowledged and areas for further work suggested
Joumal of Advanced Nursmg, 1996,23,1162-1167
A concept analysis of empathy
Theresa Wiseman RGN BSc(Hons)(Psy) RCNT RNT PGDE
Nurse Tutor, Bloomsbury and Islington
of Nursing and Midwifery, London,
pubhcation 2 August 1995
(1996) Journal of Advanced Nursing 23,1162-1167
A concept analysis of empathy
The concept of empathy lies amid much confusion This analysis addresses that
confusion using Walker and Avant's model of concept analysis, and looks
what empathy is
is it
is it
static, and how is
recognized and measured' Implications of these findings are discussed,
limitations ofthe study are acknowledged and areas
further work suggested
is a
tenn widely used and written about
mg and,
apphcation has become
blurred When this happens,
one way to
to conduct
concept analysis When embarking
on con-
cept analysis. Walker
Avant (1983) advocate choosing
you are
akeady interested, either
associated with
or one
always been
to you
Eighteen years' expenence
author, long ago, forming
tentative opinion that
the abihty
empathize which distinguishes
nurse from
excellent nurse
in the
the patient,
how care
delivered Accompanying this
the fact that durmg
3-year breeik
to do a
time degree
author noted
m the
m the
nursing press
management, education
and the
The hterature highlights the need
analysis Tshuldm
(1989) asserts that no area of nursmg demands more empa-
thy than
more empathic nurses
are, the
more likely they are
give total care Sharkey (1985) sug-
gests that those nurses who seemed
to be
of by
colleagues were those with
the ability to imagine how each
their patients felt, from
each patient's perspective, takmg mto account their vaned
backgroimds cuid different reactions
talization Reynolds (1987) reveals that although empathy
most cntical ingredient
the helping relationship
(Kalisch 1973), there
little agreement
as to how it is to
be defined
His 1986
Scotland demonstrated
Correspondence Theresa Wiseman, 26
Park Avenue, Wanstead,
London E12 5EN England
that nurse teachers are often unclear about what they mean
by empathy and that confusion
the construct has impli-
learning Homblow
(1977) point
that research
of an
agreed theoretical framework
operational definition
The purposes
concept analysis mclude clarification
terms which have become catch-phrases
have lost
their meaning,
developing operational defi-
for use
Ul theory
and an
exercise (Walker
Avant 1983)
this analysis, the mam
purposes were
mcrease knowledge
the concept
to answer some questions Namely, what
if it
how is it
recognized, nurtured
and sus-
tained, under what conditions does
and IS it
dynamic' Walker
framework is used because, edthough sympathizing with
Rodger's (1989) comments
first attempt at concept analysis and Walker
and Avant's
book provides full information
In order
working definitions
thy used
'ordinary' nurses,
at the
Royal College
Nursmg, London, was asked 'What came
term empathy
argued that this was
not a
representative group
as they were
on a
so may
of better access
reading matenal, time,
resources They may also have higher than average motiv-
ation To address this, comments were also added
bom a
vanous ages
experience sittmg
a hospital refectory
'brainstorm' produced
1162© 1996 BlackweU Science Ltd
A concept analysis of empathy
following Listening, Canng, Understandu^,
Feelmg, Empathy, Non-)uc^emental, See how others see.
In this paper I will consider the ongins of the word
'empathy' and the dictionary defimtions, examme the
broad quahties of empathy as descnbed by Kalisch (1973)
and Bumard (1988), address the debate about whether
empathy is 'trait' or 'state', consider how researchers
define empathy emd finally, examme empathy from the
patients' point of view
The Fontana (1988) Dictionary of Modem Thought high-
lights the ongms of the word empathy It was comed by
Vemon Lee m 1904 and then employed by
a psychologist, in 1909 as a translation of the German
'Emfdhlmg' which means 'feelmg into' This notion had
been developed by Lotze (1908), provoking the Alienation
Theory of Brechtm However, this is not the forum to
develop this discussion further (see Fontana (1988)
Dictionary of Modem Thought) The following is the most
abstract definition of empathy
Projection (not necessarily voluntary) of the self mto the feehngs
of others, mto the 'being' of objects or sets of objects, it miplies
psychological involvement, at once Keat's pain and joy
This suggests that empathy can occur subconsciously as
well as consciously, with mammate objects as well as ani-
mate, that It mvolves the mind or psyche, and that it can
cause pam as well as joy Another definition which men-
tions inanimate objects is m Chambers 20th Century
Dictionary (1983 p 325)
the power of entenng into another's personality and lmagmat-
lvely experiencing his expenences, the power of entenng mto the
feelmg or spirit of somethmg (especially a work of art) and so
appreciate it fully
Here one gets the notion of a strength rather than a weak-
and the idea of valuing from 'appreciate it fully' The
Longman Dictionary of Psychology and Psychiatry (1984)
emphasizes the objectivity and interpretation Eispect
the objective awareness of another person's thoughts and feel-
mgs and their possible meanings One who empathizes sustains
his objectivity and separate feehngs even when confronted with
disturbu^ psychological matenal
Two nursmg dictionanes were then consulted Saimders
(1989) Encyclopedia and Dictionary of Medicine, Nursing
and Apphed Health pomts to the understanding compo-
nent and compares empathy with sympathy
Intellectual and emotional awareness and imderstandmg of
another person's
even those that
are distressing and disturbing Empathy emphasises understand-
ing, sympathy emphasises sharing of another's feelings and
Mosby's Medical and Nursmg Dictionary
the understandmg and significance of the person and the
importance of empathy for psychotherapy
The ability to recognise and to some extent share the emotions
and states of
of another and to understand the meaning and
significance of that person's behaviour It is an essential quabty
for effecbve psychotherapy Compare with sympathy, which
expressed mterest or concem regarding the problems, emotions
or states of mmd of another
The literature concerning empathy shows a wide range of
use ofthe word, from broad to specific Apart from diction-
ary defimtions, five of which were selected, a literature
search gave 53 references All these references were exam-
ined but consensus led to 33 bemg used in this article
The five dictionary definitions are important to begin the
analysis as each contains differing elements which come
out in the hterature
Early theonsts and wnters saw empathy as a trait or
charactenstic which was stable and could he measured but
not taught Among these are Cronhach (1955), Hogan
Smither (1977) and more recently, Astrom et al
(1991) Cronbach and Hogan devised personahty tests to
test for empathy These authors define empathy as a per-
sonality attnbute mvolvmg the capacity to respond
emotionally, cognitively and communicatively to other
persons without the loss of objectivity From this defi-
nition, it can be seen that the quahties of empathy mirror
the other theonsts but the denvation is different Latterly,
theonsts see empathy as havmg both 'trait' and 'state'
Williams (1989) maintains that people have a tendency
to expenence empathy that may or may not be actualized
in any specific situation Her research investigated the
relationship between empathy and burnout, tentatively
suggesting that they may represent opposite poles of the
same underlying construct However, no support for a
polar relationship was foimd Sharkey (1985) asks why so
few nurses with the abihty to empathize actually use it
She suggests that nurse traimng damages the innate ability
of the tramee to empathize
As noted earlier, some wnters seem very specific and clear,
about what empathy is whilst others (the minonty) are
imclear, and the concept can easily be confused with other
such as sjmipathy or commumcation Among the
latter are Smith (1985), Assimacopoulos (1987) and
Wilson-Bamett (1988) Smith (1985, p 5) says empathy is
1996 Blackwell Science Ltd,
T Wiseman
'knowing what the other person is suffenng because you
can imagine yourself in similar circumstances or because
you have had similar expenence' The reader could easily
be forgiven for confusing this with sympathy
Assimacopoulos (1987) also confuses empathy with sym-
pathy and Wilson-Bamett asserts that nurses who talk less
are perceived as bemg more empathic
Bumard (1988) defines empathy as the ability to see the
world as another person sees it or to enter mto another's
frame of reference One attempts to set aside one's own
perception of thmgs in order to think the way the other
person thinks or feel the way they feel Bumard distingu-
ishes empathy from sympathy S5rmpathy involves 'feeling
sorry' for the other person or imagining how we would
feel if we were expenencmg what is happening to them
Empathy differs m that we try to imagine what it is like
being that person and experiencing things as they do, not
as we would
Bumard (1988) sees empathy as the key to understand-
ing and, as such, a vital skill for nurses to leam He
explains that the skill of empathy involves two related
processes One is attempting to view the world as the
patient does and the other is attemptmg to identify the
personal theory that guides patients m their everyday
expenence Because Bumard sees empathy as a skill,
he concentrates on methods of developing empathy for
climcal and educational staff
Kalisch (1973) asserts that empathy must involve current
feelings of a person, not the feelmgs of yesterday or the
day before She states that it is the ability to enter mto the
life of another person, stressing the importance of the per-
ception of feelmgs bemg accurate Kalisch also compares
empathy to sympathy, explaining that m empathy helpers
borrow their clients' feelmgs m order to understand them,
but are always aware of their separateness In her defi-
nition of empathy, Kalisch (1973) does not include
the communication of understanding, but does not state
that when empathy is communication, it forms the basis
for a helping relationship She views empathetic per-
ception and communication as a state m terms of levels or
categones rather than an 'all or nothmg' charactenstic
Three components
Rogers (1957) descnbed empathy as having three com-
ponents affective (sensitivity), cognitive (observation
and mental processing), and communicative (helper's
response) LaMonica (1981) highlights the commumcation
aspect of empathy She defines empathy as sigmfymg a
central focus and feehng, with and m the chent's world
It mvolves accurate perception of the chent's world by the
helper, commumcation of his/her understandmg to the
chent, and the chent's perception of the helper's under-
standing LaMonica and others (1976) showed that nurses
initially scored low m empathy hut this level mcreased
followmg a staff development progreimme Truax
(1971) asserted that nurses are generally low m empathy
compared to other professional groups Situational factors
have been found to eiffect the level of empathy expressed
Iwasiw 1989)
Carkhuff (1969) was one of the first theonsts to assert
that if empathy was a state, it was dynamic and therefore
could be measured on different levels He suggested that
empathy is employed when one mdividual hears and
understands another It mvolves 'crawhng inside another
person's skin' and seeing the world through his/her eyes
It mvolves expenencmg the world as if you were that
person Carkhuff (1969) stressed the commimication of
empathy and devised a scale to measure empathy on five
levels based on the response, whether the feehng was
acknowledged or not, surface feehngs refiected and the
interpretation of underlying feeling communicated Other
theonsts who have also devised scales include Gazda
(1973) and LaMomca (1981)
As the consensus is that empathy is a skill which is crucial
to the helping relationship, many authors discuss methods
of teaching empathy most effectively (Layton 1979,
Bumard 1987, Cox 1989, Morath 1989 and Tshuldm 1989)
Bumard (1987) suggests that before nurses can understand
and explore a patient's perspective, they must explore
their own perspective Self-awareness, therefore, is a prere-
quisite to empathy Bumard identifies other skills neces-
sary for empathy including the ability to listen, to offer
free attention and to suspend judgement Tshuldm (1989)
highhghts self-awareness, communication skills, especi-
ally listening, perception of feelings withm self and others
and hidden feelmgs, emd not judgmg others
The literature makes very little mention of the client's
views on empathy Rogers (1957) states that bemg under-
the most basic human need, and it is only by bemg
understood and accepted that individuals are able to
change and grow Although there is literature to show that
empathy affects the helping relationship, there is a lack of
reference to the client's pomt of view Engledow (1987), a
nurse, identifies empathy as being vital to her if she were
a patient Many studies do not even use patient assessment
of empathy This is clearly a deficit ui the literature which
needs to be addressed
Having examined the literature, the next step according to
the Walker & Avant (1988) model is to identify 'defining
attnbutes' A defining attnbute is something which has to
be present for the concept to occur Each charactenstic
evident from the hterature is discussed and either accepted
or rejected as a defijiing attnbute
1164© 1996 Blackwell Science Ltd, Joumal of Advanced Nursing, 23, 1162-1167
A concept analysis of empathy
or state
This was rejected as a defining attnbute because empathy
occurs regardless of whether it is a state or trait The htera-
ture points to empathy being both People have a dispo-
sition to be empathic, but whether they are or not depends
on situational factors
See the world as others see it
All 53 references without excepbon mcluded this as a
charactenstic of empathy Two of the dictionary defi-
mtions proposed that 'others' could mean an object rather
than a person This was accepted as a definmg attnhute,
without this empathy cannot occur
Understand another's current feehngs
All references included understanding another's feehngs,
which was accepted as an attnbute Some wnters, among
them Kalisch (1973), stress the importance of current feel-
mgs because perceptions had to be accurate This part of
the charactenstic was rejected hecause if a person is relat-
mg an instance about how they felt m the past, it is still
possible to be empathic and acknowledge the feelings of
the past even though they do not feel that way at present
Most references (40) highlight ohjectivity as a component
of empathy Rogers (1957) redefines this mto non-
judgemental Although It could be argued that, if the other
attnbutes were present (that is, seeing the world as others
see it and understanding the feelmgs of
this would
automatically be present also The author consulted many
colleagues as to this attnbute because some argued that
one could understand but still be judgemental This was
accepted because of its importance, but is more tentative
than the other attributes
Communicate the understanding
Commumcation of understanding seems vital if empathy
IS to be felt Although early works do not include this, it
does seem implicit All tools for measuring empathy
mclude communication of imderstandmg, so this was
regarded as an attnbute
Summary of definmg attributes
1 See the world as others see it
2 Non-judgemental
3 Understandmg emother's feelmgs
4 Commumcate the understandmg
tenze archetypes and deviations This will help the reader
to clanfy the concept
Model case
Ann, who is 35 years old, has two children and is suffenng
from cancer of the ovary, went to see a counsellor The
counsellor, a 50-year-old man, listened to Ann as she
described her background and how she had been taku^
her anger about her illness out on the children By what
he said and how he acted, Ann knew that he understood
how she felt, and did not hlame her for being angry This
IS a model case because it contains all the attnbutes Even
though Ann and the coimsellor have very different 'terms
of reference', he listens to what she says, sees the situation
from her point of view, is not judgemental and is able to
communicate that imderstandmg to her
Borderline case
It was Joe's first day back at school since his father had
died At break-time, he was in the classroom crymg His
teacher came m, listened to how he felt but said nothing
He thought she understood, but she did not say anythmg,
he wished his father was there
This IS a borderline case because the teacher listens to
Joe and he thinks she understands that he is upset about
his father and is a 'cry baby' But he is not sure, as she did
not say anjrthmg It leaves him feelmg uncertsun about the
mteraction and wishmg for secunty
Related case
Beth was upset, she had been forbidden to go out as she
had been consistently late home She was gomg to miss a
dance which everyone was gomg to attend Kathrjrn said,
'Poor Beth,
know how you feel
had to miss an important
dance when I was your age because I'd npped my dress
and had nothing to wear'
This IS a related case of sympathy Katluyn sees Beth is
upset over missing the dance, and thinks she would feel
the same In fact, she remembers a time when exactly that
happened and she was upset Katluyn is getting the lmtial
feehng Beth is expressing But she is mterpretmg it from
her own background and expenence so she misses com-
pletely what it means to Beth Although Beth senses the
warmth of the mteraction, she does not get any feehngs of
understanding, though there does not appear to be any
At this stage. Walker and Avant (1988) advise demonstrat-
ing a model case and several borderlme cases to charac-
Contrary case
Mrs Jones felt desperate and told the nurse she could not
go on with life 'Oh, don't be silly,' the nurse replied
'You've got a lot to live for'
1996 Blackwell Science Ltd,
T Wiseman
This IS a contrary case as there is no acknowledgement
of how Mrs Jones is feeling The nurse does not attempt
to see the world through Mrs Jones' eyes She is judge-
mental and does not communicate any understandmg Mrs
Jones IS left feelmg remonstrated It took a lot for her
to voice her desperation, she knew nobody would
understand and that she was not worth bothermg about
Once the model cases have been identified, the next step
to specify the charactenstics present whenever the event
occurs These are the antecedents (the required charac-
tenstics needed before the concept occurs) and the
consequences (the product of the concept occumng)
This area was quite difficult to identify as there was con-
fusion as to whether antecedents apphed to an mcidence
of empathy or the skill of empathy It was decided to
address both Before empathy occurs there has to be (a) an
interaction mvolvmg communication of a feeling, and
(b) hstemng on both sides, one to the feelings and thoughts
of the 'empathee' and the other to empathy being
There was consideration of whether a conscious desire
to empathize was an antecedent, but this was rejected as
It could not account for mstances where empathy is sub-
conscious and not desired Self-awareness was also con-
sidered as an antecedent as many programmes teachmg
empathy begin with self-awareness This was rejected
because some people are naturally empathic (the trait
aspect) without bemg necessanly self-aware
The consequences of an empathic interaction is that
'empathees' have a hasic need to be understood satisfied,
they feel valued and more ready to understand themselves
and change The person bemg empathic feels satisfied
because he/she senses they have been of help and fulfilled
the need to be useful to others
The last stage of the model is to identify what phen-
omena demonstrate the occurrence of the concept The
empmcal referents determine when the concept has
occurred, so can be used as a measure They may be similar
or identical to the defining attnhutes Indeed, m this
analysis they are the same
Empincal referents
Empincal referents are (a) the abilify to listen, (b) the
ability to take on another's term of reference, (c) the ability
to understand and not judge, and (d) the ability to
communicate that understanding
Reading through the hterature, confusion has occurred
because of the trait/state argument and the absence of a
working definition of empathy However, there does now
appear to be consensus that a person may have a dispo-
sition to be empathic (trait) but whether she/he is depends
on a number of factors (state) The research question deter-
mines which element of empathy is examined, whether it
be the subject's disposition or the mcidence of empathy,
how often empathy occurs or the qualify ofthe interaction
It IS the latter aspect which caused the author some
difficulfy Most research is quantitative and the existing
tools which measure empathy (mcluduig Carkhuff 1969,
and LaMonica 1981) begin with level one which is 'ignores
feehngs expressed' even though it is specified that a mmi-
mum level of empathy is level three which fulfils the defi-
nition This should be addressed, as it could be this
dichotomy which is causing confusion
Research also needs to measure empathy more globally,
mcluding subject self-report, client report and observation,
both participant and non-participant This may address
verbeJ and non-verbal communication of empathy and the
feet that attitudes do not always reflect behaviour and that
what people say they do and actually do are not always
the same
The aim of this analysis was to clarify the meanmg of
empathy and address some questions The questions of
what empathy is, is it trait or state, dynamic or static, and
how it IS recognized have been considered and clearly
identified usmg the Walker & Avant (1988) model of
concept analysis
However, the questions how is empathy nurtured and
sustained, and under which conditions does it fiounsh and
diminish have not been fully examined and have major
implications for nursmg m recruitment, education (both
methods and process) and man^ement (the environment
and the delivery of care)
There is clearly a need for future research in these areas
Concept analysis may clear the way for that work to begm
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... As we start to consider how empathy can be developed, let's look at the four defining attributes of empathy (Wiseman, 1996). First, empathy allows us to see the world as others see it. ...
... Specific practices that can help us move through Wiseman's (1996) attributes of empathy include the following: (Birnie et al., 2010) • Demonstrate empathetic body language: empathy extends beyond what we say to our facial expressions, eye contact, and posture ...
... • Reflect on the four attributes of empathy as defined and articulated by Wiseman (1996) How might what you observed influence how you engage empathetically with others? ...
Full-text available
LINK TO BOOK: This Online Educational Resource textbook is intended to provide an overview and introduction of leadership through the lens of how students can develop and maximize their own interpersonal skills. Interpersonal skills are crucial to navigating the professional world and can help us to better understand ourselves. This textbook approaches interpersonal skills from a personal level and allows the reader to immerse themselves into activities and scholarship across topical areas. Through the text, learners can create their own Personal Leadership Philosophy and expand this into a Civic Leadership Philosophy to help them understand the impact leaders can have on their communities and workplaces. This text is freely available per the terms of the Creative Commons copyright. Links to digital PDF and ePUB file formats are provided but may not maintain intended page breaks or formatting. About the Editors Contributors Foreword: History Foreword: About the Title I. Main Body Introduction 1. How I See Myself 2. Defining My Personal Values 3. Defining my Vision & Setting Personal Goals 4. Communicating with Leadership Congruence 5. Nonverbal Communication & Active Listening in Small Groups 6. Developing Trust & Being Trustworthy 7. Perceptions are Only From My Point of View 8. Diversity & Inclusion 9. Meeting the Challenge of Effective Groups & Teams Membership 10. Engaging with Empathy 11. Managing Conflict Expectations 12. Leadership & Civic Engagement: Becoming the Change Maker This book was originally conceptualized as a textbook for a class at the University of Nebraska – Lincoln called “Interpersonal Skills for Leadership.” A book by the same name was originally written in 1996, with a second edition published in 2005 by Dr. Susan Fritz and colleagues (Fritz et al., 1996, 2005). Since the text was up for a new edition, we met with Dr. Fritz, who is a strong supporter of Online Educational Resources (as well as all free or low-cost texts for students). Dr. Fritz graciously offered to write a part of the Foreward for this text and offered great feedback and advice (aka, wisdom). Two of the three authors of this chapter have worked with Dr. Fritz for many years as graduate students, as staff, and, eventually, as faculty. We are grateful for her support and mentoring over the years, including with this current project.
... Similarly, an operation is likely to have quite different implications for a surgeon, a nurse, a patient and the patient's relatives and friends, and each is likely to have quite different outlooks on the experience. Wiseman, [35] The role of the interpretive researcher in the unending conversation is to listen to many narratives-the contemporary embodied experiences of clinicians in nursing education to hear the familiar and the common. In selecting a narrative that embraces the familiar, the researcher does not attempt to show the correct interpretation among many interpretations. ...
... Discussing the narrative power of phenomenological texts, Wiseman, [35] explains that phenomenological description tends to have a strong emotional appeal which the author and the reader recognise as being part of their engagement with the world. In line with this phenomenological way of thinking, the aim of this current study was to understand in greater depth the lived experiences of the clinical educator and how these experiences impacted on their teaching of undergraduate nursing students. ...
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This study looked at the lived experiences of clinical nurse educators who work with undergraduate nursing students in a hospital setting. It employed a phenomenological approach to focus on nurses’ personal experiences of death and dying. In particular this paper examined how nurses perceive the way the experiences influences the way that they instruct their students Informal interviews with four nurses were audio taped and transcribed. Rich descriptions of emotions which emerged are discussed in detail. Data were analysed using the Colaizzi method of analysis and common themes were identified. They included remaining professional, Humanizing stories and teaching different levels of undergraduates. These themes were evaluated in terms of their value of meaning for students and the possible implication for clinical care. The literature examined relevant to the study has previously identified the importance of nurses knowing the meaning of end of life care; caring and empathy; student nurses’ perception and the need for student belongingness. The study has added to the field by identifying the importance of nurses sharing personal experiences to enhance student learning in this already difficult area of nursing.
... Unlike sympathy, which is a more distant, passive attempt by an observer to feel what someone else feels, empathy is a deliberative and active pursuit to better understand another's perspective as a shared emotional experience (Davis, 2019). Wiseman (1996) defines empathy through four attributes: "1. See the world as others see it, 2. ...
... The act of perspective-taking promotes an empathic response not only for unfamiliar individuals but also for those who face stigmatization in society, which evokes an emotional response and inspires action through prosocial behaviors (Batson, 2011). However, Wiseman (1996) argues that cognitive empathy cannot develop until a child first has a sense of self-awareness. This aligns with Piaget and Inhelder's (1967) Three Mountains Task, which explored cognitive development of children; in their study, children under the age of 7 were drawn to their own perspectives while those between 7 and 12 years of age were able to envision scenes from others' points of view and appreciate diverse perspectives. ...
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This research study investigated the use of cinematic virtual reality (CVR) in a seventh-grade social studies classroom and its effects on adolescents' empathic responses. In this quantitative research study, participants (n ¼ 60) completed the Adolescent Measure of Empathy and Sympathy (AMES, Vossen et al., 2015) as a pretest a week before viewing The Displaced, a film about the lives of three refugee children, in either CVR or two-dimensional (2D), 360-degree format. Promptly after viewing the film, participants repeated the AMES as a posttest. Paired t-tests were conducted to explore the changes in mean scores for the AMES subscale scores between participants viewing the film in CVR and 2D formats as well as the changes in mean subscales between male and female participants viewing the film in CVR. Gain scores were also calculated and analyzed through a two-way MANOVA to examine the possible interaction effect between film format and gender on AMES subscale scores. The results of this study indicated that while the 2D, 360-degree film format affected adolescent students' affective empathy, there was a greater increase in both cognitive and affective empathy scores for those viewing the film in CVR with male adolescent students' scores demonstrating the most remarkable increase.
... Furthermore, it is often difficult to find, for any given concept, necessary conditions or sufficient conditions. A practical approach can be proposed on the basis of what has been developed in the context of nursing science (Branch and Rocchi 2015;Beecher et al. 2019; for examples of applications, see Wiseman 1996;Griffin-Heslin 2005;Xyrichis and Ream 2008). ...
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The high creativity at play in sustainability science and practice gives rise to a wide variety of concepts, each trying to promote new lines of thinking and action. Successful concepts may become true imperatives within professional circles or may even become buzzwords, often losing their ability to convey a well-defined meaning for all their users. The concepts at stake, known as “thick concepts”, are conveying values and inspiring action. As such, they are key in spurring or supporting collective action. However, the actors endorsing them may ascribe very different consequences behind their use. In the inter- or transdisciplinary endeavors that are the backbone of sustainability science, the polysemy or diversity of interpretation of those concepts may pose particular problems. Indeed, this lack of clarity is further amplified by the diversity of backgrounds of collaborators, which already makes communication and the common understanding of actions a daily challenge. Anchored in pragmatist philosophy and more precisely drawing on inferentialist theory of concepts, this paper is a pledge for the conscious and practical mobilization of concepts within inter- and transdisciplinary collaborations, proposing a framework to this end. It aims at exposing to a wide scientific and practitioner audience the nature and roles of thick concepts and the philosophical bases of their analysis. It then deploys the main lines of the practical implementation of concept analysis and operationalization for teams of researchers and practitioners, based on the experience gained through its mobilization in a postgraduate master anchored in the One Health approach.
Healthcare in the United States has reached a point where it is unsustainable for the long term, particularly for the poor, the elderly, and healthcare workers (HCWs) themselves. We propose a framework for making U.S. healthcare more sustainable, whereby the service returns to its core mission of healing. The framework casts that healing mission in broadly applicable, practical terms, whereby leaders of healthcare organizations and in the wider for-profit, not-for-profit, and governmental healthcare ecosystem take concrete steps to improve outcomes for patients and HCWs. Those steps involve aligning healthcare resources, incentives, and policies with the core mission of healing and then implementing change in specific ways that particular organizations have already shown are achievable and sustainable. We use those examples to illustrate how healing-oriented innovations in healthcare delivery get deployed and how progress toward sustainability then ensues. Lessons from these efforts can be tailored to individual healthcare contexts and institutions—and then applied on a national scale. The discussed initiatives can also guide the direction of future research on healthcare sustainability.
In accepting the reality of illness we are better able to make rational decisions about our health.
The purpose of this chapter is to foster a deeper understanding of andragogy, explore the features of andragogical leadership and investigate the impact of technology in supporting adult learning. With an interest in investing and carving out new territory in andragogy, the authors discuss andragogical leadership and technology in promoting collaborative learning in adults. In this chapter, they revisit andragogy from a different angle: andragogy's relation with leadership. With the teaching practice drawn from the integration of technology into adult English as a second or foreign language (ESL/EFL) online learning, they investigate the role of andragogical leadership in constructing the community of inquiry.
Over the past several years, the ongoing coronavirus disease 2019 pandemic has contributed to challenging working and life conditions. As a result, the midwifery and health care workforce has faced significant shortages due to burnout. Increased societal awareness of historical trauma and systemic racism embedded within US culture has also led to increased anxiety and signs of trauma among midwifery and health profession students. Now more than ever, innovative teaching strategies are needed to support students, reduce the risks of burnout, and increase diversity in the workforce. One strategy is to adopt a trauma-informed pedagogy within midwifery education. Trauma-informed pedagogy is founded on core assumptions of trauma-informed care and thus supports student success by recognizing that the student cannot be separated from their own life experiences. Faculty and preceptors can develop empathetic, flexible supports that communicate care and concern regarding students' personal and social situations, and emotions. Empathetic behavior from teachers also increases student learning motivation, making it easier for students to actively engage in learning thereby reducing their distress. The purpose of this State of the Science review, therefore, was to describe the literature surrounding trauma-informed pedagogy and to offer concrete educational strategies that faculty members and educational programs can employ to increase the success of a diverse student body. This can be accomplished through flexibility in curriculum design and outcome measurement to ensure attainment of end of program learning outcomes. Institutional and administrative support are essential to develop a faculty who realize the benefit and value of trauma-informed pedagogy underpinning student success.
Sixty nursing staff in geriatric and psychogeriatric care (RNs, LPNs and nurse's aides) were selected to be studied on two occasions with an interval of one year regarding the relationships between their experience of burnout, empathy and attitudes towards demented patients. A semistructured interview was performed on the second occasion to learn more about their work experience and to relate the ratings of burnout, empathy and attitudes to their experience at work. The staff's experience of burnout changed from a mean score of 2.7 in 1987 to 2.5 in 1988. Their empathic ability was moderately high and increased from 398 (m) in (1987) to 450 (m) in 1988. The attitudes of staff remained unchanged from 1987 to 1988 and no differences were found regarding the staff's age, place of work or time at present place of work. As for the staff's empathy, there was no difference with respect to sex, category of staff or place of work. RN's showed the most positive attitudes towards demented patients both in 1987 and 1988 and differed compared to the nurse's aides and LPN's. Burnout correlated with lower empathy and less positive attitudes in the staff. Regression analysis showed that ‘experience of feed-back at work’ and ‘time spent at present place of work’ were the most important factors when explaining burnout among the staff. Staff with high empathy experienced “a close contact with the patient” as the most stimulating factor at work while staff with low empathy experienced “improvement of the patient's health” and “contact with colleagues” as the most stimulating factors. The importance of counteracting burnout in the care of demented patients is stressed.
Various combinations of modeling, labeling, and rehearsal (videotaped) were used to teach empathy to four experimental groups; a fifth group served as a no-treatment control. The subjects were 56 junior and senior baccalaureate nursing students, all of whom were women. A repeated-measures design was employed, with posttesting immediately following treatment and 3 weeks later. Learning was measured by means of a written test (Empathy Test) and an interview that was evaluated using the Barrett-Lennard Relationship Inventory and the Carkhuff Empathy Scale. The treatment was effective for junior students but not for senior students, and only the groups receiving the rehearsal conditioning performed better than the control group. There was also an interaction between treatment and time, with juniors improving on the second posttesting. A secondary hypothesis about correlations between the instruments was partially confirmed, thus lending support to their construct validity. The Carkhuff scale was correlated with itself for both testings, with the Barrett-Lennard inventory for both testings, and with the Empathy Test on the second testing.
The aim of this study was to validate the empathy scale (Hogan, 1969) for use in the context of medical education in Australia. Empathy Scale scores of students in their first clinical year at Monash University were correlated with patient ratings, self ratings, and peer ratings of empathy. Inter-rater and intra-rater reliability were assessed. Correlations were also obtained between Empathy Scale scores and course marks in psychiatry. Of the empathy ratings only those by peers correlated significantly with Empathy Scale scores (r = 0-45, P less than 0-05, n = 29). Empathy Scale scores were unrelated to academic performance. In a separate part of the study, not connected to the establishing of criterion-related validity, Empathy Scale scores of the medical student group were found to be significantly higher (t=4-44, df = 52, P less than 0-001) than the scores of psychiatric patients with a diagnosis of "personality disorder". This study provides some support for the Empathy Scale as a measure of interpersonal effectiveness, but has not established it as a valid measure of empathy in a clinical setting.
A conception of empathy based on an ordinary language analysis is presented. Within this conception, the nature of the processes and skills involved in any specific case of empathy are shown to depend upon particular dimensions of the situational context, the nature of the emotions involved in the empathee’s feeling-state, and the manner in which those feelings are expressed. It is argued that providing a comprehensive view of these dimensions and their developmental components is theoretically preferable to other approaches (such as the decentration view of empathy) which do not attend to the varying role of cognitive, affective, and social factors in different types of empathetic situations.Copyright © 1977 S. Karger AG, Basel
The purpose of the study was to develop a human-relations-modeled staff development program and obtain an objective measure of the level of empathy of registered nurses who practiced in an acute- and chronic-care hospital. The short-term human-relations-modeled staff development program was designed specifically to assist nurses who scored low in empathy to increase their abilities to perceive and respond with greater empathy. The study indicated that all nurses tested possessed an extremely low level of empathy, that the staff development program significantly raised their levels of empathy, but that more training was needed to enable all or the majority of subjects to reach at least the minimal facilitative level necessary to help another person successfully.