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L’empathie peut-elle être enseignée aux soignants ?

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Abstract

Un nouvel article sur l’empathie et le soin, quelle utilité vu l’engouement des publications sur le sujet ? Le présent écrit interroge les possibilités d’enseignement de l’empathie auprès des étudiants en médecine et en soins infirmiers. Pour ce faire, une proposition de définition est formulée ainsi qu’une revue de la littérature précisant ses effets dans les soins et ses possibilités d’enseignement auprès des étudiants et des professionnels en poste. A new article about empathy and care, what use given the popularity of publications on the subject? This article questions the possibilities of teaching empathy to medical and nursing students. To do this, a definition proposal is formulated as well as a review of the literature on its effects in care and its educational opportunities for students and working professionals.

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... Évidemment, ayant ouvert la porte, il est souhaitable de travailler sur la peur de mourir, le deuil de la mère… Après la fibroscopie par exemple. La présentation ici réalisée est une invitation à explorer plus en détail le concept d'empathie dans les soins (1)(2)(3) en tant qu'attitude relationnelle et humaine positive (4) ...
... Le souci de l'autre et la recherche d'une prise de perceptive sont primordiaux au processus empathique(8) . Les aptitudes empathiques, et particulièrement relationnelles, sont accessibles à un enseignement et peuvent être cultivées, renforcées(3) . Cet enseignement, régulièrement approfondi, protégerait de l'épuisement professionnel.CONCLUSION L'empathie, incluant sa composante relationnelle, est au coeur de la relation thérapeutique. ...
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Malgré sa stigmatisation dans notre société, l'empathie s'établit comme une compétence majeure des professionnels de la santé, tant ses apports sur la qualité des soins et sur les résultats des prises en charge sont scientifiquement documentés. Associée à une communication efficiente, l'empathie est le cœur d'une relation thérapeutique humaniste et holistique. Les difficultés rencontrées dans le cas clinique présenté et la façon dont elles ont été surmontées par le praticien en sont le reflet. -- Despite its stigma in our society, empathy is established as a major skill of health professionals as the contributions on the quality of care and the results of care are scientifically documented. Associated with efficient communication , empathy is the heart of a humanistic and holistic therapeutic relationship. The difficulties encountered in this case report and the way in which they were overcome by the practitioner reflect this.
... Malgré l'explosion des publications sur ce sujet ces deux dernières décennies, elle reste encore stigmatisée dans notre société. De plus, le sens commun, abondamment repris par les messages commerciaux, en écorche davantage la quintessence (1) . À la vue du foisonnement d'écrits (articles scientifiques, livres, sites internet, etc.), l'analyse de cette littérature se complexifie. ...
... Les bénéfices de l'empathie dans le soin sont solidement établis par plusieurs études médico-scientifiques et constituent la motivation à son enseignement (1,4) . Pour l'usager des soins, l'empathie : améliore sa satisfaction, son acceptation des soins, son adhésion aux traitements prescrits ; renforce positivement les résultats des médications entreprises (en particulier pour le diabète) ; diminue le ressenti de la douleur, de l'anxiété et de la dépression (de la personne soignée et du soignant). ...
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By exploring the concept of empathy, its definition, its effects in care, its possibilities for teaching and implementation, this paper aims to examine the usefulness and feasibility of an empathetic practice in geriatric care and serves two main purposes. The first is to offer a brief overview of empathy and in particular its implementation in care thanks to its clinical application. The second is to bring perspective on the complexity of the issue by presenting an overview of the theoretical fuzziness surrounding its definition, what to watch for during its implementation and the reasonable doubts in its use. En explorant le concept d’empathie, sa définition, ses effets dans le soin, ses possibilités d’enseignement et de mise en oeuvre, cet écrit se propose d’examiner l’utilité et la faisabilité d’une pratique empathique en gériatrie et sert deux principaux objectifs. Le premier est de proposer un bref état des lieux concernant l’empathie et en particulier sa mise en oeuvre dans les soins grâce à sa déclinaison clinique. Le second est d’apporter de la perspective sur la complexité de la question par la présentation d’un aperçu des nimbes théoriques entourant sa définition, des zones de vigilance à sa mise en oeuvre et des doutes raisonnables à son utilisation.
... L'ensemble des expériences renforcent les compétences empathiques pour peu qu'elles puissent être questionnées dans un cadre approprié. C'est en cela que l'empathie peut se cultiver [8]. En plus, il est scientifiquement reconnu que les aptitudes empathiques sont bénéfiques à la personne soignée ainsi qu'aux soignants [5]. ...
... • respecter l'espace personnel en assurant la sécurité ; Pour clôturer cette partie, il est rappelé que plusieurs types de formations pour les soignants présentent des avantages indéniables [13,219]. ...
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Résumé La confusion est un événement sévère, annonciateur d’une urgence médicale. Chez la personne âgée, elle est associée à une morbidité et à une mortalité significatives. Elle se définit comme une perturbation cérébrale de début soudain et fluctuante. S’y associent des troubles de l’attention et de la fonction cognitive. Cette revue narrative explore les éléments d’épidémiologie, de physiopathologie, de diagnostic et de surveillance. Elle alerte sur les liens identifiés entre la Covid-19 et la confusion. Elle appelle à une prise en charge majoritairement non pharmacologique et multidimensionnelle, ainsi qu’à un renforcement des formations ciblées et des équipes mobiles de gériatrie qualifiées en psychogériatrie. De façon générale, l’approche thérapeutique de la confusion est holistique et humaniste plus qu’orientée sur l’organe.
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Despite the increasing awareness of the relevance of empathy in patient care, some findings suggest that medical schools may be contributing to the deterioration of students' empathy. Therefore, it is important to clarify the magnitude and direction of changes in empathy during medical school. We employed a scoping review to elucidate trends in students' empathy changes/differences throughout medical school and examine potential bias associated with research design. The literature published in English, Spanish, Portuguese and French from 2009 to 2016 was searched. Two-hundred and nine potentially relevant citations were identified. Twenty articles met the inclusion criteria. Effect sizes of empathy scores variations were calculated to assess the practical significance of results. Our results demonstrate that scoped studies differed considerably in their design, measures used, sample sizes and results. Most studies (12 out of 20 studies) reported either positive or non-statistically significant changes/differences in empathy regardless of the measure used. The predominant trend in cross-sectional studies (ten out of 13 studies) was of significantly higher empathy scores in later years or of similar empathy scores across years, while most longitudinal studies presented either mixed-results or empathy declines. There was not a generalized international trend in changes in students' empathy throughout medical school. Although statistically significant changes/differences were detected in 13 out of 20 studies, the calculated effect sizes were small in all but two studies, suggesting little practical significance. At the present moment, the literature does not offer clear conclusions relative to changes in student empathy throughout medical school.
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Background: Ineffective communication among healthcare team members is associated with decreased collaborative efforts and adverse patient outcomes. The impact of empathy on collaboration with colleagues and patient interaction has been previously demonstrated. Studies have yet to measure the impact of (Nonviolent Communication [NVC]) on empathy in nursing students. Purpose: The purpose of this mixed methods study was to test a communication intervention (NVC) with baccalaureate student nurses to examine its effect on empathy. Methods: A mixed methods single group pre/post test design incorporating the Interpersonal Reactivity Index (IRI) to measure empathy was used. A paired samples t test was calculated to compare means scores pre and post intervention. One-way ANOVA was used to examine between group differences. Interpretive methods were used to analyze qualitative data collected via journal entries during the training and focus groups immediately following and 2 years post intervention. Results/Findings: Quantitative results revealed an increase in empathy (69.1 to 71.4, p = .037) post training. Qualitative analyses demonstrated positive impact of NVC in empathizing with self and others. Clinical impact was especially noted when working with psychiatric patients. Conclusion: Incorporating NVC into nursing education could feasibly prevent future hardship as students advance their nursing careers. Further research may be needed to capture the larger impact that NVC could have on nurses and nursing students.
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The past decades have seen an explosion of studies on empathy in various academic domains including affective neuroscience, psychology, medicine, and economics. However, the volumes of research have almost exclusively focused on its evolutionary origins, development, and neurobiological bases, as well as how the experience of empathy is modulated by social context and interpersonal relationships. In the present paper, we examine a much less attended side of empathy: why it has a positive impact on others? After specifying what the construct of empathy encompasses, we briefly review the various effects of empathy on health outcomes in the domain of medicine. We then propose two non-mutually exclusive mechanistic explanations that contribute to explain the positive effects of physician empathy on patients. (1) The social baseline theory (SBT), building on social support research, proposes that the presence of other people helps individuals to conserve metabolically costly somatic and neural resources through the social regulation of emotion. (2) The free energy principle (FEP) postulates that the brain optimizes a (free energy) bound on surprise or its complement value to respond to environmental changes adaptively. These conceptualizations can be combined to provide a unifying integrative account of the benefits of physicians’ empathetic attitude on their patients and how it plays a role in healing beyond the mere effect of the therapeutic alliance.
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We have been advocating cognitive developmental robotics to obtain new insight into the development of human cognitive functions by utilizing synthetic and constructive approaches. Among the different emotional functions, empathy is difficult to model, but essential for robots to be social agents in our society. In my previous review on artificial empathy (Asada, 2014), I proposed a conceptual model for empathy development beginning with emotional contagion to envy/schadenfreude along with self/other differentiation. In this article, the focus is on two aspects of this developmental process, emotional contagion in relation to motor mimicry, and cognitive/affective aspects of the empathy. It begins with a summary of the previous review (Asada, 2014) and an introduction to affective developmental robotics as a part of cognitive developmental robotics focusing on the affective aspects. This is followed by a review and discussion on several approaches for two focused aspects of affective developmental robotics. Finally, future issues involved in the development of a more authentic form of artificial empathy are discussed. Copyright © 2014. Published by Elsevier Ireland Ltd.
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Objective: The objective of this systematic review was to identify, critically appraise and synthesize evidence for the effectiveness of empathy interventions in undergraduate nursing education. Design: A systematic review of literature. Data Sources: A three-stage systematic search of six electronic databases was conducted. Review Methods: The Preferred Reporting Items for Systematic reviews and Meta-Analyses guided the review. English language articles published between 2000 and 2018 were eligible. Methodological rigour was examined using the Medical Education Research Study Quality Instrument. Changes in empathy were assessed using Cohen's effect size correlation (r) and reported as effective when the variance was >0.2 standard deviations (r ≥ 0.2). Results: Of 23 included studies, four were experimental and four were case-control studies. Of these, the mean effect size was r = 0.45 and three were regarded as effective empathy interventions. Although 10 of 13 single group studies demonstrated a significant change in empathy between pre-test and post-test (p < 0.05), effect sizes were often low (mean r = 0.26). Six single-group studies reported an intervention effect of r > 0.2. The most effective empathy education involved immersive and experiential simulation-based interventions. Simulation modalities ranged from role plays, manikin-based scenarios, to 3D e-simulations and point-of-view simulations where students wore a hemiparesis suit\ Conclusions: Nine of 23 empathy education studies in undergraduate nurse education demonstrated practical improvements in empathy. The most effective interventions were immersive and experiential simulations that focused on vulnerable patient groups and provided opportunities for guided reflection. We noted the research designs were limited in terms of levels of evidence and use of subjective measures. Larger experimental studies are required to provide higher levels of evidence to identify unequivocal outcomes in terms of empathy research. Future studies should consider transfer to practice and longer-term changes in empathy as study outcomes.
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When we ask a chatbot for advice about a personal problem, should it simply provide informational support and refrain from offering emotional support? Or, should it show sympathy and empathize with our situation? Although expression of caring and understanding is valued in supportive human communications, do we want the same from a chatbot, or do we simply reject it due to its artificiality and uncanniness? To answer this question, we conducted two experiments with a chatbot providing online medical information advice about a sensitive personal issue. In Study 1, participants (N = 158) simply read a dialogue between a chatbot and a human user. In Study 2, participants (N = 88) interacted with a real chatbot. We tested the effect of three types of empathic expression-sympathy, cognitive empathy, and affective empathy-on individuals' perceptions of the service and the chatbot. Data reveal that expression of sympathy and empathy is favored over unemotional provision of advice, in support of the Computers are Social Actors (CASA) paradigm. This is particularly true for users who are initially skeptical about machines possessing social cognitive capabilities. Theoretical, methodological, and practical implications are discussed.
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Aim: To analyse link between empathy and emotional intelligence (EI) as a predictor of nurses' attitudes towards communication while comparing the contribution of emotional aspects and attitudinal elements on potential behaviour. Background: Nurses' attitudes towards communication, empathy and emotional intelligence are key skills for nurses involved in patient care. There are currently no studies analysing this link, and its investigation is needed because attitudes may influence communication behaviours. Design: Correlational study. Method: To attain this goal, self-reported instruments (attitudes towards communication of nurses (ACO), trait emotional intelligence (TMMS24), and Jefferson-scale empathy (JSNE)) were collected from 460 nurses between September 2015 and February 2016. Two different analytical methodologies were used: traditional regression models and fuzzy-set qualitative comparative analysis models (fsQCA). Results: The results of the regression model suggest that cognitive dimensions of attitude are a significant and positive predictor of the behavioural dimension. The perspective-taking dimension of empathy and the emotional-clarity dimension of emotional intelligence were significant positive predictors of the dimensions of attitudes towards communication, except for the affective dimension (for which the association was negative). The results of the fsQCA models confirm that the combination of high levels of cognitive dimension of attitudes, perspective-taking and emotional clarity explained high levels of the behavioural dimension of attitude. Conclusions: Empathy and EI are predictors of nurses' attitudes towards communication, and the cognitive dimension of attitude is a good predictor of the behavioural dimension of ACO in both regression models and fsQCA. In general, the fsQCA models appear to be better predictors than the regression models are. This article is protected by copyright. All rights reserved.
Article
Some research shows that empathy declines during medical school. The authors conducted an updated, systematic review of the literature on empathy-enhancing educational interventions in undergraduate medical education. The authors searched PubMed, EMBASE, PsycINFO, CINAHL, Scopus, and Web of Science (January 1, 2004 through March 19, 2012) using key words related to undergraduate medical education and empathy. They independently selected and reviewed all English-language articles that described an educational intervention designed to promote empathy in medical students, assessing the quality of the quantitative studies using the Medical Education Research Study Quality Instrument (MERSQI). The authors identified and reviewed the full texts of 18 articles (15 quantitative and 3 qualitative studies). Included interventions used one or more of the following-patient narrative and creative arts (n = 7), writing (n = 3), drama (n = 1), communication skills training (n = 4), problem-based learning (n = 1), interprofessional skills training (n = 1), patient interviews (n = 4), experiential learning (n = 2), and empathy-focused training (n = 1). Fifteen articles reported significant increases in empathy. Mean effect size was 0.23. Mean MERSQI score was 10.13 (range 6.5-14). These findings suggest that educational interventions can be effective in maintaining and enhancing empathy in undergraduate medical students. In addition, they highlight the need for multicenter, randomized controlled trials, reporting long-term data to evaluate the longevity of intervention effects. Defining empathy remains problematic, and the authors call for conceptual clarity to aid future research.
There is a need for studies specifically addressing the barriers to empathy training from the perspective of medical students. The objective of this study was to evaluate attitudes of 3rd and 4th year medical students regarding their training in clinical empathy at a public teaching hospital and medical school. A questionnaire assessing students' satisfaction with, and opinions on, empathy training, as well as barriers to training, was distributed during the last quarter of the year. Of 188 eligible participants, 157 (84%) responded. Approximately one-half of the respondents said empathy could be taught. Eighty-one percent of respondents felt that their empathy had increased or stayed the same during their training. When asked about barriers for learning empathy, the majority of respondents chose time pressure and lack of good role models. Respondents rated breaking bad news, talking to patients about medical mistakes and taking care of dying or demanding patients as areas in need of more empathy-related training. Although the majority of students were satisfied with their training of clinical empathy, our study highlights the need for innovative methods to address concerns regarding barriers to practicing empathy, as well as the need for more training in how to demonstrate empathy in challenging clinical situations.
Article
Patients seek empathy from their physicians. Medical educators increasingly recognize this need. Yet in seeking to make empathy a reliable professional skill, doctors change the meaning of the term. Outside the field of medicine, empathy is a mode of understanding that specifically involves emotional resonance. In contrast, leading physician educators define empathy as a form of detached cognition. In contrast, this article argues that physicians' emotional attunement greatly serves the cognitive goal of understanding patients' emotions. This has important implications for teaching empathy.
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