Practice development in orthopaedics and trauma
Empathy in Action in Healthcare (EACH): A mixed methods study of nurses' and therapists’ empathy

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Abstract

Background

Despite a plethora of research on empathy and its associated constructs, there is little evidence exploring clinicians’ perceptions of their empathy and its impact on service level outcomes.

Methods

The aim of this single centre mixed methods study was to investigate nurses' and therapists’ empathy levels and explore their views regarding its impact on clinical decision making at a national specialist orthopaedic centre. Data were collected from 126 respondents using an online validated empathy scale (Jefferson scale) supplemented by interviews with a convenience sample of 20 respondents. Questionnaire data were analysed using descriptive and inferential statistics. Qualitative interview data were subjected to a standard process of inductive thematic analysis prior to seeking relationships between the two datasets.

Results

There was a statistically significant difference in empathy levels between nurses and therapists (p = 0.031), with nurses scoring lower than therapists. Interview findings identified four key themes; displaying empathy, therapeutic use of self, influences and impacts, and learning. Differences between empathy scores and participants’ subjective accounts of empathy were apparent.

Conclusion

Empathy is an important construct built upon personal and professional experiences. Previous research reports empathy as a positive tool, however, our data suggest that its inappropriate use might also have a negative impact on service delivery and health outcomes.

Introduction

Empathy is a complex concept that can be defined as “a predominantly cognitive (rather than emotional) attribute that involves an understanding (rather than feeling) of experiences, concerns and perspectives of the patient, combined with a capacity to communicate this understanding” (Hojat, 2007, 2016). Although there is overlap with compassion, empathy is a broader concept that is seen as more relevant and useful for clinical practice (Jeffrey, 2016).

Sternke et al. (2016) argue that empathic interactions help create a respectful, trusting relationship that enable healthcare staff to see the world from a patient's point of view and that facilitate shared decision making. However, kindness motivated by empathy may also have negative effects (Bloom, 2016). Focus group discussions conducted during a local service evaluation support this view, finding empathy to have unintended negative impacts on discharge decisions i.e. granting patients' wishes to remain in hospital longer than necessary to please and appear more caring. This paper aims to further our understanding of clinicians' perceptions of empathy and its impacts and provide new insights to support improved healthcare delivery outcomes and patient experience.

Section snippets

Background

A large number of primary research studies and systematic reviews have investigated the impact of empathy on patients' experience and health outcomes from the patients' perspective (for example, Beck et al., 2002; Derksen et al., 2013; Harun et al., 2017; Howick et al., 2018; Lelorain et al., 2012; Smith et al., 2016; Steinhausena et al., 2014). Patients view empathy as a positive construct and report that a clinician's ability to understand them and to express this understanding is key to a

Methods

Data were collected at a national specialist orthopaedic hospital. Based in London, England, this is the largest orthopaedic NHS trust in the United Kingdom (UK) providing a comprehensive range of neuro-musculoskeletal health care for both adults and children across two sites. The study received approval from the NHS Health Research Authority (ref 249452) and the hospital's research and development department.

Results

One hundred and twenty six staff completed the questionnaire, 61 (48%) nurses, 44 (35%) physiotherapists and 21 (17%) occupational therapists (OTs). The majority of respondents were female (n = 110, 87%), reflecting the local and national workforce. Most respondents were under 50 years (n = 99, 79%), however the nursing sample were older than the therapists (Fig. 1).

Whilst 26 (21%) of the sample had less than five years clinical experience, the majority (n = 52, 41%) had been qualified for more

Discussion

The aim of this study was to investigate nurses' and therapists’ empathy levels and explore their views regarding its impact on clinical decision making.

Our findings provide a somewhat contradictory picture. Whilst our quantitative data suggest that nurses have lower levels of empathy than therapists, our qualitative interview data suggest the opposite, with nurse participants perceiving themselves to be in a better position to develop a rapport. Despite differences between professional groups,

Conclusion

This study investigated nurses' and therapists' empathy levels and their views regarding its impact on clinical decision making. There were clear differences between practitioners’ subjective descriptions of their empathy and the objective data reported by the Jefferson Scale. Furthermore, whilst empathy is reported in the literature as a positive tool, our qualitative data suggest that its inappropriate use has the potential to negatively impact health outcomes and patient experience.

This

Ethics

The study design and procedures were approved by the NHS Health Research Authority (ref 249452) and the research and development department at the Royal National Orthopaedic Hospital NHS Trust.

Financial disclosure

This study was part funded by the School of Health and Social Care, London South Bank University. Funding was used to support data transcription only.

Funding

This study was part funded by the School of Health and Social Care, London South Bank University

Declaration of competing interest

We declare no conflicts of interest.

Acknowledgements

We would like to acknowledge the contribution of Julia Sach (Clinical Nurse Specialist) and Jennifer Fulton (Therapist) for their support with data collection, and Dr Nicolas Varela (Consultant) for his support with data analysis.

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