Editorial Consultant Editor Bridget Johnston Editor Craig Nicholson Associate Publisher, Medical Education Tracy Cowan Associate Publishers Chloe Benson, Julie Smith Publisher Anthony Kerr Production Manager Jon Redmayne Circulation Director Sally Boettcher Chief Executive Officer Ben Allen Editorial enquiries: [email protected] Sales enquiries: [email protected]
Editorial Board AUSTRALIA Donna Drew Clinical Nurse Consultant, Paediatric Oncology/Palliative Care, Prince of Wales Children’s Hospital, New South Wales Kate White Professor Cancer Nursing, Sydney Nursing School, Royal Prince Alfred Hospital, The University of Sydney BELARUS Anna Garcakova Director of the Belarusian Children’s Hospice EIRE Philip Larkin Professor of Clinical Nursing (Palliative Care), School of Nursing, Midwifery and Health Systems and Our Lady’s Hospice Ltd, Health Sciences Centre, University College Dublin, Ireland Julie Ling HRB Research Fellow, School of Nursing and Midwifery, Trinity College, Dublin 2 HONG KONG Cecilia Chan Professor and Director, Centre of Behavioural Health, Pokfulam NORTHERN IRELAND Sonja McIlfatrick Reader, Institute of Nursing Research, University of Ulster; Head of Research, All Ireland Institute of Hospice & Palliative Care UGANDA Julia Downing Honorary Professor in Palliative Care, Makerere University, Kampala UNITED KINGDOM John Costello Senior Lecturer, University of Manchester
Bridget Johnston Reader in Palliative Care, University of Dundee, School of Nursing and Midwifery, Dundee Daniel Kelly Royal College of Nursing Professor of Nursing Research, School of Nursing & Midwifery Studies, Cardiff University Diane Laverty Nurse Consultant in Palliative Care, St Joseph’s Hospice, London Carole Mula Macmillan Nurse Consultant in Palliative Care and Professional Lead Nurse for Division of Clinical Support Services, The Christe NHS Foundation Trust, Manchester Brian Nyatanga Senior Lecturer, University of Worcester Julie Skilbeck Senior Lecturer, Sheffield Hallam University Dion Smyth Lecturer-practitioner in Cancer and Palliative Care, Birmingham City University Anna-Marie Stevens Macmillan Nurse Consultant Cancer Palliative Care, The Royal Marsden NHS Foundation Trust, London UNITED STATES Jennifer Baird Doctoral Candidate, Department of Family Health Care Nursing, National Institute of Nursing Research NRSA Fellow, University of California, San Francisco Patricia Berry Associate Professor and Associate Director, University of Utah Hartford Center of Geriatric Nursing Excellence, University of Utah College of Nursing
UK Personal subscription rates Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£44 £174 £183 £312 £440
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997
© © 2013 2013 MA MA Healthcare Healthcare Ltd Ltd
The International Journal of Palliative Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: +44 (0)20 7738 5454 Websites: www.ijpn.co.uk
MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com
International Journal of Palliative Nursing is indexed on Medline, CINAHL, and the British Nursing Index © MA Healthcare Ltd, 2013. All rights reserved. No part of the International Journal of Palliative Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 1357-6321 Printed by Pensord Press Ltd, Blackwood, Gwent NP12 2YA The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
International Journal of Palliative Nursing 2013, Vol 19, No 10
P
Empathy in palliative care: is it possible to understand another person?
alliative care involves relating to patients and empathising with them at an emotional level. This seems to be central to the theory that when we care others ought to benefit and not be disadvantaged (Noddings, 2002). In other words, caring must be effective for the recipient. In order to establish effective caring relations, Noddings asserts that carers should step out of their frame of reference and into the patient’s or their family member’s, in order to fully understand the other person’s situation and world view. It is clear that Noddings is arguing for empathy or empathic understanding, which seems essential for person-centred and holistic palliative care. Empathy is the ability to identify with the emotional experiences of others. The ideas and functions of empathy are often associated with evidence of negative states, e.g. suffering or grief, in the other person. In palliative care today, health professionals tend to recognise not only physical threats but also emotional and psychological dangers. The response is to offer support through empathy so that the other person can achieve emotional stability. Empathy makes this support possible through the ability to ‘step into the shoes’ of the other person. However, Henry David Thoreau captured the essence of empathy when he said ‘Could a greater miracle take place than for us to look through each other’s eyes for an instant?’ The inference of this might be that we can at best only imagine, and not truly experience, how the other person might be feeling. While this might be true of the affective or emotional dimension of empathy, which relates to another’s feelings and our imaginative ability to appreciate their plight, it is possible to understand what another person thinks about their feelings. There is evidence from the work of Daniel Goleman (2011) that there are three types of empathy—emotional empathy (as above), empathic concern, and cognitive empathy—and that these are often intertwined. According to Goleman (2011), cognitive empathy enables us to understand how the other person might be thinking about their feelings. It is the ability to see or understand things from the other person’s perspective, without claiming to feel how they feel. Goleman calls this ‘perspective-taking’ and claims that the approach can help motivate patients to get involved in negotiating their best plan of care. Perspective-taking can also help to improve overall communication with patients and families, through an understanding of how to put the information across in a way that will make it easy for them to take in. This may be particularly helpful in palliative care settings, where patients and families have to deal with so many distressing and sensitive variables at the same time. Cognitive empathy gives carers an added dimension in their understanding and therefore provides more options for providing better support. A note of caution is needed. Just as emotional empathy has the downside that the carer might begin to openly express their own feelings to the extent that they are no longer in a position to provide effective support, so cognitive empathy can be damaging if carers end up exploiting patients’ or family members’ vulnerability through their deep understanding of how the person is thinking in the face of loss and grief. Emotional and cognitive empathy must work side-by-side and complement each other in facilitating the provision of balanced support that does not disadvantage the person in need of it. This is particularly true in palliative care, where we are constantly dealing with such sensitive and intimate situations. Il JPN
Brian Nyatanga Senior Lecturer, University of Worcester Goleman D (2000) Working with Emotional Intelligence. Bantram Trade Publishers, New York Noddings N (2002) Starting at Home. Caring and Social Policy. University of California Press, Berkeley
471
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
Editorial Board AUSTRALIA Donna Drew Clinical Nurse Consultant, Paediatric Oncology/Palliative Care, Prince of Wales Children’s Hospital, New South Wales Kate White Professor Cancer Nursing, Sydney Nursing School, Royal Prince Alfred Hospital, The University of Sydney BELARUS Anna Garcakova Director of the Belarusian Children’s Hospice EIRE Philip Larkin Professor of Clinical Nursing (Palliative Care), School of Nursing, Midwifery and Health Systems and Our Lady’s Hospice Ltd, Health Sciences Centre, University College Dublin, Ireland Julie Ling HRB Research Fellow, School of Nursing and Midwifery, Trinity College, Dublin 2 HONG KONG Cecilia Chan Professor and Director, Centre of Behavioural Health, Pokfulam NORTHERN IRELAND Sonja McIlfatrick Reader, Institute of Nursing Research, University of Ulster; Head of Research, All Ireland Institute of Hospice & Palliative Care UGANDA Julia Downing Honorary Professor in Palliative Care, Makerere University, Kampala UNITED KINGDOM John Costello Senior Lecturer, University of Manchester
Bridget Johnston Reader in Palliative Care, University of Dundee, School of Nursing and Midwifery, Dundee Daniel Kelly Royal College of Nursing Professor of Nursing Research, School of Nursing & Midwifery Studies, Cardiff University Diane Laverty Nurse Consultant in Palliative Care, St Joseph’s Hospice, London Carole Mula Macmillan Nurse Consultant in Palliative Care and Professional Lead Nurse for Division of Clinical Support Services, The Christe NHS Foundation Trust, Manchester Brian Nyatanga Senior Lecturer, University of Worcester Julie Skilbeck Senior Lecturer, Sheffield Hallam University Dion Smyth Lecturer-practitioner in Cancer and Palliative Care, Birmingham City University Anna-Marie Stevens Macmillan Nurse Consultant Cancer Palliative Care, The Royal Marsden NHS Foundation Trust, London UNITED STATES Jennifer Baird Doctoral Candidate, Department of Family Health Care Nursing, National Institute of Nursing Research NRSA Fellow, University of California, San Francisco Patricia Berry Associate Professor and Associate Director, University of Utah Hartford Center of Geriatric Nursing Excellence, University of Utah College of Nursing
UK Personal subscription rates Quarterly Direct Debit Annual Direct Debit Annual Credit Card 2yr Annual Credit Card 3yr Annual Credit Card
£44 £174 £183 £312 £440
Subscribe online: www.magsubscriptions.com, Subscribe by phone: +44 (0) 1722 716997
© © 2013 2013 MA MA Healthcare Healthcare Ltd Ltd
The International Journal of Palliative Nursing is published by MA Healthcare Ltd, St Jude’s Church, Dulwich Road, London SE24 0PB Tel: +44 (0)20 7738 5454 Websites: www.ijpn.co.uk
MA Healthcare Ltd is part of the Mark Allen Group
www.markallengroup.com
International Journal of Palliative Nursing is indexed on Medline, CINAHL, and the British Nursing Index © MA Healthcare Ltd, 2013. All rights reserved. No part of the International Journal of Palliative Nursing may be reproduced, stored in a retrieval system, or transmitted in any form or by any means electronic, mechanical, photocopying, recording, or otherwise without prior written permission of the Publishing Director. ISSN 1357-6321 Printed by Pensord Press Ltd, Blackwood, Gwent NP12 2YA The paper used within this publication has been sourced from Chain-of-Custody certified manufacturers, operating within international environmental standards, to ensure sustainable sourcing of the raw materials, sustainable production and to minimise our carbon footprint.
International Journal of Palliative Nursing 2013, Vol 19, No 10
P
Empathy in palliative care: is it possible to understand another person?
alliative care involves relating to patients and empathising with them at an emotional level. This seems to be central to the theory that when we care others ought to benefit and not be disadvantaged (Noddings, 2002). In other words, caring must be effective for the recipient. In order to establish effective caring relations, Noddings asserts that carers should step out of their frame of reference and into the patient’s or their family member’s, in order to fully understand the other person’s situation and world view. It is clear that Noddings is arguing for empathy or empathic understanding, which seems essential for person-centred and holistic palliative care. Empathy is the ability to identify with the emotional experiences of others. The ideas and functions of empathy are often associated with evidence of negative states, e.g. suffering or grief, in the other person. In palliative care today, health professionals tend to recognise not only physical threats but also emotional and psychological dangers. The response is to offer support through empathy so that the other person can achieve emotional stability. Empathy makes this support possible through the ability to ‘step into the shoes’ of the other person. However, Henry David Thoreau captured the essence of empathy when he said ‘Could a greater miracle take place than for us to look through each other’s eyes for an instant?’ The inference of this might be that we can at best only imagine, and not truly experience, how the other person might be feeling. While this might be true of the affective or emotional dimension of empathy, which relates to another’s feelings and our imaginative ability to appreciate their plight, it is possible to understand what another person thinks about their feelings. There is evidence from the work of Daniel Goleman (2011) that there are three types of empathy—emotional empathy (as above), empathic concern, and cognitive empathy—and that these are often intertwined. According to Goleman (2011), cognitive empathy enables us to understand how the other person might be thinking about their feelings. It is the ability to see or understand things from the other person’s perspective, without claiming to feel how they feel. Goleman calls this ‘perspective-taking’ and claims that the approach can help motivate patients to get involved in negotiating their best plan of care. Perspective-taking can also help to improve overall communication with patients and families, through an understanding of how to put the information across in a way that will make it easy for them to take in. This may be particularly helpful in palliative care settings, where patients and families have to deal with so many distressing and sensitive variables at the same time. Cognitive empathy gives carers an added dimension in their understanding and therefore provides more options for providing better support. A note of caution is needed. Just as emotional empathy has the downside that the carer might begin to openly express their own feelings to the extent that they are no longer in a position to provide effective support, so cognitive empathy can be damaging if carers end up exploiting patients’ or family members’ vulnerability through their deep understanding of how the person is thinking in the face of loss and grief. Emotional and cognitive empathy must work side-by-side and complement each other in facilitating the provision of balanced support that does not disadvantage the person in need of it. This is particularly true in palliative care, where we are constantly dealing with such sensitive and intimate situations. Il JPN
Brian Nyatanga Senior Lecturer, University of Worcester Goleman D (2000) Working with Emotional Intelligence. Bantram Trade Publishers, New York Noddings N (2002) Starting at Home. Caring and Social Policy. University of California Press, Berkeley
471
onal Journal of Palliative Nursing. Downloaded from magonlinelibrary.com by 137.189.170.231 on November 23, 2015. For personal use only. No other uses without permission. . All rights r
