AORN education
Empathy, the quality of care that makes nursing an art Imagine yourself, as I did, observing surgery, not for technique, but for empathetic understanding of the team interaction. As I watched Mr Gordon, a 50-year-old man having surgery for an aortic aneurism, I was awed by the commitment and responsibility of the surgery team members. I thought about Mr Gordon and how he had placed his trust in them as he lay in his unconscious state. I imagined his fear before he was anesthetized. I imagined his family anxiously pacing outside the surgery doors. I knew then what it meant to be a “patient advocate.” He and his family needed us to be careful in our care of him. He had only the surgery team to keep life in his body. As OR nurses, we need continuously to be aware of our responsibility as patient advocates, affirming our commitment to the patient while in his dependent state. I next observed Dr Martin amputating the left leg of Mrs Green, a 55-year-old woman with diabetes. I thought of Mrs Green and how afraid she must have been before surgery; how rehabilitation would come slowly, if at all. But in that room Dr Martin captured my thoughts. I was speechless at his callous handling of the operation. So intense were feelings in that OR that no one had regard for another person, especially the
pJ
patient. I wanted to shout, “Why don’t you help each other?” “Where is your team spirit?” There obviously was none. The nightmare had started with Dr Martin’s feelings of anxiety. Couldn’t the team members see that? Why did the nurse withdraw when he so obviously needed her support? Did the :-am members put him in such an ivory tower that they could not reach out to him? If only someone had the courage to say, “Dr Martin, this is hard for all of us, expecially you. I cannot laugh about it. I am struggling with my own feelings. Please stop.” There were other surgeries that dayother patients, other families, other physicians, and other nurses-and there would be more surgeries the following days. But each surgery performed is the only surgery for that patient and that family, that physician and that nurse that day. They can never redo that surgery, and they can never relive that experience. The commitment to that individual patient has to be then. As I observed, I understood the art of nursing to be that component of nursing care above and beyond the science of nursing. I understood the commitment of a nurse-the ability to share oneself with another human being in a meaningful way. I realized how often we have the opportunity to reach out and care, and I realized how often we struggle to make that move. Why the struggle? Reasons from our past, from the present, and from within the situation do not let us experience our attitudes and feelings fully. This seems too dangerous and too potentially damaging.’ We are fearful of hurt and
AORN Journal, August 1977, Vol26, No 2
235
rejection if we reach out. What could hurt more than to have your caring turned down? As I pondered that day in the OR, I was saddened at how frequently we let situations pass where we could reach out and help another person. I began to think about empathy for all I had to do that day was stand there and project myself into other people’s lives and feelings. I began to read and study about the concept of empathy, which to me is one of the most precious qualities of nursing care we can deliver, not only to patients but also to team members. Empathy is defined as the ability to imagine vicariously how another person feels and as a result be able to predict accurately that person’s thoughts, feelings, and actions.z Empathy has been called the sixth sense, the ability to see with another’s eyes, hear with another’s ears, and feel with another’s heart. It can be understood as the feeling a mother has for her sick child or a wife for her husband when he fails. The essential component of empathy is the ability to imagine how another person feels. In this process, the nurse must suspend value judgments to accept what the other person is feeling.3In the case above, judging Dr Martin would accomplish nothing but anger; understanding how he felt would have helped him and the entire team. Why was he so anxious? Perhaps his mother had had her leg amputated. Perhaps he was diabetic. Maybe he knew what a struggle this would be for the patient’s family. We may never know the why of his anxiety, but we know he was distressed. If we can experience some of his distress, we are more apt to give him the support he needs. To become more skilled in imagining how another person feels, the nurse must learn how to listen. The art of listening has become neglected and poorly understood. We spend much time stating our own views and neglect to listen to other people’s ideas and feelings. Listening involves trying to see the problem the way the speaker sees it, in other words, empathizing, which is experiencing the emotion with him.‘ How much easier it would be to do preoperative visits if we felt some of the emotions of the patients and their families. Many times we struggle with what to say or we hide behind a checklist. Perhaps the most impor-
236
tant message to a patient and his family the night before surgery is, “I will be there. I will care for you.” This message may be communicated by a look or a touch. It may not be communicated with words; therefore, it must be felt. You may say, “That is a lot to ask’ and you are right. If we totally immerge ourselves in the feelings of others all day long, we become immobilized. However, there is a balance between distancing and protecting ourselves and allowing ourselves to slip momentarily in and out of other people’s lives. It is this ability that makes nursing and nurses so special. To have empathy, the nurse must be able to tolerate anxiety. She needs to lay aside her own anxiety, accept herself, and trust her own judgments to experience the feelings of another person. The more self-accepting and self-assured she is, the easier this will be. She must be spontaneous and able to experience her own feelings as well as those of others. She must be able to take on many roles easily and move from her own role to another person’s role without self-consciousness. She must be comfortable with feeling intimacy and caring for other people. Empathy increases the speed and effectiveness of communicati~n.~ As nurses, we need to be more involved with and aware of this phenomenon. We need to recognize empathy as part of our helping role. We need to have empathy for our peers as well as the patient and across disciplines. Let us recognize this precious asset in nursing. We are the ones who provide the care. Let us do it with care.
Bonnie Payne, RN, MS Associate director of education Notes 1. Carl R Rogers, On Becoming A Person (Boston: Houghton Mifflin Co, 1961) 111. 2. Marlene Kramer, Claudia Schmalenberg, “The first job . . . a proving ground,” Journal of Nursing Administration (January 1977) 13. 3. Margaret Baumgartner, Empathy; Behavioral Concepts and Nursing Interventions, Carolyn E Carlson, coordinator (Philadelphia and Toronto: J B Lippincott Co, 1970) 33. 4. S I Hayakawa, Symbol, status, and Personality (New York: Harcourt, Brace & World, Inc, 1963) 32. 5. Kramer, “The first job,” 15.
AORN Journal, August 1977, Vol26, No 2
Empathy, the quality of care that makes nursing an art Imagine yourself, as I did, observing surgery, not for technique, but for empathetic understanding of the team interaction. As I watched Mr Gordon, a 50-year-old man having surgery for an aortic aneurism, I was awed by the commitment and responsibility of the surgery team members. I thought about Mr Gordon and how he had placed his trust in them as he lay in his unconscious state. I imagined his fear before he was anesthetized. I imagined his family anxiously pacing outside the surgery doors. I knew then what it meant to be a “patient advocate.” He and his family needed us to be careful in our care of him. He had only the surgery team to keep life in his body. As OR nurses, we need continuously to be aware of our responsibility as patient advocates, affirming our commitment to the patient while in his dependent state. I next observed Dr Martin amputating the left leg of Mrs Green, a 55-year-old woman with diabetes. I thought of Mrs Green and how afraid she must have been before surgery; how rehabilitation would come slowly, if at all. But in that room Dr Martin captured my thoughts. I was speechless at his callous handling of the operation. So intense were feelings in that OR that no one had regard for another person, especially the
pJ
patient. I wanted to shout, “Why don’t you help each other?” “Where is your team spirit?” There obviously was none. The nightmare had started with Dr Martin’s feelings of anxiety. Couldn’t the team members see that? Why did the nurse withdraw when he so obviously needed her support? Did the :-am members put him in such an ivory tower that they could not reach out to him? If only someone had the courage to say, “Dr Martin, this is hard for all of us, expecially you. I cannot laugh about it. I am struggling with my own feelings. Please stop.” There were other surgeries that dayother patients, other families, other physicians, and other nurses-and there would be more surgeries the following days. But each surgery performed is the only surgery for that patient and that family, that physician and that nurse that day. They can never redo that surgery, and they can never relive that experience. The commitment to that individual patient has to be then. As I observed, I understood the art of nursing to be that component of nursing care above and beyond the science of nursing. I understood the commitment of a nurse-the ability to share oneself with another human being in a meaningful way. I realized how often we have the opportunity to reach out and care, and I realized how often we struggle to make that move. Why the struggle? Reasons from our past, from the present, and from within the situation do not let us experience our attitudes and feelings fully. This seems too dangerous and too potentially damaging.’ We are fearful of hurt and
AORN Journal, August 1977, Vol26, No 2
235
rejection if we reach out. What could hurt more than to have your caring turned down? As I pondered that day in the OR, I was saddened at how frequently we let situations pass where we could reach out and help another person. I began to think about empathy for all I had to do that day was stand there and project myself into other people’s lives and feelings. I began to read and study about the concept of empathy, which to me is one of the most precious qualities of nursing care we can deliver, not only to patients but also to team members. Empathy is defined as the ability to imagine vicariously how another person feels and as a result be able to predict accurately that person’s thoughts, feelings, and actions.z Empathy has been called the sixth sense, the ability to see with another’s eyes, hear with another’s ears, and feel with another’s heart. It can be understood as the feeling a mother has for her sick child or a wife for her husband when he fails. The essential component of empathy is the ability to imagine how another person feels. In this process, the nurse must suspend value judgments to accept what the other person is feeling.3In the case above, judging Dr Martin would accomplish nothing but anger; understanding how he felt would have helped him and the entire team. Why was he so anxious? Perhaps his mother had had her leg amputated. Perhaps he was diabetic. Maybe he knew what a struggle this would be for the patient’s family. We may never know the why of his anxiety, but we know he was distressed. If we can experience some of his distress, we are more apt to give him the support he needs. To become more skilled in imagining how another person feels, the nurse must learn how to listen. The art of listening has become neglected and poorly understood. We spend much time stating our own views and neglect to listen to other people’s ideas and feelings. Listening involves trying to see the problem the way the speaker sees it, in other words, empathizing, which is experiencing the emotion with him.‘ How much easier it would be to do preoperative visits if we felt some of the emotions of the patients and their families. Many times we struggle with what to say or we hide behind a checklist. Perhaps the most impor-
236
tant message to a patient and his family the night before surgery is, “I will be there. I will care for you.” This message may be communicated by a look or a touch. It may not be communicated with words; therefore, it must be felt. You may say, “That is a lot to ask’ and you are right. If we totally immerge ourselves in the feelings of others all day long, we become immobilized. However, there is a balance between distancing and protecting ourselves and allowing ourselves to slip momentarily in and out of other people’s lives. It is this ability that makes nursing and nurses so special. To have empathy, the nurse must be able to tolerate anxiety. She needs to lay aside her own anxiety, accept herself, and trust her own judgments to experience the feelings of another person. The more self-accepting and self-assured she is, the easier this will be. She must be spontaneous and able to experience her own feelings as well as those of others. She must be able to take on many roles easily and move from her own role to another person’s role without self-consciousness. She must be comfortable with feeling intimacy and caring for other people. Empathy increases the speed and effectiveness of communicati~n.~ As nurses, we need to be more involved with and aware of this phenomenon. We need to recognize empathy as part of our helping role. We need to have empathy for our peers as well as the patient and across disciplines. Let us recognize this precious asset in nursing. We are the ones who provide the care. Let us do it with care.
Bonnie Payne, RN, MS Associate director of education Notes 1. Carl R Rogers, On Becoming A Person (Boston: Houghton Mifflin Co, 1961) 111. 2. Marlene Kramer, Claudia Schmalenberg, “The first job . . . a proving ground,” Journal of Nursing Administration (January 1977) 13. 3. Margaret Baumgartner, Empathy; Behavioral Concepts and Nursing Interventions, Carolyn E Carlson, coordinator (Philadelphia and Toronto: J B Lippincott Co, 1970) 33. 4. S I Hayakawa, Symbol, status, and Personality (New York: Harcourt, Brace & World, Inc, 1963) 32. 5. Kramer, “The first job,” 15.
AORN Journal, August 1977, Vol26, No 2
