Using Empathy in Communication

Intro

he quality of communication between nurse and patient is recognized as an influential factor in improving patients’ care (2). Luker et al. showed that effective patient care is achieved through effective communication (3). Also, effective communication can improve patients’ independence and satisfaction (4,5) and protect the patient from adverse health consequences caused by ineffective communication such as medication error (6). One of the techniques of effective communication with the patient is empathetic communication (7). Empathy is one of the communication tools that we use to understand others and share our feelings, thoughts, and experience (8

empathetic communication with patients through three main categories of: (1) having humanistic and unique behaviors with the patients; (2) providing a calm and happy environment for the patients; and (3) reducing the patients’ fear and consolation to them.

Friendly behavior with patients
The unique way of dealing with each patient
Maintaining patients’ dignity
Considering the patients’ beliefs and culture
Paying attention to changing patients’ behavior
Providing a calm and happy environment for the patients	Creating a pleasant environment
	Using jokes
	Providing conditions for family meetings
	Being neat and happy
Reducing the patients’ fear and consolation to them	Giving hope to patients
	Using distraction to reduce patients’ stress and suffering
	Using spirituality to reduce patients’ pain and stress
	Normalization of new conditions

here is evidence to suggest that empathetic provider–patient communication can lead to better outcomes,5 treatment adherence,6 and patient satisfaction.7 8 A fundamental element of high-quality healthcare is for clinicians to recognise and respond to individual and families’ perspectives. Developing an understanding of differing perspectives and cultures builds responsibility, adaptability and empathetic communication skills that are critical in ensuring patients receive high-quality care and for developing therapeutic provider–patient relationships.9 10 Therefore, the development of empathetic communication should be the cornerstone for all health service provider–patient interactions.

Empathy is a broad umbrella term commonly described as consisting of different dimensions—including cognitive empathy, the ability to understand another’s mental state and affective empathy, the ability to respond to another’s mental state with an appropriate emotion.11 These are independent from one another,12 and empathy as a whole is modifiable with interventions.13 A component of affective empathy often described is empathic concern—displaying compassion/sympathy in response to another’s suffering.14 However, there remains significant inconsistency among scholars about the terms ‘cognitive empathy’ and ‘affective empathy’ and how they are defined impacts the method of measurement, for example, observable interpersonal behaviour or self-reports.15 16 Empathy and empathy education have been reviewed a number of times though systematic reviews and meta-analyses16–19; however, the topic of ‘empathetic communication’ remains poorly understood when considering engaging in hospital-based research.

o the layperson, empathy might seem to be a simple concept: the ability to understand what someone else feels, thinks, and believes. But scholars’ perspectives on the concept remain divergent and conflicting, and there is n

o the layperson, empathy might seem to be a simple concept: the ability to understand what someone else feels, thinks, and believes. But scholars’ perspectives on the concept remain divergent and conflicting, and there is no consensus in the literature on a definition (Verducci, 2000). As far back as 300BC, Chinese scholars debated the role of empathy in human interactions, and since then, references to empathy can be found in the work of many philosophers (Nowak, 2011). Early 20th century psychologists debated whether to see empathy as a predominantly affective or emotional construct (Lipps, 1903; Titchener, 1909) or as a more cognitive one (Kohler, 1929; Piaget, 1932).

Cognitive empathy refers to the intellectual processes a person uses to ascertain another person’s emotional state. These processes help us to assign meaning to the information we receive from others and can be learned through observation and experience. One aspect of cognitive empathy is “perspective taking,” or the ability to perceive a situation from someone else’s viewpoint (Davis, 1983). Using perspective-taking skills, people are able to imagine beyond their own frame of reference or experience and do so without bias or judgment based on how they would see the situation themselves (Moore, 2005; Parker et al., 2008).

Affective empathy refers to a person’s involuntary, internal responses to the emotional state of another person. Research suggests that many aspects of affective empathy are “built in” from birth as neurological functions (Rizzolatti & Craighero, 2005), aspects of personality (Baron-Cohen & Wheelwright, 2004; Eisenberg, 2007), biophysical reactions (Decety & Moriguchi, 2007; Iacoboni, 2005), biological dispositions (Hoffman, 1984), or motor skills (Blair, 2005).Both cognitive and affective aspects of empathy focus on individuals’ understanding of another person through their own internal experiences or assessments. But as a relational process, empathy also involves individuals’ behaviors in demonstrating this understanding to the other person (Hojat, 2009) and the interactions that influence this understanding (Zaki et al., 2008). Some conceptualize empathy as part of the communication process, for example, as an aspect of developing a connection to or feelings for another person (Miller, 2007; Rogers, 1975). But developing a connection with another person involves more than just empathy; it also involves, for example, compassion, congruence, resonance, and sympathy, traits that might or might not be appropriate to apply in professional situations. Schrooten and De Jong (2017) drew attention to a gap in the literature between the cognitive and affective aspects of empathy and the expression of empathy, arguing that empathy as a mental state does not automatically lead to empathetic communicative behaviors. They also argued that authors focusing on the expression of empathy sometimes seem to advocate tips and tricks for professionals to use in order to express empathy but that these tips do not necessarily help professionals to truly experience it.

In

the nursing context, empathy refers to the capability to understand the

ideas, experiences, and feelings expressed by another person and then

create a therapeutic relationship based on this understanding by interacting accordingly (Mercer & Reynolds, 2002). Therefore, empathy

helps nurses to maintain professional objectivity and make rational

decisions regarding patient care and improves their communication. In

contrast, sympathy is defined as an immediate and uncontrolled

emotional reaction that occurs when a person puts themself in another

person’s position. Sympathy represents emotional suubjectivity and may

lead to abeyance of care or interfere with ethical actions