Using Empathy in Communication

Introduction

Successful communication in healthcare leads to effective patient care and improving patients' satisfaction and independence. In addition, effective communication can protect the patient from adverse health consequences resulting from poor communication such as medication errors or contraindications. One way to effectively communicate with patients is to use emphatic communication. Empathy allows healthcare workers to understand others and share thoughts, feelings and experiences. . Provider-patient empathetic communication has shown to lead to better outcomes and treatment adherence.

Empathy

Empathy encompasses the ability to understand how someone thinks, feels and believes Furthermore, empathy can be further divided into two dimensions:

1. Cognitive empathy: ability to understand someone else's mental state
2. Affective empathy: ability to respond to someone's mental state with an appropriate emotion

dempathetic 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

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

urses’ empathic attitudes convey a caring message to their patients

and contribute to improved patient outcomes (e.g., increased physical

and mental well-being, tension relief), recognition of patients’

emotional responses, increased harmony and cooperation among the

healthcare team, and increased patient satisfaction (Zeighami et al.,

2020). Moreover, nurses’ empathetic behaviors may improve patients’

hospital stay experience and contribute to adherence to care recom-

mendations, which may in turn reduce care errors, anxiety, and dissat-

isfaction

lSympathy is feeling pity for someone, while empathy motivates us to act on that person’s behalfwe want to understand where they are coming from and how we can help. We do this through listening to and feeling with them, experiencing and understanding them from their perspective (g empathy is a choice; it is something we can learn how to do, and we can begin simply by getting in the habit of asking people how they are and

Barriers to Active Empathic Listening (AEL) A common problem with listening is that we tend to overemphasize the physical aspect of it; we assume that if we are hearing what they are saying Empathic Listening 65 then we are being a good listener. In reality, listening is so much more than nodding our heads, not interrupting, and being a blank slate at whom they can throw their words (McClelland, 2017; Shrivastava, 2014). If basic listening is a difficult process, then it can be assumed that active empathic listening (AEL) is even harder. Knowing this, the necessity of education, especially for leaders, on common barriers to AEL is crucial. Having this knowledge will better prepare leaders and future leaders to recognize AEL barriers in their own lives and navigate a course to more empathic listening. Speaking Rate Versus Listening Rate One logistical barrier to AEL is the fact that we process words much quicker than a speaker can speak them. A 1992 study found that the average speaking rate is 120–180 words per minute whereas the average listening capacity of the brain is 500–800 words per minute (Shrivastava, 2014). This gap naturally results in excess time for our brain to wander in the listening process. In a perfect world we would use this extra time to tap into empathy, perhaps by dialing in to what the speaker’s nonverbal communication is telling us about how they are feeling. Instead, it often becomes a time where we get off track; we rehearse in our head how we will respond or become distracted by a memory their story reminds us of (Salem, 2003). Defensiveness and Shame In conflict especially, defensiveness and shame are toxic habits that fuel the conflict cycle and directly halt the empathic process. While empathy draws us to another person and allows us to accept and understand their pain, defensiveness repels us from one another, undermining any hopes of connection. When we are focused on protecting ourselves and guarding our position, listening to and validating the other side of the story is most likely not the first item on our agenda (Beckenbach, Patrick, & Sells, 2010). Shame also prevents us from exploring the other’s perspective. Note that there is a difference between shame and guilt. Guilt originates when we recognize we have caused another person distress through a particular action; we see how reparative acts, like apologizing, may restore our relationship with them. Guilt is linked to perspective taking (the goal of empathy) and motivates us to do so. Shame, on the other hand, 66 The Journal of Student Leadership condemns the whole self, resulting in personal distress. Shame tells us that the affliction we have caused another person is not because of a particular action but because we ourselves are inherently bad. Why then would we want to hear the other’s perspective and further recognize the problem that we believe we are? When shame envelops us, we don’t listen with empathy; instead, we resort to more damaging behaviors such as ignoring the problem or the person, denying responsibility, or even lashing out at the very person who needs our empathy (Leith & Baumeister, 1998). Other Barriers There are other barriers to empathy, including: criticizing, challenging the legitimacy of the speaker’s feelings, giving advice, interrupting, and changing the subject (Salem, 2003). In the vulnerability of sharing one’s story, perhaps the worst response one can receive is that of criticism. Critical phrases such as “Why did you do that?” can staunch the open flow of information sharing and may result in feelings of shame if the speaker feels that the listener is negatively judging their character and actions. Likewise, the speaker should not feel like the purpose of sharing their story is to convince the listener of the truthfulness of their feelings; they want to be trusted and validated. Furthermore, if we are interrupting, giving advice, or changing the subject, the listener may feel that we are there to listen minimally and then get our point across. These responses may communicate that we want to change them and how they do things instead of communicating understanding and support (Jones, Bodie, & Hughes, 2016; Serbin, 2013). Enablers of AEL Admittedly, we are all human, and because of this we give in to behaviors that hinder AEL. We get distracted, become defensive, shame ourselves or others, interrupt, criticize, and give advice even when we have good intentions in our listening. But, as leaders, we can do better than this. We can become agents of change in our lives and in the lives of others by learning how to overcome these barriers. The solutions to these barriers are contained within the AEL process, the steps of active listening with empathic habits woven throughout them. When acted upon, these are the habits that have the potential to transform communication, relationships, and leadership. Empathic Listening 67 Active Listening The active listening process is composed of three steps: sensing, processing, and responding. Sensing involves an active awareness of both the verbal and nonverbal, explicit and implicit information the speaker is communicating. Processing comprises synthesizing the information gained during the sensing stage into a narrative whole. The final step, responding, is the listener’s way of letting the speaker know that they hear and understand what is being communicated. This is done through verbal and nonverbal cues such as nodding one’s head, asking questions, and paraphrasing (Jones et al., 2016; Shrivastava, 2014). Together, the combination of sensing, processing, and responding contribute to the listener’s efforts to communicate empathy to the speaker. Mindfulness in the Sensing Stage In the active listening process, leaders can utilize the following empathic concepts to encourage a more compassionate flow of communication. David Sauvage, a corporation consultant, states that, “The basis of empathy is emotional self-awareness” (as cited in Manning-Schaffel, 2018). This means we have to sense and accept our own thoughts and emotions before we can do the same in our communication with others. In support of this claim, research shows that individuals who score high on mindfulness also score high on empathy and that vulnerable (empathic) listening is dependent on the listener’s understanding of what is happening internally for them (Jones et al., 2016; McClelland, 2017). In summary, if we are to accurately interpret and articulate someone’s emotions back to them, we must first be able to internalize and comprehend our own emotions. Part of this emotional intelligence is being able to differentiate when we are feeling guilt versus shame. In leadership, identifying shameful thoughts is an important step in correcting our thinking. Rather than resorting to defensiveness or retreating from a situation (which are common side-effects of shame), we can instead engage in reparative acts (i.e. apologizing, listening to the other person’s narrative) that produce empathic results in our relationships. 68 The Journal of Student Leadership Self-Exper

Empathy has an important role to play in establishing a positive nurse-patient relationship and offering favourable nursing care [4]. Nurses who show understanding of their patients’ illness experiences will find their relationship enhanced [5]. and Scott (2000) reported that nursing empathy could contribute to patient’s positive responses such as relief from pain, improved pulse, and emotional self-disclosure [12]. Williams (1979) found that the elderly patients received nursing empathy would experience a statistically significant improvement of self-concept [13]. It has also been found that nurse empathy could reduce the cancer patient’s anxiety, depression, and hostility significantly [14].

Competency can be subdivided into empathic skill, a communication skill, and the skill to build up a relationship with a patient based on mutual trust. Empathic skill is the approach by which the physician can elicit the inner world of the patient and get as much information as possible from the patient, while at the same time recognising the patient’s problem.2,30,31 Communication skill is used to check, clarify, support, understand, reconstruct, and reflect on the perception of a patient’s thoughts and feelings.15,23 The skill to build up a trusting and long-standing patient–physician relationship encourages physicians to resonate with the patient emotionally. These long-term relationships are important for telling and listening to the stories of illness.32,33

Behaviour has a cognitive and an affective part. The cognitive part includes verbal and/or non-verbal skills.14,15,22,25,26 The affective part includes recognition of the emotional state or situation of the patient, being moved, and recognising a feeling of identification with someone who suffers with anger, grief, and disappointment. After this recognition, the physician, in their behaviour, reflects on and communicates their understanding to the patient (Figure 1).20,23here is a relationship between empathy in patient–physician communication and patient satisfaction and adherence, patients’ anxiety and distress, better diagnostic and clinical outcomes, and strengthening of patients’ enablement.

1. Listen without interruption
2. Pause and imagine how your employee is feeling
3. Show you hear them by reflecting back what they are saying: “What I hear you saying is…”
4. Validate their feelings: “I understand you’re feeling…”
5. Offer support and close the conversation
6. Follow up to see how the person is doing after a little time has passed

https://www.youtube.com/watch?v=IYkpnYzxz4k&t=5s