Of the many concepts associated with professional practice in the realm of health care, few are more uniquely attributed to nursing than “empathy”. Some people may remember this concept from the dark days of nursing school history, while others may come across this term in articles, discussion, or academic literature. Despite the seeming omnipresence of the term empathy, it remains an elusive concept. We are told that we must express empathy to our patients; that empathy is what makes nursing unique compared to the primarily mechanistic or bio-centric tendencies of medicine. So, the question arises: what is empathy?
A personal reflection on my own nursing school history brings me to my second year clinical rotation. Unlike the stereotypical ivory tower “head-in-the-clouds” characteristics that are common among many nursing academics, my second year clinical professor had a practical, down-to-earth approach to clinical practice that was quite refreshing. Consistent with her supposed realism, I distinctly remember this professor making the statement: “Empathy is a very abstract philosophical idea, and I’m not sure it even exists.”
As a relatively novice practitioner, yet with enough experience to develop my own ideas, I have decided to put the question of empathy to the test. What is empathy, how is it validated, and how is it applied to nursing practice?
A dictionary definition of empathy states that empathy is the understanding of another’s feelings: the ability to identify with and understand another person’s feelings or difficulties (Encarta, 2004). It is also said that “the term is usually used to convey the idea of the ability to enter the perceptual world of another person; to see the world as they see it. It also suggests an ability to convey this perception to the other person (Burnard, 1995).”
A review of some nursing literature indicates that empathy can be broken into various components and can be conceptualized as behaviour, a personality dimension, and an experienced emotion (Bennet, 1995). There seems to be a consensus among nursing scholars that empathy is a very complex, interpersonal phenomenon that has proven difficult to study (Bennet, 1995). For instance, is it an understanding, in the cognitive sense, of what another is thinking or feeling? Or is it when one personally feels what another person is feeling?
This brings us to another concept that is frequently associated and/or confused with empathy. That is, what is the difference between empathy and sympathy? The dictionary definition of sympathy is capacity to share feelings: the ability to enter into, understand or share somebody else’s feelings; sorrow for another’s pain; the feeling or expression of pity or sorrow for the pain or distress of somebody else (Encarta, 2004). Empathy is different from sympathy because “sympathy suggests â€˜feeling sorry’ for the other person perhaps identifying with how they feel (Burnard, 1990).” In other words, sympathy appears to be rooted more in the subjective experience of another person, as opposed to an objective understanding of another person’s circumstances. Sympathy is primarily focused on emotions whereas empathy requires identifying the source of emotions.
With some background and some definitions of empathy, along with the differentiation between empathy and sympathy, my second year clinical professor’s proposition remains un-tended to. Recall her statement that empathy is “abstract” and possibly does not exist.
In syllogistic format, my professor’s argument is as follows. Abstractions do not exist. Empathy is an abstraction. Therefore empathy does not exist.
My position is that although empathy is an abstract concept, it needs to be clarified and validated. In order to validate the concept, it requires some philosophical investigation. I sustain that the key component of empathy and therefore its usefulness and application to nursing practice is hinged upon objectivity. This includes looking outward at the world and identifying the facts of reality, and looking inward and applying principles of self-objectivity.
The philosophical debate concerning the nature of abstractions is very complex, would require volumes of discussion, and is beyond the scope of this essay. For my intents and purposes, I can summarize the debate as a question whether abstractions such as empathy are valid in the sense that they can be derived from the facts of reality; or, are they arbitrary, disconnected, and “out-there” but never fully attainable?
The philosopher Plato is commonly associated with notion of abstract ideas being disconnected from reality, existing in another dimension in an almost mystical sense. This is the basis for terms like “platonic love” or “platonic friendship.” Other philosophers such as Berkeley and Hume of the empiricist school of philosophy took it upon themselves to deny that there is such thing as abstract ideas (Russell, 1912).
The theory of concepts on which I am basing my defense of empathy is derived from Ayn Rand’s philosophy of Objectivism. In this philosophy, concept formation is described as an isolation of a group of concretes (distinct perceptual units), on the basis of observed similarities which distinguish them from all other known concretes; then, by a process of omitting the particular measurements of these concretes, one integrates them in to a new mental unit: which subsumes all concretes of this kind (Peikoff, 1967).
As previously stated, the key component in empathy is objectivity. This means that the human conceptual faculty, i.e. our consciousness, is capable of identifying and integrating the facts of existence into concepts which serve as a basis to form higher-level abstractions such as empathy.
Consider a situation in which one empathizes with a patient. One cannot observe empathy at the immediate sensory level. One cannot see a nurse and a patient interacting and point to something concrete and call it empathy. Rather, empathy is an abstraction derived from concretes determined by a nurse-patient context; the concretes are integrated in our mind thus forming the concept. Recall the dictionary definition of empathy in which one “identifies and understands” another person’s feelings or difficulties. Identifying and understanding another person’s situation requires a feat of abstract thinking while at the same time keeping two feet firmly planted in reality.
Of course, one cannot physically “enter into” the mind of another person. If that is what is meant by empathy, then it certainly is impossible, and empathy is an invalid concept. Yet if we are all discrete individuals, how can a nurse really know how a patient is feeling? If I have never been a patient myself, then how can I know what it is like to be a patient? This is where self-objectivity plays an important role. Even though I may have never been a patient in a hospital, perhaps I have been sick requiring bed-rest at home. From the standpoint of my current health status, current well-being, and knowledge of all my values, I can identify the sense of loss, anxiety, distress, and depression if I were to succumb to life threatening illness.
I emphasize here the ability to identify abstractions such as “value” and “loss” as lower level abstractions upon which empathy is based. Although we are all unique individuals, whose values may differ concretely, it is the identification of concepts such as value and loss that play an important role in allowing me to enter the perceptual world of another person, and therefore empathize with them. Although my values may include reading philosophy while another person’s values may include playing sports, it is the abstraction “value” that I objectively identify and retain. For example, I may have a patient who, after recovering from post-op complications, expresses distress over the well-being of her cats at home. If I have no cats at home, or no pets for that matter, how can I truly empathize with my patient? Again, by observing objectively that this patient is expressing concern for her cats which are of value to her, I can then apply some self-objectivity and discern that I personally have values. By understanding what my patient is experiencing in relation to objectively identified abstractions such as “value”, it allows me to enter into a level of understanding with my patient that would be impossible if I focused only on concretes such as “cats.” Empathy depends on our own level of sensitivity and common human understanding of life and life events as opposed to merely similarities of personal experience (Brykcznska, 1992).
It can be seen how empathy would differ from sympathy. Since sympathy has a basis in subjectivity, it negates the kind of thinking requirements that empathy demands. To sympathize is to identify another person’s feelings, as opposed to empathy which is identifying the source and the objective basis of the patient’s feelings. To identify the objective basis of the patient’s situation requires more than looking at the concrete facts, but to integrate them into broader abstractions that lead toward a shared experience.
At this point, I have identified the existence and the nature of the concept empathy. In summary, it is the ability to identify the shared experience in nurse-patient relationship, not exclusively at the concrete level, but at the abstract level. It is the possibility of shared experience at this abstract level that validates the concept empathy.
Knowing what empathy is and having an understanding of how it is applied raises a further question: what is the value of empathy? My personal view is that empathy does not have any intrinsic value. As opposed to being and end-in-itself, I view empathy as being a means to an end. This presupposes the question as to what ends does empathy serve. Since we, as nurses, engage in the practice of treating and monitoring patients, our ends consist of the promotion of the health and well-being of our patients.
There are numerous examples of how empathy can serve as a means to various ends within the context of promoting the health and well-being of the patient. For instance, return to my example of the patient who is distressed about the well being of her cats. Empathizing with her concern over something she values, it can motivate one to seek a resolution and alleviate this source of anxiety.
It is the empathizing with family that plays an important role in nursing practice in the intensive care unit (ICU). Using the principles of objectivity and self objectivity, one can try to understand the perceptual world of family member whose loved one is requiring care in the ICU. An example of how one can use these principles, if one has never had a family member of their own require intervention in the ICU, is to imagine a first day as a nurse or a student upon entering the ICU. Recall the overwhelming lights, noises, and activity. Perhaps you can recall more recently being floated to work in ER and being overwhelmed by that experience. By identifying and isolating certain abstractions such as fear and uncertainty, regardless of the concretes that give rise to the emotions, one can begin to empathize with a family member entering into the ICU for the first time. Thereby empathizing, it should lead one to alleviate or at least mitigate the fears and anxieties felt by the family member. This may include explaining things a certain way, or speaking in a slow and calm tone for example.
In conclusion, it is evident that empathy is a valid concept and is very important in the RN’s role. By applying the principles of objectivity, including self-objectivity, nurses can use their abstract thinking abilities to identify with patients and therefore, within each patient’s context, promote their health and well-being.
Bennet, J. (1995). Methodological notes on empathy: further considerations. Advanced Nursing Science. (18): 36-50.
Brykczynska, G. (1992). Nursing Care: The Challenge to Change. Edward Arnold: London, UK.
Burnard, P. (1990). Learning Human Skills: An experiential guide for nurses (2nd ed). British Library Cataloguing in Publication Data: Oxford, UK.