Can you learn how to be empathic? A new nursing education intervention says yes

It is not easy to change health risk behaviors, and it can be even more difficult for nurses to provide counselling on such delicate issues. In this pilot study recently published in BMC Nursing, the authors develop their Heart Health Whispering intervention, teaching nursing students perspective-taking and clinical empathy.

Researchers from the University of Manitoba, Canada, worked towards the development of a promising Heart Heath Whispering intervention, seen as needed to fill a gap in nursing health promotion education, as they state:  ‘Training opportunities to foster confidence and skills in empathetic counselling are needed.’

Due to the high cost and low quality of life associated with chronic illness, an effective counselling system that could help people to change their health risk behaviors could represent a useful upstream approach to prevent illness instead of treating it.

But health risk behaviors, such as smoking, binge eating or lack of exercise, are often tied to very personal situations and stressful variables, which can be difficult to face in counselling.

This is particularly clear if we consider the example of family carers, a big segment of the population that tends to engage in health risk behaviors, due to high expectations and stressors associated with facing both caregiving and employment challenges. Unfortunately, carers often report a feeling of not being heard or understood by care providers, as the latter were perceived as not concerned for their wellbeing.

On the other hand, nurses describe a lack of motivation to counsel, due either to clients’ resistance or to lack of empathy, patience or time.

The authors explain that only ‘when nursing students make it a priority to perspective-take, empathically listen, and discern the carer’s unique circumstances’ is the carer bolstered to take ownership for his or her own health risk behaviors. Moreover, ‘the capacity of nurses to demonstrate clinical empathy is best achieved at the student level, while their attitudes and skills are being formed.’

Students receiving the training reported that perspective-taking enhanced their ‘exploring skills’ and made them feel greater clinical empathy ….

With this in mind, the authors developed the Heart Health Whispering intervention, ‘a novel person-centered approach for counselling and health promotion.’ Through video-tagging sessions between nursing students and carer actors, they tested how nursing students could learn clinical empathy, especially through self-evaluation and perspective-taking.

Perspective-taking is a teachable component which, in this context, aims to sensitizes the clinicians to be aware of their own thoughts and feelings regarding risk behaviors, to control them in order to enter ‘in the client’s shoes,’ and to seek validation of his/her inferences of the client’s viewpoint.

Training clinical empathy

In this pilot study, the ability to learn clinical empathy was tested in nursing students either receiving or not perspective-taking instructions and training, taking into account both students’ and carer actors’ perceptions.

Students receiving the training reported that perspective-taking enhanced their ‘exploring skills’ and made them feel greater clinical empathy, highlighting the potential importance of introducing such training, once standardized, into educational curricula.

During their recorded dialogue with the carer actor, students of both groups demonstrated empathy, even if one group did not receive a preparation training of perspective-taking.

Interestingly, carers rating of the students empathy was higher than the students’ self-assessment and, even more unexpected, carers found the students who did not receive the training more empathic than the others, who seemed sometimes ‘not delving enough’, ‘inauthentic’ or ‘paternalistic.’ It is possible that the trained students ‘were struggling with practicing their new skills resulting in poorer performance than students’ of the other group, who likely were less distracted and just focused on their previously acquired skills, the authors suggest in their discussion.

Carers and students were able to see their recorded dialogue, and this afterwards ‘video analysis’ encouraged self-awareness in the students, who referred to this practice as ‘eye-opening’ and ‘a good way to learn.’

The authors conclude that the results of this pilot study ‘appeared promising and warrant further testing.’ The Heart Heath Whispering intervention ‘has implications for ongoing empirical work to … bolster clinician clinical empathy so as to avoid “jumping ahead of the patient” when engaging in therapeutic conversations on carer self-care.’

There is great potential value of such a technique, which gives the students the opportunity to self-evaluate and practice in taking the patients’ perspective, as the long-term goal is to alter health risk behavior choices of family carers  and promoting health care by increasing counselors’ communication skills and empathy.

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