doi: 10.56294/cid202367
SHORT COMMUNICATION
Empathy in nursing professionals for care subjects with depression
La empatía en los profesionales de enfermería para los sujetos de atención con depresión
Lorena del Carmen Toconas1 
*
1Universidad ISALUD. Ciudad Autónoma de Buenos Aires, Argentina.
Cite as: Toconas L del C. Empathy in nursing professionals for care subjects with depression. Community and Interculturality in Dialogue 2023; 3:67. https://doi.org/10.56294/cid202367
Submitted: 15-05-2023 Revised: 30-06-2023 Accepted: 20-07-2023 Published: 21-07-2023
Editor:
Prof. Dr. Javier González Argote
Translated by: Cristhian Alejandro Pérez Pacheco *
ABSTRACT
Introduction: empathy in nursing professionals and its impact on quality of care, as well as the challenges they face, are highlighted. Compassion fatigue” due to frequent use of empathy is explored. The study seeks to improve communication and empathic care, especially in patients with psychological health disturbance. The research aims to identify strategies for better care management.
Methods: a literature search was conducted in PubMed with the keywords “empathy”, “empathy”, “nursing” and “depression”, establishing inclusion and exclusion criteria to select 7 relevant articles on empathy in nursing professionals for care subjects with depression in the last 5 years and open access.
Results: the studies provide valuable information on the psychological health of health professionals and the importance of empathy in their practice. The results highlight the need to implement effective interventions to improve the mental health of these professionals and their empathic capacity in patient care.
Conclusions: empathy is crucial in nursing care, but the presence of negative mental states, such as depression, can affect it. The high prevalence of depression and anxiety disorders in mental health also influences empathy towards patients with eating disorders. Addressing stress, burnout, and stigma is essential to improve empathy in health professional practice and benefit patients.
Keywords: Empathy; Nursing; Depression.
RESUMEN
Introducción: la empatía en profesionales de enfermería y su impacto en la calidad de atención, así como los desafíos que enfrentan, son temas destacados. Se explora la “fatiga por compasión” debido al uso frecuente de la empatía. El estudio busca mejorar la comunicación y el cuidado empático, especialmente en pacientes con alteración de salud psicológica. La investigación pretende identificar estrategias para una mejor gestión de cuidados.
Métodos: se realizó una búsqueda bibliográfica en PubMed con las palabras claves de “empatía”, “empatía”, “enfermería” y “depresión”, estableciendo criterios de inclusión y exclusión para seleccionar 7 artículos relevantes sobre la empatía en los profesionales de enfermería para los sujetos de atención con depresión en los últimos 5 años y de acceso abierto.
Resultados: los estudios proporcionan información valiosa sobre la salud psicológica de los profesionales de la salud y la importancia de la empatía en su práctica. Los resultados resaltan la necesidad de implementar intervenciones efectivas para mejorar la salud mental de estos profesionales y su capacidad empática en la atención a los pacientes.
Conclusiones: la empatía es crucial en la atención de enfermería, pero la presencia de estados mentales negativos, como la depresión, puede afectarla. La alta prevalencia de depresión y trastornos de ansiedad en salud mental también influye en la empatía hacia pacientes con trastornos alimentarios. Es esencial abordar el estrés, agotamiento y estigma para mejorar la empatía en la práctica de profesionales de la salud y beneficiar a los pacientes.
Palabras clave: Empatía; Enfermería; Depresión.
INTRODUCTION
By definition, empathy involves the human capacity to place oneself in other people’s position, and is divided into two main dimensions: emotional/affective empathy, which entails the emergence of feelings or emotions in response to the other person's condition, and cognitive empathy, characterized by the ability to identify and understand the other person’s condition.(1)
Nursing professionals may be more susceptible to negative mental states, such as depression, anxiety, and stress, which may be related to certain work conditions, including workload and the necessity to work multiple shifts. Furthermore, the prevalence of institutionalized mental health issues is high, becoming a factor that increases dependence. Impairment or disturbance of mental health can have a detrimental impact not only on their own well-being but also on the quality of care they provide.(2)
While empathy is one of the key factors contributing to the quality of care, a poor balance can potentially harm the health of professionals.
The frequent utilization of empathetic capacity in dealing with the suffering of the subject of care can result in a syndrome known as “compassion fatigue”.(3)
From the healthcare perspective, the results of the current investigation can contribute to improving the quality of care provided by nursing and other professionals who have direct contact with patient throughout the health and illness process. This improvement contributes to better communication during anamnesis, physical examination, or consultations with the indicated therapist, ultimately leading to an increased adherence to treatment. Moreover, it positively impacts patient, family, and healthcare professional satisfaction, resulting in a highly competent professional who delivers humanized, polite, and empathetic treatment.(4,5)
Nursing involves providing care to patients on a day-to-day basis. The subjects of care, in general, often find themselves in new situations for them or, at least, most of the time, unwanted or unexpected situations; sometimes filled with fears, insecurities, uncertainty, sadness, and distress.(6)
Comprehending the circumstances, emotions, and necessities of the subjects of care is crucial for initiating a therapeutic relationship. The cornerstone of this approach is empathy, as it is the attribute that provides nursing professional with the genuine ability to understand the experiences of the other person.(7)
The capacity to communicate an understanding of the patient's experience allows the information to be validated by the patient themselves: it involves the use of appropriate and effective communication. It is through this ability to perceive and comprehend the other that the cognitive and emotional dimensions of empathy can converge, creating an integrated view within the concept of empathy.(8)
Until recently, patients with mental health disorders were typically concentrated in hospitals designed specifically for this purpose, leading to their isolation from society, as any patient manifesting a mental health-related illness would be interned in separate institutions. However, with the enactment of the new mental health law (Law 26.657), the main argument being that individuals with these type of disorders should be treated in their habitat or community, alongside their family and in cases requiring hospitalization, it should be carried out in general hospitals to prevent the isolation of the individual.(9) Due to the implementation of this law, it is essential to possess specific knowledge for the care of patients suffering from such disorders to ensure a high quality of care.(10)
The contributions of the research aim to characterize the concept of empathy among healthcare professionals engaged in care management. Simultaneously, the review on the topic aims to disseminate the provided knowledge for identifying and addressing this issue. This implies considering strategies to enhance the care management skills of nursing professionals for improved patient care, ultimately achieving a more empathetic approach.
METHODS
To conduct the bibliographic search on empathy in nursing professionals for subjects with depression, the PubMed database was utilized. The keywords were: empathy, nursing, and depression. The search expression used was “empathy AND nursing AND depression”. Inclusion and exclusion criteria were established to select relevant studies, such as: a focus on identifying actions that involve thinking about strategies to improve the care management of nursing professionals for better patient care, being in English, Spanish, or Portuguese, falling under the nursing thematic area, being published in the last 5 years (2018-2023), and being open access and freely available. On the other hand, studies were excluded if they focused their information on caregivers and therapeutic assistants or if they addressed empathy in other types of pathologies and not depression. The review was conducted following the PRISMA workflow.(11)
Finally, 6 articles were included for analysis after applying the selection criteria. The workflow algorithm used is summarized in Figure 1.
RESULTS
In this context, the manner in which care is provided to the subjects of attention is the principal point of discussion, and the healthcare professionals need to be trained technically and emotionally to fulfill this role, with the development of empathy being crucial for them.
The workflow conducted according to the proposed methodology is presented in figure 1.
|
Identification |
|
Studies identified with the filters, inclusion and exclusion criteria applied. (n=12) |
→ |
Excluded duplicate articles (n=0) |
|
|
|
↓ |
|
|
|
Selection |
|
Articles selected to read titles and abstracts (n=12) |
→ |
Articles eliminated as not related to the topic. (n=5) Subscription articles (n=1) |
|
|
|
↓ |
|
|
|
Inclusion |
|
Papers included in the selection (n=6) |
|
|
Figure 1. PRISMA workflow diagram
In table 1, the main results of the included articles for reading and analysis are presented. It includes the author, country of origin, year, type of study, research sample, and main findings.
|
Table 1. Characteristics and findings of the included articles |
||||
|
Author, year, country. |
Type of study |
Sample |
Intervention |
Main findings |
|
Pérula-de Torres et al. 2019. Spain. (12) |
Controlled clinical trial |
66 tutors and 66 residents |
Comparative analysis of a mindfulness and self-compassion 4-session program versus an 8-session program to reduce work stress and burnout in family and community medicine physicians and nurses. |
The “MUNDUDD” study is a clinical trial that evaluates a mindfulness and self-compassion program in family and community medicine physicians and nurses. Questionnaires are employed to assess stress, burnout, and anxiety-depression. The aim is to evaluate the effectiveness of the condensed program and its seamless integration into training. The standard 8-session program was proven to diminish levels of work stress and burnout among both residents and tutors. |
|
Borges et al. 2021. Brazil. (2) |
Cross-sectional study |
101 health professionals |
Verify the relationship between empathy and depressive symptoms among health professionals.
|
In health professionals, the presence of depression can be a predictive factor for exhaustion and, consequently, can directly interfere in the quality of care provided to the patient. A prevalence of depression at 19,8 % was identified. Professionals with depression exhibited higher levels of empathy, especially in the emotional domain. |
|
Murfield et al. 2021. Australia. (3) |
Review |
32 scientific papers |
Overview of mindfulness- and compassion-based interventions with family carers of older adults, to aid healthcare practitioners in their decision-making around referral to healthcare services. |
A variety of health outcomes were assessed across interventions, with the most common being depression, anxiety, burden, quality of life, and stress. Results varied across different studies, and the evidence-base for each intervention was insufficient and too heterogeneous to make clear statements regarding effectiveness. The interventions show some potential utility in supporting family carers in their role, and the collective rate of attrition was 18 %, suggesting that these interventions may be acceptable to carers. |
|
Kim et al. 2018. China. (13) |
Brief review |
Scientific papers |
Literature reading on enhancing empathy skills.
|
Empathy can be enhanced by reading literature. Among programs that proved efficient are role exchange programs, here-and-now spontaneity, perspective taking, simulation exercises, and so on. The problem with them is that they require special facilities and equipment. If they are not available, reading practice would be the best alternative. |
|
Fan et al. 2023. Taiwan. (14) |
Clinical trial |
62 women |
Three nursing counseling sessions. |
Participants in the experimental group exhibited significant reductions in stress and depression following the nursing counseling. No significative differences were found in the control group for any of the outcome measures. |
|
Huang et al. 2021. China. (15) |
Systematic review |
31 studies involving a total of 7114 patients |
Investigation on the correlates of stigma for patients with cancer. |
Cancer stigma shared positive associations with male gender, symptoms, depression, anxiety, body image loss, self-blame, social constraint, intrusive thoughts, and ambivalence over emotional expression. Nursing staff plays a pivotal role in the emotional recovery of patients. |
DISCUSSION
The reviewed articles delve into diverse aspects related to empathy among nursing professionals within the context of psychological health disorders such as depression. The “MINDUUDD” study presents noteworthy findings regarding the effectiveness of a mindfulness and self-compassion program for family and community medicine physicians and nurses. The questionnaires employed to gauge work stress, burnout, empathy, and anxiety-depression, yielded relevant information on the psychological well-being of health professionals.(12,16)
Healthcare professionals concurrently grappling with depression have an increased risk of experiencing burnout, which can detrimentally impact the quality of care provided to patients. The prevalence of depression within this group was 19,8 %, underscoring the imperative to address the mental health of healthcare professionals appropriately.(2) Similar observations were reported by Marshman et al.(17)
In the realm of empathy, it was observed that professionals with depression tend to exhibit higher levels of empathy, especially in the emotional domain.(18) This could have significant implications for how these professionals interact with their patients and deliver care. (13) However, other authors suggest that sentiments such as sympathy, pity, solace, compassion, and commiseration should be reexamined and may be more suitable than empathy during certain phases of the illness experience.(19)
In relation to interventions to enhance health, it was observed that outcomes vary across different studies, and the evidence-base is both insufficient and heterogeneous. Nevertheless, these interventions show potential utility in supporting family carers.(14)
In the context of enhancing empathy, reading literature emerged as an efficient and practical method to attain it. Reading enables readers to identify and sympathize with the characters in the narrative, thereby fostering empathy.(13,20)
Concerning cancer stigma, the study identified positive associations with empathetic attitudes among nursing professionals.(15)
CONCLUSIONS
Empathy plays a pivotal role in determining the quality of care provided by nursing professionals to their patients. Nevertheless, the existence of negative mental states, such as depression, can adversely affect the empathetic capacity of professionals and, consequently, the quality of care delivered. It is essential to pay attention to the mental health of healthcare professionals and implement strategies to address burnout and stress they may experience.
Literature reading has been acknowledged as an efficient and practical approach to augment empathy among nursing professionals and in other domains. The capacity to identify oneself with characters in stories can foster a heightened understanding and empathy toward others.
The stigma associated with cancer constitutes a significant aspect that can exert influence on both empathy and the quality of care provided to patients. The results of the review and meta-analysis underscore the diverse correlations between stigma and various emotional and well-being aspects among patients with cancer.
In general, it is imperative for healthcare professionals, encompassing nurses and physicians, to recognize the importance of empathy in their practice and address factors such as stress, burnout, and stigma that may impact their empathetic capacity. The focus on mental health and well-being for both healthcare staff and patients can yield a positive impact on the overall quality of care and the therapeutic relationship between medical professionals and patients.
REFERENCES
1. He J, Wang J, Zhong H, Guan C. The Effectiveness of Multi-Component Interventions on the Positive and Negative Aspects of Well-Being among Informal Caregivers of People with Dementia: A Systematic Review and Meta-Analysis. Int J Environ Res Public Health 2022;19:6973. https://doi.org/10.3390/ijerph19126973.
2. Borges MM, Bomfim AJDL, Chagas MHN. Depression and empathy in health professionals who work in the long-term care institutions for older adults. Dement Neuropsychol 2021;15:381-6. https://doi.org/10.1590/1980-57642021dn15-030011.
3. Murfield J, Moyle W, O’Donovan A. Mindfulness- and compassion-based interventions for family carers of older adults: A scoping review. Int J Nurs Stud 2021;116:103495. https://doi.org/10.1016/j.ijnurstu.2019.103495.
4. Moreno ZV, Ravelo EN, Llanes LA, Castillo IES, Tamargo YC. Ansiedad, depresión y estrategias de afrontamiento en pacientes convalescientes de Covid-19. Interdiscip Rehabil Rehabil Interdiscip 2022;2:10-10. https://doi.org/10.56294/ri202210.
5. Montano M de las NV. The psychiatric dysfunctions associated to the labor estrés in professionals of the education. Interdiscip Rehabil Rehabil Interdiscip 2023;3:60-60. https://doi.org/10.56294/ri202360.
6. Pardo AAE, Solorzano RE, Garnica J, Condo A. Evaluación de la ansiedad en adultos drogodependientes institucionalizados en centros de rehabilitación. Salud Cienc Tecnol 2023;3:226-226. https://doi.org/10.56294/saludcyt2023226.
7. Meekums B, Karkou V, Nelson EA. Dance movement therapy for depression. Cochrane Database Syst Rev 2015;2015:CD009895. https://doi.org/10.1002/14651858.CD009895.pub2.
8. Moudatsou M, Stavropoulou A, Philalithis A, Koukouli S. The Role of Empathy in Health and Social Care Professionals. Healthc Basel Switz 2020;8:26. https://doi.org/10.3390/healthcare8010026.
9. Cámara de Diputados de la Nación Argentina. Ley Nacional de Salud Mental/Ley 26.657 2010.
10. Soto IBR, Calmet VGV, Armas HMA, Mantilla MMF, Sánchez GJV. Ansiedad y depresión durante la pandemia por COVID-19 en habitantes de Perú. Salud Cienc Tecnol 2022;2:128-128. https://doi.org/10.56294/saludcyt2022128.
11. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Rev Esp Cardiol 2021;74:790-9. https://doi.org/10.1016/j.recesp.2021.06.016.
12. Pérula-de Torres L-A, Atalaya JCV-M, García-Campayo J, Roldán-Villalobos A, Magallón-Botaya R, Bartolomé-Moreno C, et al. Controlled clinical trial comparing the effectiveness of a mindfulness and self-compassion 4-session programme versus an 8-session programme to reduce work stress and burnout in family and community medicine physicians and nurses: MINDUUDD study protocol. BMC Fam Pract 2019;20:24. https://doi.org/10.1186/s12875-019-0913-z.
13. Kim MJ, Moon S, Oh B-C, Jung D, Ji K, Choi K, et al. Association between perfluoroalkyl substances exposure and thyroid function in adults: A meta-analysis. PLOS ONE 2018;13:e0197244. https://doi.org/10.1371/journal.pone.0197244.
14. Fan Y-C, Hsiao F-H, Hsieh C-C. The effectiveness of compassion-based interventions among cancer patients: A systematic review and meta-analysis. Palliat Support Care 2023;21:534-46. https://doi.org/10.1017/S1478951522001316.
15. Huang Z, Yu T, Wu S, Hu A. Correlates of stigma for patients with cancer: a systematic review and meta-analysis. Support Care Cancer 2021;29:1195-203. https://doi.org/10.1007/s00520-020-05780-8.
16. Shah UN, Gupta S, Koshy B. El impacto del entrenamiento en mindfulness para enfermeras en la reducción del estrés y la mejora del bienestar. Salud Cienc Tecnol 2023;3:446-446. https://doi.org/10.56294/saludcyt2023446.
17. Marshman C, Hansen A, Munro I. Compassion fatigue in mental health nurses: A systematic review. J Psychiatr Ment Health Nurs 2022;29:529-43. https://doi.org/10.1111/jpm.12812.
18. Torres A, Pérez-Galavís A, Ron M, Mendoza N. Factores Psicosociales Laborales y Estrés en el Personal Médico Asistencial. Interdiscip Rehabil Rehabil Interdiscip 2023;3:42-42. https://doi.org/10.56294/ri202342.
19. Fernandez AV, Zahavi D. Basic empathy: Developing the concept of empathy from the ground up. Int J Nurs Stud 2020;110:103695. https://doi.org/10.1016/j.ijnurstu.2020.103695.
20. Nuñez JMA, Balarezo GMS, Garcés MGP, Supe FAS. Carga laboral en áreas críticas y “TISS 28”. Salud Cienc Tecnol 2023;3:385-385. https://doi.org/10.56294/saludcyt2023385.
FINANCING
No external financing.
CONFLICT OF INTEREST
There are no conflicts of interest.
AUTHORSHIP CONTRIBUTION
Conceptualization: Lorena del Carmen Toconas.
Research: Lorena del Carmen Toconas.
Methodology: Lorena del Carmen Toconas.
Project administration: Lorena del Carmen Toconas.
Original writing-drafting: Lorena del Carmen Toconas.
Writing-revision and editing: Lorena del Carmen Toconas.