CPNRE® Comprehensive Review Series: Part 7





Moving ahead with the serialization of the CPNRE® Comprehensive Review eBook, today’s post is all about arguably the most important, and the most difficult skill we should practice – and what happens when we don’t. To catch you up, here’s part 1, part 2, part 3, part 4, part 5 and part 6.

Nurse-client interactions: Empathy

Real empathy is easier said than done, it’s hard work – because it’s more than just saying the right words. Real empathy is about feeling uncomfortable feelings and understanding the experience of another person.

Part of the reason why empathy is so difficult is because it’s not our natural instinct to walk in someone else’s shoes. It’s a skill that requires tremendous practice.

Empathy is generally defined as “the ability to think about our own experiences in order to connect with an experience someone else is going through”. In other words, it’s the skill of perceiving a situation from someone else’s perspective.

In order to understand the power of empathy, I think it’s helpful for us to understand how the absence of empathy can cause harm. The best teachable moments are usually the ones where people screw up, so here’s a story from my past that will hopefully illustrate for you how dangerous it is when we don’t feel empathy for the people we care for:

When I was 29 years old, I was diagnosed with thyroid cancer – a stage 2 Hurthle cell carcinoma. Unfortunately, it wasn’t the ‘good’ kind of thyroid cancer. It was the kind of thyroid cancer that often happens in older adulthood; the kind that often kills people. Naturally, I was devastated.

At the time of my diagnosis, I was in the last year of my nurse practitioner and Master’s program. It was my 25th year of formal education, and I was un-married, childless and in thousands of dollars of debt. By every expectation and measure of success in society, I was not doing well. Graduate school and life were huge stressors for me, and experiencing cancer on top of not feeling good enough was more than I could handle.

Besides facing my mortality at a young age, one of the hardest parts of having cancer was experiencing shaming comments from my family, friends and health care professionals. Comments like:

  • “You’re going to have a scar. You have a nice neck, why ruin it if you don’t have to?”
  • “You need to do better. You can do better. You need to pull yourself together.”
  • “You’re not actually sick. Why can’t you work?”
  • “People go through worse things than this.”
  • “At least you found it early. My mom died from it.
  • “You don’t look cancerous; I think you look fine. “
  • “Thyroidectomy patients are so demanding.”
  • “This is so disgusting.”

The shame and fear I was already feeling about myself grew worse after I heard these comments. The shame of, “I’m not a good enough woman” turned into “I’m not going to be pretty enough”. The shame of, “I’m afraid” turned into “I’m weak”. And the shame of “I’m broke” turned into “I’m demanding and disgusting”. These well-meaning people unintentionally judged and shamed me instead of practicing empathy. They threw just enough shame into my life to make me feel small and unworthy. They didn’t validate my fears or feelings about what I was experiencing. Most importantly, they didn’t see my world the way I was experiencing it – or try to understand what I might be experiencing. A lack of empathy from important people led me to feel ashamed about myself.

Researcher Brené Brown says that while we can’t make everything better for other people, we can help people feel accepted, validated and connected through empathy. Empathy, she says, has the ability to reduce aggression and agitation and alleviate shame. It can help us build meaningful relationships and connection.

Empathy, then, is the act of understanding why people say what they say and behave the way they do. It’s being aware of and sensitive to the feelings and thoughts of someone else. It’s the ability to feel something in ourselves that someone else is feeling. We can never really know what it’s like to be someone else, or provide people with what they need – unless we ask about, clarify and validate our understanding of their experience. When we’re practicing empathy, it usually leads us to say “I understand. I hear you. I see you. How can I help?”

Nursing professor Teresa Wiseman has identified four qualities of empathy:

  1. The ability to see the world as others see it
  2. The ability to be non-judgmental
  3. The ability to recognize another person’s feelings
  4. The ability to communicate our understanding of that person’s feelings

I believe that practicing empathy is arguably one of the most important things nurses can do for clients and families. Because the truth is, what we say and how we say it can make the difference between truly helping and causing harm.

When we talk about empathy, I think it’s equally important that we understand the difference between empathy and sympathy. Sympathy is best defined as “feeling sorry for someone”. It’s looking at someone who’s suffering or going through a tough time and saying to them “I feel bad for you”, while thinking to ourselves, “I don’t understand what it’s like, and am I ever glad I’m not them right now”.

The problem with sympathy is that it leads people to feel disconnected and alone, and diminishes their feelings and self-worth. We lean towards sympathy because it’s easier to feel sorry for someone than it is to feel what they’re feeling. For example, it’s easier for us to feel sorry for a child who’s lost her parent than it is for us to dig deep within ourselves and feel a sense of loss and communicate that to her.

Sympathy is also a by-product of our desire to want to make people feel better. By using sympathy to try and make someone feel better, we’re led to say things that we think will make someone’s situation seem better than it is. For example, when a woman experiences a miscarriage, sympathy is saying to her “I’m sorry for your loss, but at least you know you can become pregnant”. Or, when a parent loses a child, sympathy is saying to them “I can’t imagine losing a child, but at least they’re no longer suffering”.

From my experience with cancer, I can tell you that when people communicated with sympathy, they often made me feel worse. Hearing comments like “It sucks to have cancer, but at least you caught it early” or “At least you don’t have to have chemotherapy” made it very clear that these people didn’t see the experience from my perspective.

Here’s how we can demonstrate empathy with the clients and families we care for:

  • Listen to clients’ concerns, preferences, opinions, values, and beliefs (nodding, smiling, encouraging responses)
  • Maintain direct eye contact when appropriate
  • Use an open body language and a calm voice
  • Use open-ended rather than close-ended questions
  • Be attuned to clients’ behaviours
  • Put aside our own biases and judgments
  • Be consistent in our approach and responses
  • Clarify what we’re seeing and hearing to ensure we understand
  • Feel an experience from our own lives that connects with what someone else is feeling
  • Communicate our understanding of someone else’s experience, feelings and thoughts

Exam tactic

You can never go wrong with answering questions on the CPNRE® from a posture of empathy. Look for the answers that reflect the practical nurse seeking to understand what a person is feeling, and offering help based on their needs. Try to avoid choosing answers that reflect the practical nurse using sympathy. More often than not, sympathy diminishes people’s experiences, thoughts and feelings – and that’s not what clients need from us.