1. R. Pardoe & I. Yeung

2. The Empathic Process and Its
Mediators – A Heuristic Model
(Gallop, Lancee, & Garfinkel, 1990)
 Objective: describes the model of empathic process
 Empathy is a tri-phasal, time-sequenced process:
 Inducement phase
 Matching phase
 Participatory-helping phase
 In each phase, different mediators can either hinder or
advance the empathic process

3. The Empathic Process... (cont’d)
Definition of Empathy:
“…there is a general agreement that empathy refers
to the ability to “know” the experience of another and
that some degree of matching of emotions is
inferred.”

4. Inducement THE EMPATHIC PROCESS
phase Disinterest
Overwhelmed
Matching
phase Over
identification
Engaged Perplexed
Participatory-
Helping phase
Defensive No action
State
Nonspecific
emotional
support
Match Instrumental
problem
solving
Understanding

5. Inducement Phase Outcomes
 Disinterested – observer proceeds to next
event.
 Overwhelmed – observer only focuses on
his/her affective response to event. Observer
may assume that the other person experiences
similar feelings and feel pity for the other but
not as an expression of desire to understand the
world of the other.
 Engaged – observer attends to observed and
wishes to proceed to next phase.

6. Inducement THE EMPATHIC PROCESS
phase Disinterest
Overwhelmed
Matching
phase Over
identification
Engaged Perplexed
Participatory-
Helping phase
Defensive No action
State
Nonspecific
emotional
support
Match Instrumental
problem
solving
Understanding

7. Matching Phase Outcomes
 Overidentification – Observer experiences loss
of self due to associated distress. Cannot help the
observed.
 Perplexed – generated hypotheses do not contain
observed content and affect. No match made.
 Defensive State – Observer experiences a
personal hit and the need to defend oneself is
stronger than the desire to help.
 Match – hypothetical situation matches observed
situation

8. Inducement THE EMPATHIC PROCESS
phase Disinterest
Overwhelmed
Matching
phase Over
identification
Engaged Perplexed
Participatory-
Helping phase
Defensive No action
State
Nonspecific
emotional
support
Match Instrumental
problem
solving
Understanding

9. Participatory-Helping Outcomes
 No action – does not mean no match!
 Nonspecific emotional support – observer
wants to “make person feel better”.
 Instrumental problem solving – attempt to
solve patient’s problems

10. Inducement THE EMPATHIC PROCESS
phase Disinterest
Overwhelmed
Matching
phase Over
identification
Engaged Perplexed
Participatory-
Helping phase
Defensive No action
State
Nonspecific
emotional
support
Match Instrumental
problem
solving
Patient: “I don’t know if I
Understanding
can get through this all”

11. The Empathic Process... (cont’d)
 Implications
 Guideline for nurses to…
 reflect on previous dialogues and identify which
stage and by which mediator an empathic process
ended
 communicate meaningfully and therapeutically
 In using this process, it becomes easier to
distinguish between empathy and other similar
concepts
 Empathy vs. Sympathy

12. Questions to consider
Do you think this model for the
empathic process is accurate? Why
or why not?

13. Questions to consider
Are there any ways it could be
improved?

14. Questions to consider
How can we go about teaching
empathy?

15. Pair up and discuss an example from
your clinical experiences in which
you followed the trajectory of the
empathic process? Where did you
end up in the model?

16. The Usefulness of the Staff-Patient Interaction
Response Scale for Palliative Care Nursing for
Measuring the Empathetic Capacity of Nursing
Students
(Adriaansen, van Achterberg, & Borm, 2008)
 Objective: To determine the reliability and validity of the
SPIRS-PCN as a measure of empathy in palliative care

17. The Usefulness of Staff-Patient Interaction...
(cont’d)
Definition of Empathy:
“…the ability to perceive the meanings and feelings of
another person and to communicate those feelings to
the other”

18. SPIRS-PCN (Appendix A)
Instructions: Please write a short response to the
patient's statement as if you were talking to the patient
 Context: Frank is a patient in his mid-60s. He was
admitted to hospital 4 days ago for chemotherapy for
advanced prostate cancer.
 Stimuli: While under your care, this patient says:
 “People at home are going to have trouble with this.”

19. Rating Table (Appendix B)
Likely to cause defensiveness Likely to engage in interaction
 Confronting  Trying to empower the pt
 Strong negative response  Giving an explanation
 Denial of responsibility  Asking superficially on the well-being of the
patient
 Asking for clarification
Reflective listening attitude
Patient : “People at home 
 Expressing interest
are going to have trouble 

Acknowledging fears
Explanation of the situation
with this.” 

Giving advice
Expressing a relevant opinion
Likely to terminate interaction Likely to keep discussion going
 Generalization  Inviting the patient to continue the dialogue
 Cliches  Inviting the patient to explore the situation
 Use of flattering statements  Trying to recognize feelings of the patient
 Focused on oneself  Recognizing the reality of the situation
 Accepting flattery of patient  Investigating profoundly the feelings of the pt
 Looking for reassurance
 Irrelevant opinion
 Giving presumptuous advice
 Giving presumptuous solution

20. The Usefulness of Staff-Patient Interaction...
(cont’d)
Major findings:
 Validity partially supported – SPIRS may also measure
maturity (or the ability to place oneself in another’s
shoes)
 Reliability supported (interrater reliability)
 Secular students scored lower on the SPIRS-PC than
religious students
 Students with experience scored higher than students
with no experience

21. Activity
 Form groups of 4
 Pick one of the two examples from the next slide and
come up with one response for each of categories listed
below:
 Likely to cause defensiveness
 Likely to terminate interaction
 Likely to engage in interaction
 Likely to keep discussion going
 Present in Skit Game form!

22. Examples
1.Frank is a patient in his 2. Anne is a patient in her
mid-60s. He was mid-20s with a hx of
admitted to the intravenous drug use
hospital 4 days ago for who was admitted to
chemotherapy for hospital 2 days ago for
advance prostate a liver biopsy. She is
cancer. positive for Hepatitis B
He says: “I don’t want to and HIV
be a burden to you” She says: “I just want to
stay in bed – please”

23. Likely to cause defensiveness Likely to engage in interaction
 Confronting  Trying to empower the pt
 Strong negative response  Giving an explanation
 Denial of responsibility  Asking superficially on the well-being of the
patient
 Asking for clarification
 Reflective listening attitude
 Expressing interest
 Acknowledging fears
 Explanation of the situation
 Giving advice
 Expressing a relevant opinion
Likely to terminate interaction Likely to keep discussion going
 Generalization  Inviting the patient to continue the dialogue
 Cliches  Inviting the patient to explore the situation
 Use of flattering statements  Trying to recognize feelings of the patient
 Focused on oneself  Recognizing the reality of the situation
 Accepting flattery of patient  Investigating profoundly the feelings of the pt
 Looking for reassurance
 Irrelevant opinion
 Giving presumptuous advice
 Giving presumptuous solution

24. The Impact of Nurses’ Empathic Responses on
Patients’ Pain Management in Acute Care
(Watt-Watson, Garfinkel, Gallop, Stevens & Streiner, 2000)
• Objective: To look at the relationship between nurses’
empathic responses and patients’ pain rating and
analgesia after surgery
• Definition of Empathy: “…an interactive process in
which health professionals wish to know and
understand the subjective experience of the patient.
Empathy is a sensing of another person’s
experience, whether simple or complex, and can occur
in brief interactions with patients”.

25. Methods
• 225 post-operative bypass patients were interviewed on:
• Pain intensity and quality
• Perception of the nurse as a resource for pain
• 94 nurses were asked to fill out a questionnaire to
determine their:
• Level of empathy
• Knowledge and beliefs on pain
• 80 nurse-patient pairs
• Patient data grouped and matched with their nurse to
form nurse-patient pairs

26. Finding #1
• Level of empathy does not correlate with level of pain
• Level of empathy does not amount of analgesia
• However, patients with more empathic nurses perceived
themselves as receiving analgesia when needed
Finding #2
• Nurses’ level of empathy varied directly with nurses’
level of knowledge and beliefs about pain assessment
and management (nurses agreeing with and believing
patients statements of pain)
• More empathic nurses give opioids for pain

27. Finding #3
 Level of empathy did not vary nurse characteristics
such as years of unit/nursing experience, level of in-
service education
Finding #4
 Levels of empathy did not vary in relation to patients’
age

28. Psychiatric Comorbidity following Traumatic
Brain Injury
(Rogers & Read, 2007)
 Objective: to explore the relationships between
psychiatric disorders and TBI; to review the evidence
for causality using Hill’s criteria
 Implications:
 Referral for psychiatric services
 Screening in the community
 Medical history assessments

29. Psychiatric Comorbidity... (cont’d)
Hill’s Criteria
1. Strong association between causative agent and
outcome
2. Temporal sequence – causative agent precedes
outcome of interest
3. Biological gradient – greater severity of causative
agent = poorer outcome
4. Fitting observed causative relationship to accepted
biological models
... Etc.

30. Psychiatric Comorbidity... (cont’d)
Results
Disorder Relationship with TBI
Major Depression -Maladaptive psychosocial factors related to TBI increases
risk
-Premorbid psychosocial factors
Bipolar Affective -No relationship
Disorder
Schizophrenia -Increased risk with genetic predisposition
Substance Abuse -Premorbid SA/hx of psychiatric condition – short term
(SA) increased risk post-injury

31. Psychiatric Comorbidity... (cont’d)
Results
Disorder Relationship to TBI
Generalized Anxiety -No relationship
Disorder -Cultural differences may increase risk
Panic Disorder -Increased risk with latency period of 10+ years
PTSD -Hx of psychiatric disorder/location of TBI
OCD -Mixed results

32. The Experience of Living with Stroke: A
Qualitative Meta-synthesis
Salter, Hellings, Foley, & Teasell (2008)
 Objective: to review qualitative literature to enhance
understanding of the experience of living with stroke
 Themes
 Change
 Loss
 Uncertainty
 Social Isolation
 Adaptation and Reconciliation

33. The Experience of Living with Stroke… (cont’d)
 Change, Transition and transformation
 A sudden and overwhelming catastrophe
 A fundamental life change and profound
disruption
 Ongoing process of re-interpretation of self

34. The Experience of Living with Stroke… (cont’d)
 Loss
 Loss of control
 Loss of confidence
 Loss of independence
 Previously taken-for-granted way of being now a
conscious effort
 A passive role

35. The Experience of Living with Stroke… (cont’d)
 Uncertainty
 Anxiety or uncertainty about the future
 Fears of another stroke
 Physical body unreliable and unpredictable

36. The Experience of Living with Stroke… (cont’d)
 Social Isolation
 Relationships provide support, comfort, consolation
 Connections helped to maintain continuity in life
 Difficult to explain their experiences to others
 Misunderstood or dismissed
 Avoidance of being a burden to others

37. The Experience of Living with Stroke… (cont’d)
 Adaptation and Reconciliation
 Focus on positive aspects of their lives
 Regaining control
 Mastering new skills
 Changing their environment
 Getting back to normal
 Arrived at a truce with themselves

38. Why Empathy?
 http://www.youtube.com/watch?v=nRduvwuM-VM

39. What are some strategies to
achieve empathy? (Cynthia)