Empathy: What role does it play in competent psychiatric care?
The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. To successfully implement these steps it is necessary to seek an understanding of the clients’ individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients’ uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients.
"I just wanted to tell you 'thank you', I can tell you really care." Anonymous, 2015
So often I have heard this statement from my clients. Not to toot my own horn, but I began to wonder personally how much my empathy for the mentally ill population promoted my competency in providing optimal care. So I began to analyze the fundamental components of my work as a psychiatric registered nurse that are conducive to promoting my psychiatric clients' stability.
The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. The nursing process includes the following steps:
Assessment, Diagnosis, Planning, Intervention, and Evaluation.
In saying such I would like to rephrase these steps into the perspective of a mental health nurse. In similar order of the nursing process assessment is viewed as "I need to know what you are experiencing so I can help you", diagnosis as "I listened and acknowledged your needs", planning as "This is what we can implement to meet your needs", interventions as "let's apply these individualized strategies and alleviate your acute circumstances", and evaluation as "How did this work for you? ".
Each stage conveys the primary idea of client - focus care; centering around the client's individuality. However, with clients experiencing severe depression, paranoia, and/or psychosis establishing rapport is essential in obtaining accurate data to promote stability (Decety & Fotopoulou, 2015). This requires implementation of the vital principle of Jean Watson's Theory of Human Caring which is to promote the client to achieve HIS/HER optimal being of holistic health (Suliman, Welmann, Omer, & Thomas, 2009). For the psychiatric nurse this requires empathy that encompasses finding understanding of the client's current stressors, perceptual, and actual needs through genuine interest that encompasses calculated verbal and non-verbal communication (Derksen, Bensing, & Largo-Janssen, 2012).
Finally, the "light bulb" illuminated for me on the reason why my clients felt potentially more considered than their peers. It was a simple math equation of caring by distinguishing individuality, building rapport through sincere, calculated, verbal/nonverbal communication that resulted in an accurate empathic understanding of my clients. Thus, a healthy nurse-client relationship is established providing a platform for a conducive and productive recovery from acute mental illness. The following were communicative actions implemented:
"I need to know, so I can help you":
Establish rapport/ building trust, by active listening, respecting individuality, giving time, maintaining individuality actions throughout each stage
Nonverbal communication i.e. body movement, facial expression
Removing overwhelming stimuli
Discussing more than the reason for admission but general topics of conversation; "implementation of "soft concepts of empathy with hard science" (Derksen, Bensing, & Largo-Janssen, 2012, p. 2).
"I listened and acknowledged your needs": (Decety & Fotopoulou, 2015)
You have noted the external symptoms of this patient
The patient has shared, their internal symptoms experienced
You have noted the congruency or non-congruent behaviors/symptoms in their diagnosis
"This is what we can implement to meet your needs":
Active participation in planning with a client to meet his/ her needs; promoting compliance
Confirmation of short and long term goals; the steps in which the client desires to reach these goals
Suggestions offered and multidisciplinary, familial, and outpatient supports established
"Let's apply these strategies according to your circumstances":
Implementation begins, support measures positioned to encourage
Consensus of specific supportive mechanisms implemented by the multidisciplinary team, and family
The flexibility provided to the client's circumstances
"How did this work for you?":
The noted growth, stagnant, or regression of results reviewed
Challenges acknowledged, barriers noted
Suggestions on interventions that may promote his/her desired outcomes
To successfully implement these steps it is necessary to seek an understanding of the clients' individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients' uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients. (Decety & Fotopoulou, 2015). Empathy allowed me to care for the client's individuality by grasping an understanding of their personal strengths, struggles, and journey to mental stability. Likewise, empathy is the foundation for competent psychiatric care.
References
Decety, J., & Fotopoulou, A. (2015, January 14). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Why empathy has a beneficial impact on others in medicine: unifying theories
Derksen, F., Bensing, J., & Largo-Janssen, A. (2012, December 19). NCBI Resources. Retrieved March 5, 2015, from PMS US National Library of Medicine; National Institutes of Health: Effectiveness of empathy in general practice: a systematic review
Suliman, W., Welmann, E., Omer, T., & Thomas, L. (2009). Applying Watson's Nursing Theory to Assess Patient Perceptions of Being Cared for in a Multicultural Environment. Journal of Nursing Research, 293-299.
Alicia Doss -Pierre, MSN, RN-BC is a charge nurse for the inpatient psychiatric unit for Atlanta Veterans Affairs Medical Center. Doss-Pierre has held various positions including medical- surgical nurse, outpatient psychiatric intensive case management, and inpatient psychiatric nurse. In 2014, she completed her board certification in psychiatric mental health nursing and master degree in informatics.
Specializes in Behavioral Health, Disability Case Mgmt.
In 100% agreement with your premise, " empathy " is imperative to good behavioral health nursing. A fine line exists as to when the empathy needs to take a back seat, drop from the forefront, in order to optimize outcomes for acutely mentally ill clients. It is always there, fundamental to crisis stabilization in an psychiatric intensive care unit. I work in a Behavioral Health Program with three distinctly different units: Psych ICU, Therapeutic Milieu, and a Dementia Unit. As you have indicated, it is fundamental to all three platforms of care, however it takes slightly different forms in all three venues . . . Spot on assessment, thank you, well done!
You are so so so so right, but I suspect that in all nursing empathy is one of the "soft" skill that can make a big difference in the quality of care. What some think is intuition really comes from listening to the patient.
My nursing practice includes the theory of Authentic Use of Self. Nursing is something you do with all your heart, mind and spirit. It is amazing what you learn from your patients when you open your "receiver" (brain) to recovery possibilities and your heart (empathy) to what the patient is going through. it's a connection and the patient responds.
Thank you Klriggs53, RN! I agree with you that each assessment must be individualized to meet the needs of patient dependent on their mental acuity, however we base our initiation of assessing with our fundamental "platform of care".
Scout's mom I agree with you that often the answers to promoting positive outcomes for our patients comes directly from listening to our patients, Thank you.
BarbLuttrell, I agree with you, empathy promotes a mutual understanding from caretaker's and patient's perspective promoting rapport. Thus, opens an avenue to establish active collaboration with patient to develop an individualized care plan to encourage his/her recovery. It is altruistic benefit to see their positive outcomes in addition to learning from our patients' journey to recovery, Thank You Ms. Luttrell!
"I just wanted to tell you 'thank you', I can tell you really care." Anonymous, 2015
So often I have heard this statement from my clients. Not to toot my own horn, but I began to wonder personally how much my empathy for the mentally ill population promoted my competency in providing optimal care. So I began to analyze the fundamental components of my work as a psychiatric registered nurse that are conducive to promoting my psychiatric clients' stability.
The fundamental foundation in initiating competent skills as a psychiatric nurse is similar to any specialty in nursing. We must implement the necessary processes of providing the standard of care by using the method known as the nursing process. The nursing process includes the following steps:
Assessment, Diagnosis, Planning, Intervention, and Evaluation.
In saying such I would like to rephrase these steps into the perspective of a mental health nurse. In similar order of the nursing process assessment is viewed as "I need to know what you are experiencing so I can help you", diagnosis as "I listened and acknowledged your needs", planning as "This is what we can implement to meet your needs", interventions as "let's apply these individualized strategies and alleviate your acute circumstances", and evaluation as "How did this work for you? ".
Each stage conveys the primary idea of client - focus care; centering around the client's individuality. However, with clients experiencing severe depression, paranoia, and/or psychosis establishing rapport is essential in obtaining accurate data to promote stability (Decety & Fotopoulou, 2015). This requires implementation of the vital principle of Jean Watson's Theory of Human Caring which is to promote the client to achieve HIS/HER optimal being of holistic health (Suliman, Welmann, Omer, & Thomas, 2009). For the psychiatric nurse this requires empathy that encompasses finding understanding of the client's current stressors, perceptual, and actual needs through genuine interest that encompasses calculated verbal and non-verbal communication (Derksen, Bensing, & Largo-Janssen, 2012).
Finally, the "light bulb" illuminated for me on the reason why my clients felt potentially more considered than their peers. It was a simple math equation of caring by distinguishing individuality, building rapport through sincere, calculated, verbal/nonverbal communication that resulted in an accurate empathic understanding of my clients. Thus, a healthy nurse-client relationship is established providing a platform for a conducive and productive recovery from acute mental illness. The following were communicative actions implemented:
"I need to know, so I can help you":
"I listened and acknowledged your needs": (Decety & Fotopoulou, 2015)
"This is what we can implement to meet your needs":
"Let's apply these strategies according to your circumstances":
"How did this work for you?":
To successfully implement these steps it is necessary to seek an understanding of the clients' individuality which takes effort, establishment of rapport, and time. Empathy is an essential factor to obtain accurate data, individualize interventions, and best outcomes addressing the clients' uniqueness. As a psychiatric nurse one noted that empathy plays a significant role in providing competent care and optimizing positive outcomes for my acute mentally ill clients. (Decety & Fotopoulou, 2015). Empathy allowed me to care for the client's individuality by grasping an understanding of their personal strengths, struggles, and journey to mental stability. Likewise, empathy is the foundation for competent psychiatric care.
References
About addoss78
Alicia Doss -Pierre, MSN, RN-BC is a charge nurse for the inpatient psychiatric unit for Atlanta Veterans Affairs Medical Center. Doss-Pierre has held various positions including medical- surgical nurse, outpatient psychiatric intensive case management, and inpatient psychiatric nurse. In 2014, she completed her board certification in psychiatric mental health nursing and master degree in informatics.
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