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A qualitative exploration of "empathic labor" in Chinese hospice nurses
BMC Palliative Intendance book 21, Article number:23 (2022) Cite this commodity
Abstract
Background
Hospice nurses may devote more than emotional labor during the empathy process with patients, and this empathy can exist used equally a form of psychological behavior of emotional labor in the hospice care model. The aim of this study was to analyze hospice nurses' empathy characteristics in the context of emotional labor theory, and explore the impact of empathy on patient intendance.
Methods
Nosotros conducted semi-participant observations from iii hospitals and multicenter in-depth interviews with northward = 26 hospice nurses from viii cities. Interviews were transcribed, and directed content analysis was applied.
Results
2 categories with four sub-categories were extracted from the data assay. Category one described the "empathic labor" process which covers cerebral empathy (including empathic imagination, empathic consideration, and empathic perception) and affective empathy (including natural empathy, surface empathy, and deep empathy). The 2d category concerns the event of nurses' "empathic labor" which incorporates both positive and negative effects.
Conclusions
The findings indicated that hospice nurses' empathy process should be understood as emotional labor. Nursing managers should pay more attention to raising the ability of deep empathy with hospice nurses, and explore more sufficient active empowerment strategies to alleviate the negative impact of empathy on nurses and to strengthen nurses' deep empathy with terminal ill patients.
Peer Review reports
Groundwork
Palliative care as defined by the Earth Wellness Organization (WHO) is an approach to improve the quality of life of patients with life-threatening illnesses and their families. The WHO points out that an estimated 40 million people are in demand of palliative care; however, only approximately 14% of people who demand palliative care currently receive palliative care worldwide [1]. At present, People's republic of china is facing the dilemma of increasingly aging demographic modify [2]. Thus, the need for palliative care is growing commensurately, and enabling nationwide access to palliative care is of special importance, every bit Mainland china aims to accomplish health care standards comparable to those in developed countries by 2030 [three]. To achieve this goal, Mainland china launched a pilot projection of hospice care in some cities in 2017. Although the Chinese regime has increased its support for hospice care in recent years, yet, the development of hospice care in China is insufficient, which is mainly reflected in the lack of instruction around hospice care, inadequate limerick of hospice care teams, unbalanced geographical distribution, and so on [4, 5].
As the cadre working members of the multidisciplinary collaborative team model of hospice care, nurses play an of import role in the health care of finish-of-life stage patients and their families. Empathy is considered to be vital to professional helping and caring relationships in hospice care, which requires nurses to take the ability to call up from the perspective of patients [6]. Co-ordinate to empathy theory, nurses can make patients feel valued and recognized through melancholia empathy or cognitive empathy, which can assistance to promote trust and strengthen the caring relationship between nurses and patients [7]. Still, previous studies have shown that hospice nurses have more opportunities to face the pain and death of patients during the empathy process [6], need to devote more emotional care to patients. It was reported that 78.3% hospice nurses or other medical staff in Mainland china believed that caring for a dying person can cause them to feel non but physically and emotionally wearied just also inevitably have a stiff sense of emotional trauma such as loss, anxiety, fear, and depression [4], which in turn fabricated them empathic fatigue or reluctant to participate in hospice care [8, ix], even directly affects the quality of hospice service and threatens the stability of the hospice nursing squad.
At that place are many different concepts of empathy that exist in the literature. These concepts come from diverse fields and are often radically discontinuous with one some other [x]. As mentioned in some studies, nurses' empathy is considered to exist a grade of psychological beliefs of emotional labor in the hospice intendance [eleven, 12]. Emotional labor is described every bit a requirement of employment in many professions which require individuals to brandish certain emotions as office of their job performance, such every bit welcoming, cheerful, patient, sympathetic or always convey a sense of security and prophylactic [13, 14]. At that place are iv major techniques in the model of emotional labor, including natural action, surface action, deep action, and deliberative noise action [15]. To a nurse, the emotional technique is equally important as clinical technique [16]. For oncology nurses, their emotional labor refers to a special bail help to establish a relationship with patients through empathy [17], and previous studies pointed out that empathy should be transformed into the form of emotional labor, and on this ground, respective grooming, practice, and research should be carried out [11, 12].
However, prior researches [xviii, nineteen] always focused on emphasizing the importance of strengthening terminal intendance operation of clinical nurses by improving their empathy power or analyzed the relationship between burnout and empathy among hospice nurses. Few researches take studied the empathy of nurses as the form of emotional labor and explored nurses' experiences of empathy in daily clinical work, specially for those in hospice nurses. To fill this gap, we conducted a qualitative descriptive study to improve the comprehension of empathy under the theory of emotional labor from the viewpoint of hospice nurses experiencing information technology. We likewise aimed to clarify hospice nurses' empathy characteristics in the context of emotional labor theory, and explore the impact of empathy on patient intendance to provide strategies for improving nurses' empathy power.
Methods
Written report design and setting
This was a descriptive qualitative study using semi-participant observations and multicenter in-depth interviews. Different from the participant observation, semi-participant observation allows the researcher to adopt "participant every bit observer" as his/her ascertainment role, which ways the researcher is known as an observer to participants, he/she establishes a relationship and participates in some activities with participants [20, 21]. Before and during the multicenter in-depth interviews, we explored the empathy behavior of hospice nurses in clinical piece of work with field research in August 2020, October 2020, and Feb 2021. Interviews were conducted either in person or via video conversation software to further elaborate and explore the perceptions and experiences of the "empathic labor" with the hospice nurses between December 2020 to February 2021. Ethical approval was granted by the Medical Ethics Commission of The First Affiliated Hospital of Soochow Academy, Cathay.
Field observation
Nosotros selected 3 hospice units in Shanghai, Shenzhen, and Lianyungang as the field sites by using purposive sampling. The researcher entered those iii field sites as a "hospice trainee nurse" for one week of observation after obtaining informed consent from the heads of the units. Field notes were obtained in three ascertainment phases, from descriptive observation to focused observation to selective observation [22], which can aid to support the information analysis and develop the themes and subthemes. In descriptive observation, it means that 1 observes anything and everything, assuming that he/she knows nothing, however, it can lead to the drove of minutiae that may or may not exist relevant to the study. The 2nd type, focused observation, emphasizes observation supported past interviews, in which the participants' insights guide the researcher's decisions most what to observe. In selective observation, the researcher focuses on different types of activities to aid delineate the differences in those activities [23].
Here are these three types of the chief processes of conducting observations in this report. On the first 24-hour interval of entering each field, the researcher conducted a descriptive ascertainment, selected suitable ascertainment objects, and communicated with them to found a trust relationship. Focus observation began when the researchers followed the objects in bedside care, to truly observe and feel the characteristics of the empathic labor of hospice nurses, the researchers as well conducted further communication with nurses about some meaningful or special phenomena observed in the observation process. Selective observation began later, and special cases such every bit "How exercise nurses empathize in grief counseling?" were selected when the obtained data were not sufficiently saturated. The daily observation time of the researcher was consequent with the working times of the objects. Field notes covered details on the field environs and the whole process of nurses' empathy, which included performance and changes in the behavior, advice, and expressions of both nurses and patients.
Multicenter interview
Hospice nurses who met the inclusion criteria were selected past using purposive sampling, and willing participants from eight cities in southern, central, and northern China were invited to participate in the in-depth, semi-structured, one-fourth dimension one-on-one interviews [24]. Before the formal interviews, we outset conducted a pre-interview with two participants, and finally defined the interview outline as follows: (1) What do you retrieve of empathy in hospice care? (2) How practice you empathize with terminal patients? (iii) What can bear on your "empathic labor" process? (4) Does the feel of empathy with terminal patients have an impact on your piece of work and life, and if so, what are those impacts? (5) What can help you better empathize with terminal patients? The interviews elapsing range was thirty to 60 min.
Participants
Those who were willing to participate were required to sign a consent form. All the participants, including hospice nurses from both the ascertainment and interview settings, were recruited if they met the post-obit inclusion criteria: (1) qualified of hospice care and more than one year of hospice intendance experience; and (2) was aware of the concept of empathy, that is, nurses could briefly and accurately describe the concept of empathy in the clinic using their own words, or could smoothly draw how to use empathy in hospice care. The exclusion criteria were as follows: (1) nurses who were not in the menses of rotation of hospice intendance or had departed this work; and (2) refresher nurses and student nurses. According to information saturation [25], 8 hospice nurses were recruited for the field observations, and 26 hospice nurses from 12 institutions in eight cities were recruited for the interviews.
Data analysis
As we wanted to develop the framework of "empathic labor" based on the theory of empathy and emotional labor, directed content analysis was used as a method for data analysis. Directed content analysis is an approach used in descriptive qualitative studies that validates or expands on an existing theoretical framework or theory and differs from conventional content analysis in its usage of pre-determined wide categories for assay [26]. The transcribed data were coded independently past the first writer [YL Due west] and some other author [ZW Y], they had to read and reread the data many times to go familiar with them before coding, meaning units and coding structure were derived from the interview outline for information reliability and validity [27].
The category of the "empathic labor" process was formed from the theory of empathy, and the sub-categories of melancholia empathy appeared from the theory of emotional labor. However, some information such every bit "empathy outcome" cannot utilize the existing coding scheme. Nosotros gave it a new coding and modified coding scheme and then reclassified it to form new categories and sub-categories. Overall, both theme acquisition and qualitative accent were determined by research group consensus. When the two separate coders had unlike topics or multiple themes were difficult to compile into one, they were determined by grouping consensus. [HL L] inspected the transcripts and themes at each coding phase independently to ensure the integrity and accuracy of the derived themes with interviews.
Rigor
The rigor of a qualitative study refers to its credibility, transferability, dependability, and conformability, and we used several methods to raise the rigor in this written report [28]. Commencement, intramethod triangulation was employed by using the methodological techniques of field observation and in-depth interview; the research team tried to carry out the observation from different field sites, also interviewed hospice nurses in different cities from southern, primal, and northern of People's republic of china, so as to improve the scientific rigor in the process of information production and analysis and obtain a comprehensive view of Chinese hospice nurses' empathy characteristics in the context of emotional labor theory. 2d, all members of the enquiry reviewed the data set and were involved in the data assay. Third, verbatim quotations from the informants were provided to improve the transferability and credibility of the written report. In addition, collecting qualitative data in one language and presenting the findings in another involves researchers taking translation–related decisions that have a directly impact on the trustworthiness of the research and its report [29]. Therefore, translation procedures in this research can be summarized as follows: two bilingual researchers who were fluent in both Chinese and English translated all original emerged categories independently and compared translation differences until the concluding English version was reached by understanding betwixt them. Another bilingual researcher was asked to dorsum translate the final English language version from English to Chinese. These initial 2 steps were repeated equally necessary to reduce whatever discrepancies that existed betwixt the original version and the back-translation, and all members of the research need to reach terminal agreement on the translation.
Results
Characteristics of the participants
The characteristics of the participants are reported in Table 1.
Experience of "empathic labor" in hospice nurses
Categories were identified according to the theory of empathy and emotional labor. Each category had two to 3 sub-categories, which were exemplified by participants' narrative examples (run into Fig. 1).
Coding tree
Category ane: "empathic labor" process
The first category describes the characteristics of Chinese hospice nurses empathizing with terminal patients during the "empathic labor" process. According to the theory of empathy and the research data, "empathic labor" as a main category could be defined as the ''cognitive empathy" and "affective empathy".
Sub-category 1: cognitive empathy
The beginning sub-category, "cerebral empathy", shows the ability of hospice nurses to perceive and empathize terminal patients' emotions, behaviors, and experiences.
Empathic imagination: imagine the patients' role and integrate into information technology
At the showtime of empathy, hospice nurses should imagine the patients' role and integrate information technology since they first visit the patients, which is the ground of establishing a trusted nurse-patient human relationship.
"When I empathize with terminal patients, I volition first integrate into the part of patients and their families." (N16)
Under these circumstances, to better convey empathic care to patients, nurses volition change their roles according to different empathic objects.
"If you want to enter the patients' centre when empathizing with them, you should constantly change your office and remind yourself that you are not just a medical staff." (N19)
Empathic consideration: consider trouble from perspective of patients
Most dying patients accept dissimilar mentalities and behaviors from ordinary people. Many hospice nurses stated that they tin can sympathize with patients by considering the problem from the perspective of the patients and agreement patients' thoughts and behaviors.
"My biggest professional characteristic is that I am good at putting myself in the patient'due south position and thinking nigh many things. You lot can imagine that if it's our relatives or ourselves lying in the hospital bed, what exercise we want others to practise to me?" (N3)
Empathic perception: perceive patients' experiences and discover their needs
Furthermore, some nurses indicated that they could even perceive the pain of patients suffering from illness, just as if they had experienced it. Therefore, they can find patients' existent needs in time and then will be eager to help patients alleviate their pain.
"When I empathize with patients, I have the same sense as if I had gone through their situation personally, that is, I can perceive the pain of patients in all aspects, including psychology, physiology, and then on." (N21)
"I tin't bear to see the patients and their families in that kind of miserable pain and helplessness, I want to do everything possible to help them." (N15)
Sub-category 2: affective empathy
"Affective empathy" is the ability of hospice nurses to emotionally attune to or resonate with the patients' experiences. According to the theory of emotional labor and the research data, information technology could be defined as the natural empathy, surface empathy, and deep empathy.
Natural empathy
Natural empathy means that no emotional conflict exists in the process of empathy between hospice nurses and patients, and the emotional response of nurses is truthful and natural. When natural empathy occurs, nurses tin can meet the requirements of professional person norms without adjusting their emotional responses.
Co-ordinate to the field data from Lianyungang, one of the notes was recorded equally, "Today is the Lantern Festival. Withal, the patients were unable to reunite with their families considering of the COVID-19 prevention and control. To allow the patients leave no regrets at the end of their life, nurses cooked dumplings and sent them to the patients' bedside to for celebrating the festival with the patients. Nurses' vacation companionship conveys the warmth of 'abode' to the hearts of patients. The whole process is full of happiness, and the emotional response of nurses is natural and unmodified."
Surface empathy
When there is a conflict betwixt nurses and patients in the process of empathy, some nurses' emotional responses will take the form of surface empathy. Our study found that in this empathic expression, nurses who ever face up negative emotional events from patients accept to passively inhibit their emotional release, making their explicit beliefs and emotional response conform to professional person norms; however, their internal emotion and sense of value have not inverse. This surface empathy of hospice nurses tin can manifest in the following 2 situations in this research.
I situation is that when hospice nurses passively accept a bad temper from patients, they will choose to hide their true feelings and try their all-time to cater to the feelings of the patients, so they will show appropriate explicit emotions that are inconsistent with their inner feelings.
Field notes every bit follows, "Nurse N15 could keep at-home and pretend not to exist aroused for a moment while she encountered the patient's bad temper. However, she felt that this patient was unreasonable when she returned to the nurse station, and in fact, she felt very wronged."
Another situation is that our hospice nurses face a group of dying patients and may face the emotional touch of the patients' death at whatever time. This working environment is inconsistent with their original professional person belief of "saving the dying and healing the wounded". Therefore, when some nurses face up sob stories during the procedure of empathy with patients, they may pretend to exist at-home, endure sadness, or even forcefulness a smile until the end of the care process.
Field notes equally follows, "The patient's condition worsened over again, although the nurse N25 seemed calm to wipe the gushing claret from patient'due south mouth, I saw his eyes filled with tears and he was trying not to permit the tears fall……when he returned to the nurse station, he told me that: 'Sometimes, if the symptoms of my patients are not well controlled, although I should show at-home and insist on completing the nursing work while caring for patients, actually I am very depressed and want to cry with them.' "
Deep empathy
In this study, deep empathy too occurred when there was a conflict between nurses and patients in the process of empathy. The difference is that nurses who tin securely understand with patients tin often actively adapt their inner emotions, understand and help patients from the heart, and respond to negative emotional events with a rational and professional attitude.
"Patients' bad temper is merely temporary, don't be angry virtually information technology and contend with them. I can treat patients' anger more objectively and rationally during the deep empathy process… There must be a reason why the patients go angry, and we should discover their deep needs through empathy with them, rather than just seeing the appearance of the patient losing his temper."(N23)
Field notes equally follows, "Nurse N13 is not afraid of her patient's 'cold violence'. On the contrary, she understood that the patient was very immature, and the reason why the patient showed long-term bad temper was that the disease disrupts patient's career and life. Therefore, as long as the nurse N13 has time, she volition accompany and communicate with the patient, gradually, she entered the patient'southward inner centre."
Meanwhile, nosotros also found that nurses with deep empathy have the donating beliefs of spontaneously helping patients to come across their unmet needs which were perceived from cognitive empathy.
Field notes as follows, "The patient was dying, and nurse N20 perceived that what the patient most wanted to see was his son abroad. Yet, his son was withal isolated because of the COVID-xix epidemic. Today, in guild to let the patient dice without regrets, nurse N3 used many methods to help them meet, including communicating with the epidemic prevention and control section to hash out the isolation time of the patient's son, accompanying and encouraging the patient, helping them to take a video call, etc."
Category 2: "empathic labor" outcomes
According to the participants, they can take unlike outcome experiences of empathizing with last patients, such as inspired from patients' life experiences during the empathy process, or fifty-fifty depressed from it, and in general, we can summarize those outcomes equally positive and negative outcomes.
Sub-category 1: positive outcomes
Nearly participants indicated that they can accept a deeper understanding of the truthful meaning of life and decease, or have beneficial experiences in their professional and life values during the empathy process.
Sense of professional achievement
Empathy tin can assistance nurses better understand patients' life experiences and perceive patients' needs, their donating behavior will be motivated and they are willing to provide more than comfortable intendance to satisfy patients' caring needs.
"With empathy, I found that this patient cared near her hygiene very much and didn't like our oral care liquid and fifty-fifty resisted it. For that reason, I consulted the literature and relevant experts, and finally fabricated blossom tea into oral care solution to let her feel more than comfortable."(N11)
Therefore, nurses tin can improve their nursing quality, and their nursing work tin exist approved by patients and caregivers. Finally, they can realize their professional person value and gain a sense of professional person achievement at the cease of a nursing procedure.
"Now I can establish deep feelings with my patients through empathy. They desire to tell me anything, and their caregivers also like and trust me."(N3)
Field notes as follows, "Today, the patient said thank you to the nurse N10 on his deathbed. His family unit were not in extremely mournful, but calmly accustomed the fact that the patient died, and then the nurse N10 told me that 'It is very meaningful when the patient says thank you to me before he closed his optics, so I think it is greater to accompany dying patients with empathy, which will bring me a certain sense of accomplishment.' "
Get reverse emotional caring behavior from patients
Our findings revealed that the empathy path betwixt nurses and patients can be bidirectional, which ways that nurses' empathy tin atomic number 82 to patients' reverse emotional caring behavior, including considerate words and supportive actions.
"Patients can empathize everything I practice for them when I constitute an empathic bail with them. Meanwhile, they can fifty-fifty comfort me, understand me, help me and tolerate me. In social club not to disturb me and reduce my workload, they do what they tin do by themselves." (N7)
In addition, this reverse emotional caring behavior can promote the spread of donating civilisation in order, and produce a cocky-transcendent part.
"Most families were profoundly impressed by the business organization we had shown them during the empathy process, many of them want to support the states reversely, and some fifty-fifty come to our ward as volunteers to care for more than dying people." (N22)
Enrichment and growth from personal life experiences
Most nurses indicated that they tin do good and learn from the life experiences of the patients they cared for through empathy, which is conducive to their cocky-growth and promotes their outlook on life values.
"At present I have become more able to calmly face life and death, more open up-minded and indifferent to fame and wealth since I went through too many stories virtually patients' death." (N10)
Some nurses expressed that they became more able to cherish their life and family and willing to spend time with and intendance for their family members.
"I cherish what I have now, intendance more about my family, and respect the meaning of my life." (N12)
Sub-category 2: negative outcomes
However, our findings found that when nurses consider problems from the perspective of the patients' roles during the empathy process, they will also fall into patients' negative emotions, even resulting in certain emotional trauma.
Negative emotional contamination
Some participants said that they were easily infected past patients' bad emotions and came into bad moods such as sadness and loss. Equally time passed, their emotions became vulnerable and fragile for suffering from those lamentable events for a long time.
Field notes as follows, "When the nurse N11 saw this kid, she said she suddenly thought of her own child, and at that fourth dimension, she couldn't control her tears when she saw this little kid suffering from the affliction."
"I was immersed in this lost mood for several days during the menses when my patient died. I even felt more than depressed and thought of him when I walked to the door of his ward." (N25)
More seriously, some nurses expressed that it is hard for them to notice ways to cascade out their bad emotions, and most of them chose to endure these bad experiences, which may even cause them to take psychological diseases such as depression.
"My family and friends don't want to listen to my feel of hospice piece of work, and so I won't tell them so as non to upset them." (N12)
"I really can't notice a fashion to relieve my mood, and now I also feel a fiddling depressed." (N20)
Negative emotion involved in life
Meanwhile, when nurses cannot adjust those negative emotions in time, they may unconsciously bring those bad emotions into their lives, which can destroy the harmony of their family unit relations and reduce the quality of their personal lives.
Field notes as follows, "Unfortunately, the patient died in hurting two weeks ago, but today, nurse N13 withal can't get out of the empathy state with him. She said she has seen several psychologists, but it was useless."
"If those bad emotions can't exist released, I will still be in a bad mood when I go dwelling. I fifty-fifty tin can't help losing my temper with my family unit sometimes, so my family relations volition also be affected." (N9)
Empathic fatigue
Nurses need to spend much time accompanying and listening to patients during the empathy procedure; however, their long-term emotional investment will hands cause them to lose sensitivity and motivation to sympathize with others. In the long run, it is easy to cause nurses to feel empathic fatigue and even empathic exhaustion.
"The state of patients willing to give their life history to you without hesitation cannot be accomplished in a solar day or ii. For instance, you may say 10 words earlier the patient is willing to answer yous at the start of nursing piece of work…I volition control myself not to accept the self-emotions opposite to my patient and observe means to go into the patient's eye. Therefore, when I follow a patient from beginning to end, I really feel exhausted and I have no patience to stick to it."(N15)
Discussion
Empathy is an institutional norm in medicine, and the empathic relationships between nurses and patients are a process that occurs almost frequently over time in the field of hospice care [30]. This written report described the process of empathy in hospice nurses by combining emotional labor and empathy theory and also analyzed the definition and features of nurses' empathy through 2 components of cognition and affection.
Cerebral empathy is the ability to think into or mentally reconstruct the other's experiences, mainly past using one's imagination [7]. From this definition of cognitive empathy, empathic imagination is an of import ability that requires nurses to imagine and share similar thoughts and feelings with their patients [31]. In this study, we developed this definition into three dimensions to be suitable for a hospice care environs. Starting time, nosotros considered empathic imagination to include hospice nurses imagining the patients' function and integrating into it. 2d, with empathic consideration, nurses demand to consider nearly caring problems from the perspective of the patients. Finally, empathic perception emphasizes the requirement of nurses to perceive patients' experiences and find their unmet needs in daily piece of work. This is considering the purpose of hospice intendance is to aid terminal patients go through their lives without regrets. Therefore, when hospice nurses empathise with patients, in addition to having the ability to imagine the patients' function and consider from patients' perspective, nurses' ability to accurately perceive the patients' end-of-life care needs is even more important. However, based on previous studies, near focused on the imagination dimension of cognitive empathy, therefore, it is not enough to imagine the experience of dying patients, and hospice nurses should be cultivated to raise their occupational sensibility of patient-centered consideration and their perception of patients' unmet needs through empathy. Strategies include taking a target'southward perspective, reading facial expressions, developing related curricula training programs, and accessing memories of relevant previous situations [32, 33].
The field of medical pedagogy has focused on the cognitive aspects of empathy, neglecting the affective components [34]. Empathy is as well a clinical skill that tin be used as a strategy to effectively create patients' feelings of satisfaction and condolement; thus, it is a form of medical work that should exist understood as emotional labor [eleven]. Therefore, this written report focused on exploring the characteristics of nurses' affective empathy under a hospice caring environment, considered information technology emotional labor, and found that nurses' empathy is also an emotional labor process, including dimensions of natural empathy, surface empathy, and deep empathy. This may exist because the exploration of training for palliative intendance specialist nurses in mainland China is insufficient [35], and there is no standardized hospice intendance curriculum didactics in various medical colleges and universities. When the regime launched a pilot project of hospice intendance in 2017, most nurses engaged in hospice were transferred from other departments and carried out hospice care afterwards brusk training. This may lead to the uneven empathy ability among nurses, and therefore, display these three unlike dimensions of functioning in the empathic labor process.
Nurses with surface empathic labor can easily suppress their true feelings and force themselves to smile or resist anger in front of patients. Nevertheless, nurses who have the power of deep empathy with patients can self-adjust their inner emotional state, analyze the root causes of patients' bad emotions or behaviors, subtly perceive patients' unmet caring needs, spontaneously provide humanized care for patients, aid patients achieve their concluding wishes, and improve the quality of final intendance for dying patients. Different from those in the working environments of other clinical departments, hospice nurses always need to devote much emotional labor because they often face more complex psychosocial events, such as patients' astringent pain, decease, and bereavement [36]. Therefore, nosotros should not only pay attention to nurses' melancholia components of empathy but as well cultivate nurses' affective empathy to reach the level of deep empathy. Senior staff nurses can be set as good examples and encouraged to share their empathy cases to strengthen the humanistic quality and cocky-emotional regulation power of young nurses and amend their ability to deal with diverse situations encountered in hospice care with positive beliefs and flexible methods. Thus, nurses' deep empathic labor can accept a more positive event, including improving patients' nursing satisfaction, and is conducive to nurses' physical and mental health.
In add-on, nosotros also summarized the outcomes of nurses' empathy to provide a basis for their empathy empowerment in the future. Our inquiry found that the empathy of hospice nurses has of import positive significance. For the nurses themselves. Starting time, empathy can help them improve their nursing quality of hospice work past being more than sensitive to patients' hurting and needs, stimulating their active donating behavior, and providing more comfortable care for dying patients. Under these circumstances, they will obtain affirmation and support from patients or their families, and will gain the sense of professional accomplishment. Second, empathy can enrich nurses' personal life experiences and help them modify to a positive attitude toward life. This is because nurses tin can acquire almost life, cherish life, and reshape their view of life past listening to and observing the life experience of patients during the daily empathy process with patients. For patients, empathy always involves reciprocal sharing, which can help patients understand nurses' nursing piece of work and provide emotional feedback. This may exist considering empathy itself is altruistic, nurses' empathic concern can touch patients and their family members and make them willing to pay back in the form of volunteers spontaneously. Therefore, the positive significance of empathy tin exist incorporated into the quality direction of hospice care to comprehensively evaluate nurses' hospice work.
Despite these salutary gains as the issue of successful empathy, the negative impact of empathy cannot be ignored. Reverse to the traditional professional person conventionalities of "healing the wounded and rescuing the dying", the professional belief of hospice nurses is often challenged because they accept long been exposed to stupor events such as patient death. Therefore, information technology is common for them to be accompanied past sadness, depression, and other emotions. When these negative emotions are hard to remove, nurses may lose themselves in emotional trauma which volition endanger their physical and mental health. If this persists, it will even take an affect on nurses' families or their nursing quality. Furthermore, previous research points out that hospice nurses are more prone to empathic fatigue than nurses in other departments [37]. This may easily to brand nurses lack empathic ability and become indifferent to their patients and piece of work, or even make nurses accept a turnover intention [17], thus impacting the quality and safety of their hospice work and the stability of the hospice nursing team. Therefore, we should design and implement scientific empowerment strategies to help nurses intervene in the negative experience of empathy past listening to and caring for nurses, guiding nurses to larn emotion command and decompression skills, strengthening the structure of nurses' positive psychological resources, etc.
This study has some limitations. As a qualitative study, we only explored the experience of empathy in hospice nurses, and the relationship between nurses' empathy ability and different influencing outcomes could not be explained in this written report. In improver, information technology was specific to a pocket-sized number of participants inside a particular setting, and the sensitivity of some questions during the interview may interfere with nurses' expansion of the conversation; therefore, nosotros accept not found the phenomenon of hospice nurses' turnover intention considering of their empathic fatigue, every bit mentioned in other studies.
Implications for practise and research
At nowadays, hospice care in China is still in the initial stage of evolution. Nursing colleagues pay more attention to the construction of the hospice care model, and few policies bring empathy into the cadre competence cultivation organisation of hospice nurses. This study creatively discussed the importance of nurses' empathy from the perspective of emotional labor theory, aimed to telephone call on nursing managers to pay more attention to the cultivation of nurses' deep empathy, and explored the strategies of how nurses can empathize effectively.
Conclusion
In this study, empathy is an important clinical skill that tin can finer create patients' feelings of satisfaction and comfort, and nurses' empathy process should be understood as emotional labor. We should pay attention to the ability level of the empathic labor of hospice nurses, requite more sufficient active learning channels and grooming chances to strengthen nurses' deep empathy with concluding patients, and explore more sufficient agile empowerment strategies to alleviate the negative touch on of empathy on nurses.
Availability of data and materials
The datasets used and/or analyzed in this study are available from the corresponding author upon reasonable request.
References
-
World Health Arrangement (WHO). WHO Fact Sheet on Palliative Care. (2020). https://world wide web.who.int/news-room/fact-sheets/detail/palliative-care. Accessed 21 Aug 2021.
-
Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, Casey DC, Charlson FJ, Chen AZ, Coates MM, et al. Global, regional, and national life expectancy, all-cause mortality, and cause-specific bloodshed for 249 causes of decease, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015. The Lancet. 2016;388(10053):1459–544.
-
Tan 10, Wu Q, Shao H. Global commitments and China's endeavors to promote health and achieve sustainable development goals. J Wellness Popul Nutr. 2018;37(one):viii.
-
Ling M, Wang X, Ma Y, Long Y. A Review of the Current Country of Hospice Care in China. Curr Oncol Rep. 2020;22(10):99.
-
Ning X. Hospice and Palliative Care in Mainland Cathay: History, Current Status and Challenges. Chin Med Sci J. 2018;33(4):199–203.
-
Ruiz-Junco Northward, Morrison DR. Empathy equally Intendance: the Model of Palliative Medicine. Society. 2019;56(two):158–65.
-
van Dijke J, van Nistelrooij I, Bos P, Duyndam J. Towards a relational conceptualization of empathy. Nursing Philosophy. 2020;21(3):e12297.
-
Kase SM, Waldman ED, Weintraub AS. A cantankerous-sectional pilot report of pity fatigue, burnout, and compassion satisfaction in pediatric palliative care providers in the United States. Palliat Support Care. 2019;17(3):one–7.
-
Samson T, Shvartzman P. Secondary Traumatization and Proneness to Dissociation Among Palliative Care Workers: A Cantankerous-Sectional Report. J Pain Symptom Manage. 2018;56(2):245–51.
-
Betzler RJ. How to analyze the aims of empathy in medicine. Med Wellness Care Philos. 2018;21(four):569-82.
-
Vinson AH, Underman 1000. Clinical empathy equally emotional labor in medical work. Social Scientific discipline & Medicine. 2020;251:112904.
-
Larson EB, Yao X. Clinical Empathy equally Emotional Labor in the Patient-Physician Human relationship. JAMA. 2005;293(nine):1100–half dozen.
-
Hochschild AR: The Managed Heart: Commercialization of Human Feeling, 3rd edn. Berkeley: University of California Press; 2012.
-
Henderson A. Emotional labor and nursing: an under-appreciated aspect of caring work. Nurs Inq. 2001;8(ii):130–8.
-
Li JH, Gao P, Shen XY, Liu 10. A Process Model of Emotional Labor of Nursing: Case Report of Two Chinese Public Hospitals. Int J Public Adm. 2014;37(10):695–707.
-
de Castro AB. Emotional vs. Physical Labor: The demand of using emotions as a chore duty. AJN The American Journal of Nursing. 2004;104(3):120.
-
Tuna R, Baykal U. A Qualitative Study on Emotional Labor Behavior of Oncology Nurses and its Effects. Int J Caring Sci. 2017;10(2):929–36.
-
Chase PA, Denieffe Due south, Gooney Thousand. Burnout and its human relationship to empathy in nursing: a review of the literature. J Res Nurs. 2017;22(i–2):vii–22.
-
Jo KH, Park AR, Lee JJ, Choi SJ. The Upshot of Suffering Experience, Empathy Ability, Caring Behaviors on Terminal Care Performance of Clinical Nurses. J Hosp Palliat Care. 2015;xviii(4):276–84.
-
Lambert V, Glacken Yard, McCarron One thousand. Using a range of methods to access children's voices. J Res Nurs. 2013;xviii(7):601–sixteen.
-
Briggs AR, Morrison M, Coleman One thousand: Research methods in educational leadership and management, 3rd edn. Los Angeles: Sage Publications; 2012.
-
Fetterman DM. Ethnography: Step past footstep. K Oaks, CA, Us: Sage Publications, Inc; 1989.
-
Kawulich B. Participant Observation every bit a Information Collection Method. Forum: Qualitative Social Research. 2005;6(two):43.
-
Sandelowski Yard. Whatever happened to qualitative description? Res Nurs Health. 2000;23(iv):334–forty.
-
Corbin JM: Nuts of qualitative research : techniques and procedures for developing grounded theory, tertiary edn. Thousand Oaks, Calif.: Sage Publications; 2008.
-
Hsieh H-F, Shannon SE. Iii Approaches to Qualitative Content Analysis. Qual Wellness Res. 2005;15(nine):1277–88.
-
Morse JM. Disquisitional Analysis of Strategies for Determining Rigor in Qualitative Inquiry. Qual Health Res. 2015;25(ix):1212–22.
-
Forero R, Nahidi S, De Costa J, Mohsin M, Fitzgerald Thou, Gibson N, McCarthy S, Aboagye-Sarfo P: Awarding of four-dimension criteria to assess rigour of qualitative research in emergency medicine. BMC Health Serv Res. 2018;18(1):120.
-
Chen H-Y, Boore JR. Translation and back-translation in qualitative nursing research: methodological review. J Clin Nurs. 2010;19(1–2):234–9.
-
Raudonis BM. Empathic Nurse-Patient Relationships in Hospice Nursing. Hosp J. 1995;x(i):59–74.
-
Ruiz-Junco N. Advancing the Sociology of Empathy: A Proposal. Symb Interact. 2017;40(3):414–35.
-
Kang SW, Choi EJ. The Relationship of Perceptions of Hospice and Palliative Care With Emotional Intelligence and Cognitive Empathy in Nursing Students. J Hosp Palliat Nurs. 2020;22(three):213-9.
-
Cuff BMP, Chocolate-brown SJ, Taylor Fifty, Howat DJ. Empathy: A Review of the Concept. Emot Rev. 2014;8(2):144–53.
-
Preusche I, Lamm C. Reflections on empathy in medical education: What tin can we learn from social neurosciences? Adv Health Sci Educ Theory Pract. 2016;21(1):235–49.
-
Cheng Q, Zhang Q, Liu X, Chen Y. Initial exploration of training for palliative care specialist nurses in mainland Cathay. Nurse Teaching Today. 2021;101:104869.
-
Szymczak JE, Schall T, Loma DL, Walter JK, Parikh S, DiDomenico C, Feudtner C. Pediatric Oncology Providers' Perceptions of a Palliative Care Service: The Influence of Emotional Esteem and Emotional Labor. J Pain Symptom Manage. 2018;55(5):1260–8.
-
Portoghese I, Galletta M, Larkin P, Sardo Due south, Campagna M, Finco G, D'Aloja E. Compassion fatigue, watching patients suffering and emotional display rules amongst hospice professionals: a daily diary written report. BMC Palliat Care. 2020;19(ane):23.
Acknowledgements
We would like to give thanks all the nurses who participated in the interview and the caput of the field observation infirmary for their support in finding appropriate interview partners and providing a research site.
Funding
This written report was supported by The National Natural Science Foundation of Communist china (72074164) and The Health and Longevity Project of the Chinese Academy of Medical Sciences (2020-JKCS-024).
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YLW: report conception and design, data drove, data analysis, and estimation, besides as manuscript drafting and revision. LHL and LSZ: study conception and pattern and manuscript revision. ZWY: data checking and data analysis. YZT: study coordination and manuscript revision. The writer(due south) read and approved the final manuscript.
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Upstanding approvals were obtained from the Offset Affiliated Infirmary of Soochow University, Cathay (Reference Number: 2020 ER (R)258). The interview and field inquiry process and all research methods design were strictly carried out in accord with Declaration of Helsinki guidelines, and all methods and procedures had been reviewed past Ideals Committee of the First Affiliated Hospital of Soochow University. The blueprint of this study fully considered the principles of security and fairness, the research content does non constitute harm or take a chance to the nurses. Written informed consent was obtained from all participants prior to the report, all the interviewees were completely based on the principle of voluntary and informed consent, and the privacy of nurses was strictly protected.
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Wang, YL., Yang, ZW., Tang, YZ. et al. A qualitative exploration of "empathic labor" in Chinese hospice nurses. BMC Palliat Intendance 21, 23 (2022). https://doi.org/x.1186/s12904-022-00911-w
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DOI : https://doi.org/10.1186/s12904-022-00911-w
Keywords
- Hospice care
- Nurses
- Empathy
- Emotional labor
- China
Source: https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-022-00911-w
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