Elsevier

Nurse Education Today

Volume 33, Issue 4, April 2013, Pages 334-338
Nurse Education Today

Feeling at hospitals: Perspective-taking, empathy and personal distress among professional nurses and nursing students

https://doi.org/10.1016/j.nedt.2013.01.010Get rights and content

Summary

When facing a person in need, professional nurses will tend to adopt an objective perspective compared to nursing students who, instead, will tend to adopt an imagine-other perspective. Consequently, professional nurses will show lower vicarious emotional reaction such as empathy and distress. Using samples from Spain (Studies 1 and 2) and United states (Study 3), we compared perspective taking strategies and the emotional responses of nurses and nursing students when perceiving a sick child (Study 1) and a sick adult (Studies 2 and 3). Taken together, the results supported our hypotheses. We discuss the applied value of considering the relationship between perspective-taking and its emotional consequences for the nursing profession.

Introduction

Those emotions that we feel when perceiving the suffering of others (i.e., vicarious emotions) are a main component of the nurse–patient relationship. For example, William (1989) found that nursing students experienced distress and avoided the patient when she or he was described as having a terminal illness because they felt unable to relieve the patient's suffering. However, when facing a non-terminal patient, the students showed empathy and care. In the same vein, Stotland et al. (1978) had found that highly empathic nursing students became emotionally exhausted when beginning their career and would later actively avoid attending to terminal patients. Campbell-Yeo et al. (2007) suggest that nurses may feel helpless when they are unable to relieve the pain of a patient and that repeated exposure to this arousal leads to long-term exhaustion and diminished interest. And after comparing emotional responses of undergraduate students and graduate nursing students, Kunst-Wilson et al. (1981) found that empathic accuracy increased with the education level of the individual, and that nursing students feel higher levels of distress when they begin working with patients but later “learn” not to suffer. This increase in the empathic accuracy is supported by Eide et al. (2011) who showed that professional nurses showed high empathic accuracy when perceiving patients' emotional expressions. However, this emotional responsiveness only happens when patients show sadness (Sheldon et al., 2009).

Feeling either empathy or distress can be influenced by the perspective taken by the observer. This perspective-taking is a cognitive-perceptual process that determines how one individual comes to understand the thoughts, feelings, and/or perceptual awareness of another individual (Batson et al., 1987, Borrego, 2009). Two typically studied perspective-taking strategies have been: remaining detached and not emotionally involved (objective perspective), and imagining what the other is thinking and feeling (imagine-other perspective) (Batson et al., 1997, Hoffman, 2002). These two perspectives are associated with relatively distinct emotional consequences. Specifically, an objective perspective tends to minimize emotional responses to the unfortunate condition of others whereas an imagine-other perspective tends to produce vicarious emotions for the other, such us empathy and distress.

The existing research on nursing has focused on emotional responses considering either nursing students or professional nurses and without assessing the different perspective-taking strategies involved. In contrast, the present research investigates the differences in the perspective taking strategies and vicarious emotional responses to patients comparing professional nurses with nursing students.

Section snippets

Study 1

In Study 1, we compare the perspective-taking strategies and the consequences of nurses and nursing students in a Spanish population. We predict that professional nurses will tend to adopt an objective perspective whereas nursing students will tend to adopt an “imagine-other” perspective. Our hypothesis is based on two findings. First, extensive research shows that objective-perspective leads to feel a lower vicarious emotional reaction (i.e., empathy and distress) than does imagine-other

Study 2

A potential flaw in the procedure of Study 1 is that we used a picture to depict the needy other. Therefore, the study did not standardize how the picture was interpreted. This may have affected the emotional response. To remedy this potential flaw, in Study 2 we added a written description of the needy other illness to the picture in which he was depicted. Additionally, an adult male is used instead of a child. The reasons for making these procedural changes were to standardize how the picture

Study 3

The goal of Study 3 is to assess the generalizability of the results from Studies 1 and 2. We conducted a conceptual replication with a North American sample. The relationship between perspective-taking strategies and emotional consequences is discussed.

General Discussion

In the present research, perspective-taking strategies and emotional reaction among nursing students and professional students were compared. Regarding perspective-taking, the results of the three studies suggest that, in comparison with the other group, professional nurses report a higher tendency to adopt an objective perspective, whereas nursing students report a higher tendency to adopt an imagine-other perspective.

Regarding the emotional reaction, the results of the three studies showed

Acknowledgements

This research is supported by the project PSI2011-28720 from the Spanish Ministry of Science and Innovation and the grant AP2008-00065 from the Spanish Ministry of Education.

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