Abstract
It is always interesting to read new insights into familiar concepts and this study raises some fascinating points of discussion from an Iranian approach to educating intensive care nurses in empathy. The aim of the study was to ascertain whether empathy training influenced empathy skills in intensive care unit nurses.
Although the paper does not provide detail on the training undertaken by the experimental group, it would appear that eight 90-minute sessions were focused on skills development. This raises three important points of discussion.
Firstly, papers addressing empathy often raise discussions as to definitions of empathy and compassion. It would have been interesting to understand why the authors of this study focused on empathy skills training, with no mention of compassion as a concept. The skills-based training approach to achieve empathy, discussed in this paper, contrasts with van der Cingel’s work (2014: 1254) in which she defines empathy as ‘to recognize human vulnerability as a vulnerability we each have’. She goes on to argue that empathy is a fundamental ability or condition that is necessary for compassion. This can be interpreted as empathy is a prerequisite for compassion, with compassion the important outcome to be striven for. Brunero et al. (2010: 72) reviewed the literature on teaching and measuring empathy and identified a potential tension between ‘state and trait empathy’. In their discussion they suggest that learned (state-level) empathy results in a distance between the nurse and their patients, whereas trait-level empathy provides a nurse-patient attachment.
The second point of consideration is the reliability of empathy training as a skill to be learned, rather than the education being an ongoing process (Kahriman et al., 2016) to develop empathy as a conduit for compassion (van der Cingel, 2014). Several studies have discussed and questioned the benefit of empathy training and have suggested further robust research to establish the validity of the instruments used to measure the outcomes (Brunero et al., 2010). The authors of this study appear confident in their outcome measures using the Davis Empathy Scale; however, it would have been helpful to know how this instrument compares to the instruments used in Brunero et al.’s 2010 review.
The cultural perspective of this study is the final point of discussion that could be explored more fully. Work by van der Cingel (2014) and Brunero et al. (2010) raise an interesting consideration of what is required of nurses: professional empathy? Or the ‘compassion’ that many Nursing Codes of Practice name as being central to person-centred care (NMC, 2018; ANA, 2015; ICN, 2012)? It is, however, interesting to note that although the Code of Ethics for Nurses in the Islamic Republic of Iran states ‘compassion and kindness’ as being an important nursing principle (Zahedi et al., 2013: 4), the United Arab Emirates Nursing and Midwifery Council (UAE NMC, 2013) and the Crescent of Care (Lovering, 2012; Crescent of Care, 2008) do not mention either empathy of compassion explicitly. It would be interesting to understand whether compassion is woven so integrally into the cultural tapestry of a society there is no need to explicitly include it in the Code of Practice for their nurses.