EMPATHY: ANGEL OR DEVIL? How shared emotions can help or hinder nurses in their relationships with patients

Emotional empathy can be defined as the vicarious experience of the emotional backgrounds of other people: i.e. feeling and sharing how another person feels (Mehrabian 1996, Gallese, 2007). There are differences between how individuals respond to others’ emotional states and this personal characteristic may be considered as a construct with different intensities that distinguishes those who are more responsive to the emotional expressions of others. Empathic responsiveness and emotional regulation skills (to cope with the risk of emotional contagion) are particularly important in professions where the helping relationship is the central element, as in nursing. The risk, for nurses, is to be overwhelmed by the suffering of the patient. We can suppose that daily contact with suffering activates defensive attitudes when nurses feel themselves more at risk of contagion and this practice is also developed through work experiences. We present a study which aims to 1) identify which defence mechanisms/attitudes are used with greatest frequency to protect nurses from the danger of emotional contagion arising from daily contact with suffering; 2) find out if the choice and use of these mechanisms is correlated to the level of the subject’s Empathic Tendency (ET) as measured using the Balanced Emotional Empathy Scale (BEES) (Mehrabian, 1996). The Italian version of the BEES (Meneghini, Sartori, Cunico, 2012) and a structured interview were administered to 151 nurses. It emerged that continuous exposure to emotional situations associated with patient suffering leads to the development of strategies designed to protect from excessive involvement and therefore reduce the psychological cost of empathy. In particular, variations were found between nurses with different lengths of service: long-standing nurses showed a greater capacity to manage the professional assistance relationship, concentrating their attention on the other person but also on themselves. The advantage of this is that they are more exposed to involvement but with a lesser degree of risk of being emotionally overwhelmed. Data also showed differences in subjective ETs: reactions such as “seeking physical contact” and “a tendency to immerse themselves in suffering” are more frequent when the ET is high. In this case the defence mechanisms may involves a greater degree of “interruption of eye contact”. On the contrary, when the BEES index is low, the frequent utilization of the “profession as a defence” and the “rationalization of the situation” suggest that nurses protect themselves principally by using their “professional role”. Recent publications support the value of training in the modern nursing environment. It is clear that patients want empathic and emotionally competent nurses and that the ability of nurses to empathise with their patients is a desirable quality. Trainers therefore have a responsibility to provide an education that engenders empathic understanding and, at the same time indicate appropriate means to cope with the risk of emotional over-involvement. We explore the implications of the findings of our studies for the training of nurses, identifying key areas for consideration in order to develop emotional skills and empathy in student nurses.