Nursing is considered a caring profession, if not the caring profession.
Empathy is one of the caring characteristics that many nurses hold dearly and the Nursing Council lists demonstrating empathy as one of the indicators of nursing competency.
“There is an accepted view – and it may be axiomatic – that nursing is the pre-eminent caring profession,” nurse and educator Dr Peter Gallagher told the recent Australasian Nurse Educators Conference. “I’m not saying it is or it isn’t, but it is a view that is widely shared.”
Many examples of uncaring nursing that were highlighted by the Mid Staffordshire NHS Foundation Trust Public Inquiry in 2013 caused great shock in Britain and led to headlines such as ‘Nursing is no longer the caring profession’ in The Telegraph.
There is also a significant body of nursing theory examining the nature and role of empathy and caring in nursing and nursing education. Amongst the most prominent of these is nursing theorist Jean Watson, who said “caring is the essence of nursing and the most central and unifying focus for nursing practice”.
Gallagher says while empathy is regarded as a characteristic of all health professionals there remained a view, within nursing at least, that nursing is the most empathetic of the health professions.
Such views prompted one nursing colleague to tell him he was “crossing to the dark side” when he took a position at the University of Otago Wellington School of Medicine.
But once at the medical school, Gallagher told the conference, he was surprised at the amount of caring – both explicit and implicit – within the medical curriculum. “I started to think maybe we [nursing] didn’t have complete ownership over that [characteristic].”
He said it was also unclear whether people applying to become health professionals were inherently empathetic to start with or whether it was something they ‘caught’ by seeing it modelled in clinical practicums or something that should be explicitly ‘taught’ during their studies.
Some fifth-year Otago medical students receive up to five hours of empathy training, involving actors and role play, where they are assessed and given feedback on their portrayal of empathy. But other cohorts have no explicit training in empathy.
Since about 2009, the medical school has been measuring all medical students’ self-reported empathy levels using the Jefferson Scale of Empathy (JSE) tool, which was initially developed by an American medical school to measure empathy in physicians but was later adapted for other health professionals and health professional students.
Gallagher told the conference that he and his colleagues decided to use the empathy tool to test out the aphorism that nursing students are more empathetic than their medical school counterparts.
The JSE tool involves 20 questions, with students asked to rank how strongly they agree or disagree with the 20 statements (slightly altered depending on whether the students are medical or nursing students) with the highest potential score being 140. Statement examples include: “Attentiveness to patients’ emotions is not important in history taking” and “I believe that empathy is an important therapeutic factor in nursing care”.
The students tested were part of a nursing school cohort of third-year nursing students (soon after they had completed their transition to practice clinical placement), alongside several cohorts of fifth-year medical students (only some of whom had received empathy training).
When the results were compared, it was found that the cohorts’ mean empathy scores were all very similar and there was no statistical significance between the nursing student cohort and the medical student cohorts. (The vast majority of the nursing students were female and around 60 per cent of the medical students were female also.)
“I was surprised, as I was hoping that nursing students would portray a higher level of self-reported empathy,” Gallagher told the conference.
“But there was no evidence from our results that these student nurses were by nature more or less empathetic than their medical student counterparts, or that nursing training by its nature produces a more empathetic health professional than medical training.”
Gallagher says the numbers involved in the study were small and the study’s findings had its limitations but they did “chip away” some of the myths around nursing being the most caring profession.
*This article is based on Peter Gallagher’s presentation to the ANEC conference in November on the research carried out by himself, Faye Davenport (UCOL), Mark Huthwaite, Helen Moriarty and Bee Lim (all of the University of Otago, Wellington).
The Nursing Council of New Zealand’s Competencies for Registered Nurses
Competency 3.1: Establishes, maintains and concludes therapeutic interpersonal relationships with health consumers.
Indicator: Demonstrates respect, empathy and interest in the health consumer.
The caring professions: professions such as nursing and social work that are involved with looking after people who are ill or who need help in coping with their lives (Collins Dictionary)
Empathy: intellectual and emotional awareness and understanding of another person’s thoughts, feelings, and behaviour, even those that are distressing and disturbing. Empathy emphasises understanding; sympathy emphasises sharing of another person’s feelings and experiences. (Miller-Keane Encyclopedia and Dictionary of Medicine, Nursing, and Allied Health, Seventh Edition)