Defining compassion in a hospital setting: consensus on the characteristics that comprise compassion from researchers in the field.

Aims: To seek consensus on the key characteristics that comprise compassion in a health care setting from pre-defined experts currently researching in the field. Background: Compassion is a vital component in healthcare. There is currently little consensus on how compassion is defined or operationalized in healthcare or research. Design: Modified Delphi Study. Methods: A four phase Delphi process was conducted: (1) Literature review of contemporary research (2) open ended questionnaire (n = 9); (3) content analysis results and synthesis with literature; (4) two round Delphi approach (Round 1 n = 8; Round 2 n = 6). Results: A total of 31 out of 36 statements reached consensus. Conclusions: Experts came to a consensus that compassion was a virtuous response involving awareness of and participation in the suffering of another conveyed through action intended to reduce the suffering observed. Experts placed less emphasis on compassion as sympathetic concern or pity. Compassion does not involve witnessing of the plight of another nor suffering with the patient.

An exploratory descriptive study of compassion fatigue and compassion satisfaction: Examining potential risk and protective factors in advanced nurse practitioners.

BACKGROUND: Larger patient caseloads and increased workplace responsibility for nurse practitioners (NPs) may exacerbate factors leading to compassion fatigue (CF). PURPOSE: The purpose of this study is to analyze the rate of burnout in practicing NPs by looking at contributing factors that play a role in CF and compassion satisfaction (CS). METHODS: A NP social media platform was used to distribute a survey to a convenience sample of 208 NPs. Data included the Professional Quality of Life Scale V (ProQOL V) tool, demographic data, and protective factor questions. The data were dissected for CF and protective factors of CS. RESULTS: The relationship of mindfulness practices and levels of CS was statistically significant. The relationship between support from family, coworkers, and administration and levels of CS was also found statistically significant. A large association was found between the correlation of burnout and support from coworkers. IMPLICATIONS FOR PRACTICE: Findings showed an average to high level of CS with a low-to-average burnout rate among the NPs surveyed. There was a direct impact between the amount of support participants received from individual support systems and their level of CS. These findings could be beneficial for new NP graduates in establishing a sense of community while reducing the risk for burnout.

Exploration of empathy in Cyprus nursing and health care students: A mixed method study.

Developing professionals who are perceptive to the needs of patients and can respond by expressing empathetic behavior is one of the aims of health care education. The aim of this study was to explore the level of empathy in health care students through a mixed method. The quantitative approach included the use of the Jefferson Scale of Empathy and the qualitative a focus group approach to further deepen into the descriptive results. 869 health care students (RR=81%) participated in the study and the level of empathy ranged from 42 to 139 with a mean score of 100.6 (20-140 scale). Significant statistical differences were found between the disciplines (F=8.6, p-value<0.001) and gender (p-value<0.001) with nursing students and women scoring the higher levels. Two focus groups of ten participants each were conducted with 3rd and 4th year nursing students. Four themes were derived from the analysis of these data a) empathy as an imperative component of care b) contact with the clinical reality c) the influence of family and choice of studies d) gender stereotypes. There is a lack of mixed methodologies in the empathy research and this study provided the opportunity of a better understanding of the health care students' views.

Compassion satisfaction and compassion fatigue in Australian emergency nurses: A descriptive cross-sectional study.

INTRODUCTION: Emergency nurses are at risk of compassion fatigue. Compassion fatigue caused by exposure to suffering may compromise the individual's personal wellbeing and reduce work efficiency. METHODS: A quantitative cross-sectional survey with open responses was conducted using the Professional Quality of Life: Compassion Satisfaction and Compassion Fatigue (ProQOL) scale and open-ended questions. Responses from a convenience sample of 86 nurses from two hospital emergency departments in Victoria, Australia, were analysed. RESULTS: The median score for Compassion Satisfaction was 78% with all nurses reporting average to high scores. Most had average levels of Compassion Fatigue: Burnout median score was 53% and Secondary Traumatic Stress median score 49%. No statistically significant correlation was found between scales nor with influencing demographic characteristics. A qualification in emergency nursing was predictive of Compassion Satisfaction. Six descriptive job-associated factors contributed to nurses' stress: human resources, the organisation, job-specific components, patient mix and professional and personal components. CONCLUSION/S: Average to high levels of Compassion Satisfaction and low to average levels of Compassion Fatigue were found in emergency nurses. Issues contributing to stress were work and role related. An understanding of these stressors may help nurses and nurse managers to ameliorate emergency nurses' levels of stress and help limit staff burnout.

The compassion levels of midwives working in the delivery room.

BACKGROUND: Compassion-based practices in midwifery are the most important expression of the depth of care quality. This concept is insufficiently represented in literature, therefore, studies on this subject are of utmost importance. OBJECTIVES: This study aims to determine the levels of compassion of midwives working in the delivery room and the factors affecting these levels. The study was carried out in Kocaeli, Turkey. METHODS: This descriptive study was carried out from 1 February to 15 April 2019 in delivery rooms of six different hospitals located in the provincial centre of Kocaeli, Turkey, with 78 actively working midwives. Data were collected using a 'Compassion Scale' and analysed using the Mann-Whitney U test, the Kruskal-Wallis H test and the Spearman correlation test. ETHICAL CONSIDERATIONS: This study was conducted according to ethical scientific guidelines. RESULTS: The compassion score of the midwives were found to be 4.19 ± 0.39. The total compassion score was affected by professional factors such as number of patients, alternating shift work, number of traumatic births and work satisfaction. While the kindness subscores decreased depending on shift work and number of traumatic births, it was determined that the midwives who were satisfied with their work had higher kindness scores than those who were not. Also, as the age and professional experience of the midwives and the number of traumatic births increased, their indifference score also increased. Midwives who reported that they were not satisfied with their job had higher scores regarding separation and disengagement scores than those who were satisfied with their job. CONCLUSION: It was determined that the compassion levels of midwives were found to be negatively affected by factors such as age, professional experience, job satisfaction and number of monthly traumatic births in a month. They should be reminded that compassionate midwifery care for women is a basic human right.

Regular Aerobic Voluntary Exercise Increased Oxytocin in Female Mice: The Cause of Decreased Anxiety and Increased Empathy-Like Behaviors

Background: It is known that regular physical activity reduces anxiety. Low anxiety levels affect mood, emotions, and empathy. Oxytocin is a powerful hormone that regulates social interaction, sexual reproduction, maternal­infant bonding, milk release, empathy, and anxiety. Empathy is an important behavior in the living community; and also important for sportsmen during sportive competition and daily living life, because sportsmen are also role model of people. Aims: To investigate the effects of voluntary physical activity on oxytocin, anxiety, and empathy levels as well as the relationship between them. Study Design: Animal experiment. Methods: Male and female mice were made to exercise in running wheel cages for 6 weeks. Their empathy and anxiety levels were evaluated by using Helping Behavior test and elevated plus maze and open field test, respectively. And then the brain and blood oxytocin levels were measured. Results: Empathy-like behavior was improved in both genders of the exercise groups (door-opening time decreased in both genders of exercise groups, p for both=0.0001). As a response to exercise, both the brain and serum oxytocin levels increased in female mice (both of p=0.0001); however, in males, oxytocin levels increased in only the brain (p<0.05). Anxiety levels decreased in all the exercise groups (increased time spent in the middle area of open field test, both genders, p=0.002; increased time spent in the open arms of elevated plus maze test, females p=0.004, males p=0.0001). There was a strong negative correlation between serum oxytocin levels and door opening time of helping behavior equipment, and moderate negative correlation was found between the brain oxytocin levels and door-opening time of helping behavior equipment in females. However, there was no correlation between both the brain and serum oxytocin levels and empathy behavior in males. But there were very strong positive correlations between low anxiety indicators and both the brain and serum oxytocin levels in both the genders. Conclusion: Voluntary physical activity decreases anxiety and increases empathy-like behavior in mice; which is associated with increased oxytocin levels in female mice but not in male mice. Further research is required to investigate the mechanisms of exercise effect on anxiety and empathic brain pathways in males.

Empathic profile of nursing freshmen.

OBJECTIVE: To analyze the empathic profile and the empathy scores of freshmen of the nursing course. DESIGN AND PARTICIPANTS: Descriptive study involving 399 freshmen students of two modalities of nursing courses: Bachelor and Bachelor and Teaching Diploma, in the period from 2012 to 2015. A sociodemographic questionnaire and the Empathy Inventory were applied. ETHICAL CONSIDERATIONS: The research received approval from the Research Ethics Committee of the University of São Paulo at Ribeirão Preto College of Nursing. The students registered their acceptance to participate in the research by signing the Free and Informed Consent Form and anonymity was guaranteed. FINDINGS: The mean age of the participants was 19 years, being 85.5% female. The students were grouped by course modality and all groups presented high empathy scores. A significant difference (p < 0.001) was found, which indicates that students of the Bachelor and Teaching Diploma program presented a higher degree of empathy for the General Score, Domain 2 (Interpersonal Flexibility), and Domain 3 (Altruism) in relation to students in the Bachelor program. CONCLUSION: Results show that nursing undergraduate freshmen are emphatic, with minimum differences between the two courses. This profile is relevant for the development of future professionals capable to demonstrate a balance between instrumental and expressive competences.

Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese.

BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

Determinants of compassion satisfaction, compassion fatigue and burn out in nursing: A correlative meta-analysis.

BACKGROUND: Compassionate care is essential for better clinical and patient outcomes, but during healthcare provision it can be compromised by several factors. This study evaluates factors affecting compassion satisfaction, compassion fatigue and burnout in nursing. METHODS: Literature search in electronic databases was followed by data extraction, conversion, and meta-analyses under random effect model. Correlation coefficients (r) reported by individual studies were first converted to z-scores for meta-analyses and the overall effect sizes were then back-transformed into r. RESULTS: Eleven studies (4054 respondents; 64.34 [95% confidence interval: 38.82, 89.86] % response rate; age 39.81 [31.36, 48.27] years; 87.11 [79.48, 94.73] % females) were used for meta-analysis. There was a strong positive correlation between compassion fatigue and burnout (r = 0.59), whereas compassion satisfaction had weak negative correlation with compassion fatigue (r = -0.226) but moderate with burnout (r = -0.446). Stress and negative affect were moderately positively associated with compassion fatigue (r = 0.405) but weakly correlated with burnout (r = 0.119). Positive affect and personal/social factors had weak inverse relationship with burnout (r = -0.197). Positive affect also had a moderately positive relationship with compassion satisfaction (r = 0.396). Demographic or professional factors were not significantly related to compassion satisfaction, compassion fatigue, or burnout. CONCLUSION: In nursing, a variety of stressful factors and negative affect promote compassion fatigue and burnout whereas positive affect is helpful in achieving compassion satisfaction.

Translation and validation of Warmometer, a tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese

ABSTRACT BACKGROUND: Empathy in the patient-provider relationship is associated with important outcomes in healthcare practice. Our aim was to translate and validate Warmometer, a visual tool for assessing warmth in patient-provider relationships, for use in Brazilian Portuguese. DESIGN AND SETTING: Cross-sectional study conducted at an antenatal clinic of a public university hospital in São Paulo, Brazil. METHODS: The instrument was translated into Brazilian Portuguese and culturally adapted. It was tested for reliability and validity among 32 pregnant women, between June 2015 and January 2016. To assess construct validity, it was correlated with the Consultation and Relational Empathy (CARE) scale (gold standard for patient-provider relationships) and the Interpersonal Reactivity Index (IRI). RESULTS: The translated version of Warmometer had good face and content validity, low intra-observer reproducibility (intraclass correlation coefficient, ICC: 0.224; 95% confidence interval, CI -0.589 to 0.621;P = 0.242) and high inter-observer reproducibility (ICC: 0.952; 95% CI 0.902 to 0.977; P < 0.001). There was a strong correlation between Warmometer and CARE (r = 0.632) and a weak correlation between Warmometer and IRI (r = 0.105). CONCLUSIONS: Warmometer was translated, culturally adapted and validated for use in Brazilian Portuguese. The translated version is a reliable tool for assessing the degree of empathy perceived by the patient in a patient-provider relationship.

Empathy is a Stable Predictor of Compassionate Emotions Independent of an Attribution of Responsibility Manipulation / La empatía es un predictor estable de emociones compasivas independiente de una manipulación de atribución de responsabilidad

ABSTRACT The goal of the present research was to investigate if individual differences in empathy and personal distress were stable predictors of compassionate emotions and whether these emotions, in turn, mediate the effect of attribution on prosocial propensity. We formulated four hypotheses to be tested concerning direct and indirect effects between the variables in our model. 627 participants, mainly female (N = 408), were randomly assigned to one of two conditions in which we manipulated the attribution of responsibility of a target person (uncontrollability x controllability). Our results corroborated totally or partially all four hypotheses, indicating that empathy was a stable predictor of compassionate emotions and that these emotions mediated the effect of attribution on prosocial propensity. Notably, we found that empathy was an even stronger predictor of compassionate emotions compared to the attribution that participants made. We found evidence corroborating the assumption that these prosocial individual differences measures can predict the tendency to actually experience compassionate emotions in different situations. Thus, we conclude that the comprehension of prosocial decision-making and attribution processes underlying prosocial situations must take into account individual differences as antecedents of compassionate emotions.

RESUMEN El objetivo de la presente investigación fue evaluar si las diferencias individuales en empatía y angustia personal eran predictores estables de emociones compasivas y si estas emociones a su vez median el efecto de la atribución sobre la propensión prosocial. Hemos formulado cuatro hipótesis que se someterán a prueba por medio de los efectos directos e indirectos entre las variables del modelo. 627 participantes, principalmente mujeres (N = 408), fueron asignados aleatoriamente a una de las condiciones en las que manipulamos la atribución de responsabilidad (incontrolabilidad x controlabilidad). Nuestros resultados corroboraron total o parcialmente las cuatro hipótesis, indicando que la empatia es un predictor estable de emociones compasivas y que estas emociones mediaron el efecto de la atribución sobre la propensión prosocial. Es importante destacar que encontramos que la empatia fue un predictor aún más fuerte de emociones compasivas en comparación con la atribución que los participantes hicieron. Encontramos evidencias que corroboran el supuesto de que estas medidas de las diferencias individuales prosociales pueden predecir la tendencia a experimentar emociones compasivas en diferentes situaciones y concluimos que la comprensión de los procesos de toma de decisiones y de atribución prosociales subyacentes a las situaciones prosociales debe tener en cuenta las diferencias individuales como antecedentes de emociones compasivas.

Exploring Nurses' Meaning and Experiences of Compassion: An International Online Survey Involving 15 Countries.

PURPOSE: In recent years, there has been much focus on compassion in nursing care, and concern has been raised in a number of reports and media stories regarding decreased compassion. The aim of this study was to explore similarities and differences in the understanding and demonstration of compassion in nursing practice across 15 countries. DESIGN: A total of 1,323 nurses from 15 countries responded to questions in relation to compassion, via an international online survey. RESULTS: The data revealed the impact of sociopolitical influences on perceptions of compassion, and the conscious and intentional nature of compassion. DISCUSSION AND CONCLUSION: The study demonstrated shared understandings of the importance of compassion as well as some common perceptions of the attributes of compassionate care. The differences reported were not as significant as had been expected. IMPLICATIONS FOR PRACTICE: Further research is needed to explore the country and culture differences in the enactment of compassion.

Empathy in narcissistic personality disorder: from clinical and empirical perspectives.

Narcissistic personality disorder (NPD) is associated with an assortment of characteristics that undermine interpersonal functioning. A lack of empathy is often cited as the primary distinguishing feature of NPD. However, clinical presentations of NPD suggest that empathy is not simply deficient in these individuals, but dysfunctional and subject to a diverse set of motivational and situational factors. Consistent with this presentation, research illustrates that empathy is multidimensional, involving 2 distinct emotional and cognitive processes associated with a capacity to respectively understand and respond to others' mental and affective states. The goal of this practice review is to bridge the gap between our psychobiological understanding of empathy and its clinical manifestations in NPD. We present 3 case studies highlighting the variability in empathic functioning in people with NPD. Additionally, we summarize the literature on empathy and NPD, which largely associates this disorder with deficient emotional empathy, and dysfunctional rather than deficient cognitive empathy. Because this research is limited, we also present empathy-based findings for related syndromes (borderline and psychopathy). Given the complexity of narcissism and empathy, we propose that multiple relationships can exist between these constructs. Ultimately, by recognizing the multifaceted relationship between empathy and narcissism, and moving away from an all or nothing belief that those with NPD simply lack empathy, therapists may better understand narcissistic patients' behavior and motivational structure.

Effect of empathy trait on attention to faces: an event-related potential (ERP) study.

BACKGROUND: Empathy is deeply linked with the ability to adapt to human social environments. The present study investigated the relationship between the empathy trait and attention elicited by discriminating facial expressions. METHODS: Event-related potentials were measured while 32 participants (17 men and 15 women) discriminated facial expressions (happy or angry) and colors of flowers (yellow or purple) under an oddball paradigm. The empathy trait of participants was measured using the Interpersonal Reactivity Index (Davis, 1980). RESULTS: The empathy trait correlated positively with both the early portion (300 to 600 ms after stimulus onset) and late portion (600 to 800 ms after stimulus onset) of late positive potential (LPP) amplitude elicited by faces, but not with LPP elicited by flowers. CONCLUSIONS: This result suggests that, compared to people with low empathy, people with high empathy pay more attention when discriminating facial expressions. The present study suggests that differences exist in methods of adapting to social environments between people with high and low empathy.

The Empathy Index: an evaluation of the psychometric properties of a new empathy measure for sex offenders.

This article examines the analysis of the psychometric properties, including the validity and reliability, of the Empathy Index (EI), a new instrument designed to measure empathy deficits of sex offenders. The EI was tested with a sample of 158 sex offenders incarcerated in North Carolina prisons. An exploratory factor analysis yielded three subscales: social aggression; instrumental (proactive) aggression; and justification. Social aggression was an unexpected finding, given this type of aggression is more commonly found in young females rather than adult male sex offenders. The instrument demonstrates promising construct and concurrent validity as well as strong internal reliability. Implications for future research and practice are discussed.

Perceived maternal control and responsiveness to distress as predictors of young adults' empathic responses.

Two studies examined the relations between young adults' empathic responding and their perceptions of two maternal behaviors. As predicted from self-determination theory, perceived maternal control had unique negative associations with empathic support of one's romantic partner (indicated by both self-reports and partner reports) and with empathic concern for others in general, and a unique positive association with personal distress in response to others in need. Perceived maternal responsiveness to distress was a unique positive predictor of empathic concern. The findings suggest that the experience of one's mother as controlling is likely to interfere with one's empathic responding and that high levels of perceived maternal responsiveness do not cancel the negative effects of the experience of controlling parenting. Furthermore, the findings suggest that high levels of perceived maternal responsiveness might exacerbate the negative relations between perceived maternal control and personal distress in response to others in need.

Perspectives on caring in the classroom: do they vary according to ethnicity or grade level?

Research shows that students can articulate a definition of caring and identify specific behaviors of caring teachers. Some of this research also indicates that White students perceive caring differently from African American students. The purpose of this study was to examine what students from different cultural backgrounds and different grade levels identify as the practices teachers use to create a caring classroom. Sixth- and ninth-grade students from an ethnically diverse urban middle and high school completed a qualitative questionnaire on their teachers' classroom practices. Results indicate, although there were little differences in the categories and themes that emerged across ethnic groups and grade levels, when analyzing how the response percentages for each category were distributed within ethnic group and across grade levels, several differences were apparent.