Is the gender or age of the physician key to a good physician-patient with inflammatory bowel disease relationship?

BACKGROUND AND AIMS: A good patient-physician relationship in inflammatory bowel disease (IBD) is very important and physician empathy is its cornerstone. There is no evidence about if age and/or sex of physicians and patients could influence on perceived empathy by patients. The aim of the study was to assess the level of empathy of IBD specialist physicians perceived by their patients and if it varies according to the age and gender of the patient and the physician. METHODS: We performed a national cross-sectional study based on voluntary online survey to IBD patients that included the Consultation and Relational Empathy (CARE) scale. RESULTS: Five hundred sixty one responses to the survey were received. After applying exclusion criteria, 536 patients were included in the analysis. Total median score of CARE scale was 44.5 (maximum possible score: 50 points). Most of the patients (99.1%) considered the contents of the questionnaire to be an important issue. There were no significant differences in CARE scale scores in function of patient/physician age range or gender [physician gender: males vs. females: median 46 vs. 44, p=0.139; physician age: <40 years, 40-60 years, >60 years: 45.5 vs. 44 vs. 44, p=0.328]. CONCLUSION: Spanish inflammatory bowel disease patients have a great physician empathy perception, which is the key to a good patient-physician relationship, and this fact is not influenced by age or gender of patients or inflammatory bowel disease specialist.

Parental Efficacy Moderates the Association Between Empathy and Burden Among Parents of Children Admitted to a Psychiatric Ward.

Empathy is considered a positive aspect of caregiving, although in certain circumstances, being empathic might increase the burden of caregivers. The current study assessed the associations between empathy, parental efficacy, and family burden among parents of children who were hospitalized in a psychiatric unit. Specifically, we examined whether the association between empathy and family burden was moderated by the parents' sense of self-efficacy. Seventy parents of children with psychiatric disorders, hospitalized in an inpatient psychiatric unit, filled out questionnaires of empathy, parental efficacy, and family burden. Results supported a moderating role of parental efficacy between empathy and family burden (interaction effect: ß = -1.72, p = .0406). Specifically, empathy was positively related to family burden among parents with low self-efficacy (conditional effect = 0.70, p = .032) and negatively related to family burden among parents with high self-efficacy (conditional effect = -0.39, p = N.S). Implications for practice include the importance of self-efficacy and address the possible negative implications of empathy among parents of children treated in a psychiatric hospital.

[Clinical empathy among family and community medicine residents and tutors. The view of physicians and patients]. / Empatía médica en residentes y tutores de medicina familiar y comunitaria. La visión del profesional y del paciente.

AIM: To determine the degree of clinical empathy among family medicine residents and tutors. To gauge whether there is a relationship between physicians' self-perceived empathy levels and their patients' assessments. STUDY DESIGN: Observational, cross-sectional survey. LOCATION: Primary Care Teaching Unit. Madrid. PARTICIPANTS: A survey was sent by email to all the Teaching Unit's family medicine tutors and residents. Responses were received from 50 residents (39.4%) and 41 tutors (45%). In addition, 428 patients were opportunistically recruited at a healthcare centre and their doctors were also interviewed. PRIMARY MEASUREMENT INSTRUMENTS: Empathy was measured using the Jefferson Scale of Empathy and the Jefferson Scale of Patient Perceptions of Physician Empathy. RESULTS: The tutors scored 2.53 points higher for cognitive empathy than the residents (P=.04). Emotional empathy scores declined among older tutors (r= -0.32; P=.05). The Spanish students (82% of the total) without previous work experience scored higher for overall empathy (P=.02). Final-year residents recorded significantly worse empathy assessments than the other residents. A positive correlation (r=0.72; P=.01) was observed between physicians' self-perceived empathy and their patients' perceptions. CONCLUSIONS: Residents with previous work experience, final-year residents and those of Latin American origin score lower for empathy. There is a strong relationship between physicians' self-perceived empathy and their patients' views of their empathy levels.

[]"Sacred encounters" in primary care: What do they mean for family physicians?] / «Consultas sagradas¼ en atención primaria: ¿qué suponen para el personal médico?

OBJECTIVE: To determine the perceptions and attitudes of the general practitioners (GP) towards consultations with great emotional component, initially called "sacred encounters", and to identify areas of improvement. DESIGN: A qualitative methodology based on a socio-subjective approach and focused on health services research. Descriptive-interpretative study. LOCATION: Health Centres of Alava and Biscay. PARTICIPANTS: Selection of 23 GP from 23 urban and rural Health Centres. METHOD: Intentional sampling aimed at looking for discursive diversity. Data generated in 2016 by means of 3 discussion groups and 3 individual interviews recorded and transcribed after informed consent. Presentation to the ethics committee of the Basque Country. Thematic analysis with the aid of conceptual maps and MaxQDA program. Triangulation of the results between researchers and verification by the participants. RESULTS AND DISCUSSION: The findings were clustered into overlapping thematic areas related to the meaning of these encounters, attitudes of GP, health context, and patients. The importance of the emotions in primary care encounters and their invisibility is underlined, but the adequacy of the term "sacred" is questioned. This expression is built into the GP-patient relationship, if GP favours it and the patient also allows it, discussing the main circumstances that intervene in an essential dimension of integral care. CONCLUSIONS: The attention to the emotional dimension in the encounters has deficiencies that need to be corrected. In addition to its recognition and evaluation, it would be necessary to modify the organisational, training and professional factors that determine the involvement of the GPs in their good health care.

Specific and common processes as mediators of the long-term effects of cognitive-behavioral therapy integrated with motivational interviewing for generalized anxiety disorder.

OBJECTIVE: A trial of psychotherapy for generalized anxiety disorder (GAD) demonstrated that motivational interviewing (MI) integrated with cognitive-behavioral therapy (CBT) outperformed CBT alone on clients' worry reduction across a 12-month follow-up. In the present study, we hypothesized and tested that less client resistance and greater client-perceived therapist empathy (specific foci of MI) would account for MI's additive effect. Exploratory analyses assessed whether the common processes of homework completion and therapeutic alliance quality mediated the treatment effect. METHOD: Clients with GAD were randomized to 15 sessions of MI-CBT (n = 42) or CBT alone (n = 43). Worry was assessed throughout treatment and follow-up. Observers rated resistance at midtreatment, and clients reported on perceived therapist empathy, alliance, and homework completion throughout treatment. Mediation was tested with bootstrapping methods. RESULTS: Expectedly, MI-CBT clients evidenced less resistance and perceived greater therapist empathy, each of which related to lower 12-month worry. However, when both variables were tested simultaneously, only resistance remained a significant mediator of treatment. No indirect effects through homework completion or alliance emerged. CONCLUSIONS: Reducing client resistance may be a theory-consistent mechanism through which integrative MI-CBT promotes superior long-term improvement than traditional CBT when treating GAD. Clinical or methodological significance of this article: This study further supports the long-term clinical benefit of integrating MI into CBT when treating the highly prevalent and historically difficult-to-treat condition of GAD. In particular, it points to the theory-specific mechanism of MI (helping to reduce/resolve patients' in-treatment resistance) as accounting for the integrative treatment's additive effect on worry reduction across a follow-up period. Therapists using CBT to treat patients with GAD should be trained to incorporate MI principles (e.g., empathy, collaboration, autonomy support) in general and in response to explicit markers of resistance.

[Validación de la prueba de Tiras cómicas para evaluar la empatía en una muestra de población mexicana].

INTRODUCTION: Empathy is the ability of an individual to understand it from another cognitive and emotional point of view. Empathy is a complex that represents a retouch in its evaluation, so, it is necessary to have instruments validated in the Mexican population. OBJECTIVE: Validation of the Comic Strip Test to evaluate empathy. METHOD: Sampling for convenience, based on internal consistency, convergent validity with the Empathy coefficient, construct validity in the factorial analysis, and the ability to discriminate between subjects with lack of empathy (psychopathology) and the control subjects through a curve ROC. RESULTS: The comic strips test was evaluated in 86 controls, 19 patients with schizophrenia (Cronbach's alpha = 0.894). The correlation with the empathy coefficient was 0.88, with sensitivity of 81.3% and specificity of 38%. CONCLUSIONS: The Comic Strip Test was validated with parametric psychometric parameters.

ANTECEDENTES: La empatía es la capacidad de un individuo para entender al otro desde el punto de vista cognitivo y emocional. La empatía es un constructo complejo que representa un reto en su evaluación, por lo cual es necesario contar con instrumentos validados en población mexicana. OBJETIVO: Validación de la prueba de Tiras cómicas para evaluar empatía. MÉTODO: Muestreo por conveniencia, se midió la consistencia interna, la validez convergente con el coeficiente de empatía, la validez de constructo con análisis factorial y la capacidad de discriminar entre sujetos con déficit de empatía por psicopatología con controles por medio de una curva Receiver Operating Characteristic (ROC) por sus siglas en inglés. RESULTADOS: La escala de Tiras cómicas se evaluó en 86 controles, 19 pacientes con esquizofrenia, a de Cronbach = 0.894. La correlación con el coeficiente de empatía fue de 0.88, con una sensibilidad del 81.3% y la especificidad del 38%. CONCLUSIONES: Se validó la prueba de Tiras cómicas con adecuados parámetros psicométricos.

[Empathy, inter-professional collaboration, and lifelong medical learning in Spanish and Latin-American physicians-in-training who start their postgraduate training in hospitals in Spain. Preliminary outcomes]. / Empatía, habilidades de colaboración interprofesional y aprendizaje médico permanente en residentes españoles y latinoamericanos que inician los programas de formación médica especializada en España. Resultados preliminares.

OBJECTIVE: To identify similarities and differences in empathy, abilities toward inter-professional collaboration, and lifelong medical learning, between Spanish and Latin-American physicians-in-training who start their posgraduate training in teaching hospitals in Spain. DESIGN: Observational study using self-administered questionnaires. SETTINGS: Five teaching hospitals in the province of Barcelona, Spain. PARTICIPANTS: Spanish and Latin-American physicians-in-training who started their first year of post-graduate medical training. MAIN MEASUREMENTS: Empathy was measured using the Jefferson scale of empathy. Abilities for inter-professional collaboration were measured using the Jefferson scale attitudes towards nurse-physician collaboration. Learning was measured using the Jefferson scale of medical lifelong learning scale. RESULTS: From a sample of 156 physicians-in-training, 110 from Spain and 40 from Latin America, the Spanish group showed the highest empathy (p<.05). On the other hand, Latin-American physicians had the highest scores in lifelong learning abilities (p<.001). A positive relationship was found between empathy and inter-professional collaboration for the whole sample (r=+0.34; p<.05). CONCLUSIONS: These results confirm previous preliminary data and underline the positive influence of empathy in the development of inter-professional collaboration abilities. In Latin-American physicians who start posgraduate training programs, lifelong learning abilities have a positive influence on the development of other professional competencies.

[The medical empathy, is it born or is it made? Evolution of the empathy in medical students]. / La empatía médica, ¿nace o se hace? Evolución de la empatía en estudiantes de medicina.

OBJECTIVE: Empathy is one of the basic skills in medicine that promotes better doctor-patient relationship, best professional competition and less professional stress. We don't found studies in our area. This study aims to measure the degree of empathy in medical students in our area and associated factors. DESIGN: Cross-sectional study. LOCATION: Faculty of Medicine, University of Lleida (Spain). PARTICIPANTS: Pass in class of 1st, 3rd and second cycle of Medicine, at 191 students. 173 students (90%) completed the questionnaire. MAIN MEASUREMENTS: TECA questionnaire to measure general empathy with 4 subscales (empathic understanding, perspective taking, empathic happiness and empathic stress), and a sociodemographic questionnaire. RESULTS: We found a progression in empathy during medical courses. Women have greater empathy but also increased empathic stress. Men have less general empathy, less progression of empathy and less emphatic stress. Students that show a preference to House TV movie have less empathy and those with family doctors. Voluntary students have greater empathy and those who have had a sick friend. We don't have found relationship between empathy and preferred specialty. CONCLUSIONS: There are several variables that are related to empathy in medical students: Women, advanced courses, experiences close to serious illnesses and those involved in voluntary activities.

[Medical empathy of physicians-in-training who are enrolled in professional training programs. A comparative intercultural study in Spain]. / Empatía médica en médicos que realizan el programa de formación médica especializada. Estudio comparativo intercultural en España.

OBJECTIVE: To characterise some of the environmental factors that are sensitive to cultural influence, and are involved in the development of medical empathy in Spanish and Latin American physicians-in-training. DESIGN: Cross-sectional study using questionnaires. SETTING: Primary care and specialized medicine centres of the Healthcare System of La Rioja, Logroño, Spain. PARTICIPANTS: Physicians-in-training MAIN MEASUREMENTS: : Empathy was measured using the Jefferson Scale of Physician Empathy, version for healthcare professionals (JSE-HP). Socio-demographic, academic, and professional background information was collected. RESULTS: A total of 104 residents (67 from Spain and 32 from Latin America) answered and returned the questionnairess. The JSE-HP showed adequate psychometric properties. The empathy mean score of Spanish group was higher than that of the Latin American group (P=.01). Differences in the development of empathy were associated with: the development of professional models (P<.001), the positive encounter with other professionals (P=.001), and with a continuing medical education (P=.008). CONCLUSIONS: Some factors involved in the development of empathy that are sensitive to cultural influence have been characterised. The development of future research areas is suggested.

BABY EMPATHY: INFANT DISTRESS AND PEER PROSOCIAL RESPONSES.

Empathy is an important competence in our social world, a motivator of prosocial behavior, and thought to develop throughout the second year of life. The current study examined infants' responses to naturalistic peer distress to explore markers of empathy and prosocial behavior in young babies. Seventeen 8-month-old infants participated in a repeated measures design using the "babies-in-groups" paradigm, with maternal presence as the independent variable. Significant differences were found between response types: Gaze was the standard response to infant distress, followed by socially directed behaviors and affect, with self-distress rarely occurring. Maternal presence was not found to impact the nature or frequency of babies' responses to peer distress. During distress episodes, babies looked preferentially at the distressed peer, then other mothers, and least to their own mother. Data revealed that infant responses to peer distress resulted in a successful cessation of that distress episode over one third of the time. Case studies are provided to illustrate the quantitative data. The results provided evidence of empathic concern and prosocial behavior in the first year of life, and provoke a challenge to developmental theories of empathy.

Widening the scope: defining and treating moral injury in diverse populations.

Moral injury is an emerging concept that captures the psychosocial consequences of involvement in and exposure to morally transgressive events. In the past decade, research on moral injury has grown exponentially. In this special collection we review papers on moral injury published in the European Journal of Psychotraumatology from its inception until December 2022, that have a primary focus on moral injury as evidenced by the words 'moral injury' in the title or abstract. We included 19 papers on quantitative (n = 9) and qualitative (n = 5) studies of different populations including (former) military personnel (n = 9), healthcare workers (n = 4) and refugees (n = 2). Most papers (n = 15) focused on the occurrence of potentially morally injurious experiences (PMIEs), moral injury and associated factors, while four papers primarily concerned treatment. Together, the papers offer a fascinating overview of aspects of moral injury in different populations. Research is clearly widening from military personnel to other populations such as healthcare workers and refugees. Focal points included the impact of PMIEs involving children, the association of PMIEs and personal childhood victimisation, the prevalence of betrayal trauma, and the relationship between moral injury and empathy. As for treatment, points of interest included new treatment initiatives as well as findings that PMIE exposure does not impede help-seeking behaviour and response to PTSD treatment. We further discuss the wide range of phenomena that fall under moral injury definitions, the limited diversity of the moral injury literature, and the clinical utility of the moral injury construct. From conceptualisation to clinical utility and treatment, the concept of moral injury matures. Whether or not moral injury becomes a formal diagnosis, the need to examine tailored interventions to alleviate moral injury is clear.

Moral injury is increasingly studied outside military populations, such as in healthcare workers and refugees.Among the most impactful potentially morally injurious experiences (PMIEs) are those involving children, but betrayal trauma may be the most prevalent type of PMIE.There is a need for tailored, evidence-based interventions to alleviate moral injury.

General empathy and medical empathy in Mexican medical students: Integration of an empathic profile.

OBJECTIVE: To identify the association between general empathy and medical empathy. Detect predictors of the level of medical empathy from general empathy. To determine the psychosocial profile that describes the relationship between general empathy, medical empathy, and demographic and academic characteristics in medical students. METHOD: Descriptive cross-sectional design. Medical students completed the Interpersonal Reactivity Index (IRI) and the Jefferson Scale of Physician Empathy-student version (JSPE-S). RESULTS: Relatively high levels of general and medical empathy were detected. The total score of the IRI and the JSPE-S and their dimensions correlated positively (r = 0.14-0.52), except for the dimension personal distress of the IRI. The score of the IRI dimension empathic concern was the best predictor of the JSPE-S score and its dimensions (b = 0.27-0.54). Four profiles were detected: 1) men, preference for technology-oriented specialty, less empathy; 2) pre-clinical period students, less empathy; 3) students of the clinical period, greater empathy; and 4) women, preference for patient-oriented specialty, greater empathy. CONCLUSIONS: General and medical empathy are associated. Differentiated empathic profiles will allow the design of instructional strategies in empathy according to the specific needs of each one.

OBJETIVO: Identificar la asociación entre empatía general y empatía médica. Detectar predictores del nivel de empatía médica a partir de la empatía general. Determinar el perfil psicosocial que describa la relación entre empatía general, empatía médica y características demográficas y académicas en estudiantes de medicina. MÉTODO: Estudio transversal descriptivo. Estudiantes de medicina completaron el Índice de Reactividad Interpersonal (IRI) y la Escala de Empatía Médica de Jefferson versión estudiantil (EEMJ-E). RESULTADOS: Se detectaron niveles relativamente altos de empatía general y médica. El puntaje total del IRI y la EEMJ-E y sus dimensiones se correlacionaron positivamente (r = 0.14-0.52), excepto para la dimensión malestar personal del IRI. El puntaje en la dimensión preocupación empática del IRI fue el mejor predictor del puntaje de la EEMJ-E y sus dimensiones (b = 0.27-0.54). Se detectaron cuatro perfiles: 1) hombres, preferencia por especialidad orientada a la tecnología, menor empatía; 2) estudiantes del periodo preclínico, menor empatía; 3) estudiantes del periodo clínico, mayor empatía; y 4) mujeres, preferencia por especialidad orientada al paciente, mayor empatía. CONCLUSIONES: La empatía general y la empatía médica se encuentran asociadas. Unos perfiles empáticos diferenciados permitirán el diseño de estrategias de instrucción en empatía acordes con las necesidades específicas de cada uno.

From dissociation to integration: the value of the 'green factor'.

This paper will focus on what the author calls the 'green factor': the 'plant world's' ability to foster and manifest profound healing and self-healing processes. This factor could be considered an element capable of promoting the analytic couple's journey in individuation through a good enough rhythmical interaction. Such interaction is made possible by creating and maintaining, in therapy, a good level of empathy, mirroring and resonance that - echoing natural cyclical rhythms primarily in non-verbal communication - fosters the passage from dissociation to integration. This dynamic depends mainly on paying constant attention to the various kinds of images referring to nature, both inside and outside ourselves, i.e. attention on the green world that reconnects us with the wider ecosystem of which we human beings form a part. The author suggests that remembering and respecting the profound relationship between 'Mind and Earth' or Psyche and Gaia means developing and cultivating an ecological attitude or eco-oriented epistemology, a theory according to which, individual wellbeing can be considered a fragment of the health of our planet, in the same way as the individual anima is a spark of anima mundi. This theory has been embraced by numerous scholars ranging from Jung to Bateson, Mancuso and Schore.

Cet article portera sur ce que j'appelle « le facteur vert ¼ : la capacité du monde végétal à soutenir et manifester des processus profonds de guérison et d'auto-guérison. Je suggère que ce facteur est un élément capable de promouvoir le voyage du couple analytique en individuation à travers une interaction rythmique suffisamment bonne. Une telle interaction est rendue possible en créant et en faisant la maintenance, dans la thérapie, d'un bon niveau d'empathie, d'émulation et de résonnance, principalement par la communication non-verbale qui fait écho aux rythmes cycliques naturels et qui ainsi soutient le passage de la dissociation à l'intégration. Je décris comment cette dynamique dépend du fait que l'on accorde une attention constante aux images diverses qui surviennent (à la fois en soi et à l'extérieur de soi) à 'le mond vert' qui nous lie de nouveau à l'écosystème plus vaste dont nous les humains formons une partie. Je suggère également que de se souvenir et de respecter la relation profonde entre l'esprit et la terre ou la psyché et Gaïa signifie développer et cultiver une attitude écologique ou une épistémologie éco-orientée. Il s'agit là d'une théorie selon laquelle le bien-être individuel peut être compris comme un fragment de la santé de notre planète, de la même manière que l'anima individuelle est une étincelle de l'anima mundi. Cette théorie a été adoptée par de nombreux chercheurs allant de Jung lui-même à Bateson, Mancuso et Schore.

El presente trabajo se focalizará en lo que denomino 'el factor verde': la habilidad del mundo vegetal para promover y manifestar procesos profundos de curación y de autocuración. Sugiero que este factor es un elemento capaz de promover el proceso de individuación de la pareja analítica a través de una interacción rítmica suficientemente buena. Dicha interacción deviene posible al crear y mantener, en terapia, un buen nivel de empatía, espejamiento y resonancia, principalmente a través de comunicaciones no-verbales, las cuales reflejan ritmos cíclicos naturales, promoviendo de este modo el pasaje de la disociación a la integración. Describo cómo esta dinámica se basa en el prestar constante atención a las diversas imágenes que emergen (tanto dentro como fuera de nosotros mismos) entre la pareja analítica del 'mundo verde' que nos reconecta con un ecosistema más amplio del cual formamos parte como seres humanos. También sugiero que recordar y respetar la profunda relación entre mente y tierra o psique y Gaia significa desarrollar y cultivar una actitud ecológica o una epistemología orientada ecológicamente, una teoría de acuerdo con la cual el bienestar individual puede ser considerado un fragmento de la salud de nuestro planeta, del mismo modo que el anima individual es un destello del anima mundi. Esta teoría ha sido acogida por numerosos académicos, desde el mismo Jung a Bateson, Mancuso y Schore.

The role and tools of trust and empathic communication in healthcare during the COVID-19 epidemic / A bizalom és az empatikus kommunikáció szerepe és eszközei az egészségügyben a COVID-19-járvány idején.

Összefoglaló. A járvánnyal szembeni védekezés során mindennapossá vált a maszkhasználat, amely jelentos kihívást jelent a hétköznapi kommunikációs helyzetekben. Az egészségügy bizonyos területein korábban is jelen volt ez a probléma, azonban a most általános érvényu, folyamatos maszkviselés és védoruha-használat szimbolikus és gyakorlati értelemben is akadályként jelenik meg az orvos és a páciens között, ami több szinten nehezíti a hatékony kapcsolatteremtést és kommunikációt. Ezért szükségessé vált olyan egységes kommunikációs protokollok kidolgozása, amelyek segítik a bizalmi kapcsolat kiépítését az egészségügyben úgy, hogy az ellátók érzelmi elérhetosége és a biztonságos fizikai távolságtartás egyszerre valósuljon meg. Tanulmányunk célja, hogy a kurrens szakirodalom áttekintése révén összefoglaljuk a maszkviselés és a védoruha-használat hatásait az orvos-beteg kommunikációra és a kapcsolatban megjeleno bizalomra és empátiás folyamatokra, valamint fel kívánjuk hívni a figyelmet az egészségügyi személyzetet éro hatásokra is. Célunk továbbá, hogy a hazai és nemzetközi tapasztalatokat figyelembe véve olyan ajánlásokat fogalmazzunk meg, melyek segítségével javítható az egészségügyi dolgozók kommunikációja, azon keresztül pedig az ellátás legfontosabb szereploinek, a betegeknek és az ellátóknak az elégedettsége a kapcsolattal. Orv Hetil. 2021; 162(23): 897-904. Summary. In the fight against the epidemic, the use of masks has become commonplace, which is a significant challenge in everyday communication situations. This problem has been present in some areas of healthcare in the past, but today's universal use of masks and personal protective equipment (PPE) is both a symbolic and practical barrier between doctor and patient, making it difficult to establish an effective communication and connectivity on several levels. Therefore, it has become necessary to develop unified communication protocols that help building a relationship of trust in healthcare so that emotional availability of providers and safe physical distance are achieved simultaneously. The aim of our study is to summarize the effects of mask wearing and PPE usage on the physician-patient communication and also the trust and empathy processes that emerge within the relationship through the review of the current literature. We would also like to draw attention to the effects on healthcare staff. Our goal is also to formulate recommendations, taking into account domestic and international experience, that can be used to improve the communication of healthcare professionals, and through that, the satisfaction of the most important actors in care, patients and caregivers. Orv Hetil. 2021; 162(23): 897-904.

Embodying the psychological attitude: types of consciousness in the transformation of culture.

It is time to reclaim C.G. Jung's vision of psychology as the foundational science upon which all sciences and institutions would be based, and as the discipline, theory, and practice necessary for fostering humanity's overall psychocultural development. Jung identified eight distinct 'types' of consciousness through which humankind engages its emerging psychological attitude. Jung's view of psychological development as hingeing on the differentiation of function-attitudes provides the means for understanding not only ourselves and each other, but our society as well. This paper offers an example of such an analysis by focusing on the current conflict within American political culture. The goal is as lofty as it is necessary: the operationalization of Jung's vision of psychology as the powerful influencer of human cultural evolution that it has the potential to be. The immediate goal is to instigate the first step toward this vision of Jung's 'complex psychology' by stimulating conversations among Jungians about how they can foster that vision, leading them towards taking up roles as 'citizen therapists', actively involved in their communities in cultivating greater empathy and the withdrawal of projections in the interest of furthering 'collective consciousness'.

Le moment est venu d'assumer la vision de C.G. Jung de la psychologie en tant que science de base sur laquelle toutes les sciences et institutions seraient fondées, et en tant que la discipline, théorie et pratique nécessaires pour encourager le développement psychoculturel de l'humanité. Jung a identifié huit 'types' distincts de conscience à travers lesquels l'humanité éveille son attitude psychologique émergeante. Jung envisageait le développement psychologique comme articulé avec la différentiation de fonction-attitudes. Ceci fournit les moyens de comprendre non seulement soi-même et les autres mais encore notre société. Cet article offre l'exemple d'une telle analyse en se concentrant sur un conflit actuel au sein de la culture politique américaine. Le but est aussi ambitieux qu'il est nécessaire: rendre opérationnelle et donner tout son potentiel à la vision de Jung sur la psychologie comme influence puissante de l'évolution culturelle humaine. Le but immédiat est d'inciter au premier pas vers la vision de Jung d'une 'psychologie des complexes' en stimulant des conversations parmi les Jungiens sur comment ils peuvent encourager cette vision, les invitant à s'impliquer en tant que 'thérapeutes citoyens', actifs dans leurs communautés, cultivant une plus grande empathie et le retrait des projections, dans l'intérêt de l'avancement d'une 'conscience collective'.

Es tiempo de reclamar la visión de Jung de la psicología como la ciencia fundacional sobre la cual todas las ciencias e instituciones pudieran basarse, y como la disciplina, teoría y práctica necesarias para promover el desarrollo psico-cultural de la humanidad. Jung identificó ocho 'tipos' diferentes de consciencia a través de los cuales la humanidad desarrolla su emergente actitud psicológica. La perspectiva de Jung acerca del desarrollo psicológico como dependiendo de la diferenciación de funciones - actitudes brinda un medio para la comprensión no solo de nosotros mismos y de los demás, sino también de nuestra sociedad. Este trabajo ofrece un ejemplo de dicho análisis al focalizarse en el conflicto actual al interior de la cultura política americana. El objetivo es tan ambicioso como necesario: la operacionalización de la visión psicológica de Jung como una influencia poderosa de la evolución de la cultura humana, la cual tiene el potencial de ser. El objetivo inmediato es instigar el primer paso hacia esta visión de la 'psicología compleja' de Jung, estimulando conversaciones entre Junguianos sobre cómo pueden promover esta visión, conduciéndolos hacia la toma de roles como 'terapeutas ciudadanos', involucrados activamente en sus comunidades, cultivando una mayor empatía y el retiro de las proyecciones con el interés de fomentar 'la consciencia colectiva'.

Nurse-family relationship. Beyond the opening of doors and schedules. / Relación enfermera-familia. Más allá de la apertura de puertas y horarios.

INTRODUCTION: Care in the Intensive Care Unit involves contemplating, among other dimensions of the patient, the family. For this, it is necessary for the nurse to establish relationships with the patient's relatives. OBJECTIVE: To identify the way in which the nurse-family relationship is established in the adult ICU, as well as the conditions, elements and factors that favour or hinder it. METHOD: Integrative narrative review of the scientific literature. The databases consulted were Ovid, PubMed, Science Direct, Scopus, Clinical Key, Google Scholar and Scielo. Articles in English and Spanish published between 2014 and 2018 were searched. The descriptors and formulas used were selected according to the acronym Population and their problems, Exposure and Outcomes or themes- PEO. The population comprised ICU nurses and the relatives of patients in critical condition; Adult Intensive Care Unit exposure or context; the expected results, and how they are related. For the methodological evaluation, the STROBE guide was used for observational articles, PRISMA for review articles, COREQ for qualitative articles and CASPe for articles derived from projects. RESULTS: We identified 214 articles, of which 63 were selected to be included in the review. The central themes identified were: the ICU environment and its effects on the family, empathy as an indicator of relationship, interaction as a means of relating, communication as the centre of relationships and barriers to the establishment of relationships. CONCLUSIONS: The nurse-family relationship in the Intensive Care Unit is based on interaction and communication amidst human, physical, regulatory and administrative barriers. Improving the nurse-family relationship contributes to the humanization of Adult Intensive Care Units.

Risk and protective factors of secondary traumatic stress in Intensive Care Units: An exploratory study in a hospital in Madrid (Spain). / Factores de riesgo y protección del estrés traumático secundario en los cuidados intensivos: un estudio exploratorio en un hospital terciario de Madrid.

AIM: To propose a predictive model of secondary traumatic stress. DESIGN: A descriptive cross-sectional study was carried out. CONTEXT: The study was conducted in the Intensive Care Units of a hospital in Madrid (Spain). PARTICIPANTS: The sample comprised 103 health professionals. INTERVENTIONS: A series of questionnaires were created and completed by the participants. Network analysis and multiple regression were used for data analysis. VARIABLES OF INTEREST: Sociodemographic variables such as gender, years of experience and position, secondary traumatic stress, passion for work, work stressors, emotional effort, empathy and self-compassion were evaluated. RESULTS: The result identified the following: a) years of experience as a risk factor for compassion fatigue (ß=0.224 and P=0.029), and harmonious passion as a protector (ß=-0.363 and P=0.001); b) emotional effort and empathy as risk factors for shattered assumptions (ß=0.304 and P=0.004; ß=0.394 and P=0.000, respectively); and c), work stressors and empathy as risk factors for symptomatology (ß=0.189 and P=0.039; ß=0.395 and P=0.000, respectively), and years of experience as a protector (ß=-0.266 and P=0.002). CONCLUSIONS: This predictive model of secondary traumatic stress identifies protective factors which could be reinforced, such as harmonious passion, and risk factors which should be reduced, such as empathy and emotional effort, with a view to promoting quality of care and quality of life among these professionals.

Empatía con el paciente en médicos especialistas que trabajan en un Hospital de Cuenca (Ecuador) / Empathy with the Patient in Medical Specialists Working in a Hospital in Cuenca ­ Ecuador / Empatia com o paciente em médicos especialistas que trabalham em um hospital em Cuenca, Equador

ntroducción: la empatía es uno de los componentes de la estructura de la humanización en la atención de los pacientes. Los médicos especialistas deben tener mucha empatía. El objetivo del artículo es des-cribir los índices de empatía en médicos que trabajan en un hospital de alta complejidad y explorar si existen diferencias entre las especialidades estudiadas. Métodos: se accedió a una muestra por conve-niencia de 237 médicos que representa el 53.55 % del total poblacional (n = 443). La empatía se midió con la Escala de Empatía para Profesionales de la Salud (hp), junto con análisis factorial confirmatorio y análisis multigrupo (para examinar la invarianza del modelo entre los sexos) y análisis de confia-bilidad (α de Cronbach, coeficiente de correlación intraclase y ω de McDonald). Resultados: la espe-cialidad de pediatría tuvo los mayores índices de empatía general y en las dimensiones "cuidado con compasión" y "caminando en los zapatos del paciente", no así en la dimensión "toma de perspectiva", donde es semejante a las especialidades de anestesiología, medicina crítica y terapia intensiva, y gine-cología. Conclusión: los valores de la empatía y los valores en las subescalas "cuidado con compasión" y "caminando en los zapatos del paciente" fueron (en valores absolutos, pero no estadísticos) mayores en la especialidad de pediatría. En la subescala "toma de perspectiva", las especialidades de pediatría, anestesiología, cirugía y clínica se observaron puntuaciones prácticamente iguales. Se requieren otros estudios que permita arribar a una explicación que permita entender por qué algunas especialidades tienen valores de empatía mayores que otras

Introduction: Empathy is one of the components of the structure of humanization in patient care. Medical specialists must have high levels of empathy. Objective: The aim of this paper is to describe the levels of empathy in doctors working in a highly complex hospital and to explore whether there are differ-ences between the specialties studied. Methods: A convenience sample of 237 physicians representing 53.55% of the total population (n = 443) was accessed. Empathy was measured using the Empathy Scale for Health Professionals (hp). Confirmatory factor analysis and multigroup analysis were performed to examine the invariance of the model between the sexes and reliability analyzes (Cronbach's α, intraclass correlation coefficient and McDonald's ω). Results: The specialty of pediatrics had the highest levels in general empathy and in the Compassionate Care and Walking in Patient Shoes subscales, but not in the Perspective Taking subescale where it presents levels similar to the specialties of anesthesiology, critical medicine and intensive care. and gynecology. Conclusions: The empathy values and the values in the compassionate care and "Walking in the patient's shoes" subscales were (in absolute values, but not sta-tistically) higher in the Pediatrics specialty. In the subscale Perspective Taking, Pediatrics, Anesthesiology, Surgery, and Clinic, practically the same scores were observed. Other studies are required to arrive at an explanation that allows us to understand why some specialties have higher empathy values than others.

Introdução: a empatia é um dos componentes da estrutura de humanização no atendimento ao paciente. Os médicos especialistas devem ter altos níveis de empatia. Objetivo: o objetivo deste artigo é descre-ver os níveis de empatia em médicos que trabalham em um hospital de alta complexidade e explorar se há diferenças entre as especialidades estudadas. Materiais e métodos: foi acessada uma amostra de conveniência de 237 médicos, representando 53,55% da população total (n = 443). A empatia foi medida usando a Escala de Empatia para Profissionais de Saúde. A análise fatorial confirmatória e a análise mul-tigrupo foram realizadas (para examinar a invariância do modelo entre os sexos) e a análise de confia-bilidade (α de Cronbach, coeficiente de correlação intraclasse e ω de McDonald). Resultados: a pediatria apresentou os níveis mais altos de empatia geral e nas dimensões "cuidado compassivo" e "estar no lugar do paciente", mas não na dimensão "tomada de perspectiva", em que os níveis foram semelhantes aos da anestesiologia, da medicina crítica e da terapia intensiva, e da ginecologia. Conclusões: os valores de empatia e os valores das subescalas "cuidado compassivo" e "estar no lugar do paciente" foram (em valo-res absolutos, mas não estatisticamente) mais altos na especialidade de pediatria. Na subescala "tomada de perspectiva", as especialidades de pediatria, anestesiologia, cirurgia e clínica tiveram pontuações quase iguais. São necessários mais estudos para explicar por que algumas especialidades têm valores de empatia mais altos do que outras

Conducta prosocial en adultos: relación con la empatía y variables sociodemográficas

Diversos estudios han mostrado que existe una asociación entre el comportamiento prosocial y la habilidad empática. La forma más frecuente de evaluar ambos constructos es a través de escalas de autorreporte, siendo la Escala de Conducta Prosocial (ECP) y el Indice de Reactividad Interpersonal (IRI) las más utilizadas en población adulta. Hasta el momento, no hay reportes disponibles sobre la relación entre la empatía y la conducta prosocial en adultos de habla hispana evaluados con dichas escalas. Objetivo: Evaluar la conducta prosocial utilizando la ECP en personas adultas de habla hispana y analizar su interacción con la empatía evaluada con la escala IRI, así como también identificar su relación con otras variables de interés (edad, género y orden de presentación de las escalas durante la evaluación). Método: Se administró la ECP y el IRI a una muestra de 115 participantes, quienes fueron asignados de manera aleatoria a un orden específico de exposición a las escalas (IRI-ECP y ECP-IRI). Resultados: El rendimiento en la ECP mostró estar asociado a la edad y a la interacción entre el rendimiento en el IRI y el género, mientras que el orden de presentación de las escalas no mostró asociación con las puntuaciones. Conclusión: La empatía y variables sociodemográficas como el género y la edad se relacionan con las conductas prosociales de individuos adultos de habla hispana y por lo tanto deben considerarse en la evaluación.

Previous research has shown an association between prosocial behavior and empathic ability. These constructs are normally assessed in the adult population using self-report scales, such as Prosocial Behavior Scale (ECP) and Interpersonal Reactivity Index (IRI). Currently, there is no available data about the interaction between empathy and prosocial behavior assessed with these scales in Spanish-speaking adults. Objective: To assess prosocial behaviors using ECP in Spanish-speaking adults and analyze its interaction with empathy assessed with IRI, as well as identify the relationship with other variables of interest (age, gender and order of presentation of the scales during the assessment). Method: ECP and IRI were administered to a sample of 115 subjects, who were randomly assigned to a specific order of exposure to the scales (IRI-ECP and ECP-IRI). Results: Performance on ECP was associated with age and the interaction between IRI scores and gender. The order in which the scales were presented during assessment showed no association with ECP scores. Conclusion: Empathy and sociodemographic variables, such as gender and age, are associated with prosocial behaviors of Spanish-speaking adults and therefore need to be considered during the assessment.

Vários estudos mostraram que existe uma associação entre o comportamento pró-social e a capacidade empática. A forma mais comum de avaliar ambos os construtos é por meio de escalas de autorrelato, sendo a Escala de Comportamento Pró-Social (ECP) e o Índice de Reatividade Interpessoal (IRI) os mais utilizados na população adulta. Até o momento, não há relatos disponíveis sobre a relação entre empatia e Comportamento pró-social em adultos falantes de español avaliados com essas escalas. Objetivo: Avaliar o comportamento pró-social por meio da ECP em adultos falantes de español e analizar sua interação com a empatia availada com a escala IRI, bem como identificar sua relação com outras variáveis de interesse (idade, gênero e ordem de apresentação das escalas durante a avaliação). Método: A ECP e o IRI foram aplicados a uma amostra de 115 participantes, os quais foram aleatoriamente designados para uma ordem específica de exposição às escalas (IRI-ECP e ECP-IRI). Resultados: O desempenho na ECP mostrou-se associado à idade e à interação entre o desempenho no IRI e o gênero, enquanto a ordem de apresentação das escalas não apresentou associação com os escores. Conclusão: A empatia e variáveis ​​sociodemográficas como gênero e idade estão relacionadas aos comportamentos pró-sociais de indivíduos adultos falantes de espanhol e, portanto, devem ser consideradas na avaliação.

Contributions of a Reflective Practice Group of Male Perpetrators of Violence Against Women / Contribuições de um Grupo Reflexivo em Homens Autores de Violência Contra Mulheres / Contribuciones de un Grupo de Reflexión a Hombres Perpetradores De Violencia Contra Mujeres

Abstract In Brazil, reflective practice groups and groups for the liability of men who commit violence against women represent a public policy with good results in reducing violence between intimate partners. This study aimed to assess the contributions of a reflective practice group on feelings such as empathy, aggressiveness and anger in men who commit violent crimes against women. Using the Empathy Scale - ACME, the Aggression Tendency Assessment Scale - EATA, the State-Trait Anger Expression Inventory 2 - STAXI 2 and a sociodemographic questionnaire, a quantitative study was carried out with 80 men divided into a reflective practice group and a control group. It was found that the members of the reflective group showed a decrease in mean aggressiveness and an increase in mean empathy compared with the control group. It is suggested that empathy, aggressiveness and anger be integrated into interventions using active methodologies.

Resumo No Brasil, os grupos reflexivos e de responsabilização para homens autores de violência contra a mulher representam uma política pública com bons resultados na redução da violência entre parceiros íntimos. Este estudo objetivou avaliar as contribuições de um grupo reflexivo na empatia, agressividade e raiva em homens autores de violência contra a mulher. Utilizando a Escala de empatia - ACME, a Escala para Avaliação de Tendência à Agressividade - EATA, O Inventário de Expressão de Raiva como Estado de Traço - STAXI 2 e um Questionário sociodemográfico foi realizado um estudo quantitativo com 80 homens, divididos em grupo reflexivo e grupo controle. Verificou-se que os integrantes do grupo reflexivo apresentaram diminuição nas médias de agressividade e aumento nas médias de empatia quando comparados com o grupo controle. Sugere-se integrar empatia, agressividade e raiva nas intervenções do grupo reflexivo por meio de metodologias ativas.

Resumen En Brasil, los grupos de reflexión y responsabilización para hombres perpetradores de violencia contra la mujer son una política pública con buenos resultados en la reducción de la violencia entre parejas. Este estudio tuvo como objetivo evaluar las contribuciones de un grupo de reflexión sobre la empatía, la agresividad y la ira a hombres perpetradores de violencia contra la mujer. Utilizando la Escala de Empatía - ACME -, la Escala de Evaluación de Tendencias Agresivas - EATA -, el Inventario de Expresión de Ira como Estado Rasgo - STAXI 2 - y un cuestionario sociodemográfico, se realizó un estudio cuantitativo con 80 hombres, divididos en grupo de reflexión y de control. Se encontró que los integrantes del grupo tuvieron reducción en los promedios de agresividad y aumento en los promedios de empatía en comparación con el grupo de control. Se sugiere integrar empatía, agresión e ira en las intervenciones mediante metodologías activas.