Although Wilmer refers to physicians, these observations apply equally to all caring professionals including nurses.
Empathy helps determine the most considerate and compassionate way to be- have towards the patient. We can anticipate situations that may cause distress, embarrassment and anxiety and take measures to avoid or at least ameliorate the effects. The ability to empathize is one of the attributes that patients value in nurses and it is only by actively listening to patients and being aware of both their verbal and non-verbal cues that we can understand their needs.
Below are two vignettes that are based on nursing situations that frequently occur.
The activities based on them are designed to promote reflection on the part of the reader and may be used with colleagues to provoke discussion. The points raised after each activity are not exhaustive, but simply identify some important aspects for consideration.
Vignette Visiting time
Mrs Garcia managed to get away from work early and rushed up to the hos- pital to be there within the appointed visiting time. She is there to see her mother who has recently been admitted to a medical ward. When she arrives at the ward there is a crowd of staff around the nurses’ station. She is unsure what to do, so she hovers at the desk but nobody looks up. They all seem to be chatting or tapping away at computers. She coughs and moves forward to be noticed and one nurse glances up at her and then continues the conversa- tion. Another person walks away and a third picks up the phone and starts a call.
r How do you think Mrs Garcia feels?
After a while Mrs Garcia says, ‘Excuse me,’ and a nurse looks up at her. ‘I am here to see my mother, Mrs Grant.’ The nurse sighs and continues to rifle through the pile of paper on the desk. ‘She’s not one of mine. Is she the COPD that came in today?’ The nurse shouts up the corridor to another colleague ‘Do we have a Mrs Grant?’ ‘Yes. The asthmatic in Bay 4,’ comes the shouted reply. The nurse at the desk carries on with her paperwork and Mrs Garcia sets off up the corridor to find Bay 4.
r How is Mrs Garcia feeling now?
Activity
r Discuss or write down the ways in which the communication in the above vignette conveys a lack of respect and dignity for Mrs Garcia and her mother.
How do the individual attitudes of the nurses contribute to such communi- cation? How could the communication have been improved?
r What aspects of organizational culture lead to such poor communication and how can these be challenged and changed?
Below are some of the points that you may have identified from the last activity.
r There is no welcome for Mrs Garcia on the ward. A smile and a greeting from at least one member of staff would have helped to put her at ease.
r Mrs Garcia is already anxious and harassed and it is not clear who she should approach when she enters the ward. If there is no receptionist available, all staff should take responsibility for acknowledging visitors to the unit.
r Although Mrs Garcia indicates non-verbally that she needs help, nobody ac- knowledges her presence. Being sensitive to other people’s non-verbal cues and responding appropriately to them is an important part of clinical practice.
r When Mrs Garcia finally speaks, the nurse indicates irritation by sighing. This indicates to Mrs Garcia that she is being a bother and is not really important enough to warrant disturbing the nurse. Suppressing the sigh and responding with a smile even though everyone is busy indicates to other people that they and their time is valuable and worthy of respect.
r By using the label of a medical diagnosis to identify Mrs Grant, it sounds as if her status as an individual is diminished. Is she just another asthmatic?
r Confidentiality is breached by shouting out the name, diagnosis and where- abouts of the patient for all to hear.
r Mrs Garcia is new to the environment. She is anxious and does not know where to find Bay 4. Anticipating this need by offering help, or better still providing a guide, would show empathy with her situation.
Vignette A visit from the nurse
Mr McKay waits for the community nurse to call to change his leg dressing.
He knows that she is due to visit today, but is not sure when. As he is hard of hearing he is afraid of missing the sound of the doorbell, so he has sat with the radio turned off all day. It takes him a long time to get to the front door, so he has also been worried about going up to the toilet or out to the back kitchen in case the nurse arrives while he is there.
When the nurse finally arrives he opens the door and lets her in. ‘Hello Don. How are you? I’m here to do your dressing. Brrr it’s cold outside.’ The nurse bustles past him without waiting for an answer and is into the front room before Mr McKay can turn round. He is taken by surprise. This is a new nurse and they have never met before. Mr McKay starts the long journey back to his chair.
‘I’ll just pop and wash my hands. Is this the bathroom?’ says the nurse cheerily, opening a broom cupboard. To Mr McKay’s embarrassment the contents of the cupboard fall out all over the floor. By the time he gets back to his chair he finds the nurse has moved all the bits and bobs from his little side table and opened up a dressing pack on it. She is hovering with her gloved hands waiting.
He wonders ruefully whether after this nurse has left he will be able to find the spectacles that had once been on the table.
r How do you think Mr McKay is feeling?
Activity
Identify the ways that the nurse’s behaviour in this vignette conveys a lack of respect and dignity for Mr McKay. Why is the nurse behaving like this? How could this encounter have been improved?
Below are some of the points that you may have identified when working through the activity concerning Mr McKay’s treatment.
r Pinpointing visit times is difficult, but giving Mr McKay an indication of when the visit will take place recognizes that his time is valuable too and that the business of his everyday life is not unimportant.
r The fact that the nurse did not introduce herself and her use of Mr McKay’s first name without first asking his permission may be an attempt to be friendly and save time, but is rude.
r Barging into someone’s house uninvited and/or entering a room uninvited is rude. Just because the nurse is there in a professional capacity does not make it less rude.
r Opening a door or cupboard in someone’s house without asking permission led to Mr McKay feeling embarrassed. It shows a lack of empathy and a disregard for his feelings.
r Again the nurse may be saving time, but moving Mr McKay’s belongings around without first asking permission demonstrates a particular lack of respect for his personal space.
r The nurse is disempowering Mr McKay by her behaviour and communication in this scenario. She is taking control and ownership of the space and setting the pace of the encounter to suit her busy schedule. She is not listening to Mr McKay even though she is in his home.