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Empathy is the foundation of understanding patient’s needs, concerns and emotions, and is fundamental to nursing practice. Empathy is the attribute that gives the nurse the ability to truly understand another person. Do nursing educators, students, and patients acknowledge the value of empathic communication? Two key questions emerge which are centered in a critical care scenario regarding a patient and his family. These questions explore whether nursing educators view their teaching role as inclusive of empathic communication with patients from both an ethical perspective as well as consideration of accreditation. Also identified is the saliency of the ANA (American Nurses Association) Code of Ethics for Nurses and the ICN (International Council of Nurses) Code of Ethics for Nurses in addressing the realm of empathic communication. Nursing faculty must be cognizant of any aspect of nursing education that compromises their ethical responsibility. The inclusion of teaching empathic communication to nursing students and ensuring their competency is vital to all the patients and family encountered along their professional journey. TEACHING NURSING STUDENTS EMPATHIC COMMUNICATION 2 The Online Journal of Health Ethics Volume 6, No. 1 July, 2010 Teaching Nursing Students Empathic Communication: A Mandate from the Code of Ethics for Nursing Case Study Mr. B struggled for his life in ICU Bed 229 in the early morning hours of a busy shift at Central General Hospital. His family had been emotionally drained from a conference previously requested by the Nursing and Physician care teams to discuss the family’s wishes as to whether or not to discontinue life support measures. In short, medically there was nothing left to do other than to continue life for him with IV drugs carefully regulated to maintain blood pressure, artificial airways and ventilator support to provide vital oxygen to his deteriorating aged body tissues, and a stiff feeding tube curled through his crusted nose to ensure nutritional support. Tubes were connected to every orifice, and monitors beeped, pulsated and alarmed frequently as he was seemingly nearing his final chapter in life. Family had been counseled by the physicians and nurses that he could exist in this state an indefinite length of time. Bobby, the eldest son, conferred with the other family members present as to what decision they wished to make regarding the possibility of stopping all resuscitative measures. The verdict was finally reached after the family and nursing staff had shed many emotional tears. The family spokesman rendered the answer, “Do everything you can,” as the primary nurse, Brenda, charted the words “Full Code” in red letters on the front of the chart. Suzy, a senior nursing student, came to Brenda with a bounce and a smile and exclaimed that she was going to lunch soon with her peers, because she was trying her best to avoid talking with the renal failure patient in Room 229’s family. Brenda queried Suzy as to why she was uncomfortable with this situation. Suzy explained that she preferred to do “real nursing” on patients and she had already mastered titrating vasopressor drugs, as well as managing the ventilator. TEACHING NURSING STUDENTS EMPATHIC COMMUNICATION 3 The Online Journal of Health Ethics Volume 6, No. 1 July, 2010 Brenda encouraged the student to go to lunch immediately, largely due to herself feeling heartsick. While the student had clearly demonstrated superb cognitive and technical skills that day, Suzy had failed in what was the most critical element in this situation. This student had failed miserably in demonstrating empathy and communicating effectively with the patient and family. This scenario certainly contained components of utilizing high technical and cognitive abilities to titrate life-saving drugs, while managing blood pressure and surveying and interpreting endless laboratory results. The student, however, never addressed the other side of the clinical picture, which dealt with the impact of the family’s journey of making decisions that could never be reversed in respecting and impacting their father’s final days and wishes. Sadly, this situation is not entirely unique to seasoned nursing professionals or educators. There is sufficient evidence to suggest that students are seemingly prepared to function in clinical settings on a technical and cognitive level, but severely lack an equally vital skill base in the realm of empathic communication. The student that recognizes, appreciates, and captures the magnitude of the impact his or her management of patient-nurse communication is well poised to enter their chosen profession. However, students are often not taught or are unaware of the level of damage, destruction, and sorrow left in their wakes because they do not possess a high degree of empathic communication skills. Do nursing educators, students, and patients acknowledge the value of empathic communication? Two key questions emerge from this scenario regarding Mr. B and his family. Question 1: As nursing educators, do faculty view their role as educating nursing students to include empathic communication with patients from an ethical perspective as well as consideration of accreditation? TEACHING NURSING STUDENTS EMPATHIC COMMUNICATION 4 The Online Journal of Health Ethics Volume 6, No. 1 July, 2010 Empathy is the foundation of understanding patient’s needs, concerns and emotions, and is fundamental to nursing practice. Empathy is the attribute that gives the nurse the ability to truly understand another person. There are many researchers that posit that empathy is the single-most important ingredient in the helping relationship (Kunyk and Olson, 2001; Lauder et al, 2002; Thorne et al, 2005; Freshwater and Stickley, 2003). Lauder, Reynolds, Smith, and Sharkey (2002) describe the presence and developing of therapeutic relationship as the cornerstone of nursing practice that improves the patient’s wellbeing. It is through this understanding that the nurse can effectively promote the health of that person and establish a therapeutic relationship with the patient (Kunyk & Olson, 2001). Through the perspective of viewing nursing as an art as well as a practice discipline, the concept of empathy is critical in terms of providing the unique element that has been philosophically identified as part of holistic nursing. This art extends well beyond the technical aspects of performing a nursing assessment, but includes understanding how a patient attempts to maintain his or her health. Empathy is what involves the nurse in this process. Reynolds and Scott (2000) further elaborate on the results of the absence of empathy. These researchers posit that a lack of nursing empathetic awareness of the patient’s goals and capabilities results in an inability to provide care that is appropriate to the patient’s needs. There are several reasons why empathy is an essential part of the patient-nurse relationship. Among these are the links to positive role in patient outcomes, which allows the patient to have a dual role in problem-solving (Lauder et al, 2002). Medical research has linked empathy with promoting healing, detouring malpractice suits resulting from heightened anger, improving patient satisfaction, and improving patient perspectives of the illness experience (Fields, et al, 2004; Thorne et al, 2005; Hojat, et al, 2003; Kruijer et al, 2001). TEACHING NURSING STUDENTS EMPATHIC COMMUNICATION 5 The Online Journal of Health Ethics Volume 6, No. 1 July, 2010 Reynolds & Scott (2000) cite six meaningful nursing goals that empathy enables the nurse to achieve in order to help the patient. Among these are (a) empathy enables the nurse to create a climate of trust and establishes the patient’s perception of need, (b) empathy enables nurses to judge the patient’s state of willingness to talk, (c) empathy helps nurses understand the origins and purpose of patient’s responses to health problems, (d) empathic nursing works to help facilitate positive health outcomes for the patient, (e) empathy leads to reduction of physiological distress, improved self-concept and reduction of anxiety and depression, (f) the ability to provide empathy in high levels correlates to the success of outcomes. Since empathy has been linked with improving patient care outcomes by allowing the patient to feel understood, this has important implications for nurse educators because they are the primary conduit of exposure to empathic principles that prepare nursing students for the profession (Chant et al, 2002; Cook & Cullen, 2003; Reynolds et al, 1999). An important step toward understanding the phenomenon of effective empathic communication and the role of nursing school educators is the need to analyze descriptions of how empathy is experienced and “lived” within clinical practice and how the phenomenon of empathy “shows” . One way of obtaining this understanding is through obtaining faculty perspectives and gathering evidence of curricular content, methods of instruction, and evaluation of core empathic communication competence through an ethical attentiveness. The implications for nurse educators stems from the daunting task of preparing nurses to meet the demands and expectations of the profession in the current world of health care. As nursing educators in Baccalaureate programs, there is the professional commitment to adhere to standards set forth by the American Association of Colleges of Nursing (AACN), which provides a core set of values and behaviors. In the context of professional nursing as a discipline, as TEACHING NURSING STUDENTS EMPATHIC COMMUNICATION 6 The Online Journal of Health Ethics Volume 6, No. 1 July, 2010 defined by the AACN, the role of the nurse is to provide care as an active partner with patients. This is expanded to include individual patients, families, groups, or communities in order to foster and support active participation in determining health car