5/8/2017

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5/8/2017

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WELCOME

This webinar will begin at 1 p.m. ET.

For technical assistance with GoToWebinar, please call 888.259.8414.

Disclosure

Kati Kleber, BSN, RN, CCRN, Nurse, Author, Speaker, and Podcaster, has no financial relationships to disclose.

The planners and author of this course have declared no relevant conflicts of interest that relate to this educational activity.

OnCourse Learning guarantees this education activity is free from bias.

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This presentation is the sole property of OnCourse Learning Corporation and cannot be reproduced or used without written permission.

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Accreditation Information

In support of improving patient care, OnCourse Learning is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

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OnCourse Learning is also accredited by the Florida Board of Nursing and the District of Columbia Board of Nursing (provider # 50-1489). OnCourse Learning’s continuing education courses are accepted by the Georgia Board of Nursing. OnCourse Learning is approved by the California Board of Registered Nursing, provider # CEP16588.

Earning CE Credit

• FREE CE exam

– Links to the course will be provided at the end of this presentation

– Existing CE Direct subscribers: Log in as normal and look for the

“webinars” category

– In addition, e-mail with instructions will be sent within two hours at the end of this session.

– This is an OnCourse Learning CE event. Participants who attend the webinar in its entirety and complete the evaluation survey will earn:

• Registered Nurses: 1 contact hour

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EMPATHY 101 FOR NURSES

How to Care for Yourself While Emotionally Supporting Others

• Author of ANA’s Admit One and What’s Next and the self-published Becoming Nursey

• Blogger and podcaster on top nursing trends

• “2015 Nurse of the Year” by Charlotte Business Journal

• Featured in the media, including CNN, The Dr. Oz Show, U.S. News, The TODAY Show

Your Presenter

Kati Kleber, BSN, RN, CCRNNurse, Author, Speaker, Podcaster

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The goal of this presentation is to describe and examine empathy.

Upon completion, participants will be able to:

• Define empathy and differentiate it from sympathy

• Identify how to empathize practically with patients and colleagues

• Discuss how to care for self emotionally while being present emotionally for others

Goal and Objectives

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https://vimeo.com/81492863

Definition of Empathy

Brown, B: audio. The Power of Empathy. [Video]. Source: RSA. https://vimeo.com/81492863 Accessed April 6, 2017. Used with permission from RSA. 10

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Compassion

“Compassion (‘suffering with’) is more engaged than simple empathy, and is associated with an active desire to

alleviate the suffering of its object. With empathy, I share your emotions; with compassion I not only share

your emotions but also elevate them into a universal and transcending experience. Compassion, which builds upon

empathy, is one of the main motivators of altruism.”

— Dr. Neel Burton (emphasis added)

Burton N. 11

Distinctions

Sympathy

“I feel bad for you”

Empathy

“I feel bad with you”

Compassion

“I want to take part in alleviating your

suffering”

Burton N. 12

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My Experience

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Four Qualities of Empathy

RSA Replay - The Power Of Vulnerability. [Video]; Wiseman T. 1996

1Perspective-taking

2Staying out of

judgment

3Recognizing

emotion in other people

4Communicating the recognition

of their emotions

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See the World as Others See It

https://www.youtube.com/watch?v=cDDWvj_q-o8

Free video by Cleveland Clinic

Empathy: The Human Connection to Patient Care. [Video]; Wiseman T. 1996 15

Consider …

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Consider …

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Consider …

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Consider …

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Non-judgmental

Wiseman T. 1996 20

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Understanding Another’s Feelings

Wiseman T. 1996 21

Communicating Our Understanding

Wiseman T. 1996 22

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Compassion

Just take really good care of their loved one.

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To Summarize

Step 1:Try to view the world from

their perspective

Step 2:Check your

judgment(s) at the door

Step 3:Try to understand

internally what they’re feeling

Step 4:Communicate that

understanding to them

Step 5:Provide amazing compassionate

care

Wiseman T. 1996 24

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So why is this so tough for us to do?

We’re nurses, aren’t we?

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How often do you see death, dying, or patients undergoing major life-changes at work?

A. Almost weekly or daily

B. Once in a while; every other month or so

C. Rarely; only a few occasions in my career

D. Never; I have never dealt with these situations as a nurse

Poll Question 1

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If You’re Doing It Right, It Hurts

“In order to connect with you, I have to connect with something within myself that knows that feeling”

— Dr. Brene Brown

RSA Replay - The Power Of Vulnerability. [Video]. 27

What Empathy Really Feels Like

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Negative Effects of Empathy

• Empathy

– Perceiving and comprehending and relating to how another feels

• Compassion

– Caring interest for another that is correlated with wanting to help another

• Alert

– “… when confronting the suffering of others, intense sharing of the other’s pain can be a primary cause for empathic distress and decreased helping behavior”(p873)

– “This may be especially problematic for people working in professions where suffering is routinely encountered.”(p873)

– Burnout and increased risk for suicide have been noted among physicians.

Klimecki OM, Leiberg S, Ricard M, Singer T 2014 29

Empathy and Self-Compassion

A cross-sectional study of 280 nurses in Portugal on empathy and self-compassion and how it relates to professional quality of life in the International Journal of Nursing Studies:

• Professional quality of life, empathy, and self-compassion were measured with self-report.

• Median amount of nursing experience was 14.74 years.

• Findings:

– Empathetic feelings may be a risk factor for compassion fatigue.

– Self-compassion components mediate and moderate the relation between affective empathy and compassion fatigue.

Duarte J, Pinto-Gouveia J, Cruz B. 2016 30

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Empathy and Compassion Fatigue

“In other words, negative self-oriented emotions elicited by others’ distress, a tendency to be self-critical and to feel cut off from others when in distress and over-identification with negative experiences can lead to burnout and compassion fatigue.”(p7)

(emphasis added)

31Duarte J, Pinto-Gouveia J, Cruz B. 2016

Empathy and Compassion Fatigue

This study outlines compassion fatigue as a “reduced capacity for compassion as a consequence of being exhausted from dealing with the suffering of others”(p3)

“It has been suggested that empathy for patients may be at the very root of compassion fatigue”(p3)

“Nurses may be at particular risk for compassion fatigue because compassion and empathy are at the core of their work”(p3)

(emphasis added)

Duarte J, Pinto-Gouveia J, Cruz B. 2016 32

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What Does This Mean?

Duarte J, Pinto-Gouveia J, Cruz B. 2016

“High levels of affective empathy may be a risk factor for compassion fatigue, whereas

self-compassion might be protective.”(p1)

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The balance of empathy and compassion with self-compassion is important.

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Fluctuations and Adjustments

Empathy and Compassion for Others

Self -Compassion

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Self-compassion

Compassion

Empathy

Empathy, Compassion, Self-Compassion

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What Is Self-Compassion?

• Self-kindness

– “Being kind and understanding toward oneself in instances of pain or failure rather than being harshly self-critical”(p85)

• Common Humanity

– “Perceiving one’s experiences as part of the larger human experience rather than seeing them as separating and isolating”(p85)

• Mindfulness

– “Holding painful thoughts and feelings in balanced awareness rather than over-identifying with them”(p85)

Neff K. Self-compassion. 2003 37

Another Definition

“Without self-compassion, moment-to-moment awareness can become excruciating. Life is hard, and we often work fairly hard to avoid that awareness. This allows a lurking belief that life is hard

because we are doing something wrong, that it is our fault.”

“Through self-compassion, we change this response to ourselves and notice that life isn’t hard because we’re doing something wrong—

life is hard for everyone. We start to receive God’s grace and treat ourselves like a friend when we’re hurting rather than beating up on

ourselves because we’re suffering. We stop comparing and experience gratitude for whatever abundance (in whatever form) we have.”

– Dr. Irene Kraegel, clinical psychologist (emphasis added)

Kraegel I. 38

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Self-compassion

Compassion

Empathy

Empathy, Compassion, Self-Compassion

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• When Do You Feel the Most Vulnerable?

– Standing over my child while they’re sleeping

– Acknowledging how much I love my husband/wife

– Spending time with my parents

– Having a baby

– Being happy

Foreboding Joy

Brown B. Daring Greatly. p119 40

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Vulnerability

“I’d argue that joy is the most difficult emotion to feel.”(pp117-8)

— Dr. Brene Brown

Brown B. Daring Greatly. 41

Foreboding

a fearful apprehension,

“a feeling that something bad is going to happen”

Merriam-webster.com. 2017. Foreboding. 42

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Foreboding Joy

“… the concept of foreboding joy as a method of minimizing vulnerability is best understood as a continuum that runs from

‘rehearsing tragedy’ to what I call ‘perpetual disappointment.’ ”(p121)

“Some of us … scramble to the bleakest worst-case scenario when joy rears its vulnerable head, while others never even see joy, preferring to

stay in an unmoving state of perpetual disappointment.”(p121)

Brown B. Daring Greatly. 43

Foreboding Joy

Nurses know all of the nitty-gritty details of the worst-case scenarios.

If foreboding joy were basketball,

being a physician would be like the NCAA;

being a nurse would be like the NBA.

We’re pros.

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How often would you say that you experience foreboding joy?

A. Daily

B. Weekly to monthly

C. Yearly

D. Never

Poll Question 2

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The Antidote to Foreboding Joy

Leaning into gratitude

Brown B. Daring Greatly. 46

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Practical Tips

“Self-compassion is a practice of goodwill, not good feelings.”(Neff)

Directing compassion toward self may stir up pain as you realize ways you did not receive compassion in life.

“… mindfully accept that the moment is painful …” and do not do whatever you can to stop the pain as it will likely just get worse.(Neff)

“Some people find that when they practice self-compassion, their pain actually increases at first.”(Neff)

This does not mean you are failing, you may be just progressing through the process.

“… embrace ourselves with kindness and care in response, remembering that imperfection is part of the shared human experience”(Neff)

Imperfection can be a tough pill to swallow for all of us perfectionists out there.

Respond to foreboding joy by leaning into gratitude. — Dr. Brene Brown

Neff K. Self-compassion: tips for practice; Brown B. Daring Greatly. 47

Feeling with someone

Define Empathy

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Identify How to Empathize Practically with Patients and Colleagues

• Take their perspective.

• Don’t judge them.

• Recognize their emotion(s).

• Communicate that recognition.

• Try to alleviate their suffering.

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Discuss How to Care for Self Emotionally While Caring for Others

• Practice self-compassion

– Self-kindness, common humanity, and mindfulness

• Counteract foreboding joy (dress-rehearsing tragedy) with gratitude

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Our Colleagues Are Part of the Human Experience as Well

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Maslow’s hierarchy of needs

Emotionally Caring for Yourself While Being Emotionally Present for Others in a Sustainable Way

Compassion

Empathy

Self-compassion, Gratitude

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References

• Brennan EJ. Towards resilience and wellbeing in nurses. Br J Nurs. 2017; 26(1): 43-7. doi: 10.12968/bjon.2017.26.1.43

• Brown B. Daring Greatly. 1st ed. New York: Avery Publishing Group; 2012: 117-123.

• Brown, B: audio. The Power of Empathy. [Video]. Source: RSA. https://vimeo.com/81492863 Accessed April 6, 2017. Used with permission from RSA

• Burton N. Empathy Vs Sympathy. Psychology Today. 2015. https://www.psychologytoday.com/blog/hide-and-seek/201505/empathy-vs-sympathy. Accessed March 27, 2017.

• Decety J, Yang CY, Cheng Y. Physicians down-regulate their pain empathy response: an event-related brain potential study. Neuroimage. 2010; 50(4):1676–82. doi: 10.1016/j.neuroimage.2010.01.025

• Duarte J, Pinto-Gouveia J, Cruz B. Relationships between nurses’ empathy, self-compassion and dimensions of professional quality of life: a cross-sectional study. Int j Nurs Stud. 2016; 60:1-11. doi: 10.1016/j.ijnurstu.2016.02.015.

• Empathy: The Human Connection to Patient Care. [Video]. Source: Cleveland Clinic via YouTube. https://www.youtube.com/watch?v=cDDWvj_q-o8 Accessed April 6, 2017.

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References

• Klimecki OM, Leiberg S, Ricard M, Singer T. Differential pattern of functional brain plasticity after compassion and empathy training. Soc Cogn Affect Neurosci. 2014; 9(6): 873-9. doi:10.1093/scan/nst060

• Kraegel I. Grace (& Self-Compassion). Available at: http://www.themindfulchristian.net/grace--self-compassion.html. Accessed March 27, 2017.

• Merriam-webster.com. 2017. Foreboding. Available at: https://www.merriam-webster.com/dictionary/foreboding. Accessed March 28, 2017.

• Neff K. Self-compassion: tips for practice. Available at: http://self-compassion.org/tips-for-practice/ Accessed March 28, 2017.

• Neff K. Self-compassion: an alternative conceptualization of a healthy attitude toward oneself. Self and Identity. 2003; 2:85-101. doi:10.1080/15298860390129863.

• RSA Replay - The Power Of Vulnerability. [Video]. Brene Brown event. https://www.youtube.com/watch?v=QMzBv35HbLk Streamed live 2013. Accessed April 6, 2017

• Wiseman T. A concept analysis of empathy. J Adv Nurs. 1996; 23(6):1162-7. doi: 10.1046/j.1365-2648.1996.12213.x

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Poll Question 3

OnCourse Learning offers continuing education for hospitals, healthcare corporations, and organizations.

Are you interested in learning about OnCourse Learning’s CE Direct continuing education platform for your staff?

A. Yes

B. No

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Continuing Education Credit

To access this recorded webinar, visit:

http://ce.nurse.com/course/Web332

Existing CE Direct subscribers: Log in as normal and look for the “webinars” category

In addition, e-mail with instructions will be sent within 2 hours at the end of this session.

For a complete schedule of online CE courses, visit:

• http://ce.nurse.com

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THANK YOU

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