“Could a greater miracle take place than for us to look through each other’s eyes for an instant?” ― Henry David Thoreau
Hospice professionals see people at their worst: patients suffering a terminal illness and are no longer pursuing curative treatment. Family members dealing with their loved one staring down a ticking clock. Patients in pain, on heavy doses of pain killers, with limited or even no ability for self-care, in bed, having shed a lifetime of daily norms, dressing, working, communicating.
Further, unlike other sectors of health care, there are no cases of trying a new treatment that results in a positive outcome other than a comfortable death.
And the next day, and every day after, the hospice professional starts over, going from facility to facility, room to room, home to home, to help manage pain and symptoms of people and caregivers at their worst with providing some comfort and relief as their medical goal.
It’s no wonder that the result of heavy caseloads, documentation requirements, being surrounded day in and day out with this endless cycle of pain, can lead to apathy and eventually burnout.
Studies have shown that with time medical professionals’ empathy levels decreases. Conversely, studies also show that empathy in patient care is associated with great satisfactions by patients and family members, fewer errors, and improved outcomes.
Working towards increasing empathy is a win-win. Empathy will benefit the hospice professional, the patient, their loved ones, and will be reflected in your hospice agency’s CAHPS surveys.
Tips To Build Empathy in Hospice Care
Tip #1. One Of These Things Is Not Like The Other
To build empathy skills it’s important to first know what empathy is and what it is not. Though often used interchangeably, empathy is not the same as sympathy or pity.
Empathy is defined as: the ability to understand and share the feelings of another.
Sympathy is defined as: feelings of pity and sorrow for someone else’s misfortune.
Pity is defined as: the feeling of sorrow and compassion caused by the suffering and misfortunes of others.
Given how similar these definitions are, it’s easy to understand why they are used as synonyms for each other. However, they are different.
Empathy is feeling what somebody else feels through their own feelings. Sympathy is feeling what somebody else feels through your feelings. Pity is expressing sadness for someone else’s misfortune though not necessarily relating to their’s or your feelings.
With pity there is no indication that the patient has been heard. Pity can be expressed without deriving from any emotional impact. When you are being sympathetic, while acknowledging the other’s feelings, you’re making the situation about you and your feelings, your understanding of them through feeling the same way. Empathy, expressing that you understand their feelings as their feelings, allows the patient to feel heard and creating a path to deeper communication with the focus remaining on the patient and their situation.
Here are three different real-life statements to clarify the difference between reactions when a patient or their loved one expresses a bad situation:
Pity statement: That’s awful.
Sympathy statement: I know how you feel, that’s awful.
Empathy statement: That sounds awful, tell me more.
Tip #2. Listen
Cultivate the art of active listening. Take the time at the beginning and end of every patient visit to create a space for listening.
While hospice pros are super busy and often overloaded by caseloads, documentation needs, regulatory requirements to be filled, and a host of other time drains, taking the time to listen to your patients is a lot like driving safely.
If you’ve ever take a driver’s ed. program you may have seen the film clip where two drivers make their way across town. One driving recklessly, speeding through yellow lights, frequently changing lanes, zipper merging after a red light on a one lane road, and worse. The other driver makes their way across town following all the rules of the road. At the end, the reckless driver made it to their destination about 2 minutes ahead of the safer driver.
While you may feel rushed, in truth, taking the time to listen to your patient is rarely the cause or contributor to your overworked schedule; it’s simply the easiest thing to drop and makes you feel like you’ll get somewhere faster.
Don’t minimize their feelings through well-intentioned pity or sympathy. Use empathy to provide the space for them to express themselves. Being heard is an important element of the patient and family feeling that they’ve been treated with empathy and respect. And hearing your patients delivers far greater benefits than the few minutes it takes. Listening to your patients and their loved ones allows you to get a complete picture of their situation, which may even deliver new information about their status that can inform clinical decisions leading to better patient care.
Tip #3. The Golden Rule, With a Twist
Don’t treat your patients the way you would want to be treated. That falls into a sympathy trap replacing the patient with yourself. But we often don’t treat ourselves nearly as well as we treat others, especially our loved ones. Treat patients the way you would want your family member treated.
Don’t imagine how you would want hospice care to look were you in the patient’s shoes. Rather, imagine how you would want hospice care to look if your mother or father or other loved one were in this patient’s shoes.
This twist will allow you to feel their feelings through them, not through you. If you’re in a facility and the room is cold, you might be okay with that. But imagine if your mother or grandmother were in that facility bed, would you bring them extra blankets? While you might not mind being called ‘sweetie’ for example, would you want your mom to be addressed that way, or have people entering her room without knocking, or left to lay around immodestly with only a thin half open gown as cover, or have treatments decided on her behalf without her involvement?
By imagining, not yourself but someone you love in the shoes of your patient you can feel how they would feel using empathy rather than sympathy or pity.
Tip #4. Learn from Cats
Cats, once they are no longer kittens, meow to communicate with people but don’t meow at each other.
Most communication is non-verbal. Be aware of your physical cues.
- Make eye contact.
- Don’t look at your phone or other devices while communicating with the patient.
- Dress professionally so your patients feel like they are being treated and heard by a professional.
- Pull up a chair for a brief moment of communication so that you are communicating at the same level and not towering over them while they lay in bed.
Practice this when you’re at home. Lay in bed and have another adult stand over you for a conversation and see the radical difference it will make in communication if they then pull up a chair and sit beside you.
Tip #5. Multiple Identity Order
Culture is a word that is often used synonymously with traits like religion or ethnicity. However, that view of culture limits our view of the patient’s identity and the distinct culture of each identity.
Every patient and family member you has multiple overlapping identities, which means understanding each person’s cultures may be more than just a general idea of their religion or ethnicity.
It may mean recognizing the culture of being a breadwinner who is now in the position of having their most basic needs cared for. Or the culture of a teenager who may not want to discuss their issues with a chaplain or social worker as their age culture has a heighten value of privacy. Or the culture of someone who has been struggling for many years with a variety of health issues and has a culture of being distrustful of medical professionals.
Navigating the tapestry of identities and cultures within an individual is no easy feat. However, with patience, active listening, professionalism, and empathy, you’ll find that picking up your patients’ cues is less complicated than you imagine.
Empathy is crucial to patient-care and self-care. Practicing these skills and developing a mindset of empathetic patient driven care will create better outcomes for patients, their loved ones, yourself & your co-workers, and will show in the responses to CAHPS surveys.
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