What is empathy?
To the general public, empathy is most commonly understood through phrases such as 'putting yourself in someone else's shoes' or 'seeing things through their eyes.' This suggests imagining what it is like to experience the feelings and circumstances of another person and having the capacity to understand them yourself while maintaining some level of emotional detachment. In a clinical setting, empathy extends beyond a patient's history, diagnosis, or treatment. The expression of empathy differs from that of sympathy, which is how a healthcare professional communicates with their patient.
Why is empathy important?
Paramedics are responsible for establishing rapport, providing the best care, and possible outcome possible for a patient. This is achieved through the use of critical reasoning, communication, and drawing on their academic knowledge. To a healthcare professional such as a paramedic, empathy is the validation of a patient's feelings, which may include fear, anxiety, or stress. Empathy is, therefore, an essential core skill as it supports the establishment of trust between a patient and the healthcare professional, making it an integral component in establishing a therapeutic relationship (1). In a clinical context, empathy can facilitate more accurate diagnoses and efficient treatment, contrasting from sympathy, which can ultimately impede effective treatment and objective diagnoses (2). When a paramedic has the ability to imagine the situation from their patient's point of view, it can reveal to them ways to improve their care, which may not have been considered before. In addition, a heightened level of empathetic behaviour has shown to increase patient compliance with medications and greater overall satisfaction (3).
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How showing empathy affects patients
A paramedic is usually a patient's first point of contact in a medical emergency. Regardless of the length of duration, these environments are often highly emotional and can be distressing to most. Additionally, many interactions between paramedics and patients include those a part of vulnerable groups or populations who are subject to negative stereotyping (4). The empathy displayed by paramedics during this period of contact frequently affirms how a patient may perceive other medical professionals throughout their continued exposure to health services (5). However, regardless of overwhelming support for the benefits of an empathetic approach, there is no universally agreed-upon definition in relation to its implementation in patient care (6).
How does one maintain empathy?
In the context of education, empathy is acknowledged as a personal trait; consequently, it is also tangible and can be a learned behaviour. Therefore, through educational approaches and intervention, empathy can be developed and improved with appropriate teaching styles (7). This recognition suggests that tertiary institutions play a significant role in developing empathy amongst paramedic undergraduates. A proven method to improve students' empathy is the inclusion of simulation-based training (8). Although the benefits are extensively studied, the general lack of empathy education has been slow to improve; however, paramedic programs have started to standardise summative assessments that take a holistic approach to patient interactions as of recently as 2017 (9). Despite compelling evidence that highlights the importance of empathy in patient care, studies suggest that current undergraduate health students still display less empathy than previous generations (7).
A longitudinal study conducted among Canadian paramedicine students investigated the levels of empathy in first-year students attending Fanshawe College. The publication revealed that students' empathy levels decreased as they progressed through their first year of study (3). It is suggested that the decline can be associated with the change from idealism to realism, as well as an expected general response to increased workload and responsibilities (1). It is well known that a majority of emergency callouts are to elderly patients (10) and mental health crises (11), rather than acute traumas. It may be a misconception of many students that a large proportion of cases are not an exacerbation of chronic illness or falls, a leading cause of injury for the aged population, however, this is the reality of their career (1). Nonetheless, paramedic students are still exposed to explicit and graphic examples of potential scenarios they may encounter early on. This allows them the opportunity to question whether they can realistically manage the gravity of their career. (1)
Due to only a handful of studies completed, most of which focus on paramedic students rather than paramedics, empathy in qualified paramedics is not well understood. Paramedicine students generally show lower levels of empathy than students in the fields of nursing and midwifery (12, 13). This is especially apparent towards substance abusers and mental health crises, with males scoring lower overall empathy scores than their female counterparts on the Jefferson Scale of Empathy (14, 15). Mean empathy scores also appeared to decrease for cases of intellectual disability and attempted suicide among Fanshawe College students (3). The reasoning behind lower demonstrated empathy scores towards substance abuse patients may be due to the perception that abuse patients are a waste of medical expenses, treatment, and a burden on medical resources (16).
Compassion fatigue and burnout
After prolonged exposure to a stressful environment, healthcare providers may experience decreased levels of empathy, otherwise described as compassion fatigue. A study conducted among nurses in 2018 revealed that the prevalence of compassion fatigue affects not only the quality of care provided to a patient but also the provider's own quality of life (17, 18). Low empathy also acts as a contributing factor to high burnout among healthcare providers and vice versa (19). Due to the nature of a general paramedic's workload, stressful shift work, long hours, and a poorly maintained work-life balance can contribute to burnout. Paramedics are exposed to many distressing and potentially traumatic scenarios. This makes communication between partners essential, as they both experience a series of emotions together. Communication and empathy between the two establishes a positive relationship and a healthy support system, which may help reduce burnout.
Empathy is intrinsically people-based. This means that the skill of empathy is developed over the time one spends with others in a similar role or environment (20). Through an understanding of one another, a team's ability to cooperate work together is enhanced, leading to better patient care and outcomes. Empathetic colleagues can make each other feel more supported in their work and have a positive experience on those around them.
Empathy is a core skill
Empathy is explored in many aspects and contexts when observing the role of it as a core skill for a paramedic. It is arguably one of the most critical skills due to its nature and presence in multiple relationships that are established by healthcare professionals (20). Empathy is a significant factor in the establishment of a positive therapeutic relationship between a patient and their provider (1). The importance of empathy is further heightened when faced with vulnerable peoples and populations (4). Without an establishment of trust, as achieved through displaying empathy, a rapport cannot be built, and the likelihood of patient compliance decreases. Empathy is also present in workplace relationships between paramedics in order to establish healthy support systems. While it is known that lack of empathy or contrastingly, excess empathy, can lead to burnout or compassion fatigue (17-19), this only supports its importance and the significance connected to its understanding. The correct balance and application of empathy is essential to paramedics in order to carry out their job successfully and comfortably, however, there are many other essential skills a paramedic should possess to successfully carry out their jobs. Some of which include resilience, adaptability, communication, and the ability to work well under pressure. While empathy itself is a fundamental core skill, without application in combination with other skills, it would not produce a competent paramedic.
Though many studies were focused on other sectors of healthcare, mainly in-hospital, it was found that students displayed a lack of empathy early on during their paramedicine education. With the correct resources and application of teaching, this can be combatted to ensure the integral core skill of empathy is developed as required. In order to provide further depth into the importance of empathy in qualified paramedics, further studies should be encouraged to assess their levels.
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