Direct care hospital nurses care for high-acuity patients with complex needs. Managing the care for acutely ill hospitalized patients challenges the knowledge and skills of nurses, especially those with minimal experience. Patients with neurological disorders requiring constant vigilance and quick responses to physiological changes present additional challenges to the new nurse. Disruptive symptoms and behaviors that manifest in many neurological patients can frustrate new nurses who may lack understanding of neuro-specific disease processes. This lack of understanding can interfere with the nurse’s ability to relate empathetically to their patients. Although nurses are required to develop and maintain competencies for a multitude of clinical skills and procedures, there is no formal competency for empathy.
In the second quarter of 2015, as part of a larger hiring initiative in the neuroscience service line, 1 unit hired many new graduate nurses to care for patients with stroke and other neurological diseases. The nurse manager observed that the new staff were extremely task driven and easily frustrated when patients disrupted their planned routines. These frustrations seemed to cloud their perceptions of patients’ motives and interfered with their own professional behaviors. At the time, the manager surmised that the staff’s frustrations stemmed from inexperience and assumed that their attitudes would improve as they gained experience and confidence. In the meantime, the unit’s culture was beginning to shift from a patient-centered and service-oriented approach to one that was more staff centric and task focused. Contributing to this culture shift was a lack of available experienced nurses to serve as professional role models for the new graduate nurses.
The hospital routinely collects quarterly patient satisfaction data using the Hospital Consumer Assessment of Healthcare Provider and Systems. In the third and fourth quarters of 2015, the unit’s scores were low, in particular, the score for “how often did nurses listen carefully to you.” This surprised the staff, who prided themselves on providing efficient patient care. The manager agreed that they were becoming more proficient in their clinical skills. However, he also felt that the low patient satisfaction scores may have been a reflection of patients’ experience with the staff’s attitudes. He and the Director of Patient Services enlisted the help of the patient experience coordinator (PEC) to explore ways to improve the staff’s attitudes, the unit’s culture, and the patient’s experience.
In February 2016, the PEC met with patients and staff and discovered a hardworking and stressed staff on a hectic unit that might be exhibiting behaviors that suggested a lack of empathy toward their patients. Empathy involves being present with another person in an authentic understanding of another’s feelings.1 Empathy is an essential skill in the nurse-patient relationship2 and contributes to the patient’s experience and positive outcomes.3
In a 2014 Consumer Health Insights Survey, nursing empathy had a greater impact on patient satisfaction levels than outcomes achieved.4 In this healthcare climate where patient satisfaction is scrutinized by government agencies and insurers, innovative interventions directed at fostering empathy are needed. The PEC conceptualized Empathy Huddles as a novel mechanism to promote empathy among hospital staff and to improve staff-patient relations.
In February 2016, the PEC began conducting weekly Empathy Huddles as part of the unit’s safety huddles. Approaching the staff in the spirit of collaboration helped to engage them in open dialogue. During each huddle, the PEC emphasized empathy as an essential factor in developing trusting relationships with patients. Introducing a new empathy theme each week, the PEC included a patient story to exemplify the theme. The story helped to encourage staff to view the experience from the patient’s perspective, highlighting the idea that even the smallest display of empathy can make a difference. Each week, staff members were also presented with a small tangible gift related to the empathy topic. The gift served as a reminder to respond to patients empathetically, even when patient behaviors made it difficult. To ensure that all staff were reached, the charge nurse from the preceding shift conducted the Empathy Huddle and distributed the gifts to the oncoming shift.
Examples of empathy topics included treating patients with respect, knowing the importance of a smile, providing care with compassion, really listening to patients, and remembering to center and be present in the moment when interacting with patients. Treating patients with respect starts with asking them how they would like to be addressed. Some may prefer to be called by their surname, whereas others may like to be called by their first name. Words used as terms of endearment may be offensive to some patients. The empathy topic of the importance of a smile may sound simplistic, but when a nurse, preoccupied with life issues, enters the room with a scowl, patients may perceive it as a reflection of how the nurse feels about them. Remembering to center with the intention of being empathetic before entering a patient’s room helps to stay “in the moment” while interacting with patients.
Examples of tangible gift items included an empathy stone to be carried in the pocket as a reminder to be empathetic, smile stickers to remind staff that a smile can go a long way with patients, essential oils prompting staff to slow down and stay in the moment with patients, and a heart charm reminding staff to approach patients with compassion. A dry erase board was installed in the unit break room to display the weekly empathy topic and related messages.
Preintervention and postintervention (Empathy Huddle) patient satisfaction scores on “how often did nurses listen carefully to you” were compared (Figure 1). Preintervention, in the fourth quarter of 2015, the top box response score was 46%. After 2 quarters of Empathy Huddles, the top box score rose to 75% in the third quarter and to 82% in the fourth quarter of 2016. The unit has maintained the top box score above 78%. In the fourth quarter of 2017, they achieved a top box score of 91%. Scores greater than 82% were sustained through the third quarter of 2018.
Volunteer staff participated with other units in qualitative interviews to explore the impact of Empathy Huddles on their own empathy. The project was approved by the institutional review board before conducting the interviews. Interviewees were consented immediately before the interviews, which were conducted by a nurse researcher not involved with Empathy Huddles. All interviews were audio recorded and transcribed verbatim.
Connecting was the overarching theme that emerged from the interviews. Interviewees described how Empathy Huddles helped them to connect empathetically with their patients, families, and coworkers. The patient stories relayed by the PEC reminded them to consider the day from the patients’ point of view and be mindful of their experiences. Many participants mentioned how the whiteboard was used to remind them about the empathy theme of the week, which they appreciated.
Despite general perceptions that empathy has been declining among nurses,5 results from this project support other research evidence that empathy, as an interpersonal skill, can be improved.1,6–8 In the era of diverse patient populations, it can be difficult to maintain cultural competence for every culture. Empathy Huddle has the capacity to support cultural competence by encouraging staff to approach patients in the spirit of understanding and appreciation of the unique needs of each one.
Empathy Huddle served as a novel intervention on a hectic neuroscience unit to promote empathy among hospital staff and improve staff-patient relations. When improvements in staff attitude, empathy, and patient experience are needed, Empathy Huddles can influence an internal culture shift by promoting positive interactions among new staff and their patients. For a hectic neuroscience unit, Empathy Huddles encouraged staff to respond to their patients and families in an empathetic way. Empathy Huddles have continued on the unit and are considered a valuable activity for staff. Moreover, other units within the hospital have adopted Empathy Huddles.
Managing complex neurological patients challenges new nurses with minimal experience, which can interfere with their ability to relate empathetically to their patients. This article is the story of how 1 neuroscience unit’s experience with an Empathy Huddle intervention improved the staff’s ability to respond to their patients and families with empathy and saw much improved Hospital Consumer Assessment of Healthcare Provider and Systems scores for “nurses listening carefully to me” that were sustained through the third quarter of 2018.
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