Any nurse entering the field, no matter how prepared or well trained, will do their best to learn about the realities of caring for others on the job. When I started working as a nurse back in the 1970s, I had no idea that in a few years, I would find myself on the frontlines of an epidemic that would irrevocably change and touch all our lives while also changing the career trajectories for a great number of people in healthcare.
As a young nurse, I suddenly saw many patients developing complex and difficult-to-manage illnesses. Just as devastating was that many of my friends, colleagues, and loved ones became ill. Soon, we would give this disease a name: HIV/AIDs. As the impact of the disease reverberated, it was terrifying to see the level of stigma, bias, discrimination, and fear that so many of my patients faced, with many in the medical establishment refusing care for those most in need. There was a great deal of misunderstanding and spreading of harmful misinformation about what HIV/AIDS was. It is not an exaggeration to say I felt like I was working in a war zone.
At the nonprofit VNS Health, where I worked, our home health nurses were not ones to turn their backs on the communities we served and lived in. Soon, we found ourselves on the frontlines, caring for an average of 600 HIV/AIDS patients daily in New York City in the late 1980s. By 1997, half of all HIV/AIDS patients in the city were cared for by VNS Health. Like many other nurses, I quickly learned that we were providing far more than physical care, as we helped address mental health needs and education equally for AIDS patients and their loved ones.
Despite the challenges and devastating loss all around us, it was also inspiring to work among healthcare workers, activists, and others who saw the epidemic as an opportunity to revolutionize healthcare. Those experiences helped shape the work we do today, as we strove to keep up with a rapidly evolving healthcare landscape, provide empathetic care for all underserved communities, and develop new models of care that would provide safe, in-home care.
On National HIV/AIDS and Aging Day, it’s heartening to see how individuals with HIV/AIDS now have many more treatment options and can live long, healthy, happy, and productive lives. Currently, more than half of all individuals with HIV are over the age of 50. While treatment for physical symptoms has improved by leaps and bounds, we still can’t forget the social and emotional symptoms accompanying this illness and its impact on the community and people’s loved ones.
Among older adults with HIV/AIDS, there are typically two categories of patients. The long-term “warriors” who have lived with their diagnosis for years, including those who may have contracted HIV/AIDS at birth and those who received a diagnosis more recently as an older adult. Across the board, as the number of older adults receiving care at home grows, so will the need for nurses and caregivers specializing in home health, including nurses who understand the specific needs of individuals with HIV, which vary from person to person. Race, income, gender identity, and sexual orientation are key to how someone experiences care. Being mindful of our patients’ lived experiences and understanding the unique needs of those with HIV/AIDS makes us stronger clinicians and teachers. We can improve healthcare outcomes by supporting this community in the full context of their lives, which includes addressing preventive care, psychosocial care, nutrition, housing, and other social determinants of health.
As a nurse, when you first meet an older patient with a long-standing HIV/AIDS diagnosis, it’s important to know that they’ve likely had extensive experience with the healthcare system—and it may not all have been positive. In addition, factors that many adults experience as they age, from multiple chronic illnesses to social isolation, are amplified by having HIV or HIV/AIDS. These patients are used to being told what more they need to do or how to better adhere to treatments, so it is crucial to focus on the positive and offer them options and resources.
Working in home care, we have the privilege of meeting our patients where they are most comfortable and getting to know them beyond a list of symptoms. Home care nurses are increasingly filling a crucial care gap within the HIV/AIDS community, acting as a bridge for patients by helping to determine the full spectrum of support they might need. That might mean working to connect them with a social worker to help them apply for housing and food benefits, recommending local support groups, or something as simple (but important!) as making sure they closely follow prescribed medical treatment and go to all their appointments.
Individuals with HIV/AIDS also want to be seen as more than their diagnosis and accepted as their most authentic selves. We need to recognize the bravery and hard work many have put into maintaining their health over time, often in the face of stigma and barriers to care. Ensure they feel recognized for all they have done to maintain their health!
For clinicians who want to provide informed patient-centered care to older patients with HIV/AIDS but don’t know where to start, there are many educational resources out there. Connecting with seasoned nurses with experience working with HIV/AIDS patients or with HIV advocacy groups can help give you perspective on the challenges your patients may have faced within the healthcare system. Many national and local organizations provide specialized training for clinicians and caregivers of HIV/AIDS patients.
As any nurse will tell you, we learn much from all our patients and their families. The resiliency and bravery of those living with HIV/AIDS cannot be underestimated, and it has been a privilege caring for so many who have had to fight back against hate and stigma. Caring for this community is an honor and an opportunity to help some of those who need it most and make a difference by providing care imbued with empathy, dignity, and respect.
Empathy is defined as the ability to understand and vicariously experience the feelings of another person. It’s a skill that allows you to step into the shoes of patients and fully recognize their needs. In the field of healthcare, your ability to employ empathy can mean life or death for patients.
While there is a limit to how much empathy a nurse can provide — getting too close can affect your ability to think critically and stay level-headed, after all — empathy is a powerful tool that helps nurses effectively do their jobs. Limiting yourself to sympathy only allows you to assess a patient’s needs from your perspective, which may be clouded with subconscious biases. On the other hand, employing empathy at the right times can help you achieve better health outcomes and reinforce patient cooperation with your treatment plans.
Nurses — especially those who serve diverse populations — must increasingly practice empathy to continuously improve their care. We’ll explore four ways you can incorporate more empathy into your practice and the benefits of doing so.
Increase Your Cultural Sensitivity With Formal Training
When you form authentic connections with your patients, they’re far more likely to listen to your recommendations, which allows their treatment plans to take effect. When clinicians are professionally trained communicators, patient adherence can increase by 12%.
However, as our world grows more diverse, good communication is no longer just about being good with words. Nurses must be empathetic, culturally sensitive communicators who can lead diverse peers and connect with diverse patients.
To actively boost your cultural sensitivity, consider getting professional cross-cultural awareness training. Training and certificates are offered by colleges like Central Washington University, professional organizations, and more. Take your learnings a step further by considering how cultural differences can impact medical opinions — for example, by recognizing that some religions disallow blood transfusions.
As you graduate from these programs — and even while you’re in the learning process — find ways to implement your new insights into your work. Then, get feedback from your patients, as well as any coworkers who witness your interactions. As an example, you can practice educating your patients or identifying effective alternatives when they disagree with your ideal treatment plan, rather than pushing your opinion. Post-appointment, you can follow up with your patients to get their satisfaction rating.
Global communication courses can also help you overcome language barriers and identify universal gestures that help you communicate with patients. However, it’s important not to forget to read between the lines. To uplevel your empathy, carefully observe your patients for nonverbal signs of discomfort or satisfaction.
Practice Your Empathetic Listening Skills With Professionals
While these issues can be related to several factors — from subconscious biases to limited access to family planning tools — these health disparities all point to a need for increased empathy. Nurses, especially those working with historically underserved populations, must do their part in reducing patient mortality rates by practicing their empathetic listening skills to improve patient outcomes.
Work with a mentor in the nursing field who can help you practice your empathic listening skills on a regular basis. Specific listening skills you can work on include:
Asking open-ended questions
Listening carefully for what your patients are experiencing (and what details they’re omitting
Restating patients’ statements or feelings to get clarification and show you’re listening
Using your body language (like eye contact and open arms) to encourage patients to let down their walls
Avoiding assumptions
Seasoned nurses can give you feedback on how you’re responding to your patients in difficult situations. Additionally, you can request that they help you build a list of open-ended questions to ask your patients. Mentorship programs may be available at your workplace, although you can always get matched with a mentor through the American Nurses Association or by reaching out to a senior you trust.
Recognizing Symptoms Aren’t Black and White
Diverse individuals don’t always experience medical conditions in the same way. Women are 20% more likely than men to develop heart failure or die within five years of a severe heart attack. This is in part due to disparities in access to diagnoses and frequency of care by cardiovascular care specialists in hospitals. Poor female patient outcomes are also exacerbated by the fact that women experience different heart attack symptoms than men, which has led to limited treatments and therapies.
Empathy can transform outcomes. By treating patients based on their unique demographics, backgrounds, and medical histories, you can offer better preventative and urgent care. In particular, nurses must educate themselves about how medical conditions can appear in minority and underserved groups to avoid missing any potential symptoms of a harmful medical condition.
One action you can take to build your empathetic viewpoint is signing up for continuing education courses in the nursing field. Take a handful of newly updated classes that are relevant to your field at least once a year. As research brings more medical information about diverse populations to light, nursing practices will evolve and you’ll continue to improve your capability as an empathetic nurse. Taking this step will help you stay informed about how to personalize your treatments.
Additionally, seek case studies from medical journals that outline new findings about disparities in patient symptoms, especially for conditions you frequently treat. For example, you can study the relationship between COVID-19 symptoms and ethnic backgrounds or learn about how different races are affected by depression in different ways.
Avoiding Burnout
Empathy can also help nurses support each other. As the medical field continues to face growing issues with burnout, with nearly 40% of nurses dreading work each year, nurses who can empathize with their colleagues can help alleviate their stress (and vice versa). Nurses must increasingly focus on developing strong bonds — bonds that overcome cultural and personal differences — to recognize the signs of burnout in each other.
Creating a support network can help you effectively treat patients long-term instead of running into compassion fatigue. Network with your colleagues, as well as other nurses in your area, to build a formal support group that meets regularly and chats on a Facebook Group or Discord server. Use this group to share stories or simply destress around people who understand your experiences, as long as you ensure you are not violating HIPAA regulations.
Empathy is the Heart of Nursing
Empathy will always be at the heart of good nursing. While sympathy can help us react in a caring manner, empathy allows nurses to fully step into their patients’ shoes and fully understand their needs. This is essential for ever-improving outcomes. Since every patient communicates and experiences medical conditions differently, acting with empathy can help you find the right treatment plans for every individual. Empathy can also help you avoid subconscious biases that can lead to inequitable treatment.
Empathetic nurses can also support each other through the challenges of nursing. As a result, it can lead to reduced burnout, allowing nurses to continue caring for patients as they best can.
Empathy has been recognized as an essential element to improved patient outcomes, and it plays a vital role in the practice of telehealth nursing. Empathy encourages patient engagement and enables nurses and other members of the care team to build trusted relationships with those they are treating. At the same time, telehealth, or the use of computers and mobile devices to communicate and access health care services remotely, has also been steadily rising in popularity. A report from 2019 noted that national use of telehealth services grew 53 percent from 2016 to 2017, and today, it has become a critical component of global efforts to mitigate the spread and impact of COVID-19. While telehealth services have been celebrated for increasing access to care, specifically in rural areas, some worry that the use of technology and remote consultations may have an adverse effect on empathy. With the proper training, however, that is not the case. In fact, telehealth nursing offers a unique opportunity to provide patients with the same degree of compassionate care as they would receive in person, but with even more touchpoints along the way.
Nurses
are typically viewed as a resource for patients after they’ve begun
a new therapy, but their involvement often begins much sooner. As
part of certain patient assistance programs, telehealth nurses make
outreach within 24 hours of a patient receiving a diagnosis and
treatment plan. They first confirm the clinical case qualifies for
the specified drug and then help navigate necessary hurdles before a
patient can begin treatment – benefit verification, prior
authorizations, financial assistance, etc. The telehealth nurse also
helps coordinate the drug shipment from a pharmacy to the patient or
provider, and stays in constant contact with the patient to keep them
fully informed on the status of the shipment and when they can expect
to receive it. This not only lays a foundation of support and trust
but also deters nonadherence from the very beginning. Providing a
deeper level of visibility into the process keeps patients informed
and engaged during the lag-time between initial diagnosis and the
start of treatment.
After a patient begins therapy, the telehealth nurse educates them on what to expect throughout their therapeutic journey. This can be achieved through weekly or monthly check-ins, during which nurses provide counsel on medication management, side effects, and adherence strategies. These ongoing touchpoints are especially significant considering patients typically only retain about 49 percent of the information their doctors tell them.1 Throughout the treatment journey, telehealth nurses build rapport with each of their patients and identify the unique level of support each person wants and needs. Since patients’ medical and psychosocial needs vary, telehealth nurses personalize their approach to each individual. For some patients, this may consist of check-in calls to remind them when their next injection is due, when it’s time for a refill, or when to follow up on lab work. For others, it may include emotional support and reassurance if a patient is feeling down, discouraged or overwhelmed. Telehealth nurses understand that navigating a new diagnosis and treatment plan is challenging, which is why they ensure they are always easily accessible and never more than a phone call away.
To effectively provide these services while helping patients cope with their diagnosis and achieve a new sense of normalcy, telehealth nurses require both clinical and interpersonal training. At Lash Group, a patient support services provider, telehealth nurses are conditioned to develop motivational interviewing skills, which focus on open-ended questions to understand a patient’s motivation and beliefs to promote health. This strategy encourages nurses to listen to their patients and identify how they can be the best resource. In one recent instance, a Lash Group nurse shared that a patient called her because he was struggling. She asked him questions and invited him to share his experience, which revealed that the patient was ultimately upset that he couldn’t do the things he once could do as a result of his condition. With this understanding, the nurse was able to offer much-needed affirmation and encouragement in addition to clinical advice.
Telehealth
nursing serves as a vital link in the continuum of care during times
of uncertainty—whether that be following a patient’s new
diagnosis or when facing a global pandemic like COVID-19. Telehealth
nurses collaborate with the extended healthcare team, successfully
fill gaps in care, and act as one of the most effective resources to
support medication adherence and mitigate adverse events such as
emergency room visits. With the proper training, nurses don’t have
to sacrifice empathy and human connection for convenience and
technology. Telehealth nurses are in a perfect position to foster
meaningful, long-term relationships with patients that lead to better
outcomes, no matter how many miles away.
1
Brown University School of Public Health. Factors associated with
patient recall of key information in ambulatory specialty care
visits: Results of an innovative methodology. February 2018.
Eight senior nursing students from the University of Arkansas (UA) Eleanor Mann School of Nursing have been getting to know the homeless people of Fayetteville through a 7-week clinical rotation with 7hills Homeless Center. Working with the homeless has taught them empathy and how to think beyond immediate treatment, an immensely valuable skill that they will carry with them into their graduation this Spring.
During their rotations, the students have learned that homeless people aren’t as unfriendly and scary as many people think. Homeless people come from all backgrounds and most aren’t homeless because of something they’ve done, but due to unforeseen bumps along the way. Gaining trust with their patients has taught them not to judge by first looks or impressions and educated them on many of the challenges that homeless people face. Dorian Nelson, a senior nursing student, tells News.UArk.edu:
“After you go to the emergency room, if your home is the wet, cold woods, it doesn’t matter that you had treatment. A lot of nursing is advocacy. Here, we work with case managers whose job it is to help the homeless in all aspects of their lives. They will leave here no better than when they came in if we can’t help them with resources.”
Registered nurse Janet Gardner established the clinical rotation program at the 7hills homeless enter in January 2016 and now places different groups of 8 students there two times per semester. Their clinical duties include taking blood pressure, checking blood sugar, treating wounds, and making calls on behalf of their patients who need further medical treatment. This has taught these senior nursing students how to be advocates for their patients who need help, especially those who need management of their chronic conditions.
Taking a broader mindset with them into their upcoming graduation ceremony, many of these students now plan to work in hospital emergency departments or critical care units where they can best serve some of the most vulnerable patients and populations.
To learn more about the University of Arkansas nursing program and 7hills Homeless Center, visit here.
One afternoon in nursing school, I remember a professor spending nearly an hour exploring the difference between sympathy and empathy. To me, the inexperienced novice, those words were the same—synonyms, surely, both meaning some form of caring. But in reality, as many nurses know, these two words mean very different emotions.
So what is the difference? The video below, an illustrated cartoon to the words of Brené Brown, is my favorite demonstration of the meaning of empathy.
For me, in nursing practice, sympathy is easy. It’s an, “Oh, I hope you feel better,” or “I’m sorry you’re hurting.” Empathy, though? Empathy is hard. It can be very uncomfortable to relate to patients in that way, and it can make it difficult to place boundaries around our work. Ask any nurse—a vocation often characterized by our ability to be caring—this career wouldn’t be possible if we weren’t able to construct empathetic boundaries.
I’m guilty of sympathy—I catch myself of wanting to comfort with an “at least…” or of “silver-lining it,” as Brown describes in the video. Especially in emergency nursing, it’s easy for the cynic within us to put up walls. But just as there is a difference between sympathy and empathy, there’s a difference between a boundary and a wall. Walls keep others out, whereas boundaries are erected to keep parts of us safe.
When other people are in emotional agony it can be uncomfortable to witness. It is frankly a mechanism of survival to place boundaries between us and our patients. Too much empathy and we would not be able to carry on from patient to patient, to think critically and rationally, to be cool or level-headed in a crisis. Too much empathy, and my game face dissolves. Treating every patient as if they were part of my own family would very simply be the end of my ability to do my job at all.
That’s where the boundaries come in. Nursing is a careful balance of caring the exact right amount for each patient so that we can easily move from room to room. Each of us has to be able to get close, but not too close, to our patients and their families. For some of us, that simply means remembering that the patient is someone’s mother, grandfather, sister, friend. For others, it’s remembering how scary it can feel to be in a hospital at all. As the video above shows, we as nurses have to be able to crawl down into the proverbial hole with our patients, to understand—truly—their pain and their feelings, but we very quickly must crawl back out on the other side. Because in the room next door, another patient and another hole are waiting.
It’s never easy. Sometimes, no matter how hard I try, I just can’t leave the patients at work. I’ll cry for them in the car driving home after a shift, or I’ll pray for them before bed. It’s comforting, in a way, as that tells me that I’m caring just the right amount. It’s impossible not to be touched by the stories we hear and the people we meet. I think empathetic boundaries allow us care more, to be more present with patients and their pain, and most importantly, to take better care of ourselves. When we take better care of ourselves, we can draw more readily from our reserves—we can more swiftly crawl back out of the hole. This makes all the difference when taking care of others.
