Empathy as the foundation of nursing care

Nursing was founded on the premise of ‘caring for’ patients. Since 1975, Jean Watson’s Theory of Human Caring has continued to position ‘human caring’ at the foundation of nursing care (Akbari & Nasiri, 2022).  These ideals of care, however, were largely synonymous with processes for empathy and compassion.  Watson continued to refine her theory, eventually describing ten Caritas® processes in an attempt to better describe the care work adopted by nurses (Perkins, 2021).  Today, Watson’s theory asserts that the nurse and  patient and environment have  “braided streams of consciousness melds human-environment, potentiating health, healing, love, and compassion” (Perkins, 2021, p. 157).  This rather philosophical definition of nursing care – and empathic concern for patients – is what this course intends to explore.

A fundamental need exists for nurses to establish a ‘human-being’ relationship between themselves, patients and their family systems as part of Watson’s theories of care (Akbari & Nasiri, 2022).  This process of co-creating shared understandings is the proposed mechanism by which Watson proposed a nurse demonstrated presence, sharing in the patient’s experience of care (Akbari & Nasiri, 2022).  Watson’s work is, ironically, well-supported by neurobiological research on empathy.  For example, Batson (2022) asserts that empathy is the primary mechanism by which ‘caring’ emotional pathways are provoked among almost all mammals.

While empathy appears to precede caring behaviors, the technical work of nurses is best described as a series of actions guided by the nurse’s experience of empathic concern for the patient (Jakimowicz et al., 2018).  According to Gilbert (2019), effective care almost always necessitates a compassionate stance from the nurse.  Empathic concern – a form of compassionate caring – is marked by motivational-affective components, social schemas, and neurobiological experiences (Gilbert, 2019). But, how does empathic concern happen?   In one experimental study, increased perspective-taking combined with increased awareness of physiological arousal (a.k.a. emotions) led to the re-valuing of the person in need of help and, in turn, higher levels of empathic concern for that person (Batson et al., 1995).  However, this is only one theory of how empathic concern motivates caring behaviors.  The empathy-altruism hypothesisargues that nurse care for patients to alleviate their own feelings of concern for the patient’s well-being (Batson, 2022).  Finally, a more basic interpretation of empathic concern is that nurses are motivated to help patients because they benefit from providing care, such as being paid for care work (Batson, 2022).  In all cases, empathy remains at the foundation of nursing care.