Qualitative Analysis of Empathic Behavior Process among Home-Visiting Nurses in Japan
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Session presented on Friday, July 24, 2015: Purpose: Ueno and others (2013) treated nurse's support behavior that maintains and promotes patient's peace of mind empathically as a concept of empathic behavior, developed the Empathic behavior Behavior Scale, version 2 (ESB, ver.2), and examined factors that affected nurses' empathic behavior by using this scale. The results showed that the level of home-visit nurses' empathic behavior for patients was higher than nurses in inteRN, surgical, and psychiatric departments. This research, therefore, attempts to clarify the structure and process of home-visit nurses' empathic behavior for patients. Methods: A modified grounded theory approach (M-GTA) was used to conduct semi-structured interviews with 10 home-visit nurses working for 6 home-visit nursing stations in the Kanto area. All interview data were transcribed and analyzed by focusing on a helping process by home-visiting nurses (hereinafter referred to simply as 'nurses') who tried to make patients improve their comfort level by relieving their suffering during a home visit.This research was approved and conducted by the guidance of the Ethics Committee of Health Care and Nursing, Juntendo University. Results: Subjects' sex, average age, average years of nursing experience, and average years of home-visit nursing experience were all females, 47.6 (SD=6.6), 24.4 (SD=7.9), and 11.8 (SD=4.3), respectively. Then, 18 concepts and 6 categories were generated from the analysis. The following is a storyline based on these concepts. Nurses treated each patient not as a role as a 'patient' but as one individual during a home visit and attempted to make them live their own life even if they have diseases. The attitude of appreciating a present meeting became the foundation of involvement with patients by thinking that this meeting might be the last one. On that basis they observed patients' living and health conditions carefully and imaged their problems and troubles by putting them in the position of patients. Then, they approached patients psychologically in order to check whether imaged content correspond to patient's actual feelings by using abilities to communicate thoroughly, to promote patient's understanding, and to be able to be conscious of their own personalities distinct from patient's ones. These concepts were named 'cuddling behavior' as a category. Nurses not only snuggle up to patients but also to smile at and talk to them daily and to conform to their moods without getting carried away with them. In all these acts nurses tried not to make patients alone at any time. On the other hand, in order to engage in a cuddling behavior it was necessary that a nurse had a compose through other nurses' support and a patient trusted her through physical care she provided daily. Nurse's feelings were relieved, that is, they had 'calm attitude' when a series of these processes were evolved smoothly and empathic behavior was carried out. Conclusion: A previous study (Ueno,et al;2014) considered that the level of home-visit nurses' empathic behavior was affected not by their ages and years of experience but by the level of their maturity of identity. This qualitative analysis extracted a concept that nurses snuggled up to patients in an objective awareness of self when they engaged in empathic behavior for patients, which corresponded to previous studies showing that the level of maturity among nurses was an important factor of empathic behavior. An other component of empathic behavior was to treat each patient not as a role but as the same human being, to have enough communication skills which can express one's and other's feelings and thinking verbally, to have experience of knowing one's distress, and to have reliable colleagues. Empathic behavior of a home-visiting nurse was also both a process and an act to have an image of patient's specific mental distress. It can be said that it is an involvement like an escort runner who try not to make a patient feel a sense of isolation.