Differentiating social environments of high-risk professionals and specialised nurses: a qualitative empirical study on social embeddedness.

Objective: High-risk professionals and specialised nurses in hospitals are frequently exposed to potentially traumatic events. Psychotrauma researchers have extensively studied personal risk factors of traumatisation among high-risk professionals, but it is hard to understand psychological functioning when professionals are decontextualised from their social environment. Generally, it has been well documented that to reduce the risk of posttraumatic stress disorder (PTSD) or other mental health problems related to traumatisation, it is essential to be embedded in a supportive social environment. However, study results among and within these occupational groups show great variety and even inconsistencies as to what is a supportive social environment.Method: This ethnographical research, including participant observation, in-depth interviews, and document analysis, explored the social environment of firefighters, police officers, ambulance paramedics, specialised nurses, and military personnel and aims to explore their social connections and embeddedness. We performed a thematic content analysis of data to identify themes related to social or emotional support, social relationships, and stress or traumatisation.Results: An analysis of the observational field notes, which covered 332 h of participant observation and 71 evenly distributed formal in-depth interviews, identified four themes related to social connections and embeddedness: Family, Hierarchical relations versus autonomy, Group versus individual, and Conditional family 'love'. Results revealed that the military, police, and professional firefighters have family-like hierarchical connections and highly value group unity. Paramedics and most specialised nurses, however, tend to value individuality and autonomy in their work relationships.Conclusion: This research shows noticeable differences in the social environments and social connections of these professionals, which implicates that prevention and mental health treatment might also have to be differentiated among occupational groups.

It is of great importance for high-risk professionals or frontline professionals who are frequently exposed to potential traumatic events, to be embedded in a supportive social environment; to work with the conviction that others 'have your back'. However, their social environments differ so much that we cannot lump them together in one category.The military, police, and professional or career firefighters have family-like hierarchical connections and highly value group unity. Ambulance paramedics and most nurses working in specialised departments, such as emergency rooms, operating rooms, and intensive care units, on the other hand tend to value individuality and autonomy in their work relationships.To be effective, programmes for preventions, such as professional support or formal peer support, as well as mental health treatments might have to be differentiated accordingly between occupational groups.

"Genuine and fundamentally human": a qualitative study into Dutch humanist chaplains' conceptualizations of empathy.

Empathy has been highlighted as a key concept in chaplaincy care, but its meaning has hardly been explored in depth within this field. This study aims to help develop stronger conceptual clarity by investigating humanist chaplains' conceptualizations of empathy. Data were collected through semi-structured interviews with twenty humanist chaplains working in health care, military, and prisons. A qualitative design was employed to clarify which components and features constitute empathy in humanist chaplaincy care. Empathy emerges as a multidimensional concept that is "fundamentally human." Chaplains distinguish between true and pseudo empathy based on different features including authenticity and concern. This article provides a conceptual model that combines the different components and features of empathy in humanist chaplaincy care and the relationship between them in light of empathy's humanizing quality. It may be used for educational purposes and could function as a conceptual framework for future research efforts.

Engaging otherness: care ethics radical perspectives on empathy.

Throughout the years, care ethicists have raised concerns that prevalent definitions of empathy fail to adequately address the problem of otherness. They have proposed alternative conceptualizations of empathy that aim to acknowledge individual differences, help to extend care beyond one's inner circle, and develop a critical awareness of biases and prejudices. We explore three such alternatives: Noddings' concept of engrossment, Meyers' account of broad empathy, and Baart's concept of perspective-shifting. Based on these accounts, we explain that care ethics promotes a conceptualization of empathy that is radical in its commitment to engage otherness and that is characterized by being: (1) receptive and open, (2) broad and deep in scope, (3) relational and interactive, (4) mature and multifaceted, (5) critical and reflective, (6) disruptive and transformative. This type of empathy is both demanding and rewarding, as it may inspire health professionals to rethink empathy, its challenges, and its contribution to good care and as it may enrich empathy education and professional empathy practices in health care.

"We Need to Talk About Empathy": Dutch Humanist Chaplains' Perspectives on Empathy's Functions, Downsides, and Limitations in Chaplaincy Care.

This paper investigates the functions, downsides, and limitations of empathy in chaplaincy care. Data were collected from 20 humanist chaplains working in health care, prison, and military settings using semi-structured interviews. According to the participants, empathy is at the heart of their profession but has disadvantages as well. The analysis yields seven major functions of empathy with corresponding downsides and limitations: (1) to connect, (2) to understand, (3) to guide, (4) to acknowledge, (5) to motivate, (6) to inspire, and (7) to humanize. We argue for a need to "talk about empathy" since despite its importance and challenges, there is little professional and academic discussion about empathy in chaplaincy care. We hope that the findings of this study can function as starting points for the discussion and thus contribute to the ongoing professionalization of chaplaincy care. To that end, we propose three topics for further reflection and conversation.

Attuning to the needs of structural socially isolated older adults with complex problems: the experiences of social workers with personal guidance trajectories for a less-researched group.

Many interventions to combat the social isolation of older adults are hardly effective because they ignore both the heterogeneity of the target group and the uniqueness of the individual experiences of social isolation. In order to be effective, interventions must meet the individual needs of specific clients. In this study, we aim to gain insight into the process in which professionals seek to understand how clients assess their situation, and what this means for the help they provide. We investigated how social workers in one-to-one guidance trajectories try to attune to the needs of the clients they accompany and what considerations they make in doing so. The study was conducted between 2014 and 2017 in the city of Rotterdam in the Netherlands. Participants were 20 social workers of 8 social work agencies who provided guidance to community-dwelling older adults who have been isolated for a long time and have problems in multiple life domains. We analysed 36 research-driven logbooks, written by the social workers, which contain case study descriptions with information about specific clients who belong to the target group of this study. We also interviewed the individual social workers and organised six focus groups with 8-12 of the participating social workers. Our findings make clear how social workers try to identify the needs of their clients and provide help that is tailored to their possibilities and ambitions. By giving recognition to the emotions and situations of their clients, and by practical problem-solving, they build a relationship with the older adults in which adequate help is accepted. The professionals set modest goals; their guidance helps stabilise the existing situation and may also contribute to the self-reliance of their clients. This knowledge will be highly valuable in the developing and implementation of programmes and interventions for this less-researched group.

Strategies of socially isolated older adults: Mechanisms of emergence and persistence.

Social isolation relates to a lack of social contacts and interactions with family members, friends or the wider community, and results in diminished health and well-being. And yet many interventions aimed at enhanced social participation are not effective because they do not match the needs of the socially isolated older adults themselves. Little is known about the experiences of socially isolated older adults and their need for help and support. In this paper, we use concepts from Giddens' structuration theory to understand the strategies they use to deal with social isolation in everyday life. We report on findings from in-depth interviews with 25 community-dwelling socially isolated older adults (aged 63-86). Most of them were interviewed two or three times with in-between periods of one to three years. The study shows that they see few possibilities for changing their situation. They consider their social skills as inadequate and choose a mode of behavior that they habitually follow and which implies a certain degree of safety. At the same time, these strategies further lower their chances of social integration and intensify their isolation. These long-term patterns of socialization make social isolation a persistent problem that in many cases takes on a structural character. This mechanism makes social isolation difficult to break through. Most socially isolated older adults have no desire to tackle their isolation but hope to solve their problems by themselves for as long as possible. Practical help may contribute to their self-reliance.

Towards a relational conceptualization of empathy.

Empathy is a fundamental concept in health care and nursing. In academic literature, it has been primarily defined as a personal ability, act or experience. The relational dimensions of empathy have received far less attention. In our view, individualistic conceptualizations are restricted and do not adequately reflect the practice of empathy in daily care. We argue that a relational conceptualization of empathy contributes to a more realistic, nuanced and deeper understanding of the functions and limitations of empathy in professional care practices. In this article, we explore the relational aspects of empathy, drawing on sources that offer a relational approach, such as the field of care ethics, the phenomenology of Edith Stein and qualitative research into interpersonal and interactive empathy. We analyse the relational aspects of three prevalent components of empathy definitions: the underlying ability or act (i.e. the cognitive, affective and perception abilities that enable empathy); the resulting experience (i.e. empathic understanding and affective responsivity) and the expression of this experience (i.e. empathic expression). Ultimately, we propose four inter-related understandings of empathy: (a) A co-creative practice based on the abilities and activities of both the empathizer and the empathee; (b) A fundamentally other-oriented experience; (c) A dynamic, interactive process in which empathizer and empathee influence each other's experiences; (d) A quality of relationships.

Social Embeddedness of Firefighters, Paramedics, Specialized Nurses, Police Officers, and Military Personnel: Systematic Review in Relation to the Risk of Traumatization.

Background: Firefighters, paramedics, specialized nurses working in Intensive Care Units (ICUs), Operating Rooms (OR), and Emergency Rooms (ER), police officers and military personnel are more frequently exposed to potentially traumatic events than the general population; they are considered high-risk professionals. To reduce the risk of traumatization it is of great importance to be embedded in a social environment with supportive relationships. Methods: We performed a systematic review (based on the PRISMA-Guidelines) looking for social connections within the environment in which high-risk professionals are embedded (work, home, community), to obtain evidence on the impact of these connections on the risk of traumatization. Additionally, we aim to identify relevant supportive relationships in the professionals' environments. We identified the relevant scientific literature by searching, without time, and language restriction, five electronic bibliographic databases: MEDLINE, PsycINFO, Sociological Abstracts, CINAHL, and Web of Science. These databases were last searched in January 2019. Results: A qualitative analysis of the 89 eligible (out of 9,047 screened) studies shows that for firefighters, paramedics, and emergency nurses social connections in their work environment are predominantly supportive relationships and may protect them against traumatization. In other occupations (OR-nurses, ICU-nurses, police officers), however, social connections at work are not only a source of support but are also a source of stress. For military personnel study results are inconclusive as to whether their social connections at work or at home support them against traumatization. In so far as connections are supportive, their sources vary greatly from one occupational group to another; they differ between work vs. home as well as within work between peers vs. supervisor. Conclusions: Being embedded in a social environment, i.e., having social connections, is important but not always sufficient to protect high-risk professionals against traumatization. For, while these connections may be the antecedents of supportive relationships, they can also be the antecedents of damaging relationships. Additionally, the sources of supportive relationships differ among groups. This suggests that knowledge of how the social structures of the occupational groups differ may increase our understanding of the impact of social connections and relationships, including socialization, on the risk of traumatization of high-risk professionals.

Care ethics: An ethics of empathy?

BACKGROUND: Empathy is a contested concept in the field of care ethics. According to its proponents, empathy is a unique way to connect with others, to understand what is at stake for them, and to help guide moral deliberation. According to its critics, empathy is biased, inaccurate or a form of projection that does not truly grasp and respect the otherness of the other, and that may be distorted by prejudices. OBJECTIVES: We aim to contribute to a better understanding of the significance of empathy in care ethics by reviewing both the functions and limitations of empathy in this field. RESEARCH DESIGN: Drawing on literature from care ethics and closely related fields, we identify the relevant functions and limitations of empathy from the relational, epistemic, normative, and political perspectives. These perspectives are drawn from four main characteristics of care ethics, which serve as a concise framework for understanding the significance of empathy. PARTICIPANTS AND RESEARCH CONTEXT: This article is written as part of an empirical and theoretical research project that aims to better understand the functions and limitations of empathy in care practices, from the perspective of care ethics. ETHICAL CONSIDERATIONS: We try to do justice to both the appraisal and critique of empathy in the care ethics literature. FINDINGS: Our findings stress that the relationship between care ethics and empathy is complicated and rife with opposing views. Therefore, we conclude that care ethics is not an ethics of empathy. DISCUSSION AND CONCLUSION: Based on our findings, we formulate pathways that may guide the further analysis of empathy in care practices and care ethics.