Cognitive vs. emotional empathy: It’s all in your perspective
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“A brave leader is someone who says I see you. I hear you. I don’t have all the answers, but I’m going to keep listening and asking questions.” — Brené Brown
Advanced practice providers are leaders in health care, and we strive for empathy and compassion in every encounter. Yet, we are not explicitly taught how to be empathetic or compassionate in our training.
In the busyness of daily practice, it can be difficult to focus on empathy and compassion. How we respond to our patients, families and colleagues shapes the perspective of the encounter and the relationship, and understanding those responses improves our ability to have collaborative relationships with them.
Defining empathy
There are three types of empathy — cognitive, emotional and compassionate — yet they don’t look and feel the same.
Cognitive empathy is what we know about how the other person is feeling, acting and thinking. This is used often in interacting with others, negotiating, and considering differing points of view (perspectives), as well as in motivating others. We can learn what typically motivates APPs, for example, in creating structures for recruitment and retention. We can learn how patients typically respond to a new diagnosis of cancer to create patient and family education materials. We can learn how different disciplines in the interprofessional team interact with each other to establish team dynamics and rules for engagement. Patients, families and our colleagues all have their own cognitive responses to situations — ie, what they know, how they react and what they are thinking.
Emotional empathy is responding to the “feelings” the other person is experiencing. Acknowledging their feelings is helpful to validate that you are listening and responding to them in that moment.
APPs experience emotions in many situations. We may have felt sadness when the patient we have been caring for with cancer has a relapse or progressive disease. We may feel angry at a colleague who did not respond the way we expected them to in a situation. Patients and families have their own emotional responses. The patient and/or family who receives the news of cancer progression may be incredibly angry, sad, depressed, relieved to know the problem, or a combination of all of these. Our colleagues may feel powerless that they could not cure this patient.
Compassionate empathy is a combination of cognitive and emotional empathy, with a response to action. We can look at the situation from the varying perspectives, respond appropriately to the emotion being expressed and move to action to support others. This is the type of empathy to which we aspire.
The NURSES approach
There are several tips to keep in mind when responding with compassionate empathy.
First, show up and be present in every encounter. We cannot be listening without being silent. So, stop talking and listen.
The NURSE(S) acronym is a helpful communication tool for responding with empathy to emotion. It consists of the following:
Name: “This situation is really frustrating.”
Understand: “I can only imagine what you’re going through.”
Respect: “You are such a strong advocate for your child.”
Support: “I will be here to listen and help in any way I can.”
Explore: “Please tell me more (about what you’re thinking).”
Silence: Allow time for the other person to process and respond.
Emotional or information cues can be difficult to distinguish. As an example, after sharing new information with a parent of a child with cancer, the parent may say, “I don’t understand.” This could be an emotional reaction, such as “I can’t believe this is happening,” or an indication that they do not comprehend the information being shared. Responses to the information cue might include reviewing the test results again with simple language, pausing for questions and clarifying. An empathetic/emotional response might be, “I can only imagine how hard this is to hear/understand” or “This situation must be overwhelming.” At times, both responses may be appropriate.
The NURSE(S) components are not meant to be used in a stepwise manner. You may find that a support statement, for example, is most important as an initial response rather than naming the emotion, or you may need to ask for more information before you can respond with one of the other responses. NURSE(S) is helpful in just about every communication situation, whether professional or personal.
The benefits of empathy
Taking the time to be thoughtful before reacting leads to better understanding and improved problem solving. Using our cognitive, emotional and compassionate empathy to respond to difficult situations will help improve our perspective-taking skills and actions to support patients, families and colleagues in the way that will be most helpful to them. It will also help us to better understand ourselves.
Empathy is a complex skill that must be learned and practiced. In reflecting back to the Brené Brown quote, empathy is what connects us and nurtures us as leaders and as APPs.
References:
- Annadurai V, et al. J Palliat Med. 2021;doi:10.1089/jpm.2020.0207.
- Beadle JN, et al. Front Psychiatry. 2019;doi:10.3389/fpsyt.2019.00331.
- Brown B. Dare to lead: Brave work, tough conversations, whole hearts. New York: Random House; 2019.
- Spitz ER. The three kinds of empathy: Cognitive, emotional, and compassionate. Heartmanity. Available at: blog.heartmanity.com/the-three-kinds-of-empathy-emotional-cognitive-compassionate. Accessed June 26, 2022.
For more information:
Deborah Lafond, DNP, PPCNP-BC, CPON, CHPPN, FPCN, FAAN, is CEO of PANDA Education Consultants PLLC. She can be reached at dlafond@pandaedcon.org.
Kathy Perko, MS, PPCNP-BC, CPON, CHPPN, CPLC, FPCN, is director of the pediatric track of University of Washington Palliative Care Certificate Program and chief operating officer of PANDA Education Consultants PLLC. She can be reached at kperko@uw.edu.
Healio | HemOnc Today collaborated with Association of Pediatric Hematology/Oncology Nurses on the submission of this column.
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