EMPATHY ,SYMPATHY

AND INTUITION

Presented By:
Nurlaila Ramadhan Suid
Candidate of MSc in Midwifery
Atatürk University
Supervisor: Dr. Hava Özkan
Contents
1. Relation between Midwife and Clients
2. Component of the Midwife and Clients
2.1 Trust
2.2 Respect
2.3 Professional Intimacy
2.4 Empathy
2.5 Power
3. Empathy
3.1 Definition of Empathy
3.2 Classification of Empathy
3.3 Practicing specific Empathy
3.4 Benefit of Empathy in Midwife-
Patient Relationship
4. Sympathy
5. The Differences between Sympathy and
Empathy
6. Intuition
6.1 Definition
6.2 The Notion of Intution
6.3 The Phase of Intuition
6.4 Five types of Intution
6.5 Intuition and Midwifery
7. References
1. Relation between midwife and client

The midwife-client relationship is the

foundation of caring practice across all
populations and cultures and in all
practice settings. It is therapeutic and
focuses on the needs of the client.
 It is based on trust, respect and
professional intimacy, and it requires
the appropriate use of authority.
 The midwife-client relationship is
conducted within boundaries that
separate professional and therapeutic
behavior from non-professional and
non-therapeutic behavior.
A client's dignity, autonomy and privacy
are kept safe within the midwife-client
relationship. Within the midwife-client
relationship, the client is often
vulnerable because the midwife has
more power than the client.
 The midwife has influence, access to
information, and specialized knowledge
and skills.
(https://www.crnbc.ca/Standards/PracticeStandards/Pages/boundaries.aspx)
 Midwives have the competencies to
develop a therapeutic relationship and
set appropriate boundaries with their
clients.
(https://www.crnbc.ca/Standards/PracticeStandards/Pages/boundaries.aspx
2. Components of the
midwife-client relationship

There are five components to the

midwife-client relationship: trust,
respect, professional intimacy, empathy
and power. Regardless of the context,
length of interaction and whether a
midwife is the primary or secondary
care provider, these components are
always present.
Components of the midwife-client relationship

TRUST

RESPECT

PROFESSIONAL INTIMACY

EMPATHY

POWER
2.1 Trust
Trust is critical in the midwife-client
relationship because the client is in a
vulnerable position. Initially, trust in a
relationship is fragile, so it’s especially
important that a midwife keep promises
to a client. If trust is breached, it
becomes difficult to re-establish.
2.2 Respect

Respect is the recognition of the

inherent dignity, worth and uniqueness
of every individual, regardless of socio-
economic status, personal attributes
and the nature of the health problem.
2.3 Professional intimacy

Professional intimacy is inherent in the

type of care and services that midwives
provide. It may relate to the physical
activities, such as bathing, that
midwives perform for, and with, the
client that create closeness
Professional intimacy can also involve
psychological, spiritual and social
elements that are identified in the plan
of care.
2.4 Empathy

Empathy is the expression of

understanding, feeling, validating and
resonating with the the client. In
nursing, empathy includes appropriate
emotional distance from the client to
ensure objectivity and an appropriate
professional response.
2.5 Power

The midwife-client relationship is one of

unequal power. Although the midwife
may not immediately perceive it, the
midwife has more power than the client.
The midwife has more authority and
influence in the health care system,
specialized knowledge, access to
privileged information, and the ability to
advocate for the client and the client’s
significant others
The appropriate use of power, in a
caring manner, enables the midwife to
partner with the client to meet the
client’s needs. A misuse of power is
considered abuse.
(College of midwives of Ontario, 2006)
EMPATHY
3. EMPATHY

Empathy has been emphasized,

particularly since the 1990s, as the
central helping component in
therapeutic midwife–patient interactions
Empathy is a teachable skill that is
crucial in helping relationships.
However, various investigations have
found the empathy level of midwives to
be low or moderate. Duff and
Hollingshead stated that 71.1% of
registered midwives, 80% of licensed
practical midwives,
and 74.0% of midwife aides do not
develop empathy with their patients
reported that there has been very little
development in midwives’
communication skills in the last 20
years.
Studies on empathy and
communication skills have shown that
further efforts are required to increase
midwives’ levels of empathy and
communication skills for effective care.
(Ançel, 2006)
3.1 Definition of Empathy
Empathy is the ability to perceive the
meaning and feelings of another and to
communicate those feelings to the
other person

(Ançel, 2006)
Rogers describes empathy as the state
of perceiving the internal frame of
reference of another person with
accuracy and with emotional
components and meanings that pertain
to it, as if one were the other person,
but without the loss of the “as-if”
condition.
There are some theories to clarify empathy:

Rogers’ description shows that

empathy has affective, cognitive, and
communicative components and
considers an “empathic cycle”
In Wiseman’s review of empathy and
analysis of the concept, the defining
attributes were summarized as follows:
seeing the world as others see it, being
nonjudgmental, understanding
another’s feelings, and communicating
such understanding.

(Ançel, 2006)
In another study, empathy was
characterized by five concepts, namely,
human trait, professional state, caring,
communication process, and special
relationship
(Kunyk & Olson, 2001).
3.2 Classification of Empathy

Paul Ekman an expert in understanding

facial expressions and emotions state
about three kinds of
empathy: cognitive, emotional and
compassionate.
According to Paul Ekman’s classification

1. “Cognitive empathy” is “simply

knowing how the other person feels and
what they might be thinking. Sometimes
called perspective-taking, this kind of
empathy can help in, say, a negotiation
or in motivating people.”
2. “Emotional empathy” is described as a
state “when you feel physically along
with the other person, as though their
emotions were contagious.”
3. Finally, with “compassionate empathy,”
“we not only understand a person’s
predicament and feel with them, but are
spontaneously moved to help, if
needed.”

(http://lawsagna.typepad.com/lawsagna/
2007/09/three-kinds-of-.html)
3.2 Practicing Specific Empathy

a. Listen.
Listening is one of the most important
ways of showing empathy, and this
means truly listening. When listening
to someone that is important to taking
in what the other person is saying.
True listening means being present, not
thinking ahead of what going to be
doing in the future, or mired in thoughts
of the past.
Look them in the eye (don't stare, but
try and maintain eye contact), sit facing
them.
Listening requires three things. First,
reflect back to the person that is the
mean of understanding. Second, reflect
back the emotional reaction. Third,
indicate how the response makes the
listener want to behave.
b. Open up
Just listening to someone isn't going to
build a bridge between client and
midwife. Opening up emotionally is an
incredibly difficult and brave thing to do
but it will deepen the connection with
another person.
c. Offer physical affection.
Offer physical affection can be done for
everyone and obviously midwife should
ask before giving someone physical
affection to make sure that it's okay
(even if midwife has known them for
awhile).
Showing physical affection, however,
can boost oxytocin levels and make
both of midwife and client feel better
since Oxytocin also has been known to
help people better interpret other
people's emotions
 If the client have been known well
before, give them a hug, or put an arm
around their shoulders, or a hand on
their arm.
d. Focus your attention outwards.
Pay attention to surroundings and to
the feelings, expressions, and actions
of the people. Be mindful about how
they might be feeling.
Notice surroundings, really notice them.
Pay attention to sounds, smells, sights
and register them consciously. Try to
avoid labeling other people's emotions
and behaviors as "bad" or "good"
e. Withhold judgment.
This is an important step when
practicing mindfulness and when
practicing empathy. It can be really hard
to withhold immediate judgment,
especially when first meeting or
interacting with someone
And yet, this is a crucial step towards
being empathetic. Basically this means
trying to gain a deeper understanding of
someone else's perspective without
immediately saying that it is bad or
good.
f. Offer help.
This shows that midwife see what
someone is going through and midwife
want to make life easier for them.
Offering help is a great act of empathy,
because it shows the willing to take
time out of day to do something for
someone else without asking anything
in return.
Even just offering the opportunity to
help can be an empathetic gesture. Tell
client that if they need anything they
can ask, opening up the way for
providing help and support.
3.4 Benefit of Empathy in Midwife-
Patient Relationship
The importance of empathy in the
therapeutic relationship is related to the
aims of such relationships. Irrespective
of the context of the therapeutic
relationship, there appears to be a core
set of common aims or purposes. These
include:
For Patients:
 Empathy is valuable to patients
psychological care
 empowering the patient to learn, or
cope more effectively with his or her
environment; and,
 Patient feel more comfortable for
building relation with the midwife
For midwives:

 Make midwife easier to communicate

that understanding and check its
accuracy; and,
 Make midwife easier to act on that
understanding with the patient in a
helpful (therapeutic) way.
 Enabling midwives to understand
patients physical needs and respond to
them
 accurate empathy develops the ability
to deal with differing capacities for
intimacy in counseling
 Enable midwives to appreciates the
patients perspectives
( Yeydich T, 2002)
SYMPATHY
4. SYMPATHY
Sympathy is a subjective look at
another person’s world that prevents a
clear perspective of the issues
confronting that person.
Sympathy focuses on the midwife’s
feelings rather than the client’s. Saying
“I’m so sorry about your condition, it
must be terrible to lose your baby.”
According to Morse et al. sympathy is a
first-level empathetic response and is a
verbal and non-verbal expression of the
midwife's own sorrow or dismay at the
patient's situation.
When midwives were sympathetic, the
clients felt that their feelings were
justified and made them feel like the
midwives understood their situation
and cared about them as a person.
It seemed important that midwives
communicate their recognition and
understanding of the patient's situation.
patient did not expect the midwife to be
able to ‘fix’ everything, but it alleviated
their anxiety and uncertain feelings
when they knew that someone
understood how they were feeling
(Mc Cabe, 2004)
5. The Differences between
Sympathy and Empathy
According to Baillie, midwife-
respondents defined sympathy as
‘feeling sorry for’ another person, while
empathy needed an understanding of
the other’s experience and thus
required a closer relationship.
Empathy was viewed as putting oneself
in the other’s position, ‘to imagine and
try to understand’, but this might then
require one to also ‘feel with’ the
patient.
In clinical settings, as nursing, empathy
involves an effort to understand the
patient’s experiences without joining
them, whereas sympathy involves a
feeling of sharing or joining the
patient’s pain and suffering
The distinction between sympathy and
empathy is not only a theoretical
quarrel, but has important implications
for the midwife-patient relationship.
When a midwife joins the patient’s
emotions (a key feature of sympathy),
clinical outcomes are impeded.
There are some comparisons of sympathy
and empathy:

 Sympathy emphasizes sharing

distressing feelings whereas empathy
does not emphasize any particular type
of feeling.
 Sympathy may also involve agreeing
with some aspects of the other person's
feelings, beliefs, etc. whereas empathy
emphasizes understanding all of them
with no interest in either agreeing or
disagreeing.
 The listener using empathy usually
responds more comprehensively to the
talker as compared with the listener
using sympathy.
(Bookbinder, 2006)
Chart of Comparisons
Empathy Sympathy
Definition Understanding what Acknowledging
others are feeling another person's
because you have emotional hardships
experienced it and providing
yourself or can put comfort and
yourself in their assurance.
shoes.

Example I know it's not easy to When people try to

lose weight because make changes like
I have faced the this (e.g. lose some
same problems weight) at first it
myself. seems difficult.
 Empathy Sympathy

Friends, family and

Relationship Personal community (the
experience of others)
Nursing Context Relating with your Comforting your
patient because you patient or their family
have been in a
similar situation or
experience
Scope Personal, It can be From either one to
one to many in some another person or
circumstances one to many (or one
to a group).
Conclusion

According all studies, we assume that

empathy is a positive emotional
competence which may help midwives
in handling emotional interactions with
patients and in promoting well-being
experiences at work.
INTUTION
6.INTUITION
6.1 Definition
Many authors have suggested that
intuition is a legitimate basis for
decision making in health care,
especially within nursing. Various
definitions have been given, including
(Lamond and Thompson, 2000):
 Benner & Tanner: “understanding
without rationale”
 Gerrity : “a perception of possibilities,
meanings, and relationships by way of
insight”
 Rew & Barron: “knowledge of fact or
truth as a whole; immediate possession
of knowledge; and knowledge
independent of the linear reasoning
process”
 Schrader & Fischer: "immediate
knowledge of something without the
conscious use of reason”
Young: “process whereby the midwife
knows something about the patient that
cannot be verbalized, that is verbalized
with difficulty or for which the source of
knowledge cannot be determined”
6.2 The Notion of Intuition

As long as people have no rational

explanation of a phenomenon, they tend
to turn to supernatural elucidations. For
example, it was once thought that it was
the wrath of the ‘God Poseidon’ that
caused earthquakes and tidal waves.
Today, some commentators still
believe, in a mysterious way, that
intuition causes deep understanding of
the total situation.
 This would make
‘intuition’ a scientific
terra incognita; a term
used here only to
describe an area of
knowledge as yet
unknown.
 However, by gradually uncovering
and understanding the elements
underpinning intuition, less and less
will remain hidden about it.
As was the case with Poseidon’s
earthquakes and tidal waves, it will
equally turn out that there is nothing
mystical or paranormal about intuition
after all. The description of intuition as
a ‘hunch’ or ‘sixth sense’ suggests how
difficult it is to explain how intuition
actually functions.
(Nyatanga, B and Vocht, H, 2008)
6.3 The Phase of Intution
(Welling.H, 2005)
Detection

Dichotomic Awareness

Related Object

Metaphorical Solution

Explicit Verbal Understanding

a. Detection Phase

This phase involves a sign of

something dawning in consciousness.
One’s attention is drawn to something;
one has the feeling that something is
happening or present.
Often this phase is experienced as a
feeling of confusion, alertness, or being
disturbed or troubled. An example
:“Something in the remark worked upon
me as a kind of warning signal”
b. Dichotomic Awareness Phase

The next type of intuition occurs when

some of the quality of the intuition
comes into awareness.
 People will recognize the quite
remarkable experience of feeling that
something is wrong or that a solution is
at hand before they know what it is or
what it is related to. The experience of a
lost thought; one knows it is lost and
has no clue what it was or what one was
thinking about.
c. Related Object Phase

 In this phase, it becomes clear to what

objects (observations, ideas, events)
the intuition is related, but in most
cases one still does not know what the
intuition is in itself.
someone can feel that something is
wrong (dichotomic awareness) with his
marriage (related object). However, he
can’t tell what is wrong.
d. Metaphorical Solution Phase

In this phase it becomes clear how

these elements are important. The
intuition presents itself in the form of
images, words, or feelings.
 For example: The husband who feels
something is wrong with his marriage
may experience a sense of being
trapped or
mathematician may feel that there is a
shortcut available for the problem he’s
working on.
e. Explicit Verbal Understanding Phase

 At this stage, the intuition is entirely

understood. The meaning of the
intuition is now completely clear. This
meaning has become clear through
identification of the elements that made
the proposed metaphor or concept fit.
For example: the husband understands
that his feeling of being trapped in his
marriage can be exemplified by many
instances in which he inhibited his
wishes and abstained from certain
behaviors for fear of criticism by his
wife.
6. 4 Five types of intuition:

a. Analysts
Analysts spend a lot of time
researching and data-gathering before
making a decision about a situation,
and aren’t satisfied until every potential
scenario is explored and played out. A
snap judgement is always a poor
judgement, to an “analyst.”
b. Observers
Observers gather clues, mostly visually,
about the people and scenarios around
them. If she passes a coworker in the
hallway that won’t return their smile, the
“observer” takes this subtlety to heart.
c. Questioners
Questioners are more direct about their
judgment-making. If they need to find
the perfect venue for their company
happy hour, they don’t rely on online
reviews or appearances, but ask around
for the group’s top pick. “Questioners”
make real-life, evidence-based
decisions, but neglects to pick up on
unspoken cues.
d. Empathizers
Empathizers are quick to let colleagues
and clients vent out their problems, and
go with them emotionally to the source
of the problem. Unfortunately, too much
empathy skews their judgment when it’s
time to make an unbiased call.
e. Adapters
Adapters are the all-star intuitors, the
Zoltar fortune teller of the office. They
give the best advice, and you know you
can go to them when things get hairy.
6.5 Intuition and Midwifery

Intuition can be a valuable component in

clinical decision-making. More experienced
midwives in particular can benefit from
their intuitive powers in order to function
at an expert level.
 As Benner et al claimed, experts see
the unexpected, and that which is
beyond the immediate clinical situation
– the bigger picture.
Midwives at the height of their expertise
become perceptive to distinctions and
similarities in patient situations. This
perceptive is a result of have more data
in store than can be processed
consciously, that make their intuition
stronger.
 Polgar and Thomas assumed that
however, it is important to acknowledge
that even the strongest intuition is
sometimes fallible when put to
empirical test. The cautionary point to
emerge here is that intuition should not
be measured or judged like empirical
evidence
(Nyatanga, B and Vocht, H, 2008)
The conclusion is however, this should
not be taken to mean that intuition is
not a valuable source of knowledge, but
that it can be used as a component of
decision-making processes which
should be complemented with
information from other sources of
knowledge whenever possible.
References
 Ançel, G. Developing Empathy in midwives: An
Inservice Training Program,Archives of
Psychiatric Nursing, Vol. 20, No. 6 (December),
2006: pp 249-257
 Bookbinder L. 2006. Comparison of sympathy
and Empathy. http://www.empathy-and-listening-
skills.info/)
 Boundaries in the midwife-Client Relationship
https://www.crnbc.ca/Standards/Practice
Standards/Pages/boundaries.aspx.
 College of midwives of Ontario. Therapeutic
midwife-Client Relationship. 2006.
 Dal Santo L, et all. Empathy in the emotional
interactions with patients. Is it positive for midwives
too? Journal of Nursing Education and Practice,
2014, Vol. 4, No. 2,
 How to Show Empathy.
(http://www.wikihow.com/Show-Empathy)
 Kunyk, D., & Olson, J. K. (2001). Nursing theory and
concept development or analysis, clarification of
conceptualizations of empathy. Journal of
Advanced Nursing, 35,317– 325.
 Lamond, D and Thompson C. Intuition and Analysis
in Decision Making and Choice. JOURNAL OF
NURSING SCHOLARSHIP , 2000; 32:3, 411-414.
SIGMA THETA TAU INTERNATIONAL )
 Mc Cabe, C. 2004. midwife–patient
communication: an exploration of patients’
experiences, Journal of Clinical Nursing Volume
13, Issue 1, pages 41–49, January 2004
 Nyatanga, B and Vocht, H. Intuition in clinical
decision-making:a psychological penumbra.
International Journal of Palliative Nursing 2008,
Vol 14, No 10
 The 5 Different Types Of Intuition And How To
Hone Yours. http://Fast Company_
Business+Innovation.htm
 Three Kinds of Empathy.
(http://lawsagna.typepad.com/lawsagna/2007/09/th
ree-kinds-of-.html)
 Welling, H. The Intuitive Process: The Case of
Psychotherapy.Journal of Psychotherapy
Integration. 2005, Vol. 15, No. 1, 19–47
 Yeydich, T. On the phenomenology of empathy in
nursing: empathy or sympathy? Journal of
Advanced Nursing, Volume 30. Issue 1, pages 83-
93, July 1999 and Stewart W Mercer and William J
Reyworld. British Journal of General Practice 2002
52 , S9 S13)
THANK YOU