Learning Empathy as a Caregiver Takes More Than Experience

The windshield survey: You drive through areas with high rates of poverty, and observe, from behind a windshield. The goal is to try to give nursing-students a sense of where some of their patients may come from, to build empathy. “But student often bring their biases with them on the drive, and take them back home, unchallenged,” says Karen Alexander.  Sometimes, there’s further discussion, and reflection to confront those assumptions. But not always.

New research from the College of Nursing at Jefferson shows that existing training may not adequately challenge nursing students’ pre-existing assumptions about poverty. More needs to be done to help dismantle the societal stigma of poverty.

“We should train, as nurses, to empathize with our patients and ultimately to help close the gap in health disparities,” says author Karen Alexander, PhD, RN, “In our research, we wanted to look at whether or not past experiences with poverty (either lived or as a volunteer) gave nurses a stronger sense of empathy towards populations experiencing poverty.”  The results were published in the Journal of Nursing Education.

The researchers surveyed 104 nursing students using the Jefferson Empathy Scale, an internationally-used tool to measure empathy in healthcare contexts, and a second validated survey called Attitudes Towards Poverty (short form). They also collected demographic information on students, such as exposure to poverty through lived experience or volunteer experience, as well as age, gender, ethnicity, religion and others.

“What surprised us at first was that personal experience with poverty didn’t necessarily connect with give higher empathy scores,” says Dr. Alexander.  “In fact, the scores were the same as average.” In other words, having lived in poverty for periods, didn’t always make people more empathetic towards others.

“What was more surprising was that the students who had interacted with poverty through volunteer experiences had lower empathy scores than the remainder of the cohort,” she says. Volunteer experiences included efforts such as the windshield survey, volunteering at a soup kitchen, or other in-person outreach.

“The volunteer experience is central to a lot of medical and nursing-school learning,” says Dr. Alexander. “It’s this idea that exposure is enough to challenge assumptions, and remove stigma. But it may not have the effect we think it’s having,” she says. “Our results suggest that service learning isn’t enough, and it may be, in fact, detrimental.”

Students may bring their biases to volunteer experiences, Dr. Alexander explained, and may have those biases confirmed rather than challenged.

One intervention that Dr. Alexander finds particularly useful to gently help identify and dismantle each student’s pre-existing opinions surrounding poverty is self-reflection through journaling and peer-reflection and discussion.

“It’s important for students to be able to see themselves in their patients. To think ‘that could be me or someone I know.’ It’s hard to get to that position in the absence of a meaningful relationship,” says Dr. Alexander.