Handling Exposure Cases with Compassion and Empathy

Stethoscope ©Fabio Balbi-stock.adobe.com

The COVID-19 pandemic gave the world of infection prevention and control many hard-earned gifts. These gifts include the public’s reinvigorated sense of awareness about communicable diseases and the importance of combating the spread of these diseases through contact tracing. To break the chain of infection, individuals who may have been exposed to an infected person must be contacted, tested, and treated as soon as possible. Breaking the chain of infection is increasingly essential when asymptomatic individuals can act as a reservoir, infecting others before becoming symptomatic. Although the COVID-19 virus may be the first thought for most people when the word “exposure” and its corresponding consequences are mentioned, exposure can result from many different circumstances and have varying effects on an individual’s mental, physical, and emotional well-being.

Exposures can occur almost anywhere and among anyone who is not adequately protected. Let’s consider a few predicaments that can result in exposure. First, personal protective equipment (PPE) is essential in the multifaceted approach to preventing disease transmission. However, when inadequately selected or donned and doffed inappropriately, it can leave individuals susceptible to infectious disease exposures. A health care provider involved in occupational needlestick or sharps injuries can be at risk for viral infections such as hepatitis B, hepatitis C, and HIV even if PPE is used correctly. Attending school, work, or intimate social events can render one vulnerable to the silent attack of communicable disease transmission when exposed to symptomatic or asymptomatic classmates, coworkers, family, or friends. Regardless of how an exposure occurs, the events to follow should represent a regimented physical response to the health care needs of the individual exposed to infection while encompassing compassionate and empathetic attributes.

Evoking compassion and empathy during care is particularly important because fear may be the first and most common emotion associated with the awareness of exposure to an infectious disease. There is the fear of not knowing the infectious disease(s) one has been exposed to. There is the fear of how the disease will manifest once an infection is confirmed. There is also the fear that an untimely death will be attached to the prognosis. The mind of the individual exposed to infection can easily wander into an abyss of negative thoughts, but how does the health care provider test and manage the exposure while acknowledging the trauma associated with knowing that one has been exposed? They can do so by initiating all components of compassionate care. Compassionate care “requires immersion into the pain, brokenness, fear, and anguish of another, even when that person is a stranger.”¹

Compassion
Compassionate care is deeply rooted in the essential and fundamental elements of compassion. In health care settings, compassion is “the recognition, understanding, and emotional resonance with another’s concerns, distress, pain or suffering, coupled with relational action to ameliorate these states.”² It is suggested that “compassion is discernible by the following 3 elements: recognizing suffering, relating to people in their suffering, and reacting to suffering.”³ These elements can easily be summed up by the moral principle known as the golden rule, which is to treat others as one would like to be treated. There is an element to postexposure patient care that not only requires being empathetic to the patient’s circumstances but also using inherent virtues to take physical action in supporting the patient’s care. Although the expression of compassion has been inhibited by various factors such as stress, time pressures, and a greater emphasis on quantity rather than quality, compassionate care is an expectation of patients and a professional obligation of health care providers.⁴

Examples of compassionately engaging with a patient can be exercised by offering sentiments to exposed patients such as “I know you are suffering, but there are things I can do to help” or “What can I do to improve your situation?”⁵ Such compassionate statements act as a reflection of the health care provider’s willingness to act and promote the well-being of the patient. Ideally, compassion can be exemplified when the vulnerable moment of exposure is acknowledged by a health care provider who realizes that the exposed patient is in the hands of a health care system and its capacity to actively respond to the experience with compassion and empathy.

Empathy
Empathy is “an affective response that acknowledges and attempts to understand an individual’s suffering through emotional resonance.”5
Exercising empathy after patient exposure demands a more emotionally engaged process, allowing health care providers to potentially accommodate the patient’s emotions through personalized acknowledgment of their full experience.⁵ What does this look like? Emotional resonance means putting yourself in the patient’s shoes. Findings from studies have shown that patients identify empathy in their care when their full experience is acknowledged and health care providers are willing to connect to and understand the patient. This idea requires the ability to put yourself in the patient’s shoes, imagine yourself walking in those shoes, and see how you would personally react to the situation. Engaging with patients using phrases such as “Help me to understand your situation,” “I get the sense you are feeling…,” or “I feel your (perceived emotion)” are examples of exercising empathy with patients exposed to infection.⁵

This approach differs significantly from the health care provider who displays a visceral reaction to the patient’s distressing situation through sympathy. Findings from a study suggest that patients perceive sympathy as “a pity-based response to a distressing situation characterized by a lack of relational understanding and the self-preservation of the observer.”⁵ Although sympathy can be appropriate for some situations when interacting with patients exposed to infection, it is essential to ensure that sympathy doesn’t make patients feel demoralized, depressed, or sorry for themselves.⁵ To avoid displaying a sympathetic response to the patient’s exposure experience, health care providers should reconsider the use of statements such as “I’m so sorry,” “This must be awful,” or “I can’t imagine what it must be like.”⁵ Sympathy may be the easiest emotion to display to a patient in moments of distress because it simply requires kind words or gestures, but in most moments of postexposure care, the last thing a patient will want to feel from the health care provider delivering medical care is a disingenuous, depersonalized, and emotionally distant and detached response to their experience.

Conclusion
In health care policy delivery and research, compassion and empathy are terms often used interchangeably to describe some humane qualities patients hope to see personified by their health care providers.⁵ Empathy and compassion are typically welcomed and valued by patients because they feel these concepts point to the health care provider’s ability to acknowledge, understand, and resonate emotionally with their experience. Compassionate care leans toward the right thing to do from a humanistic perspective. It can be the catalyst that raises the quality of care and helps improve patient safety. When health care providers work to build caring, trusting, and collaborative relationships during postexposure care, there are more appropriate health care decisions based on the patient’s expressed concerns, better patient adherence to treatment plans, and less costly outcomes. The future of health care has the opportunity to improve in the area of compassionate care, especially during postexposure care. Doing so can increase the patient’s hope for recovery, accountability in exposure circumstances, and overall satisfaction of care.

References
1. Roach MS. Caring: the human mode of being. In: Smith MC, Turkel MC, Wolf ZR, eds. Caring in Nursing Classics: An Essential Resource. Springer; 2012165-179.

2. Lown BA, Rosen J, Marttila J. An agenda for improving compassionate care: a survey shows about half of patients say such care is missing. Health Aff (Millwood). 2011;30(9):1772-1778. doi:10.1377/hlthaff.2011.0539

3. Way D, Tracy SJ. Conceptualizing compassion as recognizing, relating and (re)acting: a qualitative study of compassionate communication at hospice. Commun Monogr. 2012;79(3):292-315. doi:10.1080/03637751.2012.697630

4. Sinclair S, Norris JM, McConnell SJ, et al. Compassion: a scoping review of the healthcare literature. BMC Palliat Care. 2016;15:6. doi:10.1186/s12904-016-0080-0

5. Sinclair S, Beamer K, Hack TF, et al. Sympathy, empathy, and compassion: a grounded theory study of palliative care patients’ understandings, experiences, and preferences. Palliat Med. 2017;31(5):437-447. doi:10.1177/0269216316663499