Relationships among death anxiety, communication apprehension with the dying, and empathy in those seeking occupations as nurses and physicians

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  • This article was downloaded by: [New York University]On: 06 December 2014, At: 22:15Publisher: RoutledgeInforma Ltd Registered in England and Wales Registered Number: 1072954 Registeredoffice: Mortimer House, 37-41 Mortimer Street, London W1T 3JH, UK

    Death StudiesPublication details, including instructions for authors andsubscription information:http://www.tandfonline.com/loi/udst20

    Relationships among death anxiety,communication apprehension with thedying, and empathy in those seekingoccupations as nurses and physiciansHeather L. Servaty a , Mark J. Krejci b & Bert Hayslip Jr. ca Department of Psychology , University of North Texas , Denton,Texas, USAb Department of Psychology , Concordia College , Moorhead,Minnesota, USAc Department of Psychology , University of North Texas , Denton,Texas, USAPublished online: 14 Aug 2007.

    To cite this article: Heather L. Servaty , Mark J. Krejci & Bert Hayslip Jr. (1996) Relationshipsamong death anxiety, communication apprehension with the dying, and empathy in those seekingoccupations as nurses and physicians, Death Studies, 20:2, 149-161, DOI: 10.1080/07481189608252747

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    RELATIONSHIPS AMONG DEATH ANXIETY, COMMUNICATION APPREHENSION WITH THE DYING, AND EMPATHY IN THOSE SEEKING OCCUPATIONS AS

    NURSES AND PHYSICIANS ~ m m m m m m m m m m m m m m m m m m m m m m w m w m f f i m w w m w m m w m w w m w m w m w w m w w m

    HEATHER L. SERVATY

    Department of Psychology, University of North Texas, Denton, Texas, USA

    MARK J. KREJCI Department of Psychology, Concordia College,

    Moorhead, Minnesota, USA

    BERT HAYSLIP, JR.

    Department of Psychology, University of North Texas, Denton, Texas, USA

    In light of tlE modern pherunnenm ?fincreased institutionalized deaths occur- ring in hospitals and in nursing hornes, much qf recent death attitude research has ,focused on health professiouals. The present study explored possible rela- tiunships a m g mmures of death anxiety, communication appehmsion with the dying, and empathy in udrpaduate nursing, piemedical, and control subjects. Main effictsjbr year in school indicated that seniws scored h e - r than ,freshmen on communication apprehension with the dying. The multivariate efectsjbr,f;elrl ?f study were also sipijkant, with uniuariate results indicating that nursing students scored lower than controls on communication apjr/hension with the dying.

    Although death remains one of the common threads which binds all living things, there is far from a single approach to or under- standing of the topic. Currently, approximately 80 percent of all

    Address correspondence to Heather I>. Servaty, Department of Psychology, Univer- sity of North Texas, Denton, T X 76203, USA.

    Death Studies, 20:149-161, 1996 Copyright 0 1996 Taylor & Francis

    0748-1187/96 $12.00 + .OO 149

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  • 150 H. L. S m n t r p t 01.

    persons die i n an institutional setting-hospital, nursing or con- valescent fx i l i ty , or retirement home providing care for the aged (DeSpelder & Strickland, 1992). Because of their daily, one-on- one contact with the dying process and with death, medical professionals have become the focus of much research (Campbell, Abernethy, & Waterhouse, 1983-84; Dickinson & Pearson, 1980- 81; Field & Howells 1985; Powell, Thorson, Kara, & Uhl, 1990; rhomtn & Pouell, 1991).

    hlan) I esearchers agree that hospital staff are in a strategic position to either help or hinder the psychological comfort of dying patients (Cramond, 1970; Dickinson & Pearson, 1980-81; Field & Howells, 1988). In the past, studies have examined the attitiides physicians hold toward death (Campbell, Abernathy, & Waterhouse, 1983-84; Field & Howells, 1986; Howells & Field, 1982) and toward the dying (Dickinson 8c Pearson, 1980-81; Field & Howells ~ 1988; Neimeyer, Rehnke, & Keiss, 1984).

    Of greater interest, however, is the work that has centered on how these attitudes influence behavior, specifically relationships with dving persons. In particular, Trent, Glass, & McGee (1981) report that individuals with less death anxiety felt more comfort- able when they spoke with terminally ill people.

    I n an attempt to measure the degree of fear or anxiety an indk idual associates with communicating specifically with dying persons (Hayslip, 1986- 1987; p. 254), Hayslip developed the Communication Apprehension-Dying Scale (CA-Dying). He found a significant positive correlation between CA-Dying and two indices of death anxiety, conscious fears of ones own death and the fears of anothers dving.

    Hayslip (1986- 1987) reported that hospice volunteers who expressed difficultv in relating to the dying, as indicated by higher scores on ct;m mu n ica t ion apprehension with the dying were different in three main aspects from those who felt more comfortable. Thev were less likely to repress fears about their own deaths; more likely to express concerns over their own or anothers dving; and more likely to have negative attitudes to- ward aging/death (Hayslip, 1986-87; p. 257).

    Although numerous factors are thought to affect communi- cation, empathy is one that has also been studied in reference to health professionals (Morath, 1989; Jarski, 1988). Scholars have

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  • CA-Dying 151

    investigated the effects on nurses of their clinical experience with patients and found that there were no significant changes in em- pathy scores as the students moved through their clinical training (Becker & Sands, 1988). Others who have studied nurses, social workers, and teachers have, however, found that emotional em- pathy was significantly and positively correlated with both emo- tional exhaustion and personal accomplishment (Williams, 1989).

    In reference to communication patterns, Lochman and Dain (1982) reported that highly empathic physicians, in contrast to their lower-scoring counterparts, more frequently addressed problematic emotional issues in conversations with their patients. Consistent with this finding, Stiff et al. (1988) found empathic concern to have a substantial impact on communication respon- siveness.

    Although no published research exists that investigates a re- lationship between empathy and death anxiety, some evidence was found supporting the relationship of anxiety to each of these variables individually. One study reported that individuals who volunteered for hospice work self-reported themselves high in empathy while low in trait anxiety (Wilkinson & Wilkinson, 1986-87). Other research shows conscious death anxiety to be significantly associated with the Taylor Manifest Anxiety Scale (Templer, 1970) and trait anxiety (Robbins, 1989). These findings would lead one to hypothesize a possible relationship between empathy and death anxiety. The present investigation attempts to study this relationship in a more direct manner by specifically examining a possible correlation between death anxiety and em- pathy.

    Another factor that must be considered when evaluating the death-related attitudes of health professionals concerns the de- velopment of such attitudes. Some suggest that individual atti- tudes toward death may be formed before participation in any kind of practical, in-house medical training, and that those inter- ested in health occupations may select their career based on these already established attitudes toward death (Campbell, Abernethy, & Waterhouse, 1983-84). Still others believe that the death atti- tudes of health professionals develop in reaction to their occu- pational experience, suggesting that individuals react in certain situations based on the specific medical training they received

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  • 152 H. L. Seruuty et al.

    (Lattanner 8c Hayslip, 1984-85; Sundin, Gaines, 8c Knapp,

    A number of studies speak to this issue. When surveying practicing nurses and physicians, Campbell, Abernethy, and Waterhouse (1983-84) reported that nurses consistently main- tained a more positive view toward death, while physicians de- scribed it as a highly negative experience. Nurses described the process as rebirth, tranquility and victory (p. 46) whereas phy- sicians used words such as unsafe, alone, forgotten, and cold (p. 46). These data, confirming a difference between the death attitudes of nurses and physicians, led the authors to suggest the possibility that the two fields select persons a priori for differing attitudes toward death (Campbell et al., 1983).

    In this respect, other research has reported that students entering medical school may have higher death threat scores than those in other professions, suggesting to some researchers that people choose their specific field to work out their death-related personal problems (Wahl, 1969; White, 1969; both cited in Nei- meyer, Behnke, 8c Riess, 1984).

    It has also been found that practicing nurses scored lower than a control group in personal distress, a subscale of a multi- dimensional measure of empathy developed by Davis (1983), en- titled the Interpersonal Reactivity Index. The personal distress subscale is defined by Becker and Sands, (1988) as an affective measure of self-oriented feelings of unease in tense, interpersonal settings (p. 199). Thus, persons with high scores on other di- mensions of empathy, as defined by Davis (1983), such as per- spective taking and empathic concern, tend to have low scores on personal distress. This finding suggests that nurses may choose their field knowing their superior capacity to communicate in difficult situations, which could include those involving death.

    Brent, Speece, Gates, and Kaul (1992-93) compared the death attitudes of first-year medical and nursing students with no previous experience in caring for dying patients in order to explore the kinds of attitudes the two groups brought with them as they began their professional careers. The researchers studied the ways in which those attitudes influenced professional career choice and how the factors associated with gender differences interacted in affecting those attitudes. In addition, the authors

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  • CA-Dy ing 153

    explored the kinds of nonprofessional death-related experiences that influenced students attitudes. Results indicated that on five of the six attitude measures, female nursing students expressed a more positive attitude than either male or female medical stu- dents. Brent et al. (1993) also found that the number of hours of death and dying coursework and student age each appeared to contribute significantly to the attitudes, with those students with more experience having more positive attitudes.

    The present study attempted to extend the above work by examining premed students as well as nursing students. First- year medical students have already had four years of undergrad- uate training, most often in the areas of biology or chemistry. It therefore seemed important to look not only at first-year medical students, but also to study first-year premed students, who lack such training.

    The basic rationale of the investigation was that the death- related attitudes of students studying to be health professionals may be affected by their undergraduate training. To further investigate at what point in ones career possible differences in death attitudes and empathy emerge, the study utilized as par- ticipants students who had not yet entered the workforce, but who were studying to be either physicians or nurses. It also explored relationships between death anxiety, empathy, and communica- tion apprehension with the dying.

    Method

    Subjects

    The 129 volunteers in this study were drawn from students at- tending Concordia College in Moorhead, Minnesota. The three freshmen groups included a Freshman Nursing group (FN; n = 13, M Age = 18.54, Male = 1, Female = 12), a Freshman Premed group (FPM; n = 23, M Age = 19.74, Male = 7, Female = 16), and a Freshman Control group (FC; n = 31, M = 18.52, Male = 11, Female = 20). Senior groups included a Senior Nurs- ing group (SN; n = 11; M Age = 24.82; Male = 1, Female = lo), a Senior Premed group (SPM; n = 23, M Age = 21.52, Male

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  • 154 H. L. Senialy ut 01.

    = 14, Female = 9), and a Senior Control group (SC; n = 28, M Age = 21.57, Male = 8, Female = 20). Of 227 packets sent, 129 were returned for a total return rate of 56%. Return rates ranged from a low of 39% (11 of 28) for senior nursing students to a high of 71% (23 of 32) for senior premed students, with return rates for the remaining groups ranging from 50% to 68%. The premed students in the investigation had not received any formal death and dving training, while the nursing students had been exposed to death and dying discussions of an informal nature in various courses.

    Materials

    T h Mehrabzan and Eprtvzn Empathy Scale (EMP; Mehrabian & Epstein, 1972). According to Mehrabian and Epstein (1972), the object in developing the empathy scale was to offer an alternative measure of general (covering many situations) emotional empa- thy based primarily upon salience of mood. A sample item is, It makes me...

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