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Science Quarterly

A Nursing Theory of Personal System Empathy: Interpreting a Conceptualization of Empathy in King's

Interacting Systems
Martha R. Alligood and Barbara A. May
Nurs Sci Q 2000 13: 243
DOI: 10.1177/08943180022107645

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Nursing
A Nursing
Science
TheoryQuarterly, 13:3, July 2000

A Nursing Theory of Personal System Empathy:

Interpreting a Conceptualization of Empathy
in Kings Interacting Systems
Martha R. Alligood, RN; PhD
Professor, The University of Tennessee, College of Nursing, Knoxville, Tennessee

Barbara A. May, RN; PhD

Assistant Professor, School of Nursing, East Tennessee State University, Johnson City, Tennessee

This article presents a theory of empathy discovered through rational hermeneutic interpretation within Kings per-
sonal system. Personal system concepts from Kings general systems framework include perception, self, growth
and development, body image, space, time, and learning. Propositions for each concept in the personal system were
explicated and a theory of nursing empathy was developed. This nursing theory proposes that empathy organizes
perceptions; facilitates awareness of self and others; increases sensitivity; promotes shared respect, mutual goals,
and social awareness; cultivates understanding of individuals within a historical and social context; and affects
learning.

F or many years, the application of
borrowed theories of empathy to the
nurse-patient relationship has been
questioned by nurse educators and re-
searchers (Bennett, 1995). In fact, over
15 years ago, Gagan (1983) challenged
the nursing community to examine the
nature and characteristics of empathy
within the confines of the nurse-client
relationship. Since that time, some re-
searchers have conceptualized empathy
within nursing frameworks (Alligood,
1991; Alligood nee Raile, 1983;
Carmon, 1992; Wheeler, 1988), but
empathy has been studied by these
researchers as an interpersonal
phenomenon. Whereas Katz (1963)
proposed that empathy involved
intrapsychic steps, the nature of
intrapersonal empathy has not been re-
ported in nursing studies. Furthermore,
the recognition and support of two types
of empathy (Alligood, 1992; Baillie,
1996; Evans, Wilt, Alligood, & ONeil,
1998) implies a change in focus from
Authors Note: This research was funded
by the University of Tennessee, Knoxville.
Nursing Science Quarterly, Vol. 13 No. 3,
July 2000, 243-247
2000 Sage Publications, Inc.
trained interpersonal skill to basic
intrapersonal development, which pro-
vides a way for nursing to consider
these issues in empathy theory develop-
ment. Thus, this article addresses these
issues by presenting a theory of
intrapersonal empathy from an interpre-
tation of empathy discovered in Kings
interacting systems (Alligood, Evans, &
Wilt, 1995).
Empathy
Empathy in nursing has been viewed
as integral to therapeutic relationships
and related positively to client and nurse
outcomes, such as satisfaction with
nursing care (Holt-Ashley, 1986), en-
hanced self-concept (Williams, 1979),
decreased patient distress (LaMonica,
Wo l f , M a d e a , & O b e r s t , 1 9 8 7 ;
Reid-Ponte, 1992), and patient-per-
ceived empathy (Olson, 1995). Con-
sidering the importance of the concept
of empathy in nursing, it is surprising
that nursing borrowed theoretical defi-
nitions of empathy from other disci-
plines, such as psychology, philosophy,
and psychiatry, and integrated them into
the nurse-patient relationship. For ex-
ample, Carl Rogers (1957) defined em-
pathy to mean a sensing of the clients
private world as if it were the therapists
own world without ever losing the as if
quality. This view was applied carte
blanche into the nurse-patient relation-
ship (Morse et al., 1992). Rogers defi-
nition emphasized the cognitive com-
ponent of empathy and focused on the
interpersonal process. Therefore, nurse
researchers and educators directed their
attention to cognitive and interpersonal
processes of empathy. In the following
decades, nursing studies discussed ex-
tensively the teaching and learning of
empathic behaviors and skills (Clay,
1984; Cox, 1989; Fernald, 1995; Hills
& Knowles, 1983; Hodges, 1991;
Kalisch, 1971; Keefe, 1979; Kirk &
Thomas, 1982; LaMonica, Carew,
Winder, Haase, & Blanchard, 1976;
Layton, 1979; Reynolds, 1987). Only
recently have researchers and educators
questioned the emphasis on the teach-
ing and learning process of empathy
(Baillie, 1995; Davis, 1990; Evans et al.,
1998; Smyth, 1996).
Also, as a result of conceptualizing
empathy from a borrowed perspective,
theoretical and methodological prob-
lems in nursing studies have persisted,
Keywords: empathy, Kings general
systems framework, theory development

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244 Nursing Science Quarterly, 13:3, July 2000
and conflicting findings have been re-
ported (Bennett, 1995; Gagan, 1983;
Olsen, 1991). In fact, some researchers
have even begun to question the concep-
tual fit of empathy for nursing (Diers,
1990; Gordon, 1983; Morse et al., 1992;
Pike, 1990). Alligood (1992) has sug-
gested that some of these conceptual
and methodological problems may have
resulted because there has not been a
clear distinction made between two
types of empathy: basic and trained. Ba-
sic empathy is defined as a universal hu-
man trait, and trained empathy is de-
fined as a clinical skill state. She
proposed that these two types of empa-
thy have their own theoretical and meth-
odological differences. Perhaps the
most significant implication of
Alligoods proposal of two types of em-
pathy is the shift from interpersonal
(skill acquisition) to intrapersonal (de-
velopmental). Although the focus of
most empathy studies has been on the
trained type and the interpersonal pro-
cess, there is ample support that new ap-
proaches should be developed that fo-
c u s o n b a s i c e m p a t hy a n d t h e
intrapersonal process. Therefore, this
study extends Alligoods earlier work
with a purpose of developing an under-
standing of the intrapersonal nature of
empathy.
Hermeneutics
Hermeneutic interpretation was pro-
posed by Benoliel (1987) as an ap-
proach to develop holistic nursing
knowledge based on knowing. Con-
cepts and theories, which have been
published in texts and manuscripts, con-
tain the knowledge; knowing is an indi-
viduals perceptual awareness of life
situations that has been acquired
through experience. The hermeneutic
interplay bridges history, tradition, and
o r i g i n a l i n t e n t i o n s o f t h e a u-
thor/speaker/actor with the present dis-
course to increase understanding
(Reeder, 1988, p. 229).
Using hermeneutics, a conceptual-
ization of empathy was interpreted
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within Kings (1981) general systems
framework, resulting in a chapter titled
Kings Interacting Systems and Empa-
thy (Alligood et al., 1995). Peer review
of the work of Alligood et al. recog-
nized that this initial work represented
the development of an implicit theory of
empathy (Fawcett & Whall, 1995).
Based on this evaluation, a further ex-
amination was conducted to formalize a
theory of empathy from Kings three in-
teracting systems. Rational hermeneu-
tic interpretation of that chapter was the
method used to discover empathy
within King. Interpretive hermeneutics
was used because of its reliance on em-
pathy as the primary source of informa-
tion from which to interpret the world
(Holden, 1991), because both herme-
neutics and Kings work rely on an ac-
tive engagement process to understand
an object-system relationship in a holis-
tic context, and both achieve under-
standing of the whole in terms of the
parts, and the parts in terms of the whole
(Alligood et al., 2000). Allen (1995) de-
scribed the steps in this qualitative re-
search approach as follows: (a) discov-
ery of meaning through reading, (b)
interpretation of the part being exam-
ined in relation to the whole, (c) consid-
eration of the historical context of the
writer and reader(s), and (d) recording
of the newly discovered text. Thus, the
approach here included reading the text,
interpreting each sentence, and creating
propositional statements for each of the
concepts in relation to the system,
which is the hermeneutic circle; the the-
ory was then formalized by linking
these statements to the conceptualiza-
tion of empathy within Kings personal
system.
In earlier works by the empathy re-
search team in the College of Nursing at
the University of Tennessee (Alligood,
1992; Alligood et al., 1995), empathy
had been conceptualized as a develop-
mental phenomenon and defined as a
feeling attribute of persons. The re-
search question guiding this study was
the following: What explicit nursing the-
ory of empathy can be discovered from
an interpretation of the personal system
in Kings (1981) systems framework?
Kings Personal System
Kings (1981) general systems
framework is the conceptual model
from which a theory of empathy was de-
rived. This conceptual model includes
three dynamic interacting open sys-
tems: personal systems, interpersonal
systems, and social systems. Personal
systems pertain to individuals, whereas
interpersonal systems involve two or
more individuals, and social systems
encompass organizations and institu-
tions, such as family systems, education
systems, religious systems, and work
systems. These open systems interact,
and concepts within each system are not
exclusive to that system but are relevant
among all the systems.
King (1981) observed that a per-
sonal system is a unified, complex
whole self who perceives, thinks, de-
sires, imagines, decides, identifies
goals and selects means to achieve
them (p. 27). King describes individu-
als as sentient, rational, reacting, per-
ceiving, purposeful, social, controlling,
action-oriented, and time-oriented be-
ings, and that the nurse as a person is a
total system (p. 10). Although most
empathy studies and theories have fo-
cused on the interaction process or the
interpersonal system of the nurse and
patient, perceptions of the nurse can in-
fluence the interaction process (King,
1981). Thus, it is important to study the
characteristics of these individual per-
sonal systems and to begin the develop-
ment of a theory of empathy within the
personal system. Personal system con-
cepts from Kings general systems
framework (1981) include perception,
self, growth and development, body im-
age, time, and space. Learning is a con-
cept that was not in the 1981 conceptual
framework but is included in this article
because King included learning in the
personal system in later publications
(1986, 1992). The propositions for each
concept in the personal system were ex-

plicated and a theory of nursing empa-
thy was developed.
A Nursing Theory of
Intrapersonal Empathy
Perception is the major concept in
the personal system and is defined by
King (1981) as a process of organiz-
ing, interpreting, and transforming in-
formation from sense data and memory.
It is a process of human transactions
with environment. It gives meaning to
ones experience, represents ones im-
age of reality, and influences ones be-
havior (p. 24). Based on Kings ideas,
empathy has been proposed as a dimen-
sion of sensory perception and a way of
knowing that organizes sense data into
meaningful understanding. With empa-
thy, there is not only knowing but also
an interpretation of what is known
(Alligood et al., 1995). Therefore, the
first theoretical proposition proposes
that empathy organizes perceptions.
Self is another concept in the per-
sonal system. King (1981) wrote that
knowledge of self is a key to under-
standing human behavior, because self
is the way I define me to myself and to
others. Self is all that I am (p. 26). King
based her characteristics of self on
Jersilds (1952) definition, which refers
to the self as a composite of thoughts
and feelings and stated that awareness
of self helps one to become a sensitive
human being who is comfortable with
self and with relationships with others
(King, 1981, p. 28). Empathy has been
proposed to be the affective dimension
of human sensitivity that King de-
scribes and, through empathy, a wide
range of human sensitivity is developed,
increasing the use of self (Alligood et
al., 1995). Therefore, the second theo-
retical proposition is that empathy facil-
itates awareness of self and others.
Another concept in the personal sys-
tem is that of growth and development.
The manner in which a person grows
and develops is influenced positively
and negatively by other people and ob-
jects in the environment (King, 1981,
pp. 30-31). Based on Kings ideas, em-
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pathy has been proposed as a develop-
mental affective sensing that has been
part of a persons life since conception,
has an impact on the past, and influ-
ences a persons ability to become a
more sensitive human being (Alligood
et al., 1995). Thus, a third theoretical
proposition is that empathy increases
sensitivity.
King (1981) defined body image as
a persons perceptions of his [or her]
own body, others reactions to his [or
her] appearance, and is a result of oth-
ers reactions to self (p. 33). Thus,
body image relies heavily on empathy
because the reaction of others, which
may be positive or negative, occurs as
people see others reacting to them. Fur-
thermore, empathy promotes the devel-
opment of shared respect and mutual
goals (Alligood et al., 1995). Therefore,
the fourth theoretical proposition is that
empathy promotes shared respect, mu-
tual goals, and social awareness.
Space is an essential component of
an open systems framework because of
its relationship to perception and body
image (King, 1981). Space is defined
as the physical area called territory and
by the behavior of individuals occupy-
ing space (King, 1981, p. 38). In addi-
tion, King observed that space is rele-
vant for understanding self. It is through
empathic knowing that positive aspects
of persons in space and cues of viola-
tions of personal space are understood
(Alligood et al., 1995). Therefore, the
fifth theoretical proposition is that em-
pathy facilitates understanding of indi-
viduals within a social context.
The next concept in the personal sys-
tem is time. Time is a term used by in-
dividuals to give order to events and to
determine duration based on percep-
tions of each persons experiences
(King, 1981, p. 45). Because time is
subjective, empathy has been proposed
to facilitate an understanding of events
or behaviors through the viewing of oth-
ers in an expanse of time (Alligood et
al., 1995). Therefore, the sixth theoreti-
cal proposition is that empathy culti-
vates the understanding of individuals
within a historical context.
A Nursing Theory 245
As stated previously, learning is the
concept that King added later to the per-
sonal system. King formulated her defi-
nition of learning from characteristics
that described the nature of learning.
One of those characteristics is that
learning is a self activity and requires
active participation on the part of the
learner. Another characteristic is that it
requires communication of information
through verbal or nonverbal messages.
Additionally, learning is individual and
learners bring to learning situations
their personal interests, needs, and past
experiences. Learning is dynamic and a
self-regulating process. Perception is
essential for learning, and factors that
influence perception are socio-cultural,
psychological, and physiological. Thus,
King (1986) defined learning as a pro-
cess of sensory perception, conceptual-
ization, and critical thinking involving
multiple experiences in which changes
in concepts, skills, symbols, habits, and
values can be evaluated in observable
behaviors and inferred from behavioral
manifestations (p. 24). According to
King (1986), learning is influenced by
feelings and emotions. Because empa-
thy is a feeling attribute, it can influence
learning. In addition, perceptions and
learning are interrelated (King, 1981).
Because empathy is a dimension of sen-
sory perception that affects the way
nurses organize and interpret sense data,
the relationship of perception and empa-
thy has been proposed to be fundamental
to how nurses learn nursing (Alligood et
al., 1995). Therefore, the final theoreti-
cal proposition is that empathy affects
learning because it is a feeling attribute
that organizes perceptions.
Conclusion
Based on the above theoretical prop-
ositions, a nursing theory of empathy
within Kings personal system is pro-
posed. The components of this theory
are presented in Table 1. Simply stated,
this nursing theory of intrapersonal em-
pathy proposes that empathy organizes
perceptions; facilitates awareness of
self and others; increases sensitivity;
246 Nursing Science Quarterly, 13:3, July 2000
Table 1
Components of a Theory of Empathy
Concept
Perception Empathy organizes perceptions
Self Empathy facilitates awareness of self and others
Growth and development Empathy increases sensitivity
Body image Empathy promotes shared respect, mutual goals, and social awareness
Space Empathy facilitates understanding of individuals within a social context
Time Empathy cultivates understanding of individuals within a historical context
Learning Empathy affects learning
promotes shared respect, mutual goals,
and social awareness; cultivates under-
standing of individuals within a histor-
ical and social context; and affects
learning.
Summary
The application of borrowed theo-
ries of empathy to the nurse-patient re-
lationship has resulted in a focus on the
interpersonal process and learning of
skills. These borrowed theories did not
account for the basic intrapersonal de-
velopmental empathy that nurses pos-
sess and use in interactions with their
patients. Perceptions of the nurse influ-
ence this interaction process (King,
1981). Therefore, it is important to un-
derstand and study the intrapersonal as-
pects in the formalization of a nursing
theory of empathy. Consequently, in
this study, an interpretative hermeneutic
approach was used to discover empathy
in the personal system of Kings general
systems framework. Even though King
did not discuss empathy per se in her
writings, all of the concepts within the
personal system have been linked with
the concept of empathy (Alligood et al.,
1995).
The theory of nursing empathy being
proposed confirms that in a nurse-pa-
tient interaction, empathy is more than
saying the appropriate words or using
learned behavioral skills; it is also a
feeling within a person that provides
understanding of self and others. Rote
trained responses to patients without
feeling may be inappropriate and even
harmful to nurse-patient relationships
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Proposition
(Alligood et al., 1998; Evans et al.,
1998; Morse et al., 1992). Furthermore,
because systems are interactive and dy-
namic, intrapersonal developmental
empathy will have an impact on inter-
personal and social development of the
individual nurse.
The outcome of the discovery pro-
cess was a theory of empathy with a
nursing systems approach and a con-
ceptualization of empathy in Kings
personal system. This proposed nursing
theory of empathy facilitates an under-
standing of empathy within a nursing
perspective, expands Kings work, and
provides a holistic approach to nursing
care. Most important, this theory pro-
poses theoretical constructs to be tested
in future studies on the nature of nursing
empathy.
References
Allen, D. G. (1995). Hermeneutics: Philo-
sophical traditions and nursing practice
research. Nursing Science Quarterly, 8,
174-182.
Alligood, M. R. (1991). Testing Rogers the-
ory of accelerating change: The relation-
ships among creativity, actualization,
and empathy in persons 18 to 92 years of
age. Western Journal of Nursing Re-
search, 13(1), 84-96.
Alligood, M. R. (1992). Empathy: The im-
portance of recognizing two types. Jour-
nal of Psychosocial Nursing, 30(3),
14-17.
Alligood, M. R., Evans, G. W., & Wilt, D. L.
(1995). Kings interacting systems and
empathy. In M. A. Frey & C. L. Sieloff
(Eds.), Advancing Kings systems frame-
work and theory of nursing (pp. 66-78).
Thousand Oaks, CA: Sage.
Alligood, M. R., Evans, G., Wilt, D., Seavor,
C., May, B. A., & Witucki, J. (1998, Feb-
ruary). A conceptualization of nursing
empathy using hermeneutics. Paper pre-
sented at the 12th Annual Conference of
the Southern Nursing Research Society,
Ft. Worth, TX.
Alligood, M. R., Evans, G., Wilt, D., Seavor,
C., May, B. A., Witucki, J., Gunther, M.,
Gerstle, D., Walker, K., & Shea, W.
(2000, February). A theory of nursing
empathy. Paper presented at the 14th An-
nual Conference of the Southern Nursing
Research Society, Little Rock, AR.
Alligood nee Raile, M. (1983). The relation-
ship of creativity, actualization, and em-
pathy in unitary human development: A
descriptive study of M. Rogers principle
of helicy. Unpublished doctoral disserta-
tion, New York University, New York.
Baillie, L. (1995). Empathy in the nurse pa-
tient relationship. Nursing Standard,
9(20), 29-30, 32.
Baillie, L. (1996). A phenomenological
study of the nature of empathy. Journal
of Advanced Nursing, 24, 1300-1308.
Bennett, J. A. (1995). Methodological
notes on empathy: Further consider-
ations. Advances in Nursing Science,
18(1), 36-50.
Benoliel, J. Q. (1987). Response to Toward
holistic inquiry in nursing: A proposal
for synthesis of patterns and methods.
Scholarly Inquiry for Nursing Practice:
An International Journal, 1(2), 147-152.
Carmon, B. W. (1992). Relationship be-
tween self-awareness, social anxiety and
perceptual empathy in undergraduate
nursing students. Unpublished masters
thesis, University of Alaska, Anchorage.
Clay, M. (1984). Development of an em-
pathic interaction skills schedule in a
nursing context. Journal of Advanced
Nursing, 9(4), 343-350.
Cox, H. (1989). Drama in the arts lab. Build-
ing empathy skills. Australian Nurses
Journal, 19(1), 14-15.
Davis, C. M. (1990). What is empathy, and
can empathy be taught? Physical Ther-
apy, 70(11), 707-715.
Diers, D. (1990). Response. Journal of Pro-
fessional Nursing, 6(4), 240-241.
Evans, G. W., Wilt, D. L., Alligood, M. R., &
ONeil, M. (1998). Empathy: A study of
two types. Issues in Mental Health
Nursing, 19, 1-9.
Fawcett, J., & Whall, A. L. (1995). State of
the science and future directions. In M. A.
Frey & C. L. Sieloff (Eds.), Advancing
Kings systems framework and theory of
nursing (pp. 327-334). Thousand Oaks,
CA: Sage.
Fernald, P. S. (1995). Teaching students to
listen empathically. Teaching of Psychol-
ogy, 22(3), 183-186.
Gagan, J. M. (1983). Methodological notes
on empathy. Advances in Nursing Sci-
ence, 5(2), 65-72.

Gordon, M. (1983). A philosophical analy-
sis of caring in nursing. Journal of Ad-
vanced Nursing, 8, 289-295.
Hills, M. D., & Knowles, D. (1983). Nurses
levels of empathy and respect in simu-
lated interactions with patients. Interna-
tional Journal of Nursing Studies, 20(2),
83-87.
Hodges, S. A. (1991). An experiment in the
development of empathy in student
nurses. Journal of Advanced Nursing,
16(11), 1296-1300.
Holden, R. J. (1991). In defense of Cartesian
dualism and the hermeneutic horizon.
Journal of Advanced Nursing, 16(11),
1375-1381.
Holt-Ashley, M. (1986). Relationship of em-
pathy training to empathic level of
nurses and patient satisfaction with
nursing care. Unpublished doctoral dis-
sertation, Texas Womens University,
Denton, TX.
Jersild, A. T. (1952). In search of self. New
York: Columbia University, Teachers
College Press.
Kalisch, B. J. (1971). An experiment in the
development of empathy in nursing stu-
dents. Nursing Research, 20(3),
202-211.
Katz, R. I. (1963). Empathy: Its nature and
uses. Glencoe, IL: Free Press.
Keefe, T. (1979). The development of em-
pathic skills: A study. Journal of Educa-
tion for Social Work, 15(2), 30-37.
King, I. M. (1981). A theory for nursing:
Systems, concepts, process. Albany, NY:
Downloaded from nsq.sagepub.com at Bibliothekssystem der Universitaet Giessen on October 20, 2014
Delmar.
King, I. M. (1986). Curriculum and in-
struction in nursing. Norwalk, CT:
Appleton-Century-Crofts.
King, I. M. (1992). Kings theory of goal
attainment. Nursing Science Quarterly,
5, 19-26.
Kirk, W. G., & Thomas, A. H. (1982). A
brief in-service training strategy to in-
crease levels of empathy of psychiatric
nursing personnel. Journal of Psychiat-
ric Treatment and Evaluation, 4,
177-179.
LaMonica, E. L., Carew, D. K., Winder, A.
E., Haase, A. M., & Blanchard, K. H.
(1976). Empathy training as the major
thrust of a staff development program.
Nursing Research, 25, 447-451.
LaMonica, E. L., Wolf, R. M., Madea, A.
R., & Oberst, M. T. (1987). Empathy
and nursing care outcomes. Scholarly
Inquiry for Nursing Practice: An Inter-
national Journal, 1(3), 197-213.
Layton, J. M. (1979). The use of modeling
to teach empathy to nursing students.
Research in Nursing and Health, 2(4),
163-176.
Morse, J. M., Anderson, G., Bottorff, J. L.,
Yonge, O., OBrien, B., Solberg, S. M.,
& McIlveen, K. H. (1992). Exploring
empathy: A conceptual fit for nursing
practice? Image: Journal of Nursing
Scholarship, 24(4), 273-280.
Olsen, D. P. (1991). Empathy as an ethical
and philosophical basis for nursing. Ad-
vances in Nursing Science, 14(1),
A Nursing Theory 247
62-75.
Olson, J. K. (1995). Relationships between
nurse-expressed empathy, patient-per-
ceived empathy and patient distress. Im-
age: Journal of Nursing Scholarship,
27(4), 317-322.
Pike, A. W. (1990). On the nature and place of
empathy in clinical nursing practice.
Journal of Professional Nursing, 6(4),
235-241.
Reeder, F. (1988). Hermeneutics. In B. Sarter
(Ed.), Innovative research methods for
nursing (pp. 193-238). New York: Na-
tional League for Nursing.
Reid-Ponte, P. (1992). Distress in cancer pa-
tients and primary nurses empathy skills.
Cancer Nursing, 15(4), 283-292.
Reynolds, W. J. (1987). Empathy: We know
what we mean, but what do we teach?
Nurse Education Today, 7(6), 265-269.
Rogers, C. R. (1957). The necessary and suf-
ficient conditions of therapeutic personal-
ity change. Journal of Consulting
Psychology, 21, 95-103.
Smyth, T. (1996). Reinstating the person in
the professional: Reflections on empathy
and aesthetic experience. Journal of Ad-
vanced Nursing, 24(5), 932-937.
Wheeler, K. (1988). A nursing science ap-
proach to understanding empathy. Ar-
chives of Psychiatric Nursing, 2(2),
95-102.
Williams, C. L. (1979). Empathic communi-
cation and its effect on client outcome. Is-
sues in Mental Health Nursing, 2, 15-26.