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ARTICLE Asia-Pacific Management


and Business Application
6 (3) 115-136
When Empathy Works: Towards Finding Effective ©UB 2018
University of Brawijaya
Ways of Sustaining Empathy Flow Malang, Indonesia
http://apmba.ub.ac.id

Lesley Gilla*
Marjolein Schaddeleeb
Phil Ramseyc
Sam Turnerd
Tom Naylore


Otago Polytechnic, Dunedin, New Zealand; c Massey University, Palmerston North
a,b,d,e

, New Zealand

Abstract
The need for developing empathy skills in the workplace continues to challenge
organizations today. Findings from earlier research highlighted the need for developing
these empathy skills. Interviews were undertaken in early 2017 with a mix of empathy
trainers and managers of organizations where empathy is signalled as a key skill. The
purpose of the inquiry was to explore their perspectives of empathy so as to discover
emerging themes that increase our understanding of empathy in the workplace, eluci-
date optimal ways for developing one’s empathy and for reducing or mitigating em-
pathy burnout. Challenges that emerged from the findings were: maintaining empathy
across professional and personal environments; generally, participants found they had
the energy for one of other, not both; caring too much; having time to empathize; man-
aging expectations; professional boundaries; empathy equality i.e. to victim and offend-
er; communicating empathy, and desensitisation. This paper explores these challenges.
Four themes emerged from the findings: interpretations of empathy, context; including
the theory of mind, empathy burnout, and strategies for developing empathy. These
themes informed the development of a Flow Model of Empathy.

Keywords
Empathy; training; emotional intelligence; theory of mind; empathy burnout
Received: 15 January 2018; Accepted: 27 February 2018; Published Online: 30 April 2018
DOI: 10.21776/ub.apmba.2018.006.03.1

*Corresponding author Email: lesleyg@op.ac.nz P-ISSN: 2252-8997


Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136 E-ISSN: 2615-2010
116 Lesley Gill, et. al

Introduction purpose of the inquiry was to mine the


There is no doubt that empathetic perspectives of empathy trainers and
employees are vital to all organizations, organizational representatives so as to
and particularly to customer service and deepen our understanding of empathy
caring professions. However, high levels in the workplace, to identify strategies
of empathy can be hard to maintain for teaching empathy-related skills and
(Hojat, et al., 2009). Empathy burnout is for developing models that guide those
“a syndrome of emotional exhaustion and involved in designing programs aimed
cynicism that occurs frequently among at developing empathy.
individuals who do ‘people-work’ Initial questioning sought people’s
of some kind” (Maslach & Jackson, viewpoint of what empathy is and why
1981, p. 99). This view is reinforced by it is important personally and in the
Johnson (2013) who believes that trying workplace. Our findings uncovered
to deal empathetically with people all the some of the challenges that trainers
time leads to the empathizer being worn and managers experience in relation to
out and likely to suffer from burnout. empathy in the workplace.
Empathy burnout, sometimes referred We begin by presenting the research
to as compassion fatigue, is an issue method, background and early findings
for organizations whose employees are on which this present research was
dealing with high-stress situations, or are premised. This paper presents a
dealing with difficult people or people theoretical perspective of empathy,
with high needs. The cost of compassion in tandem with exploring the rich
fatigue in the caring industry is a discourse of empathy descriptions that
worrying both financially and the human participants articulated. We then present
cost to employees and their families four of the emerging themes: findings
(Slatten, Carson, & Carson, 2011). related to interpretations of empathy,
particularly in customer service and context, empathy burnout, and strategies
caring The cost appears to be growing in for developing empathy.
the 21st century, particularly in customer
service and the caring industries (Smart, The paper is organized so as to offer a
et al., 2014). Some organizations are background in the context of this new
responding to this cost by investing in research and findings. Literature is
empathy training for employees. presented with the findings across four
themes. We begin by describing the
Interest was sparked to identify research method.
how empathy can be maintained
in the workplace, and indeed, how Research Method
empathy training and development
Many studies of emotional intelligence
could mitigate the effects of empathy
are quantitative in nature. Research that
burnout. To explore this notion further,
aims to build theory by incorporating a
interviews were undertaken in early
fresh perspective into existing models
2017 with a mix of empathy trainers
calls for exploratory, qualitative
and managers of organizations where
processes that produce rich data
empathy is signaled as a key skill. The

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When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 117

(Neutens & Rubinson, 2002) that findings have been organized around
needs to be understood in a particular four key themes: (1) What empathy
context in order to establish a credible is; (2) Empathy context; (3) Empathy
interpretation (Tuckett, 2005). In an burnout; and (4) Empathy development.
effort to explore the perspective of EI
We began with the full transcript of the
trainers and organizational practitioners
interviews and highlighted key phrases
who benefit from this training, a
or words on the originals that offered
qualitative approach is appropriate.
a perspective on empathy. Several
The research used semi-structured of the researchers met together to
interviews of five managers who worked analyze these ‘highlighted’ comments.
in helping professions and five empathy This process resulted in four themes
trainers. Semi-structured interviews are emerging. Although there is a direct link
appropriate for mining the perspectives between interpretations of empathy and
of people’s experience while providing the first question (what is empathy?),
a guideline for maintaining consistency reference to describing ‘empathy’ was
(Dey, 1996). The organizations we also found throughout the interviews,
contacted spanned hospital, police, adding richness to our understanding of
correctional facility, social service empathy and justifying ‘interpretations
agency, and hospice. Ethics approval of empathy’ as an emerging theme. The
was gained from Otago Polytechnic. We four themes we discuss in this paper
conducted semi-structured interviews demonstrate a progressive element of
based around seven primary questions: empathy knowledge-building. Next, we
present the background and description
1. In your view, what is empathy? of the earlier research that informs this
2. Why is empathy training important to study.
you?
3. Why is empathy important in the Background
workplace? To begin, the concept of empathy
4. What activities/exercises do you describes a person’s ability to
employ in your training programme to “understand the feelings transmitted
help people increase their empathy? through verbal and nonverbal messages,
5. What are some of the challenges you to provide emotional support to people
have experienced in your: when needed, and to understand the
6. [Empathy training programmes? – links between others’ emotions and
Trainers] OR behavior’’ (Polychroniou, 2009, p. 345).
7. [organization? Managers] Salovey and Mayer (1990, pp. 194-
195) define empathy as the ability to
8. What have you implemented to
comprehend another’s feelings and to re-
address the challenges (at 5)
experience them oneself; a core concept
9. Something else? of emotionally intelligent behavior.
Interviews took 30-45 minutes, were Empathy refers to the ability to reach into
audio recorded, transcribed and analyzed another person’s situation to appreciate
to identify emerging themes. The what they may be thinking and feeling

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


118 Lesley Gill, et. al

(Baron-Cohen & Wheelwright, 2004; relationships were also identified as


Mayer & Salovey, 1997; Singer, et al., helping to sustain one’s empathy, as
2004). “relationships make empathy outward-
looking”, and, “so that people don’t
As part of an earlier study, 21 Emotional get overwhelmed”. Many people
Intelligence trainers were asked about commented that for empathy to be
how they developed empathy in their sustainable, people needed to “recognize
trainees. One way that emerged was in personal boundaries”. Another element
showing empathy to people suggesting of sustaining empathy related to
that people who hadn’t experienced differentiating between professional
(received) empathy, struggled to empathy and personal empathy. Others
empathize with others. Others said pointed to the need for having ‘fun
telling personal stories that people things’ happening such as “an enjoyable
could relate to, developed empathy. habit” that maintained some life
Another way was showing kindness equilibrium.
to themselves and others. Learning,
listening and questioning techniques was Self-kindness emerged again as
also highlighted as a training strategy delegates mentioned the importance of
for developing empathy, for example by deliberate self-care so as to, “recognize
asking, “How do you think the people when we don’t have the capacity to help
felt in that situation?” someone”, and another stated, “People
need to start with how they keep their
In 2016, one of the researchers own wells full”. Yet others pointed to
organized the 3rd Emotional Intelligence evaluating work systems. People are
Symposium which focused on exploring becoming more overwhelmed by the
empathy in the workplace. Using the demands placed on them, and less able to
World Café method (Brown, 2002; respond with empathy to new demands,
Brown, Isaacs, & Margulies, 1997) as workloads increased.
participants were asked to write
about, “How do we design sustainable In summary, people’s responses appear
empathy?” In this context, “sustainable” to be based on a “stock” (or a well) of
referred to people maintaining empathic empathy, thus people need to learn how
responses while experiencing their own to manage the flow of energy in and the
and others’ trauma or crises over time. flow of energy/empathy out. Here is the
Delegates identified, “needing to allow basic model that literature and findings
time for reflection” suggesting a gentle seem to be outlining. We can do things
recovery time was needed. Another that help people learn to manage the
suggested they could imagine they are ‘stock’ of emotional energy available:
in a helicopter thus flying above the either by increasing the amount of flow
situation to gain a greater perspective. in or decreasing the flow out.
Building and maintaining meaningful

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When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 119

Figure 1. Empathy Flow of Energy (Maintained) Model

The Energy Flow of Empathy model Findings


(Figure 1) shows how an empathic person Each of the interviews was analyzed
uses the ‘store’ of empathy. However, for notions that might inform potential
this raises the question as to how to themes related to empathy, for the purpose
maintain an equilibrium between flow- of adding to the field of knowledge and
out and flow-in. We turn our attention to for model building. This paper focuses
the findings from this current research to on the following our themes: (1)
inform this question. Interpretations; (2) Context; (3) Burnout
and (4) Development (See Figure 2).

Figure 2. Empathy Themes

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120 Lesley Gill, et. al

In the case of each theme, relevant feelings and situations. It enables us


literature is presented, alongside to make predictions and behaviors and
participants’ comments. A brief respond in appropriate ways (Allison,
discussion then draws out further Baron-Cohen, Wheelwright, Stone, &
understanding of each theme. Muncer, 2011).

Interpretations of Empathy It’s not looking through their eyes (as


some say); it’s looking through my eyes
Salovey and Mayer (1990, pp. 194-195) to recognize it from my point of view
define empathy as the ability “to com- but being very perceptive of the other
prehend another’s feelings and to re-ex- person. You have your eyes and they
perience them oneself; a core concept of have their eyes.
emotionally intelligent behavior”. Ac-
cording to Sadri (2012, p. 22), empathy Participants’ interpretations of empathy
is the ability “to put oneself in another align with the theoretical definitions
person’s shoes and understand his or presented above. The findings point to
her thoughts and feelings, to view and a relational component to empathy, and
experience the world as the other person which relies on the empathizer’s ability to
views and experiences the world.” communicate that empathy. By default,
there is a need for self-awareness, a
Comments that participants made are: perceptive element of the need to offer
empathy in a given situation. Gill
The ability to understand why someone (2015) found that emotional intelligence
feels a certain way [and] why it’s trainers used their empathy to identify
important in their world. with the learner’s story; in this way,
It is that capacity to pick up how other training is focussed on the learner, not
people are feeling, and have some I the trainer. Additionally, learners who
guess connection with that so that you’re experienced empathy from the trainer
able to put yourself in the other person’s were better equipped to empathize with
shoes. others.

A person’s ability to understand and Additionally, the person the empathy


relate to somebody else’s situation. is focussed towards must comprehend
the empathy being offered them, as the
Empathy describes “a capacity to following comment denotes:
recognize or understand another’s state
of mind or emotion” (Hill, Hill, & Empathy is more about the receiver’s
Richardson, 2012, p. 95). perception of receiving empathy, than
the person who is giving it.
Empathy is seeing something from
another’s perspective… understanding Emotional intelligence literature
another person’s reality from a non- explicitly includes empathy as an
egocentric point of view. important element of EI (Bar-On, 1997;
Goleman, 1999; McEnrue, Groves,
Empathy is essential in connecting us & Shen, 2009; Salovey, Brackett, &
to other people, to understand others’ Mayer, 2007). Cherniss and Goleman

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When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 121

(2001) add that empathy derives from


there with them. Empathy would be on
one of the two foundations of social
the side, throwing the rope down, saying
effectiveness - the other one being self-
I’ll pull you out.
management - both of which are essential
for successful relationship management. [Empathy is] acting in the other person’s
Singh (2014) says that empathy is an best interest.
essential emotional intelligence quality Empathy is also regarded as a vital
that teachers must openly include in element that successful managers and
their instructional strategies. Cooper leaders need (Gentry, Weber, & Sadri,
(2004) links the degree of empathy that 2007), particularly in service industries.
teachers display is directly related to the Khan and Butt (2013) note that the
degree of empathy students demonstrate. financial performance of banks is
Within counseling and social work improved when managers are empathic.
professionals, a high degree of empathic
understanding was needed with clients Harsolekar and Tatuskar (2014)
(Clark & Simpson, 2013; Gerdes & found that bank employees must also
Segal, 2011) resulting in improved be empathic so as to form positive
outcomes. relationships with their customers and
I think most people associate emotional which improves the bottom line. Their
intelligence with the empathy piece. research found that empathy was the
second most important factor next to
According to Mehrabin and Eptein reliability in the Opportunity Score, a
(1972, p. 525) empathy has value in matrix designed to reveal the factors
service industries where caring is a key that customers consider important to
focus, perceived as a “visceral emotional enhance the level of satisfaction of
reaction and interest [that] focuses banking services.
on topics such as helping behavior”.
Empathy is a recognized quality that A study of call center workers by Varca
individual need in service industries, (2009) reported that in order for front-
and in particular, caring and helping line employees to engage with their
professions (Herbek & Yammarino, customers, they must form a relational
1990) such as first responders, teachers, connection, and that empathy was
counselors, and social workers. Nurses ‘key’. One participant focused on what
who demonstrate empathy have a positive happens when there is a deficit:
effect on the treatment and recovery Sadly, people who are not good at
times of patients (Williams, Boyle, & [empathy], devalue its currency; there
Howard, 2016). Our ‘ organization’ is value in dealing with the emotional
participants also commented on the role component of interactions.
of empathy as targeted helping behavior In summarising, participant perspectives
in the interests of the receiver: build on our theoretical understanding
Sympathy is when you jump in the hole of empathy in the workplace. These
with the person. You really are not interpretations might help explain why
helping the person, because you are in Varca (2009) found that employees

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122 Lesley Gill, et. al

who had higher levels of empathy than In social situations, people use common
their colleagues were more likely to social edict derived from previous
suffer from stress and burnout caused by experiences, to assess the situation and
their interactions with their customers; conduct themselves accordingly. Similar
particularly from people who care about to the use of empathy, the capacity to
empathy expressing it in a context where give and receive is based on previous
it is not valued by those in power. experiences (Melloni, et al., 2014).
Clarke (2006) suggested one’s capacity
for empathy varies between organizations
Empathy Context
in different industries, such as people
The particular context that empathy working in services sectors, where they
is demonstrated (or expected to be de- must show empathy as part of their
monstrated) might further clarify peop- role, and people in administrative roles
le’s ability to empathize. According to where empathy is not at the forefront of
Head (2016), there is a politics of em- their day-to-day operations. However,
pathy, where the capacity of one’s em- Bernhardt and Singer (2012) state that
pathy and the ability to show empathy individuals should tread with caution
towards others, varies depending on the when entering social situations with
situation and context. For example, the pre-conceived notions of the interaction.
empathy one shows towards a colleague Each interaction may be different
in a workplace setting, differs from the and yield vastly different outcomes
level of empathy shown towards a loved compared to previous experiences. One
.one at home unique interaction does not necessarily
reflect how other situations may evolve.
I guess I’m talking about family and
Therefore, it is not always certain how
stuff like that, where I’m maybe not
one will receive empathy.
as [empathic]. If I was dealing with
someone from work, a victim at work Coulter and Coulter (2002) discussed
that said the same thing, I’d probably be the correlation between the length of
more empathetic towards the person at service an individual has contributed to
work. their organization, and their capacity to
There is a range of meanings that are be empathic. Depending on the industry,
attributed to empathy, that differs a longer service record may result in
depending on the current conditions. A an increase or decrease in empathy.
study conducted by Melloni, Lopez, and Similarly, Parra (2013) stated that a
Ibanez (2014) revealed there are socio- particular context may differ in the
political conditions where the position eyes of someone with a different level
and stature of an individual, may block of experience, due to their experiences
the ability to empathize with someone at lending them a different point of view.
a different or lower level. Furthermore, For example, someone working in a
Kennedy and Adolphs (2012) suggest public service role may experience a
the regional context for an individual wide range of situations where they
also plays an important role in emotional must be empathic towards their clients
expression and empathy towards others. for 8-10 hours a day. As a result, they

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When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 123

may become clinical in their advice and So I think the stereotypes, the black
recommendations, and more cynical humor, the cynicism, we do find that if
when discussing situations with their you’ve worked with us for a long time,
colleagues. Luchner and Tantleff-Dunn it’s easy to fall into that kind of trap […]
(2016) suggest this is an example of how and become experienced and deal with
people use a higher level of cognitive things a little more clinically.
empathy while demonstrating little
A study conducted by Martinovski,
emotional empathy. One participant
Traum, and Marsella (2007) found that
described this scenario:
employees are predisposed to a certain
Sometimes, if staff has been here a long work ethic based on their previous
time, they slip into their [task] role, experiences and context. Personal
rather than genuinely caring. context has a strong ability to affect
how an individual engages with their
Compassion or emotional fatigue might colleagues, as well as their ability
describe an individual’s high level of to interpret empathy. Like any other
cognitive empathy to understand the communicative act, empathy can be
emotions and mental states of others given and received, but it is subject to
but lacks the capacity to address these the perceptions of both parties and may
observations with emotion (Kinnick, be accepted or rejected. Employees
Krugman, & Cameron, 1996). Employees that are experienced in their role may
with a long service record (though not become clinical as a result. They may be
exclusively) are likely to experience more inclined to reject empathy towards
compassion fatigue, particularly them or show lower levels of empathy
those working in helping industries. towards others (Martinovski, et al.,
Employees conveying a high level of 2007; Parra, 2013).
empathy are also liable to experience
emotional fatigue, as they are putting Theory of Mind
more emphasis on other’s emotions and
mental state, and becoming less mindful Declerck and Bogaert (2008) describe
of one’s emotions and self-preservation the theory of mind (ToM) as the ability
(Kinnick, et al., 1996; Miller, Considine, to take on another person’s perspective
& Garner, 2007). As well as considering and attribute mental states to others, as
the situations of others, it is important well as oneself. An individual with this
to be mindful of one’s own personal ability is enabled to understand and
context and avoiding falling into the trap perceive someone’s intentions, beliefs
that is compassion fatigue. or desires. Gick and Gick (2001) further
explain that ToM is the acknowledgment
…for example, my sisters a nurse, and and acceptance that others may
we always laugh, and sort of joke about understand, and grasp concepts in a way
the fact that she thinks I’m a bit harsh, that is better than you. ToM operates
and I think she’s a bit emotional, and that as a mechanism that is widely used in
might be because of what our different social situations. It fuels interactive
roles encompass. emotions such as empathy and rapport,
which enables the user to accurately

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124 Lesley Gill, et. al

interpret a social situation, and allows however, a few responses referenced


an individual to understand how people cognitive empathy.
view the world, as this often varies
from our own (Gick & Gick, 2001; …need to cognitively understand how
Martinovski, et al., 2007). According to you think, and think about your thinking
Luchner and Tantleff-Dunn (2016), ToM in order to be properly empathic towards
is also referred to as cognitive empathy the people who you’re helping.
and “has been associated with the ability I don’t know what it’s like to be like that,
to take someone else’s perspective and but you just know that some people are
understand what they are experiencing and that’s how they engage with the
intellectually without appreciating their world.
particular emotional state” (p.599). The Freedberg (2007) examined the
use of ToM is crucial in the development relationship between empathy in the
of the human brain, as the inability to workplace and professional boundaries.
consider another’s point of view, is It was found that empathy allows
characterized as egocentric, which often for more flexible boundaries in the
blocks empathy (Gick & Gick, 2001). relationships between employees, as
Declerck and Bogaert (2008) argue well as the relationships formed with an
that ToM is a precursor for empathy organization’s customers. Empathy in
as it operates as a strong social skill the workplace aids in building trust for
related to empathic and cognitive teams and customers, by sharing a level
perspective taking. Empathy and ToM of empathy towards others. However,
rely on neural pathways associated with Benton (2005) argued the risk of
making inferences and assumptions on breaching professional boundaries has
the mental states of others. Therefore, the potential to cause serious harm to a
are closely related in the context of relationship, and ultimately affect team
perceiving another person’s worldview, cohesion. Sharing a level of intimacy
and how they engage with others by way of empathy is important for
(Vollm, et al., 2006). Martinovski (2014) building trust, but must be done in such
stated that empathy may be a general a way that professional boundaries are
cognitive capacity that is necessary for not breached.
human interaction and is often learned Understanding others situations and how
in the early stages of infancy. However, they engage with the world, is crucial in
complex cognitive-emotional processes building relationships in the workplace
are sometimes not learned at this crucial and developing trust in teams. Cognitive
age, nor emphasized by a child’s parents and emotional empathy enables
(Declerck & Bogaert, 2008). This individuals with the capacity to engage
creates an inability to relate and interact with people on different levels and gives
with others and negatively affects team individuals the capacity to engage with
cohesion, negotiation and decision and increase their knowledge of how
making later in life. other’s around them work. However,
Participants were not directly asked a balance of cognitive and emotional
questions about the theory of mind, empathy is preferred, as some may react

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When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 125

differently to others. Becoming mindful refuel one’s own emotional tank. There
of different contexts in which people is no doubt that empathetic employees
operate, and one’s own context based are vital to all organizations, and not
on experiences is of great importance to just to the traditional caring professions.
empathize with others. Two participants However, high levels of empathy can
commented on the importance of be hard to maintain (Hojat, 2009) and
maintaining professional boundaries. researchers have explored the subject
of empathy burnout, or compassion
I’m quite clear on my boundaries. It’s fatigue, and have found that this is an
not like you get a kick out of finding out issue for organizations whose employees
everybody’s personal business, because are dealing with high-stress situations
I’ve got plenty of exciting things to be or are dealing with difficult people or
doing in life, and fill it up with. I don’t people with high needs. Figley (1995)
have to go mining. But it’s just when it described it as when we…
becomes an issue – in the workplace, or
in your friends or something like that. …have not been directly exposed to the
There is a politics of empathy, those trauma scene, but we hear the story told
with little power, are typically excepted with such intensity, or we hear similar
to sense the feeling of those who hold stories so often, or we have the gift and
power, while those in power feel less curse of extreme empathy and we suffer.
obligation to be sensitive in return. We feel the feelings of our clients. We
experience their fears. We dream their
In summary, participant responses dreams. Eventually, we lose a certain
confirm the theoretical understanding spark of optimism, humor, and hope. We
of empathy in various contexts as tire. We aren’t sick, but we aren’t our-
previously described by Martinovski, selves (p.13).
et al. (2007) and Melloni, et al.
(2014). Empathy operates in different According to Maslach and Jackson
ways depending on the context of the (1981), the definition of burnout is “a
setting, and individual positions and syndrome of emotional exhaustion
experiences. It is important to note, that and cynicism that occurs frequently
there is no perfect way to engage with among individuals who do ‘people-
each situation. Becoming mindful of and work’ of some kind” (p.99). This
accepting that everyone is different, and view is reinforced by Johnson (2013)
the way in which they engage the world who believes that trying to deal
varies, enables individuals to approach empathetically with people all the time
interactions in an open way. leads to the empathizer being worn out
and likely to suffer from burnout. As one
Empathy Burnout participant said:
Empathy burnout also referred to as I needed a break from the [work]
‘compassion fatigue’ describes the environment – I’m still on that break –
emotional exhaustion of someone who over a year now – in a less demanding
is relied on to constantly show empathy department.
without the opportunity or resources to

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126 Lesley Gill, et. al

Remen (1996) aptly points out that “the Research carried out by Hojat (2009)
expectation that we can be immersed showed that although empathy levels
in suffering and loss daily and not remained constant through the first
be touched by it is as unrealistic as two years of their subjects’ medical
expecting to be able to walk on water training, by the third year their empathy
without getting wet. This sort of denial levels had declined significantly. The
is no small matter” (p. 52). reasons for this decline were varied and
complex and included time pressure,
Dealing with the general public a lack of role models, a high volume
constantly means, to a certain extent of materials to learn, and patient and
you get a bit desensitized to it, or maybe environmental factors. Neumann, et
compartmentalize the investigations (i.e. al. (2011) found that empathy levels
sexual assaults). I think [the situations] in medical students declined as they
take a toll on staff…you get to a point progressed through their studies, and
where you ‘hit the wall’. they believed the decline was due to the
The type of work that we do develops distress experienced by the students. In
our empathy – constantly sharing in this case, distress included factors such
people’s bad situations, in itself, creates as depression, diminished quality of life,
an empathic response; however, that can burnout, and a low sense of well-being.
be tiring too. Newton, Barber, Clardy, Cleveland,
Helping (or caring) professions are filled and O’Sullivan (2008) also noted the
with people who are emotionally burned decline in medical students’ empathy as
out (Johnson, 2013). The medical they progressed through medical school.
profession has been the subject of much In particular, there was a noticeable
research on burnout as both students decline once students entered their
and qualified doctors learn to deal with first clinical year (year 3). This decline
situations and people that require a high in empathy might be seen as a coping
level of empathy. Mother Teresa was mechanism although it was of concern,
familiar with compassion fatigue when given the importance of a patient’s
working in particularly demanding need for an empathetic caregiver. In
circumstances, stipulating her nuns contrast, Quince, et al. (2016) found in
must take a full year off after 4-5 years their study of four English and one New
of service (Newmeyer, et al., 2014). Zealand medical schools that there was
no decline in empathy levels at the end
Our work…weighs people down after a of the undergraduates’ study, though
while; it’s the cumulative effect of that. they wondered how empathy could
And then tomorrow there’s another best be supported through the pressures
murder… of starting out in medical practice.
We get to see what family violence looks We suggest that empathy should be
like from a child’s perspective, but we constantly reinforced through students’
still have to translate it into what can we education. Paro, et al. (2014) noted that
do for this individual, the perpetrator – burnout and a low perception of quality
to get them to stop. So we are translating of life seemed to be a factor in lower
empathy into something else all the time. levels of empathy in medical students.

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 127

These factors appear to have initiated around to a family to tell them a loved
students to reflect and look inwards, and one has died. The experience teaches
not outwards to others. It is important for empathy.
medical schools to support measures that
Another participant pointed out the need
improve students’ well-being, especially
to manage one’s empathy:
at critical times such as initial clinical
training (Paro, et al., 2010). Their focus There is empathy, and then there are
is on their studies and situation, i.e., people who become the fireman (sic) or
self-absorbed and so a focus on others, the superhero and do everything as well.
such as empathy requires, did not occur.
Some people stated they saved their
If people are too caught up in their own “best empathy for work” because they
world there’s not a capacity to connect were paid to be empathic, but felt their
with others. ‘empathy tank’ was drained, so when
When you do become emotionally they got home, they were less empathic.
involved, you build defenses to protect
I felt like I lacked empathy at home; I
yourself. And that stops empathy running
could give it at work, but I couldn’t
its proper course.
give it at home. I needed a break from
In contrast, a study of fifty-two the [work] environment – I’m still on
Australian Bachelor of Midwifery that break – over a year now – in a less
students (McKenna, et al., 2011) found demanding department.
that students’ empathy rose consistently
Some of the strategies that people used
and substantially with each year of their
to sustain their empathy was taking a
undergraduate program which they
break, black humor, and talking to each
attributed to the notion that midwifery is
other (as they experienced similar events
different to other medical professions in
on the job).
that childbirth is usually a happy time for
families. Though they acknowledge that While we don’t train specifically in
midwives face the same difficulties and empathy, we do focus a lot on wellness.
challenges as other health professionals, They can just take a long weekend; we
the authors make the observation that say, ‘you need a block of time; take it
midwives are working with healthy off’. We do a lot of resilience work.
women rather than ‘sick’ women. Sometimes we vent; sometimes we
While compassion fatigue might be use black humor…and sometimes it
considered the ‘cost of caring’ (Figley, helps keep people sane. It’s a coping
1995) it should not be assumed that mechanism.
empathy burnout is acceptable outcome Get past responding to people always
employees and volunteers in caring/ with an answer and a perspective. Learn
helping, first responder or counseling to slow down the conversation and ask
organizations. questions [which] shows a level of ‘I’m
interested in your point of view; I’m
It’s very hard to potentially train open to hearing another perspective’.
someone about how to deal with going

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


128 Lesley Gill, et. al

People having access to more of a diverse 3) offers a model that can guide those
workplace (their stories across genders) designing empathy training. Burnout
increases empathy in our workplace. occurs when the empathy ‘stock’ gets
In summary, comments from the critically low and people lose the ability
participants have added richness to the to re-stock as shown in Figure 1.
model. The revised diagram (see Figure

Figure 3. Critical Levels of Empathy Depletion using the Empathy Flow Model

This criticality of empathy depletion (as Empathy Development


shown in Figure 3) of the Empathy Flow The notion of empathy training has
Model signals the need for intervention, undergone considerable debate with
such as empathy training, which equips Lonie, Alemam, Dhing, and Mihm
people with strategies which acts to (2005) identifying divergent views
‘prime the pump’ externally (by the regarding the plasticity of empathy
trainer) so as to help people to go on to with some arguing it is predominantly
‘fill their own tank’ and to maintain a a personality trait i.e., nature (Davis,
healthy balance of ‘in’ and ‘out’ flow, as 1990) versus those who perceive it as a
well as to recognize the signs the tank trainable skill, i.e., nurture argument (La
is getting low, before it becomes critical. Monica, Wolf, Madea, & Oberst, 1987;
Oz, 2001). Konrath, et al. (2015) claim

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 129

that many scholars perceived empathy attention to a patient’s perspective than


as a relatively stable disposition that previously. They concluded that the way
is not amenable to change. Others empathy was positioned in the training
view empathy as malleable, or plastic, design could result in trainee doctors
which can be developed through increasingly demonstrating empathy in
training (Baillie, 1996; Goleman, 1999; practice.
McEnrue, et al., 2009; Reynolds & Scott,
1999). According to Shapiro (2002) In the business world, empathy
empathy can be learned, thus managers training programmes are considered
(and workers) can enhance their vital to relationships and social skills
empathy skills through developmental development at all levels in the
opportunities and initiatives, coaching, workplace. Sensitivity to others is
and training. However, there is a critical for exceptional job performance
sense that some have more empathy when the focus is on interactions
than others, suggesting it is part of the with other people, and this sensitivity
personality as well as being able to can only come from well-developed
be enhanced through empathic skill empathy (Cherniss & Goleman, 2001).
development. Singh (2014) emphasizes Empathy requires a high level of self-
that empathy is so important that it awareness; if people are aware of their
should be taught at school; a comment own feelings they are more likely to be
that implicitly acknowledges that aware of others’ feelings and concerns.
empathy has plasticity. Empathy is also a vital element of
communication in the business world
Hojat (2009) regards empathy training and people with high empathy are better
as vital to healthcare workers so as able to communicate in a manner that
to champion empathetic engagement makes other people prefer to deal with
between healthcare workers and their them. Because empathy is so important
customers. Brunero, Lamont, and to business success (and profits) there
Coates (2010) make a link between is a renewed focus on empathy training
experiential learning processes and (Cherniss & Goleman, 2001). Concepts
increased empathy amongst healthcare aligned with developing empathy
students. Interviews with medical include listening, self-awareness, digital
students in a study by Austin, Evans, empathy, and role modeling.
Magnus, and O’Hanlon (2007) showed
that female medical students’ empathy Parks (2015) argues that both listening
declined after the first year, whereas and empathy skills are vital components
male medical students’ empathy rose and of successful organizational contexts and
leveled out in subsequent years. While culture. Davis (1990) states that the best
the study did not provide a conclusive counselors are the ones who are good
explanation, one reason offered was that listeners and who can accurately respond
those who rated highly may have learned to both words and underlying feelings,
to moderate their behavior so as to act arguing that training programmes
effectively around a patient’s distress, have been set up to teach counselors
while low scorers learned to pay more empathy skills by offering experiences
that develop their listening skills. Parks

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


130 Lesley Gill, et. al

(2015) states that “Neither empathy people’s exposure to high stress induc-
nor listening is givens; both are skills ing and empathy-draining events and
and competencies that organizations provide respite through organizational
can develop within their individual strategies and self-care opportunities.
members and organizational cultures” (p The implementation of strategies men-
18). Gentry, et al. (2007) argues active tioned earlier would be most effective
listening enables managers to be more before symptoms of empathy fatigue are
empathic which in turn improves their experienced.
effectiveness and performance.
Empathy is a very sought-after human
Strategies for dealing with and/or quality that needs to be applied in
preventing empathy burnout include such measure so that the giver and the
assigning shorter stints where high receiver are fulfilled. However, attention
demands are made on one’s empathy, must be paid to maintain a balance
in “recognition of their heightened between flow-in and flow-out. The
potential for burn-out or compassion Empathy Flow Model provides a useful
fatigue” (Adams, 2007, p. 6). Work-life paradigm for appreciating the need to
balance, education, work interventions make time to re-fill a person’s empathy
(support groups and interventions) reserves by increasing elements that
spiritual support and self-care and self- boost emotional energy, while also
efficacious opportunities are some of the paying attention to elements that deplete
ways that people who are experiencing one’s emotional energy. Given that these
empathy burnout can be restored. elements are likely to be individualized,
Webb (2014) found that the creation the role of empathy training solutions
of a “Spiritual Formation Group” for has also been considered. The Empathy
hospice workers was similar to groups Flow Model and empathy development
described in research undertaken by ideas offer pathways that make
Running, Tolle, and Girard (2018) and emotional energy available so as to offer
(Castle & Phillips, 2003). The purpose empathy to others on an ongoing basis,
of these groups was to give hospice care while still maintaining one’s emotional
professionals a platform to express their equilibrium.
grief toward the loss of their patients
Notes on Contributors
and to provide mutual support (Webb,
2014). These hospice workers articulat- Lesley Gill is a Principal Lecturer
ed that participating in this group helped at Otago Polytechnic, New Zealand.
to decrease the risk of compassion fa- Lesley has a keen interest in professional
tigue and burnout. Debriefing sessions development training, with an emphasis
were also valuable for disaster relief on Emotional Intelligence, Human
volunteers (Adams, 2007). Resource Management, and Leadership.

Conclusion Marjolein Schaddelee is a Senior


Lecturer at Otago Polytechnic, New
With compassion fatigue now catego- Zealand. Marjolein’s research spans
rized as an occupational hazard, or- organizational learning, contemporary
ganizations would be wise to manage

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 131

Human Resource issues, and learning life.


organizational behavior.
Sam Turner is a third-year student
Phil Ramsey is a Senior Lecturer in on course to complete his Bachelor
Organizational Learning, Training, and of Applied Management at Otago
Leadership Development at Massey Polytechnic in 2018. His research
University in Palmerston North. interests are in the field of emotional
Currently, Phil’s research is helping intelligence, empathy, and mindfulness.
develop innovative software that
enables students and instructors to track Tom Naylor is an Otago Polytechnic
their progress in skill acquisition and to alumnus student who worked as a research
do so in a way that enhances their inner assistant contributed to this paper.

References
Adams, P. (2007). Caring overload An investigation of adults with
- compassion fatigue affects Asperger Syndrome or High
disaster relief volunteers mentally Functioning Autism, and normal
and physically. Journal Star, 6. sex differences. Journal of Autism
Allison, C., Baron-Cohen, S., and Developmental Disorders,
Wheelwright, S. J., Stone, M. H., & 34(2), 163-175.
Muncer, S. J. (2011). Psychometric Benton, R. J. (2005). Empathy, intimacy,
analysis of the Empathy Quotient and the psychoanalytic space:
(EQ. Personality and Individual Empathy and intimate strangers.
Differences, 51(7), 829-835. Psychoanalytic Review, 92(4),
Austin, E. J., Evans, P., Magnus, 637-648.
B., & O’Hanlon, K. (2007). A Bernhardt, B. C., & Singer, T. (2012).
preliminary study of empathy, The neural basis of empathy.
emotional intelligence and Annual Review of Neuroscience,
examination performance in 35(1), 1-23.
MBChB students. Medical
Brown, J. (2002). A resource guide for
Education, 41(7), 684-689.
hosting conversations that matter
Baillie, L. (1996). A phenomenological at World Cafe Retrieved 29 June,
study of the nature of empathy. 2012, pages 1-20 from http://
Journal Of Advanced Nursing, www.inscena.ch/fileadmin/user_
24(6), 1300-1308. upload/inscena/pdf/worldcafe.pdf
Bar-On, R. (1997). The Bar-On Brown, J., Isaacs, D., & Margulies, N.
Emotional Quotient Inventory (1997). The World Cafe: Creating
(EQ-i): A Test of Emotional the future, one conversation at a
Intelligence. Toronto: Multi- time Retrieved 8 August, 2012,
Health Systems. pages 1-9, from http://www.
Baron-Cohen, S., & Wheelwright, S. theworldcafe.com/articles/TWC.
(2004). The Empathy Quotient: pdf

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


132 Lesley Gill, et. al

Brunero, S., Lamont, S., & Coates, to empathy and the ability to read
M. (2010). A review of empathy the mind in the eyes. The Journal
education in nursing. Nursing of Social Psychology, 148(6), 711-
Inquiry, 17, 65-74. 726.
Castle, J., & Phillips, W. (2003). Grief Dey, I. (1996). Qualitative Data
rituals: Aspects that facilitate Analysis: A User-friendly guide
adjustment to bereavement. for social scientist. London:
Journal of Loss and Trauma, 8(1), Routlage.
41-71. Figley, C. R. (1995). Compassion fatigue:
Cherniss, C., & Goleman, D. (2001). Toward a new understanding of
The emotionally intelligent the costs of caring. Lutherville,
workplace: How to select for, MD: Sidran.
measure, and improve emotional Freedberg, S. (2007). Re-examining
intelligence in individuals, groups, empathy: A relational-feminist
and organizations. San Francisco: point of view. Social Work, 52(3),
Jossey-Bass. 251-259.
Clark, A. J., & Simpson, T. M. (2013). Gentry, W., Weber, T., & Sadri, G.
Imagination: An essential (2007). Empathy in the workplace
dimension of a counselor’s - A tool for effective leadership
empathy. The Journal of Paper presented at the The Society
Humanistic Counselling, 52(2), of Industrial Organizational
164-176. Psychology Conference.
Clarke, N. (2006). Emotional Gerdes, K. E., & Segal, E. (2011).
Intelligence: A case of caveat Importance of empathy for social
emptor. Human Resource work practice. Integrating new
Development Review, 5(4), 422- science. Social Work, 56(2), 141-
441. 148.
Cooper, B. (2004). Empathy, interaction Gick, E., & Gick, W. (2001). F.A.
and caring: Teachers’ roles in a Hayek’s theory of mind and
constrained environment Pastoral theory of cultural evolution
Care in Education, 22(3), 12-21. revisited: Toward and integrated
Coulter, K. S., & Coulter, R. A. (2002). perspective. Mind & Society, 2(1),
Determinants of trust in a service 149-162.
provider: The moderating role of Gill, L. J. (2015). Exploring trainer
length of relationship. The Journal perspectives of emotional
of Services Marketing, 16(1), 35- intelligence training design.
50. Massey University, Palmerston
Davis, C. (1990). What is empathy and North.
can empathy be taught? Physical Goleman, D. (1999). Working with
Therapy, 70(11), 707-715. Emotional Intelligence. London:
Declerck, C. H., & Bogaert, S. (2008). Bloomsbury.
Social value orientation: Related Harsolekar, D., & Tatuskar, S. (2014).

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 133

An empirical analysis of customer https://doi.org/10.5688/aj690229


satisfaction of Indian public sector Kennedy, D. P., & Adolphs, R. (2012).
banks. Drishtikon : A Management The social brain in psychiatric and
Journal, 5(2), 56-70. neurological disorder. Trends in
Head, N. (2016). A politics of empathy: Cognitive Science, 16(11), 559-
Encounters with empathy in 572.
Israel and Palestine. Review of Khan, Z., & Butt, S. (2013). Emotional
International Studies, 42(1), 95- intelligent managers are
113. required. International Journal
Herbek, T. A., & Yammarino, F. J. (1990). of Information, Business and
Empathy training for hospital staff Management, 5(1), 242-270.
nurses. Group & Organization Kinnick, K. N., Krugman, D. M., &
Studies (1986-1998), 15(3), 279- Cameron, G. T. (1996). Compassion
295. fatigue: Communication
Hill, D., Hill, A., & Richardson, S. and burnout toward social
(2012). Dealing with the Touch problems. Journalism and Mass
Stuff: How to achieve results from Communication Quarterly, 73(3),
crucial conversations. Milton, 687-707.
Queensland: Jossey-Bass. Konrath, S., Falk, E., Fuhrel-Forbis, A.,
Hojat, M. (2009). Ten approaches for Liu, M., Swain, J., Tolman, R.,
enhancing empathy in health and et al. (2015). Can text messages
human services cultures. Journal increase empathy and prosocial
of Health and Human Services behavior? The development and
Administration, 31(4), 412-450. initial validation of text to connect.
PLoS One, 10(9), 1-27.
Hojat, M., Vergare, M., Maxwell, K.,
Brainard, G., Herrine, S., Isenberg, LaMonica E, R Wolf, A Madea and M
G., et al. (2009). The devil is in the Oberst. (1987). Empathy and
third year: A longitudinal study nursing care outcomes. Scholarly
of erosion of empathy in medical Inquiry for Nursing Practice 1:
school. Academic Medicine: 197–213.
Journal of the Association of Luchner, A. F., & Tantleff-Dunn, S.
American Medical Colleges, (2016). Dysfunctional empathy
84(9), 1182-1191. in vulnerable narcissism. North
Johnson, D. (2013). Empathy can be American Journal of Psychology,
exhausting. ISHN, 47(9), 10. 18(3), 597-610.
John M. Lonie, Rola Alemam, Conrad Martinovski, B., Traum, D., & Marsella,
Dhing, and David Mihm S. (2007). Rejection of empathy in
(2005). Assessing Pharmacy negotiation. Group Decision and
Student Self-Reported Empathic Negotiation, 16(1), 61-76.
Tendencies. American Journal Maslach, C., & Jackson, S. (1981).
of Pharmaceutical Education: The measurement of experienced
Volume 69, Issue 2, Article 29. burnout. Journal of organizational
behavior, 2(2), 99-113.

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


134 Lesley Gill, et. al

Mayer, J. D., & Salovey, P. (1997). Academic Medicine: Journal


What is emotional intelligence? of the Association of American
In P. Salovey & D. Sluyter Medical Colleges, 86(8), 996-
(Eds.), Emotional Development 1009.
and Emotional Intelligence: Newmeyer, M., Keyes, B., Gregory, S.,
Implications for Educators. New Palmer, K., Buford, D., Mondt,
York: Basic Books. P., et al. (2014). The Mother
McEnrue, M. P., Groves, K. S., & Shen, Teresa Effect: The modulation
W. (2009). Emotional intelligence of spirituality in using the CISM
development: Leveraging model with mental health service
individual characteristics. Journal providers. International Journal
of Management Development, of Emergency Mental Health,
28(2), 150-174. 16(1), 251-258.
McKenna, L., Boyle, M., Brown, T , Newton, B. W., Barber, L., Clardy, J.,
Williams, B., Molloy, A., Lewis, Cleveland, E., & O’Sullivan, P.
B., & Molloy, L. (2011). Levels (2008). Is there hardening of the
of empathy in undergraduate heart during medical school?
midwifery students: An Australian Academic Medicine: Journal
cross-sectional study. Women and of the Association of American
Birth, 24(2), 80-84. Medical Colleges, 83(3), 244-249.
Melloni, M., Lopez, V., & Ibanez, A. Neutens & Rubinson, (2002) Research
(2014). Empathy and contextual Techniques for the Health
social cognition. Cognitive, Sciences, 3th Edition. London:
Affective, & Behavioral Bloomsbury.
Neuroscience, 14(1), 407-425. Parks, E. (2015). Listening with empathy
Mehrabian, A., & Epstein, N. (1972). in organizational communication.
A measure of emotional Organization Development
empathy. Journal of Personality, Journal, 33(3), 9-22.
40(4), 525-543.http://dx.doi. Paro, H. B., Morales, N. M., Silva, C. H.,
org/10.1111/j.1467-6494.1972. Rezende, C. H., Pinto, R., Morales,
tb00078.x R. R., et al. (2010). Health‐related
Miller, K., Considine, J., & Garner, J. quality of life of medical students.
(2007). “Let me tell you about Medical education, 44(3), 227-
my job”: Exploring the terrain 235.
of emotion in the workplace. Paro, H. B., Silveira, P. S., Perotta, B.,
Management Communication Gannam, S., Enns, S. C., Giaxa,
Quarterly, 20(13), 231-260. R. R., et al. (2014). Empathy
Neumann, M., Edelhäuser, F., Tauschel, among medical students: is there
D., Fischer, M. R., Wirtz, M., a relation with quality of life and
Woopen, C., et al. (2011). burnout? PloS one, 9(4), 1-10.
Empathy decline and its reasons: a Parra, A. (2013). Cognitive and
systematic review of studies with emotional empathy in relation
medical students and residents. to five paranormal/anomalous

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


When Empathy Works: Towards Finding Effective Ways of Sustaining Empathy Flow 135

experiences North American Shapiro, J. (2002). How do physicians


Journal of Psychology, 15(3), teach empathy in the primary
405-412. care setting? Academic
Polychroniou, P. V. (2009). Relationship medicine: Journal of the
between emotional intelligence Association of American Medical
and transformational leadership of Colleges, 77(4), 323-328.
supervisors: The impact on team Singer, T., Seymour, B., O’Doherty,
effectiveness. Team Performance J., Kaube, H., Dolan, R. J., &
Management, 15(7/8), 343-356. Frith, C. D. (2004). Empathy
Quince, T. A., Kinnersley, P., Hales, J., da for Pain Involves the Affective
Silva, A., Moriarty, H., Thiemann, but not Sensory Components of
P., et al. (2016). Empathy among Pain. from Science: http://web.
undergraduate medical students: ebscohost.com.ezproxy.massey.
A multi-centre cross-sectional ac.nz/ehost/detail?sid=bb98a5c6-
comparison of students beginning 05e5-40f3-bd8e-425f0e47a1aa%
and approaching the end of their 40sessionmgr11&vid=1&hid=7
course. BMC Medical Education, &bdata=JkF1dGhUeXBlPWlwL
16(92), 1-10. GNvb2tpZSx1cmwsdWlkJnNp
Remen, N. R. (1996). Kitchen table dGU9ZWhvc3QtbGl2ZQ%3d%
wisdom: Stories that heal. New 3d#db=iih&AN=12390782
York, NY: Riverhead Books. Singh, P. (2014). Employees’ use of
Reynolds, W. J., & Scott, B. (1999). empathy to improve their job
Empathy: A crucial component of behavior. The International
the helping relationship. Journal Business & Economics Research
of Psychiatric and Mental Health Journal, 13(3), 599-610.
Nursing, 20(6), 363-370. Slatten, L., Carson, K., & Carson, P.
Running, A., Tolle, L., & Girard, D. (2011). Compassion fatigue and
(2018). Ritual: The final expression burnout: what managers should
of care. International Journal of know. The Health Care Manager,
Nursing Practice, 14(1), 303-307. 30(4), 325-333.
Sadri, G. (2012). Emotional intelligence Smart, D., English, A., James, J., Wilson,
and leadership development. M., Daratha, K., Childers, B., et
Public Personnel Management, al. (2014). Compassion fatigue
41(3), 535-548. and satisfaction: a cross-sectional
survey among US healthcare
Salovey, P., Brackett, M. A., & Mayer,
workers. Nursing & Health
J. D. (Eds.). (2007). Emotional
Science, 16(1), 3-10.
intelligence: Key readings on the
Mayer and Salovey model. Port Tuckett, (2005). Applying Thematic
Chester, NY: Dude Publishing. Analysis Theory to Practice:
a researcher’s experience.
Salovey, P., & Mayer, J. D. (1990).
Moral distress in nursing:
Emotional Intelligence.
contributing . factors, outcomes
Imagination, Cognition and
and interventions. Nursing Ethics,
Personality, 9, 185 - 211.

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136


136 Lesley Gill, et. al

20 (3). functional magnetic resonance


Varca, P. E. (2009). Emotional empathy imaging study in a nonverbal task.
and front line employees: Does NeuroImage, 29(1), 90-98.
it make sense to care about the Webb, S. (2014). An action research
customer? The Journal of Services study pertaining to compassion
Marketing, 23(1), 51-56. fatigue and hospice clinical staff
Vollm, B. A., Taylor, A. N. W., workers Capella University.
Richardson, P., Corcoran, R., Williams, B., Boyle, M., & Howard,
Stirling, J., McKie, S., et al. S. (2016). Empathy levels in
(2006). Neuronal correlates of undergraduate paramedic students:
theory of mind and empathy: A A three-year longitudinal study.
Nurse Education in Practice,
16(1), 86-90.

Asia-Pacific Management and Business Application, 6, 3 (2018): 115-136