Effective Nursing Communication: Card Game is a Tool for Learning to Respond With Empathy

Can someone learn to be empathetic? The answer is yes, according to Jasmine Hudnall, DO, and Kimberly E. Kopecky, MD.¹ Dr Hudnall is a palliative care physician with the Department of Hospice and Palliative Care at the Gundersen Health System in La Crosse, Wisconsin; Dr Kopecky is with the department of surgery at Stanford University in California. When they were both fellows in the University of Wisconsin-Madison Palliative Fellowship Program, they developed a game-based tool for learning how to communicate empathy.

Easy to Learn, Easy to Unlearn

Quite a bit of evidence shows that empathy is a skill that can be both learned and unlearned (personal communication, J Hudnall, April 2020). Of course there are people for whom empathy comes easily, and there are those for whom it is more of a challenge. However, the evidence shows that with tools, practice, and education people can develop their ability to express empathy in meaningful ways. Dr Hudnall does not know if empathy is something we are born with, if it is the result of upbringing, or just the type of person each of us is. However, for whatever reason, empathy does come easier for some people.

She noted that empathy gets confused with sensitivity and that often very sensitive people are not able to express empathy because they feel things so deeply themselves. Engaging with other people’s emotional processes can be overwhelming. As a result, the most sensitive people are the ones who actually have the hardest time being expressive about sharing feelings between people.

The developers wanted to create a low-pressure way to practice communicating empathy. They sat down for a brainstorming session in their office and asked themselves, “How could we do this? How could we practice this without getting into trouble with a real patient? Well, we could come up with a game.” And so they did.

Gameplay as a Learning Tool

The Empathy Project: A Skills Development Game (TEP), is a tabletop card game that directly reflects their philosophy that empathy is a set of skills that can be developed.¹ The game is intended to help learners express empathy. Using the themes in VitalTalk, an evidence-based framework for responding to emotion, as a model, it engages learners’ creative processes to practice responding to the emotions expressed in patients’ and family members’ statements. The 5 broad VitalTalk themes of articulating empathy are defined in the mnemonic NURSE: 

• Naming
• Understanding
• Respecting
• Supporting
• Exploring²  

Drs Hudnall and Kopecky came up with 25 statements that patients and family members may use to express emotions such as grief, worry, fear, anger, frustration, and guilt. These statements became the cards for the game pack. In addition, they also developed a rule book and a facilitator guide. To gather feedback while developing the game, they played it with colleagues, nurses, residents, and medical students on their teaching service. They also presented it at the 2017 Annual Assembly of the American Academy of Hospice and Palliative Medicine, continuing to modify the game after reviewing the feedback they received.