• Hilde Eide, Tonje Sibbern, and Tone Johannessen.
• Clinical Communication and Health Counseling, Faculty of Health Sciences, Buskerud University College, Drammen, Norway. hilde.eide@hibu.no
• J Adv Nurs. 2011 Jun 1; 67 (6): 1242-53.

AimThis paper is a report of an observation study designed to describe and evaluate nurses' immediate responses to fibromyalgia patients' expressions of negative emotions in first consultations at a pain clinic.BackgroundProviding comfort to patients in emotional distress is an important task for nurses. Empathic accurate perception of patients' emotions is a precondition for empathic accurate responses.MethodsWe analysed 58 videotaped assessment consultations with patients with fibromyalgia performed from April 2005 to June 2007. Implicit and explicit negative emotional expressions were identified with the Verona Coding Definitions of Emotional Sequences. Nurses' responses were coded with the Hierarchical Coding System for Sensitivity of Comforting Strategies, with three levels of response to the person's perspective: (i) denial, (ii) implicit recognition or approval and (iii) explicit recognition of the expressed emotion.ResultsWe identified 801 expressions of negative emotions, 591 implicit and 210 explicit, on average 14 per consultation. Nurses responded with implicit recognition, mostly using minimal encouragement, to 75% of emotional expressions, with explicit recognition to 13% of expressions while 12% of responses were not within the perspective of the patient. Nurses responded with a higher degree of explicit recognition (Level 3 responses) to patients' explicit negative emotional expressions.ConclusionThe effects of empathic accurate response to implicit and explicit expressions of negative emotions should be explored further. The combination of coding systems used appears to be valid and reliable for assessing verbal empathic accuracy by observers in nursing settings.© 2011 The Authors. Journal of Advanced Nursing © 2011 Blackwell Publishing Ltd.

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