The model as a tool for interdisciplinary working
The Jack and Miller (2008) model can be used to support effective interdisciplinary team working. An example is how this model was successfully used during the HIV team’s peer supervision session. It was highlighted that the team were struggling to meet the needs of a patient who was experiencing multiple health and social care challenges. The team utilised the stages within the model to explore the current strengths and limitations of the team. They also explored how they might need to develop as a team to effectively support the patient, taking into account what support they may need to make the changes required to provide the care for the patient. As a result of undertaking the stages in the Jack and Miller (2008) model, the team were able to learn from what they had discovered in order to work more collaboratively to provide the patient with the care that they needed.
Self-awareness as a tool for caring
It seems clear that as we become more mindful of our strengths and areas for development, we arc better able to appreciate our own acts and omissions in relation to care for people with HIV and take positive steps towards redressing the balance. We must then begin to extrapolate what it feels to be someone else and how it must feel to be a user of healthcare services. Rungapadiachy (2008) argues that successful engagement with others requires us to use our ‘self’ as agents of three key therapeutic interventions: empathic understanding, social and emotional intelligence.
Empathic understanding or empathy (Nelson-Jones 2000) is the ability to see the world from another person’s view. Unlike sympathy, which is relating to another as though they were us and we were experiencing the situation (Miller and Nambiar-Grccnwood 2011), empathy is relating to the other person and understanding their experience. It is the ability to understand an individual’s private world as if it were your own without necessarily experiencing the feelings. It is a human to human connection that relates to Rogers’ (1959) definition of humanism as a ‘mode of thought in which human interest, values and dignity arc taken to be of primary importance’. Building empathy requires effort that deepens one person’s engagement with the experiences and suffering of another (Aronson 2014). Professionals who use more empathic communication arc rewarded for that effort as they elicit more relevant information from patients (Maguire et al. 1996) and help people with HIV overcome hurdles such as stigma and discrimination (Parker and Aggieton 2003) and barriers to trust (Saha et al. 2010).
To be truly empathetic wc need to know people’s medical and psycho-social history, and this means focusing our attention on that individual, acknowledging and actively listening to verbal and observing non-verbal cues. The feminist psychologist Blythe Clinch refers to ‘connected knowing’, a process that requires us to use our imagination to get behind the other person’s eyes and look at it from that person’s point of view. Being empathic requires us to suspend our personal beliefs and judgements but be willing to use self-disclosure where appropriate (Moss 2012). This is not the same as being more interested in ourselves than in others, rather it is a means of sharing experiential encounters that engender shared interpretations, interests and values (Cohen 2017). For example, ‘I remember when I went for health screening myself; I know how it made me feel’ might enlighten a patient’s anxiety about HIV testing. However, sharing is a fine balance as it can pose problems; for example, if there is too much self-disclosure or it comes too soon in the relationship, there is a risk that the patient may feel invalidated or not fully understood. However, it can help to build trust, and once one person engages in selfdisclosure, it is implied that the other person will do so too. This is known as the norm of reciprocity and can help both people understand each other more. Still, it is important to remain within professional boundaries (refer to Chapter 5 for more information on this aspect of care).
Tentative, open questioning develops people’s stories and reflection helps to clarify what has been said to develop a clearer understanding. These ways of building an empathic rapport require practice with friends, family members and colleagues, and becoming more empathic requires us to be self-aware. Whilst empathic understanding may be seen as an individual ability, the end result is improved rapport. Professionals are tasked with managing those interactions and relationships we have with patients, and knowing what, when, how and where to say things that support positive outcomes (Rungapadiachy 2009).