Empathy at the Edge of Care: A Trauma Nurse’s Early Lesson in Patient Experience

Introduction: Empathy, Compassion, and Caring in Patient Experience

Empathy, compassion, and caring form the moral and emotional foundation of healthcare and are central to the modern understanding of patient experience. While clinical competence, technology, and evidence-based protocols are essential, they are insufficient on their own to meet the needs of patients during moments of profound vulnerability. Patient experience is created not only through what clinicians do, but through how patients feel seen, heard, and valued—particularly when outcomes are uncertain or irreversible.

Empathy is the ability to understand and appreciate another person’s emotional state and perspective, while compassion moves that understanding into action through a desire to alleviate suffering. Caring, especially in nursing, represents the sustained commitment to accompany patients through illness, fear, and, at times, death. Together, these concepts shape trust, preserve dignity, and humanize care (Halpern, 2003; Sinclair et al., 2017).

Before Empathy Had a Name: Nursing Practice in the 1970s and Early 1980s

When Deborah Burns was educated and trained as a nurse in the mid-1970s and early 1980s, the language of healthcare was very different from today. The word empathy was not commonly used in nursing education, clinical competency frameworks, or organizational mission statements. Empathy was not taught, measured, or framed as a professional skill.

Nursing education emphasized technical proficiency, task completion, and clinical vigilance. Emotional engagement was often viewed as a personal trait rather than a professional competency, and in some settings, too much emotional involvement was discouraged. As a result, responses to suffering were driven not by theory, but by instinct, moral judgment, and humanity.

What Deborah Burns did for a dying burn patient—remaining present, listening, writing letters, and honoring his relationships—was not learned in a classroom. It came from her gut and her humanity. Only decades later would healthcare formally recognize and name these behaviors as patient-centered care.

The Institute of Medicine later defined patient-centered care as care that is respectful of and responsive to individual patient preferences, needs, and values (Institute of Medicine, 2001). Similarly, the Agency for Healthcare Research and Quality emphasized emotional support, dignity, and respect as essential components of care (AHRQ, 2020).

Why This Matters to Patient Experience (PX) Leaders

For Patient Experience leaders, this history matters. Empathy is often discussed today as a modern competency, yet clinicians have always practiced it—often without recognition or support. Patient experience is created in moments of vulnerability where empathy, compassion, and caring are either present or absent. Metrics such as HCAHPS and CAHPS are important, but they are lagging indicators. The true drivers of experience are the behaviors demonstrated at the bedside, especially when outcomes are poor or uncertain.

A Personal Narrative from the 1980s

One day, we received a call from medics stationed in Yellowstone National Park. They reported that a young man had jumped into a hot spring, sustaining catastrophic burns. When they pulled him from the near-boiling water, his skin had sloughed away. Ninety-eight percent of his body was covered with third-degree burns. They needed an ICU nurse to accompany him by helicopter to the burn center in Salt Lake City.

This was long before organized medical flight programs. The helicopter was old, deafening, and stark. I was a young ICU nurse, about six years into my career, and utterly unprepared for what I encountered. Nearly all of his skin was gone, leaving raw tissue exposed—except for the area around his eyes, which were strikingly beautiful and profoundly sad.

I focused on what I knew clinically: fluids, IV access, and pain control. But when I offered morphine, he told me he was not in pain. Later, I learned that third-degree burns destroy nerve endings, rendering them paradoxically painless.

When the receiving nurse at the burn center said he had less than a one-percent chance of survival and should be taken wherever he wanted to go, he heard every word. At that moment, my role shifted completely. I could not cure him, but I could care for him.

He asked me to write letters to his mother, his brother, and his best friend. I wrote them, sobbing, on paper charting forms. He told me he jumped into the hot spring to save his dog. He lived for only eight more hours.

That day changed my understanding of nursing forever. As Deborah Burns, RN, reflects in her unpublished manuscript, The Mud, The Blood, and the Beer, this experience reshaped her understanding of presence, compassion, and what it truly means to care when nothing can be fixed (Burns, unpublished manuscript, 2026).

Empathy as the Core of Patient Experience

Empathy in patient experience is not simply feeling sorry for someone; it is recognizing another person’s humanity and responding in a way that honors it. Research consistently demonstrates that empathic care strengthens communication, trust, and perceptions of quality—even when outcomes cannot be changed (Derksen et al., 2013; Hojat et al., 2011).