Committed nurses cope with stress by dehumanising themselves and their patients – Italian study

Nursing must be one of the most stressful professions. Not only are the hours long and the work challenging, many nurses are exposed routinely to patient suffering and death. A new study conducted in Italy finds that nurses appear to cope by seeing themselves and their patients as less than fully human.

Elena Trifiletti and her colleagues surveyed 108 nurses (54 men; age range 31 to 50). The nurses answered questions about their experience of stress. They also rated how much patients and nurses exhibit various traits. Some of these were uniquely human (e.g. morality; reasoning), and others were traits usually considered relevant to humans and animals (e.g. instinct, impulsiveness).

Nurses who viewed their patients as less human (in terms of attributing to them fewer uniquely human traits, and more shared human/animal traits) reported experiencing less stress. This was especially true for nurses who were more emotionally attached to their employer, the hospital, and to their patients. This sounds like a contradiction, but Trifiletti and her team explained that it is precisely those nurses who are more devoted to their work and their patients, who likely need to use the strategy of dehumanisation to cope with the stress of their work.

Nurses who viewed nurses in general as less human (by allocating to them fewer uniquely human traits) also reported less stress. The researchers speculated this is because seeing oneself as fully human comes with the expectation that one should share the suffering of others – a recipe for stress when you work with sick patients.

This study is weakened by its cross-sectional design. We can't know for sure the direction of the processes involved. It makes sense to think that committed nurses experience high stress and then cope with this by dehumanising their patients and themselves, but longitudinal research is needed to confirm if this is true.

The findings build on a wider literature suggesting that medical professionals cope with their challenging work by dehumanising their patients. For example, a recent study found that oncologists who attributed more human traits to their patients experienced more burnout. Another study from 2003 found palliative physicians admitting that they used dehumanisation as a coping mechanism.

All this presents something of a conundrum for the medical world. We demand and expect commitment, emotional engagement and dedication from our health professionals, and yet by doing so, we increase the likelihood that they will cope with the stress this creates by viewing us, the patients, as less than human. This is bad news, because, unsurprisingly, there's research showing that the dehumanisation of patients is linked with a range of negative outcomes, including alienation and distrust.

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Trifiletti, E., Di Bernardo, G., Falvo, R., & Capozza, D. (2014). Patients are not fully human: a nurse's coping response to stress Journal of Applied Social Psychology DOI: 10.1111/jasp.12267