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Is compassion possible in a market-led NHS?
Abstract
The principle of compassionate care is increasingly seen as the core element of good nursing practice. However, recent media reports have focused on the "compassion deficit". We carried out a review of national and international evidence on core professional values, which showed that caring and compassion are inherent nursing values. While the development of these values is influenced by training and role modelling, the main influence is the organisation and culture in which nurses work. This article discusses the findings of the review in relation to the national debate around compassionate care within an NHS that is being fundamentally changed. We suggest any failure in compassion is more likely to be due to government health policy and NHS organisational culture than to any shortcomings of nurses or nursing practice.
... The issue of compassion in healthcare has been examined from a variety of perspectives including psychology, ethics, health education and policy (1)(2)(3). Prompted by the recent disclosures of failures of care in the National Health Service (NHS) in England (4,5), this debate has been centred on compassion as an individual attribute enabling health professionals to provide high quality responsive care. Several professional bodies are now actively working on developing guidelines in order to promote more patient-centred care. ...
... There is recognition of the role compassion plays in health professionals' individual morality (2) but it often appears to be in conflict with organisational logics and policies. As Poppke argues with reference to Lévinas: 'the question that arises is how can we live up to the demands of ethics and responsibility in a world held together by an array of impersonal organisations, institutions, and forms of discursive power?' (p. ...
... It might also impose a whole new set of burdens on the health services (11) if health professionals are required to meet newly proposed compassion targets with resources being further diverted towards the management, measurement and monitoring of compassion. The issue therefore is not the absence of compassion by doctors and nurses per se but how organisational cultures, policies and politics might exert a damaging influence on caring values (2). Shift towards impersonal surveillance systems coupled with cost savings measures imposed by those who are distanced from the reality of care militates against developing compassionate caring institutions. ...
Recent disclosures of failures of care in the National Health Service (NHS) in England have led to debates about compassion deficits disallowing health professionals to provide high quality responsive care. While the link between high quality care and compassion is often taken for granted, it is less obvious how compassion – often originating in the individual’s emotional response – can become a moral sentiment and lead to developing a system of norms and values underpinning ethics of care. In this editorial, I argue why and how compassion might become a foundation of ethics guiding health professionals and a basis for ethics of care in health service organisations. I conclude by discussing a recent case of prominent healthcare failure in the NHS to highlight the relationship between compassion as an aspect of professional ethics on the one hand, and values and norms that institutions and specific policies promote on the other hand.
... There is a need to define how compassion in health care is formulated and constructed through language as the relevance of compassion as being "a core component" of "quality" nursing care worldwide is well documented (Officer & Adviser, 2012;Flynn & Mercer, 2013;NMC, 2015;Sinclair, Norris, et al., 2016). Healthcare definitions refer to compassion in terms of "how" care is given, through relationships based on empathy, respect and dignity. ...
... Although whether individual comments that were used from this publicly accessible site were people from healthcare communities or the general public is not known, the responses extrapolated from each source are believed to constitute a UK narrative. However, this research and its findings are transferable to an international audience, as insights surrounding the issue of compassion in nursing and health care more broadly, and how it might be fostered, are of contemporary international relevance and concern (Flynn & Mercer, 2013;Hayter, 2013;Sinclair, Norris, et al., 2016). ...
Aims and objectives
To examine how the concept of compassion is socially constructed within UK discourse, in response to recommendations that aspiring nurses gain care experience prior to entering nurse education.
Background
Following a report of significant failings in care, the UK government proposed prior care experience for aspiring nurses as a strategy to enhance compassion amongst the profession. Media reporting of this generated substantial online discussion, which formed the data for this research. There is a need to define how compassion is constructed through language as a limited understanding exists, of what compassion means in healthcare. This is important, for any meaningful evaluation of quality, compassionate practices.
Design
A corpus‐informed discourse analysis.
Methods
A 62626‐word corpus of data was analysed using Laurence Anthony software ‘AntCon’, a free corpus analysis toolkit. Frequent words were retrieved and used as a focal point for further analysis. Concordance lines were computed and analysed in the context of which frequent word‐types occurred. Patterns of language were revealed and interpreted through researcher immersion.
Results
Findings identified that compassion was frequently described in various ways as a natural characteristic attribute. A pattern of language also referred to compassion as something that was not able to be taught, but could be developed through the repetition of behaviours observed in practice learning. In the context of compassion, the word‐type ‘nurse’ was used positively.
Conclusion
This paper adds to important debates highlighting how compassion is constructed and defined in the context of nursing. Compassion is constructed as both an individual, personal trait and a professional behaviour to be learnt. Educational design could include effective interpersonal skills training, which may help enhance and develop compassion from within the nursing profession. Likewise, ways of thinking, behaving and communicating should also be addressed by established practitioners in order to maintain compassionate interactions between professionals as well as nurse‐patient relationships. Future research should focus on how compassionate practice is defined by both health professionals and patients.
Relevance to clinical practice
In order to maintain nursing as an attractive profession to join, it is important that nurses are viewed as compassionate. This holds implications for professional morale, associated with the continued retention and recruitment of the future workforce. Existing ideologies within the practice placement, the prior care experience environment, as well as the educational and organisational design are crucial factors to consider, in terms of their influences on the expression of compassion in practice.
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... colleagues and patients; and isolating the nurse from these interactions brings with it concerns for patient safety (Hayes et al. 2014). Furthermore, the rigidity with which some current strategies are undertaken can compromise the delivery of compassionate care (Flynn & Mercer 2013). ...
... Compassionate care, though accepted as fundamental in all aspects of nursing education as well as when providing quality nursing care, can however be eroded by organizational restraints specific to some nursing tasks (Flynn & Mercer 2013;Pryce-Miller & Emanuel 2014). This is especially true of medication administration where initiatives to reduce interruptions include strategies such as wearing tabards displaying the words 'do not disturb' and the introduction of 'no interruption zones' (Anthony et al. 2010;Hayes et al. 2014;Relihan et al. 2010). ...
Aims and objectives:
The aim of this paper is to describe the effect that immersive simulation experiences and guided reflection can have on the undergraduate nurses' understanding of how stressful environments impact their emotions, performance and ability to implement safe administration of medications.
Background:
Patient safety can be jeopardised if nurses are unsure of how to appropriately manage and respond to interruptions. Medication administration errors are a major patient safety issue and often occur as a consequence of ineffective interruption management. The skills associated with medication administration are most often taught to, and performed by, undergraduate nurses in a controlled environment. However, the clinical environment in which nurses are expected to administer medications is often highly stressed and nurses are frequently interrupted.
Design/methods:
This study used role play simulation and written reflections to facilitate deeper levels of student self-awareness. A qualitative approach was taken to explore students' understanding of the effects of interruptions on their ability to undertake safe medication administration. Convenience sampling of second year undergraduate nursing students enrolled in a medical surgical subject was used in this study. Data were obtained from 451:528 (85.42%) of those students and analysed using thematic analysis.
Results:
Students reported increasing consciousness and the importance of reflection for evaluating performance and gaining self-awareness. They described self-awareness, effective communication, compassion and empathy as significant factors in facilitating self-efficacy and improved patient care outcomes.
Conclusions:
Following a role play simulation experience student nurses reported new knowledge and skill acquisition related to patient safety, and new awareness of the need for empathetic and compassionate care during medication administration. Practicing medication administration in realistic settings adds to current strategies that aim to reduce medication errors by allowing students to reflect on and in practice and develop strategies to ensure patient safety. This article is protected by copyright. All rights reserved.
... [2] Compassionate care is considered to be an essential principle of patient-centered care. [1][2][3] Healthcare consumers request compassion in the form of compassionate care from nurses. [2][3][4] In the literature, compassion is defined as propitiation combined with action. ...
... [1][2][3] Healthcare consumers request compassion in the form of compassionate care from nurses. [2][3][4] In the literature, compassion is defined as propitiation combined with action. Compassion has also been described as caring toward another's suffering and being present emotionally. ...
Background
Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was to explore these facilitators.
Materials and Methods
This ethnographic study was conducted in 2014–2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in-depth semi-structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin.
Results
Data analysis defined three main themes and eight subthemes as the fundamentals of compassion-based care. Nurses' personal factors with subcategories of personality, attitudes, and values and holistic view; and socio-cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors.
Conclusions
The findings of this study showed that nurses' communication with patients is nurse's duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.
... Experience gained from years of working and educating in the field of cancer and palliative care suggests that attitudes and behaviours of nursing students at all levels can be influenced through opportunities to develop insight, understanding and by reflection on people's lives and illness experiences. Finding the most effective ways to offer these types of learning opportunities in today's educational environment of large classes, increasing use of technology enabled learning, and stressful clinical placement environments involves creative adaptation of available resources (Flynn and Mercer, 2013). Family sculpting, arising from the social sciences, has been one mechanism that can facilitate empathy development in a classroom setting by providing an opportunity to enter the world of others (Wiseman, 1996;Satir, 1988). ...
... Using experiential methods which can be helpful in developing compassionate care in an educational culture which is looking for ways and means of delivering education to ever increasing numbers of students on existing or reducing budgets as we see in most areas of higher education and in the NHS is a challenge (Flynn and Mercer, 2013) as these types of experiences cannot be done with very large groups or the sense of connection is lost. In addition, not all educators are comfortable with these types of teaching methodologies so conducting such an experience in small groups but to a large cohort is difficult in terms of resourcing. ...
: This article explores the use of family sculpting as an educative tool to achieve a better I- thou awareness of the patient's support needs from a family and social system approach.Ensuring we provide appropriate and effective opportunities for nurses to develop compassion when caring for patients facing ill health is a complex challenge that faces nurse education at all levels. The piece explores a sculpting exercise developed in nurse education which engages students' awareness of the complicated nature of peoples' social networks and through attitudinal learning, helps nurses to provide compassionate care that integrates family support.
... Failings in compassion, with associated failings in care quality, have been identified however (e.g. Francis, 2013) and consequently, compassion is foregrounded internationally as an issue of concern (e.g., Field-Richards et al., 2023, Tierney et al., 2019, Sinclair et al., 2016, Flynn and Mercer, 2013, Sinclair et al., 2017, Blomberg et al., 2016, Bond et al., 2018. ...
... Burnell and Agan (2013), argue that despite the importance of empirical research, nursing lacks a standardised scale for measuring compassionate care. The scarcity of instruments may have stemmed from the ongoing arguments based on whether compassion can be measured empirically, or if one should even attempt to measure it at all (Flynn and Mercer, 2013). Ford (2009) suggests that this may be due to the complexity surrounding the reliability of such a measure. ...
Despite considerable research and rhetoric on the importance of compassion in nursing, progress has been hindered by the lack of an adequate psychometric instrument to measure its multidimensional nature. This paper reports several studies conducted over three stages, to develop and validate a new instrument to measure nurses’ compassion strengths. A purposive sample of UK pre-registered nursing students studying at a University took part in this study. The eight indicators highlight the multidimensional nature of compassion. The Bolton Compassion Strengths Indicators (BCSIs) demonstrated robust psychometric properties and could provide the means by which nursing students can empower themselves, as they strive to develop their professional identity as compassionate practitioners. This new measure will also help other researchers and educators who wish to study the development of compassion strengths in nursing.
... Interestingly, this review also reveals circumstances where staff are conscious of the adverse psychological impact of physical interventions, for both patients and themselves, and critical of gung-ho colleagues who are indiscriminate in their use of violence. All of this applies in the context of legitimated coercive practices, but there is also a lengthy history of illegitimate and abusive use of coercion(Department of Health 2012, Hopton 1997) so much so that nursing in the UK is currently facing its own crisis of legitimacy(McKeown & White 2015), characterised by an alleged lack of compassion(Flynn & Mercer 2012, Spandler & Stickley 2011, Stenhouse et al. 2016).The fact that health care staff and service users might see matters of violence differently is demonstrated in Rose and colleagues' (2013) research on UK wards. In this study, nurses felt impotent to carry out care in the face of administrative burden and patients in turn viewed the nurses is uncaring and inaccessible. ...
This chapter is written by people with quite different experiences of violence in relation to the practice and organisation of psychiatric services. It is our intention to draw upon our own collective experiences, including some relevant research studies to explore the notion of legitimacy with regard to violence and psychiatry. The social relations of care and associated power distribution demand more nuanced understandings than are often applied in practice, and critical reflection on the ways in which legitimacy is established, or appealed to, is similarly required.
... Shortly before the events outlined in this paper took place, myself and a colleague were commissioned by NHS North West to undertake an evidence review into 'NHS values and behaviours' [55] precipitated by reported 'failings' in UK health and social care services (e.g. CQC [56]). ...
... No Reino Unido (25), em face das medidas de austeridade na saúde, o paradigma de mercado impregnou instituições e organizações, incorporando os valores de mercado na prática de enfermagem, não integrando o conhecimento mais humanizado e interpessoal do cuidado e despersonalizando o cuidar, numa envolvência da competitividade emergente na mercantilização da saúde. Nessa pesquisa acerca da evidência produzida na Inglaterra, confirmou-se que as culturas sociais, políticas e organizacionais influenciam os valores profissionais dos enfermeiros, mas que estes profissionais não são os potenciadores desta transformação, mas sim as alterações decorrentes da mercantilização da saúde. ...
Objetivo:
conhecer as identidades profissionais de enfermeiros portugueses e os sentidos das transições em curso, para fornecer os suportes necessários aos desafios identitários profissionais.
Materiais e método:
investigação de abordagem mista realizada entre 2016 e 2017. Utilizou-se como instrumento de recolha de dados um Inventário de Identidade Psicossocial de Zavalloni e Louis-Guérin, junto duma amostra de 102 enfermeiros, dos quais 19 foram posteriormente entrevistados.
Resultados:
analisaram-se alguns dados que correspondiam aos possíveis selves e à identificação do núcleo central e dos elementos periféricos da identidade profissional, tais como as condicionantes profissionais. Verificou-se a existência de um grupo dominante de enfermeiros numa dualidade identitária entre o enfoque nos cuidados e na autonomia profissional e o enfoque nas exigências institucionais, com o receio de despersonalização dos cuidados. Também se identificou um outro grupo profissional, mais relacionado com o cuidar, que não apresenta marcas dessa institucionalização, mas que deseja um maior desenvolvimento das relações humanas e do conhecimento científico.
Conclusões:
as possíveis transições identitárias identificadas podem ocorrer conforme os reforços e os reconhecimentos oferecidos, ora com correspondência a fatores de mercado e consequente despersonalização do cuidar, ora com a conquista da autonomia e resgate do cuidar, assentem na cientificidade profissional.
... As a result, the causes of public failures and scandals are labelled as individual deficitsas 'bad apples'rather than a combination of bureaucratic, professional and work-related pressures grounded in overall policy and organisational cultures (Flynn andMercer 2013, Traynor 2014). There is therefore a powerful incentive for policy-makers and managers to scapegoat individuals for what are often systemic failures. ...
Action learning has evolved over a period of time when managerialism and performativity, which are aspects of neoliberalism, have become stronger and this explains, in part, the emergence of Critical Action Learning (CAL). Performativity, in particular, has increasingly become internalised by people at work. CAL seems to be limited to power relations within and between organisations and thus tends to ignore the dominant ideology of the day – neoliberalism. The paper asserts that action learning is antithetical to a neoliberal worldview and there are therefore practical implications for action learning practitioners.
... Citing pressures on the NHS, it stressed that there was a risk that the energy put into supporting staff would "slip". Others have questioned whether culture change is actually realistic in the context of the political ideology that drives healthcare in the UK -namely market forces, competition and an increasing culture of privatisation (Flynn and Mercer, 2013). ...
Over the past 30 years, leadership and management in the NHS have been
shaped by political and economic drivers, most notably the neo-liberal principles of
new public management (NPM). In this article, the author argues that NPM has
harmed the organisation, as laid bare by the Mid Staffs scandal. She takes us through
these historic changes, delves into the psychology of healthcare staff’s responses to
stress, and affirms the need for the NHS to rid itself of a noxious legacy, which she
deems incompatible with the aim of increasing staff wellbeing and providing more
compassionate care. In another article, published simultaneously, the author describes
insights on staff stress and wellbeing gained from a study into the benefits of
Schwartz Rounds.
... Yet everyone has individual preferences and personalities and recognising these and putting them at the heart of nursing care is essential (Todres et al, 2009;Borbasi et al, 2012;Hemingway et al, 2012). It matters that care is compassionate, humanised and empathic, and uninhibited by market forces (Flynn and Mercer, 2013). ...
Community nurses face many challenges when trying to practice evidence-based, person-centred care. Ongoing concerns regarding the impact of the 2013 Francis Report (Ford and Lintern, 2017) suggest that individualised and holistic care is an impossible dream, one made harder when the client appears uncooperative. This paper presents a case study that sets out how some of these challenges were met in a potentially difficult situation experienced by a student nurse and her mentor in practice, in which the student was supported to further examine and explore issues that may have influenced the situation. In this instance, the solution came with the recognition that the client had expertise and knowledge that needed to be taken into account, alongside that of the nurses looking after him. His care became a partnership, not an imposition of expertise; a principle which is transferable to many other situations. Underpinning it was the recognition of our shared humanity, wherein lies the essence of truly holistic care, and student nurses learning this, through the guidance and support of their mentor.
... It is arguable whether market values (competition and profit) apply at all in an NHS, as efficiency and "customer" focus can be accommodated within clan and ad-hocracy. 84 Market values create the self-focused competitive mentality associated with compassion deficit. This is borne out by research which found that clan cultures in hospitals were associated with higher staff morale and fewer patient complaints. ...
Compassionate health care is universally valued as a social and moral good to be upheld and sustained. Leadership is considered pivotal for enabling the development and preservation of compassionate health care organizations. Strategies for developing compassionate health care leadership in the complex, fast-moving world of today will require a paradigm shift from the prevalent dehumanizing model of the organization as machine to one of the organizations as a living complex adaptive system. It will also require the abandonment of individualistic, heroic models of leadership to one of shared, distributive, and adaptive leadership. “Command and control” leadership, accompanied by stifling regulation, rigid prescriptions, coercive punishments, and/or extrinsic rewards, infuses fear into the system with consequent disempowerment and disunity within the workforce, and the attrition of innovation and compassion. It must be eschewed. Instead, leadership should be developed throughout the organization with collective holistic learning strategies combined with high levels of staff support and engagement. Culture and leadership are interdependent and synergistic; their codevelopment needs to be grounded in a sophisticated, scientifically based account of human nature held within a coherent philosophical framework reflected by modern organizational and leadership theories. Developing leadership for compassionate care requires acknowledging and making provision for the difficulties and challenges of working in an anxiety-laden context. This means providing appropriate training and well-being programs, sustaining high levels of trust and mutually supportive interpersonal connections, and fostering the sharing of knowledge, skills, and workload across silos. It requires enabling people to experiment without fear of reprisal, to reflect on their work, and to view errors as opportunities for learning and improvement. Tasks and relational care need to be integrated into a coherent unity, creating space for real dialog between patients, clinicians, and managers, so that together they can cocreate ways to flourish in the context of illness and dying.
... A focus on values, and outlining the 6C's positions nursing as 'character based moral work' (Traynor 2014) requiring the moral integrity of would be, and current, registrants to be measured. However, Flynn and Mercer (2013) suggest that lapses in compassion (one of the C's) are more likely to do with government health policy and organisational cultures rather than the shortcomings of nurses themselves. ...
This discussion paper argues for understanding nursing care as a commodity within capitalist relations of production, ultimately as a product of labour, whose use value far exceeds its exchange value and price. This under recognised commodification of care work obscures the social relationships involved in the contribution to the social reproduction of labour and to capital accumulation by nursing care work. This matters, because many care workers give of themselves and their unpaid overtime to provide care as if in a ‘gift economy’, but in doing so find themselves in subordinate subject positions as a part the social reproduction of labour in a ‘commodity economy’. Thus they are caught in the contradiction between the ‘appearance’ and reality. A focus on the individual moral character of nurses (e.g. the UK’s 6Cs), may operate as a screen deflecting understanding of the reality of the lived experiences of thousands of care workers and supports the discourse of ‘care as a gift’. The commodification of care work also undermines social reproduction itself. Many nurses will not have tools of analysis to critique their subject positioning by power elites and have thus been largely ineffectual in creating change to the neoliberalist and managerialist context that characterise many healthcare and other public sector organisations. The implications of this analysis for health care policy and nursing practice is the need for a critical praxis (an ‘action nursing’) by nurses and nursing bodies, along with their allies which may include patient groups, to put care in all its guises and consequences central to the political agenda.
... 27 Against this background, the author of the present paper, with a colleague, was commissioned by NHS North West to undertake a 'values and behaviours' evidence review. 38 The findings, and themes, were congruent with the work of Fotaki. ...
In response to the International Journal of Health Policy and Management (IJHPM) editorial, this commentary adds to the debate about ethical dimensions of compassionate care in UK service provision. It acknowledges the importance of the original paper, and attempts to explore some of the issues that are raised in the context of nursing practice, research and education. It is argued that each of these fields of the profession are enacted in an escalating culture of corporatism, be that National Health Service (NHS) or university campus, and global neoliberalism. Post-structuralist ideas, notably those of Foucault, are borrowed to interrogate healthcare as discursive practice and disciplinary knowledge; where an understanding of the ways in which power and language operate is prominent. Historical and contemporary evidence of institutional and ideological degradation of sections of humanity, a 'history of the present,' serve as reminders of the import, and fragility, of ethical codes.
Healthcare has an impact on everyone, and healthcare funding decisions shape how and what healthcare is provided. In this book, Stephen Duckett outlines a Christian, biblically grounded, ethical basis for how decisions about healthcare funding and priority-setting ought to be made. Taking a cue from the parable of the Good Samaritan (Luke 10:25-37), Duckett articulates three ethical principles drawn from the story: compassion as a motivator; inclusivity, or social justice as to benefits; and responsible stewardship of the resources required to achieve the goals of treatment and prevention. These are principles, he argues, that should underpin a Christian ethic of healthcare funding. Duckett's book is a must for healthcare professionals and theologians struggling with moral questions about rationing in healthcare. It is also relevant to economists interested in the strengths and weaknesses of the application of their discipline to health policy.
This conceptual chapter offers a critical review of contemporary theory and research in relation to ‘burnout' and ‘moral injury' to consider how understandings of burnout and moral injury can be usefully applied to healthcare workers during the COVID-19 pandemic. The authors find that whilst there are significant overlaps in the conceptualisation of ‘burnout' and ‘moral injury', there is also significant potential in drawing on systemic understandings of moral injury originating in military literature to understand and support healthcare workers. A focus on the systemic and organisational support needed to work with moral injury in healthcare staff would reduce staff burnout, time-off, and turnover improving patient outcomes and offering economic advantages to healthcare organisations. Whilst much research has been undertaken in relation to healthcare staff burnout, this chapter offers an original contribution to knowledge by offering a conceptual account of the usefulness of systemic understandings of moral injury in healthcare settings during the COVID-19 pandemic.
Background
One of the results of burn injuries is the appearance of scars and deformities in various organs of the body, which can cause many physical and psychological challenges to burn patients. Lack of proper communication between nurse and patient leads to inaccurate identification of psychological and social needs of these patients and thus affects the quality of care.
Aim
This study aimed to investigate the effect of seeing the patient's pre-burn face photo on the quality of care and empathy of nurses with patients admitted to the burn intensive care unit.
Methods
The present study is a quasi-experimental interventional study conducted on 26 Burn Intensive Care Unit (BICU) nurses who were selected by census sampling method in 2018. Data were collected through QUALPAC Nursing Care Quality Questionnaire, Lumonica Empathy Questionnaire and Demographic Questionnaire, which were completed by nurses before and after the intervention. Pre-burn photos of patients with facial burns were displayed at the nursing station for one month and the data were compared before and after the intervention. Descriptive statistics and paired t-test and independent t-test, Mann-Whitney and Pearson correlation tests were used to analyze the data.
Findings
The results of present study showed that there was a statistically significant difference between the quality of nursing care (p = 0.001) and its psychological dimension (p < 0.001) before and after the intervention in the group of nurses. However, no significant relationship was found between nurses' empathy with patients before (p = 0.901) and after intervention (p = 0.001).
Conclusion
Seeing the photo of the patient's pre-burn face and establishing a relationship between the nurse and the patient had an effect on the quality of nursing care and especially its psychological dimension. However, in order to generalize the results and implement this low-cost, convenient and low-complication intervention for all patients admitted to the intensive care unit, more studies are needed in this field.
Background:
Compassion fatigue refers to the emotional and physical exhaustion felt by professionals in caring roles, whereas compassion satisfaction encompasses the positive aspects of helping others. Levels of compassion satisfaction and fatigue have been found to be inconsistent in palliative care professionals, which could have serious implications for patients, professionals and organisations.
Objectives:
This study explored the experiences of clinical psychologists working in palliative care, all worked with adults with cancer, to gain an understanding of the impact this work has on their self and how they manage this.
Methods:
A qualitative approach was taken, using semi-structured interviews and interpretative phenomenological analysis.
Results:
Three superordinate themes were identified: commitment, existential impact on the self and the oracle. The participants' experiences were characterised by the relationship between themselves and their patients, the influence of working in palliative services on their world view and the impact of organisational changes. Differences between working as a clinical psychologist in palliative care versus non-palliative settings were considered.
Conclusions:
Professionals working in palliative care should be supported to reflect on their experiences of compassion and resilience, and services should provide resources that facilitate staff to practice positive self-care to maintain their well-being.
Policy directives and the new NHS constitution require managers and leaders to adopt strategies that motivate and encourage teams to work collaboratively with staff and patients. These innovative ways of working are seen as a means of improving the quality and coordination of patient care, thus impacting on the patients’ experience.
Despite this focus, the evidence of what constitutes and therefore what can deliver effective collaboration between managers, staff and patients is sparse. This study identifies a conceptual model of effective management strategies and behaviours that will assist in achieving partnership and collaborative working.
This research is based in the real world which is complex and uncertain. The study uses an explorative framework and gains insight from a number of different perspectives. The methodological approach is a qualitative case study. Data was collected from an NHS Trust based in Wales and a District Health Board in New Zealand. Data was collected through document analysis and semi-structured interviews.
The findings support a move from a managerialist approach (where managers are target driven, transactional and administer activity) to a more reflexive, egalitarian, transformational approach that can be adapted to cope with complex environments and function successfully in the zone of chaos (where problems are ill defined and messy). The ability of a middle manager to interpret context and operate a balanced approach would appear to be key to navigating a constantly changing and negotiated environment. This study supports adoption of a servant leadership model and proposes guidance for middle managers undertaking change. The guidance proposed is a move away from the dominant doctrine of managerialism and describes the principles for working collaboratively with front-line staff in the NHS and the New Zealand health system.
Background & Aim: Although compassionate care is recognized as a core component of nursing care, there is not still a precise definition about this complex and challenging concept. This study aimed to analyze the concept of compassionate care in nursing using a hybrid model.
Methods & Materials: A three-phase hybrid model (theoretical, field work, and final analysis) was used in this study. In the theoretical phase, the concept of compassionate care was searched in main databases from 2000 to 2016. In the field work phase, in-depth, face to face interviews were done with 11 nurses. The content analysis method was used to analyze the data. Final analysis was done in the last phase.
Results: The results of the final analysis showed that compassionate care is a process in which nurses interactively communicate with patients, try to explore patients’ concerns by putting themselves in their positions and understanding their situations, and do their utmost to eliminate these concerns.
Conclusion: According to this concept analysis, the constructive interaction between nurse and patient is one of the most important features of compassionate care that has not been mentioned in previous definitions. Also in this study, the nurses emphasized that they did their best to resolve the patients’ concerns. Therefore, the current study could be the basis for future studies in the area of compassionate care.
Keywords: compassionate care, nursing care, concept analysis, hybrid model
Purpose
– “Inclusivity” and “empowerment” are central concepts in the philosophy of nursing practice and education. Recent professional concern has focused on the need to embed compassion in healthcare cultures where practice contributes to learning. The purpose of this paper is to explore an innovative partnership approach to undergraduate placement provision for adult-general nursing students in the context of learning disability and mental health.
Design/methodology/approach
– Critical discussion focuses on evaluation of a non-clinical placement centred on the health and social care of individuals with a learning disability or mental health needs. Two projects from practice around healthy living and hate crime illustrated the value of transformative learning as a pedagogic philosophy.
Findings
– Student feedback offered insight into social and cultural processes that impact on practice-based learning, and factors promoting inclusive engagement. Such included the context of identity formation, narrative as an evidence-base for caring, and personal/emotional growth through critical reflection.
Practical implications
– Evaluation provided a platform to re-think model(s) of clinical practice learning in healthcare education derived from a non-clinical placement. There are tangible benefits for sustaining value-led practice at a time of political change in the way health services are configured and delivered.
Social implications
– When engagement with the principles of inclusivity and empowerment become part of the lived-experience of the nursing student, longer-term recognition and retention of caring, and enabling values are more likely to endure.
Originality/value
– The emotional development and skills acquired by nursing students transfer to all branches of the profession by revitalising core conditions of compassion, respect, dignity, and humanity.
Healthcare is a dynamic and evolving culture within which chaplaincy has continually adapted to maintain professional relevance and respect. Over time, forms of chaplaincy have emerged as responses to changes in culture: multi-faith chaplaincy and the subtle shift in focus from religious care to spiritual care being two examples. However, adaptation impacts on the character of chaplaincy and questions its core values. Outcome Oriented Chaplaincy (OOC) is a response to the “paradigm shift” in healthcare chaplaincy that aims to integrate assessment, intervention, outcome evaluation and care planning into the chaplain’s role. OOC seems perfectly adapted to the culture of contemporary market-driven healthcare; however, the values underwriting this culture are being questioned, and their impact on professional values challenged. This paper accepts OOC has much to offer chaplaincy, but calls for a critical engagement with the model, arguing that the demand to remain relevant to contemporary healthcare culture should not be at the expense of person-centred, person-focused values of compassion, dignity and respect embodied within the presence model of spiritual care.
This qualitative exploratory study was grounded in local patient and service user experiences and was designed to investigate how the language and metaphors of cancer influence personal and social adjustment after completion of a course of treatment.
The study employed a focus group design, in which eighteen people, recruited through regional networks and support groups, participated. Meetings elicited participants' stories and focused discussion on key words and common phrases in the cancer lexicon. Data from transcribed focus group recordings were analysed thematically and organised into descriptive categories concerned with the interpretations of common terms and how these influenced the management of identity and emotions.
The thematic categories emphasised the importance of language in the way participants managed their illness and sought to control their feelings and their interactions with others. Interpretation of findings revealed a strong central idea linking participants' accounts, which was that language, metaphor and euphemism are central to adjustment and the forging of an altered identity as a survivor of cancer diagnosis and treatment.
The findings are consistent with what is already known about the language and metaphors of cancer, with language being an important mechanism for managing uncertainty. From participants' accounts it also appears that there may be subtle but important differences in professional and lay understandings of cancer language and metaphor. This suggests a need for oncology nurses to elaborate their broad understanding of communication skills and move toward a more detailed understanding of the language used during interactions with patients.
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