DELIVERING COMPASSIONATE CARE
Introduction
Introducing the requirements and key concepts being covered in the assignment
This assignment aims to undertake a critique of the contemporary literature exploring the delivery of compassionate and spiritual care within the context of nursing. The author of this assignment works as a critical care nurse, therefore, will reflect compassionate care into her current role. Where possible due to limited research, the assignment will briefly relate to the provision of compassionate care during the current COVID- 19 pandemic (World Health Organization, 2020).
The assignment will also provide a critical analysis of the factors underpinning compassionate care, values, attitudes, and beliefs. In addition, the tools, techniques, and strategies to create a culture of compassionate care will also be critiqued. The principles themes within the main factors that will be explored include spiritual care, compassion fatigue, the Francis report, Schwartz rounding, self-compassion measuring compassion, Compassion in Practice and Healthcare Quality strategy.
Delivery of compassionate and spiritual care
A contemporary vision of compassionate care, based on historic events
Critically understand the concept of delivering compassionate (*including spiritual) care.
From reviewing the literature compassionate care can be difficult to define as it is often viewed as being subjective to each individual (Hewison and Sawbridge, 2016). A study conducted by Curtis (2015) explored patient's views on compassionate care. One theme that arose from the study was that patients believed that compassion was a sense of empathising with their situation. Nevertheless, Straughair (2012) describes compassion as nursing excellence and captures two distinctive concepts, which include understanding and engaging with the suffering of others, and a virtuous response aimed at addressing suffering and facilitating healing through knowledge and practice. Despite the absence of a universal definition, a recurring theme emerges from the reviewed literature to define compassion, which is understood to involve recognition and mitigation of suffering (Roze des Ordons et al., 2019). Furthermore, it is noted by Banafsheh et a.l (2019) and Day (2015) compassion is more than just necessary care, it involves respecting and maintaining a patient’s dignity, showing kindness, and recognising other personal characteristics.
Furthermore, Jones et al (2016) argue that compassionate care is not only about relieving a patient’s suffering; it should be seeing the person within the patient. According to Crawford et al. (2014) a nurse can create a genuine relationship with their patient by understanding and fulfilling a patient's needs. Literature by Gillick (2020) indicate compassionate nurses encourage greater disclosure by the patients about their symptoms, concerns and behaviour, thereby are significantly more effective in providing treatment, thus increasing patient satisfaction. Furthermore, Sinclair et al. (2016) states there is a strong link between compassionate care and higher levels of patient and family satisfaction. Thereby contributing to more effective healing and higher compliance levels, thus resulting in better use of resources and even lower costs.
The linkage between nurses and the delivery of compassionate care is not new, dating back to the work of Florence Nightingale in the 18th century (Bivins, Tierney and Seers, 2017). Florence Nightingale believed, good nurses were good people who acquired individual virtues and attributes in their character, one of which was compassion (Bradshaw, 2011). Furthermore, Fairman and Lynaugh (1998) state critical care nursing is a specialty that was established in 1950 by the American Association of Critical Care Nurses. Additionally, the same authors state that they developed the standards of care to educate nurses entering the field. In current times, these efforts continue to guide the education and clinical competence of critical care nurses to deliver compassionate care (Munro and Hope, 2019).
In recent years, increased focus has been put on providing compassionate care in nursing, particularly following inquiries into sub-optimal healthcare care practices, such as the Francis Report (Francis, 2013) and the Vale of Leven Hospital Investigation (MacLean, 2014). A recent public inquiry carried out by Francis (2013), documented the severe failings and lack of compassionate care at Mid-Staffordshire hospital that lead to the appalling and unnecessary suffering to many patients (Newdick and Danbury, 2015). The findings from the inquiry found a growing body of evidence that there has been a general decline in care and specifically compassionate care. Conversely, the Nursing and Midwifery Council (2015) standards reflect many of the issues that happened in the Francis (2013) report; therefore, the code had to be re-written, raising standards and bringing about the changes in culture. From the report (Francis 2013), it can be said that the delivery of compassionate care is paramount to providing safe, effective, person-centered care and is now commensurate with The Code (NMC, 2018). Gillen (2014) notes that the Vale of Leven hospital had inadequate facilities and an absence of leadership and reduced nursing care that led to many patients' death. As a result, Straughair (2012) argues that professional and political drivers have re-endowed the concept of compassionate care as a critical component of contemporary nursing care.
Spiritual care
In comparison to compassionate care, spiritual care is also unique to each patient as it involves dealing with how patients perceive life and death by exploring their values, beliefs, and meanings of life (Ferrell and Munevar, 2012). Rushton (2014) notes that being compassionate is a necessity to fulfill the spiritual needs of a patient because of the mutual empathy demonstrated between nurse and patient. According to Ho et al. (2018), spiritual care is an essential element of high-quality health care, specifically for critically ill patients, as spirituality can be a fundamental component in the way patients cope when they are critically unwell. Clarke (2013), suggests spiritual people are likely to have a more optimistic perspective and a better quality of life. For instance, Jones (2013) asserts patients living with cancer who find consolation in their faith and spiritual beliefs were more content with their lives, were happier, and suffered less pain by giving patients inner peace and enhancing patient’s healing. Likewise, O'Brien (2018), suggests people who have regular spiritual practices tend to live longer in comparison to those who are not spiritual.
Despite most critical care nurses being knowledgeable and well- trained in providing physical and curative care, Abuatiq (2015) argues that many critical care nurses feel ill-equipped to deliver adequate spiritual care. As, referrals to chaplains with specialised knowledge and spiritual care skills are often made in this environment since nurses may lack the training to provide spiritual care and may be uncomfortable with this aspect of the practice (Bone et al., 2018). Furthermore, a qualitative study carried out by Cavendish et al's.(2006) explored the nursing role in spiritual care. The authors reported that spiritual care was not considered the nursing role, indicating patients perceive spirituality and compassionate care as separate entities provided by different health care professionals. Moreover, Neville (2020) states during this current pandemic the way patients die in hospitals have significantly changed due to visitor restrictions and the wearing of personal protective equipment (PPE); adversely impacting the delivery of compassionate care. For these reasons, it is therefore, imperative that nurses can adapt to a patient's end-of-life by being able to provide sufficient spiritual care (Aitkin, Marshall and Chaboyer, 2020). This could be further supported by Ferrell and Paice (2019), who state it is paramount that nurses can demonstrate a holistic approach when attending to the suffering of a patient's physical, emotional, and spiritual needs; in doing so, it is ultimately delivering compassionate care.
The reviewed research has identified the positive and negative effects while fostering a culture of compassionate care, further validating the significance of compassionate and spiritual care as a fundamental component of person-centered-care (Savel and Munro, 2014). Nevertheless, it is emphasised by Roberts and Machon (2015) that attitudes, values, and beliefs also further influence the delivery of compassionate care.
Values, Attitudes and beliefs: Impact on the delivery of compassionate care
Factors impacting on the delivery of compassionate care
Individual, organisational and political factors impeding/facilitating the effective delivery of compassionate care Critically review and contextualize the attitudes, values and beliefs which may impact upon the delivery of compassionate care
According to McSherry, McSherry, and Watson (2012) organisational culture is a complex concept that reflects the values, attitudes, and beliefs that underpin the facilitation of compassionate care. Furthermore, healthcare organisations must have influential, compassionate leaders to cultivate a compassionate culture that promotes clinical excellence in employee engagement and staff morale (Haslam, 2015). As the authors, West et al. (2017) suggest that leadership is the most significant factor in creating a positive organisational culture. Furthermore, Horsburgh and Ross (2013) state, supportive environments facilitate compassionate care, however it is also noted that practioners remain accountable for their practice. According to Nightingale (2018), compassion should be essential in healthcare, but nursing is the only truly compassionate profession. It is therefore essential that other professions focus on improving this.
Evidence from a study carried out by Coffey et al. (2019) suggests that compassionate care programs have a positive effect on clinical leadership in creating a culture of compassionate care. The positive effects noted by Saab et al. (2019) are improved job satisfaction, a heightened sense of well‐being, and increased pride in the nursing profession. However, the participants in Coffey et al. (2019) study included representatives of managerial and senior positions. This could be a limitation as managers and senior staff are less likely to have direct patient care than nurses in frontline clinical leaders who are more likely to be involved in direct patient care. However, Smith et al. (2017) argue that compassionate care programmes should apply to both senior and junior staff in facilitating and implementing change to promote a culture of person-centered compassionate based care. Additionally, the Scottish Government (2017) notes that a positive culture helps staff feels valued and thereby enhances their practice; in comparison to a negative culture, where nurses may feel undervalued and may discourage them from speaking out about poor standards of care.
Values
According to Samuriwo et al. (2017) values-based nursing is the top agenda for the NHS, as values underpin all aspects of professional nursing practice. Furthermore, compassion is a value inherent in the NHS, (The Patient Rights Scotland Act 2011), and The Code (NMC, 2018), as it informs individual nurses of the conduct, attitudes, and expectations of their peers, the nursing profession, and the broader community expect of them. Furthermore, values can be de described by Baillie and Black (2015) as various nursing principles such as altruism, integrity, justice, and human dignity; that serve as a framework for ethics, professional practice, and evaluation. Schmidt and McArthur (2018) indicate that values are fundamental convictions of what is right, good or desirable, and inspire social and professional behaviour. However, while Nutall and Pezaro (2020), agree that values, determine one’s behaviors and convictions, they see these values as being learned rather than innate. According, to Tetley et al. (2016), nursing values intensify as nurses evolve and face new challenges
Beliefs
Moreover, according to Medes (2018), being culturally competent also plays a pivotal role in facilitating compassionate care. Papadopoulos (2019) states that being culturally competent involves having the knowledge, attitudes, and skills of cultural beliefs, allowing practitioners to provide adequate health care. Additionally, the same author states that culturally competent compassion is not something we are born with as he states that neuroscientists have recently discovered that our brains can develop it. Furthermore, Mendes (2018) states that cultural competency is a popular and recognised approach to improve the provision of health care to ethnic minorities and to reduce ethnic health disparities. The efficient provision of healthcare services by providers and organisations meets patients’ cultural, social, and linguistic needs. Furthermore, Christiansen et al. (2015) state that consideration of patients' cultural beliefs regarding how their care should be provided may help mitigate cultural barriers. A study conducted by the same author demonstrated the detrimental effect on the nurse-patient relationship when a nurse's values and beliefs ……XXXX…… Kaihlanen, Hietapakka, and Heponiemi (2019) noted many types of interventions for practitioners to become more culturally aware, such as training sessions and workshop programs.
Attitudes
Our actions are thought to express through our attitudes; therefore, professional behaviours are viewed as professional attitudes (Maio, Haddock, and Verplanken, 2015). In recent years research on health professionalism has emphasised the significance of assessing observable behaviours as evidence of attitudes (Price, 2015). However, findings from high-profile cases such as the Mid-Staffordshire report (Francis, 2013) indicate that behaviour cannot always be credible for identifying professional attitudes. Kennedy et al. (2017) further support this as the author's state behaviour cannot always reflect an individuals' true attitudes, as the individual may behave in a caring way towards a patient; still, underneath, they may feel ambivalent or negative towards them. Furthermore, a study conducted by McConnell (2015) demonstrated that prejudicial beliefs about patients were transferred during the handover from one nurse to another and that attitudes of colleagues towards patients were influenced by poor communication and stereotypical label such as labelling a patient as 'difficult.' Consequently, impeding the delivery of compassionate care. The Code (NMC, 2018) states that nurses should be a model of integrity and leadership for others to aspire to. Similar research carried out by Pope (2012) discovered that if nurses held the attitude of patients being ill, the patient would take on the patient-dependent role, consequently impacting their rehabilitation and day to day function. However, it could be argued that that it is dependent on what level of care the patient requires. As research carried out by Wunsch et al. (2015) state, critical care patients require the highest level of care; therefore, being dependent on the nurse for rehabilitation is paramount to enhancing a patient's outcome.
The research conducted by McConnell's (2015) and Pope's (2012) suggests the need for positive role models and excellent leadership to influence attitudes and behavioural change, to create a culture of compassionate care. As attitudes that are filtered down from the organisation to the team affect the individual; likewise, an individual can influence the attitudes of a team and organisation (Straughair, 2012).
Organisational barriers
Henderson and Jones (2017) have shown that organisational barriers can impede a nurse's ability to provide compassionate care. As Baughan and Smith (2013) notes, unsupportive environments, excessive workload, and inadequate staffing contribute to compassionate fatigue. Compassion fatigue is not a new concept in nursing; Figley, (1995) first defined it as a unique form of burnout.
Furthermore, Ledoux (2015) states compassion fatigue can occur due to exposure to one case or can be due to a multifaceted combination of emotional, physical, and spiritual depletion consequently, impeding the delivery of compassionate care. The weakening effects of compassionate fatigue upon a nurse can then lead to a lack of empathy, therefore, significantly impacting a patient's overall care, by delaying healing, thus leading to a more extended hospital stay. Some recent stressors reported by Shanafel, Ripp, and Trockel (2020) include the global shortage of PPE, wearing PPE for prolonged periods, and the risk of being exposed to COVID-19 at work and potentially transmitting the virus to others.
Mol et al. (2015) and Urden et al. (2015) note that providing nursing practice in the critical care department challenges the fundamentals of delivering compassionate care because of increasing technology and requiring comprehensive skills in specialised life-sustaining medical therapies. Vega and Hayes (2019) and Sacco et al. (2015) argue that compassion fatigue is prevalent in critical care settings, as critical care nurses are exposed to ethical decision making, observing the continuous suffering of patients, and end-of-life issues that lead to moral distress.
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