Compassionate Care in Nursing

From the exploration of many investigations and vast amounts of research, it has been discovered that nurses can deliver compassionate care in innumerable ways. Compassionate care is a top priority in the nursing profession (Dewer, 2012). Compassionate care is “witnessing another person’s suffering and experiencing a subsequent desire to help” (Goetz, Keltner and Simon-Thomas, 2010). There are many facilitators that enable nurses to deliver compassionate care in the most caring and respectful way, but before we can deliver compassionate care effectively we must first understand what compassion is and explore the many ways of delivering this care. The deliverance of compassionate care is facilitated by the learning and understanding of the meaning of compassion, the teaching of ways to care compassionately, the enhancement of vital skills and crucial knowledge and the necessary experience gained from oneself or learned from the observation of others. Unfortunately compassionate care is not always a priority due to the many challenges nurses face such as compassion fatigue and the unfavourable circumstances in which they strive to work successfully in.

According to Schantz (2007), compassion is “nursing’s most precious asset”, but before a nurse can use this significant asset in her profession, she must first understand what the meaning of compassion is and how can she deliver it in her care of patients. Youngson (2008, p2) describes compassion as “the humane quality of understanding suffering in others and wanting to do something about it”. Compassionate care is revealed through the smallest acts of kindness. It needs no permission and requires no resources other than our individual willingness to be kind, understanding, respectful and considerate, to listen and to respond to suffering. “When we bring these attributes to our daily practice, we influence others around us. Compassion is contagious.”  (Robin Youngson, 2014). Evidence suggests that fundamental elements of compassion such as empathy, Kindness, understanding, attention to pain, consideration given to basic needs and attention to dignity, are imperative to alleviating pain, stimulating a faster recovery from injury or illness and relieving stress and anxiety. Evidence of physiological benefits of compassion have also been found in studies which show that small acts of kindness and touch can alter the heart rhythm and brain function in both the person receiving the care and the nurse providing it (Fogarty et al. 1999; Shaltout et al. 2012: Science Daily 2012). A UK Department of Health Report (2009), states that in providing compassionate care “we respond with humanity and kindness to each person’s pain, distress, anxiety or need. We search for the things we can do, however small, to give comfort and relieve suffering, we find time for those we serve and work alongside. We do not wait to be asked, because we care”. A nurse must think only of the patients comfort, not of herself, and that she should be conscientious and diligent, seen and unseen. Nightingale believed a nurse should be intelligent in her comfort to her patients, giving it honestly from her heart with her strength and mind, and not pretending to care. Catherine Woods (1878) “gentleness of the heart will teach gentleness of the hands and to the manners. I can give your no better rule than to put yourself in your patients’ place”. “The nurse must always be kind, but never emotional. The patient must find a real, not forced, or ‘put on’, centre of calmness in the nurse”, (Nightingael 1882:1038-1049). “The nearness of another human being helps tremendously. A nurse by kindly little attentions, such as gently adjusting the bedclothes and pillows, moving a shaded light, altering the patient’s position in his bed or chair, provided that these alterations are performed with a genuine interest in him, will all help” (Pearce 1969:39).Providing compassionate care however is not as straightforward as it seems (Theodosius, 2013). Recognising that each patient has individual preferences and personalities and putting them at the heart of nursing care is essential (Todres et al, 2009; Borbasi et al, 2012; Hemingway et al, 2012), but many competing priorities can intervene to prevent the provision of compassionate care leading to disengagement among nurses and could be compromising professional practice.

There is a growing awareness and evidence that identifies that the delivery of compassionate care by a nurse is of eminent importance and is highly valued by patients and their loved ones. The way in which a nurse delivers the care a patient requires is of equal importance as the care itself (Firth-cozens and Cornwell 2009: Pearcy 2010: Dewer 2013). A nurse possesses the skills and knowledge needed to provide medical care for patients through education, experience and learning from other nurses. Compassionate care is often more difficult to articulate and there is much debate as to if compassionate care can be taught (Bradshaw 2009: Shea and Lionis 2010). Some people believe that compassion is a trait a person is born with and that it cannot be taught (Barker 2013) while other people believe it is a virtue to be cultivated (Bradshaw 2009).  Other opinions suggest that compassion cannot be taught but help can be given to student nurses to develop the knowledge and skills they need to enable them to care compassionately (McLean 2012). “In order to develop these skills we must first discover what makes care compassionate, or not, and hearing about the experiences of patients, carers and those who provide care can help to inform this” (Adamson and Smith 2014). Compassionate nursing is embedded within the undergraduate nursing curriculum and this is proving to facilitate in the successful delivery of compassionate care to patients by nurses (NHS Lothian 2012).  This curriculum should support learning about compassionate care and should integrate nurturing and further develop existing knowledge, skills and exposure to experiences of compassion. “Sharing and hearing individual narratives of what compassionate care looks like, helps to stimulate and challenge how individual practitioners and teams think about and practically deliver this type of care” (Adamson and Smith 2014), listening to experiences,  responding to feedback and having caring conversations can keep the delivery of compassionate care a priority for nurses.

Compassionate fatigue can be a major barrier for nurses to provide compassionate care to their patients. Compassion fatigue is a combination of physical, emotional, and spiritual exhaustion associated with the care of patients with significant pain and physical distress (Lombardo & Eyre, 2011). Compassionate fatigue is a condition of gradual lessening of compassion over time which is brought on by the exposure to trauma and by caring for trauma victims. “The expectation that we can be immersed in suffering and loss daily and not be touched by it is as unrealistic as expecting to walk on water without getting wet. This sort of denial is no small matter.” (Remen, 1996). There are many personal and professional attributes that put a nurse at risk of developing compassionate fatigue.  Those who are overly meticulous, devoting and committed with high levels of stress in their personal lives are more likely to develop compassionate fatigue. In the professional setting, it is found that the therapeutic relationship between nurse and patient is a contributing factor to compassionate fatigue (Sabo 2011; Lombard and Eyre 2011).It is generally believed that nurses who are empathetic and caring are more prone to absorb the traumatic emotional stress of those they care for (Joinson 2010). A nurse’s capacity for empathy and ability to engage in a therapeutic relationship is considered central to providing compassionate care, but those who display high levels of empathy are more vulnerable to experiencing compassionate fatigue. In 1995, Figley’s ground-breaking observations revealed that nurses who listened to patients fears, witnessed their pain and supported them through their suffering often feel similar fears. Pain and suffering because they care. “Sometimes we feel we are losing our own sense of self to the patients we serve”. It is this “compassionate fatigue” that is said to hinder such nurses’ performance and make them prone to burnout.  Although a nurse may still carry out care as mandated by policy, their desire to help and their ability to show empathy can be impacted significantly. Nurses experience a reduced capacity for, or interest in being empathic towards patients and their families (Lombard and Eyre 2011). Compassionate fatigue may even reduce the quality of care for patients and relatives (Donchin Y, Seagull FJ 2002). Compassion is the invisible work of nurses and is only noticed when it is absent (Dewar, 2012). In the absence of compassion, patients are left feeling frightened, stressed, confused, depressed and agitated and are often made feel like they are nothing “ more than just the appendectomy in room 207” (Corbin, 2008, p163). Compassionate fatigue causes professional and organisational implications. It is known to have a major impact on nurses’ job satisfaction and their performance ability (Lombard and Eyre 2011). Inaccurate documentation, poor interpersonal skills, lack of record –keeping, medication errors, avoidance of intense patient situations and insufficient patient information being communicated are only some examples of the professional consequences of compassionate fatigue. Organisational negative impacts include reduced productivity, absenteeism, unwillingness, tardiness which all have a direct effect on the hospital team and definitively the patients (Showalter 2010).

In this assignment ithas been explored how a nurse can deliver compassionate care. While acknowledging the numerous facilitators to compassionate care, the focus was primarily on the most simple but yet most important attribute to being competent in delivering compassionate care; learning and understanding what it means to have compassion, strengthening skills and knowledge which aid the deliverance of compassionate care, exploring the different ways of providing compassionate care and how learning from one’s own experience and from observing the compassionate work of others can teach a nurse how to care compassionately “the most important practical lesson that can be given to a nurse is to teach them what to observe” (Florence Nightingale).The meaning of compassionate fatigue and the causes of it were investigated in this assignment to understand how it is a major barrier in the deliverance of compassionate care and what can be done to prevent it. But after exploring the facilitators and barriers to compassionate care it is not either that have the most predominate effect on how a nurse can deliver compassionate care with such prestige but it is the continuous learning and understanding of compassion that makes the care possible. “Let us never consider ourselves finished nurse.. We must be learning all of our lives” (Florence Nightingale).

Refernces:

• 12. Donchin Y, Seagull FJ (2002) The hostile environment of the intensive care unit Review. Curr Opin Crit Care 8: 316–320.
• Youngson, Time to Care: How to Love Your Patients and Your Job. 2012, Raglan: Rebelheart Publishers
• Department of Health UK. (2009). The NHS constitution: The NHS belongs to us all. (online).
• Fogarty, L.A., Curbow, B.A.,Wingard, J.R., McDonnell, K., Somerfield, M.R. (1999). Can 40nseconds of compassion reduce patient anxiety? Journal of Clinical Oncology 17(1):371.
• Science Daily. www.sciencedaily.com/releases/2012/12/121203145952.htm
• Shaltout, H.A., Tooze, J.A., Rosenberger, M.S., Kemper, K.J. (2012). Time, touch and compassion: effects on autonomic nervouse system and well-being. Explore 8:177-184.
• Woods, C.J. (1878) A Handbook of Nursing for the Home and the Hospital London: Cassell.
• Nightingale, F. (1882) Nurses, Training of; Nursing the Sick In Quain, R. (ed.) A Dictionary of Medicine 1^st edn. London: Longmans, Green, abd Co. pp. 1038-1049 (part II).
• Pearce, E.C. (1969) Nurse and Patient: Human Relations in Nursing Lomdon: Faber and Faber
• Figley , C. (1995) Compassion Fatigue: Coping with SecondaryTramatic Stress Disorder in Those who Treat the Traumatized. New York: Brunner-Routledge.
• Lombard, B., Eyre, C. (2011). Compassion Fatigue: a nurse’s primer The Online Journal of Issues in Nursing 16(1), Manuscript 3
•   Sabo, B. (2011). Reflecting on the concept of compassion fatigue The Online Journal of Issues in Nursing 16(1), Manuscript 1
• Remen, .R. (1996) Kitchen Table Wisdom: Stories That Heal. New York: Riverhead Books.
• Barker, K. (2013) Can care and compassion be taught? British Journal of Midwifey 21(2), 82.
• Bradshaw, A. (2009) Measuring compassion: The McDonaldised nurse? Journal of Medical Ethics 35(8), 465-8.
• Firth-Cozens, J., Cornwell, J. (2009) The Point of Care: Enabling Compassionate Care in Acute Hospital Settings. London: The Kings Fund.
• McLean, C. (2012) The yellow brick road: A values based curriculum model Nurse Education in Practice 12, 159-63.
• Shea, S., Lionis, C. (2010) Restoring humanity in health care through the art of compassion: An issue for the teaching and research agenda in rural health care Rural and Remote Health Journal 10(4), 1679. 
• Pearcey, P. (2010) Caring? It’s the little things we are not supposed to do anymore International Journal of Nursing Practice 16(1), 51-6.
• Corbin, J. (2008) Is caring a lost art in nursing? International Journal of Nursing Studies. 45 (2) 163-165.
• Dewar, B.,  (2011) cited in Dewar, B ( 2013) Cultivating compassionate care Nursing Standard 27,34 48- 55.
• Dewar, B. (2012) Using creative methods in practice development to understand and develop compassionate care. International Practice Development Journal. 2(1) 1-11.
• Edinburgh University & NHS Lothian (2012) Leadership in Compassionate Care Programme. Final Report. Edinburgh University: Scotland