Compassion in Health Care: An Empirical Model

The Mediating Effect of Professional Values on the Relationship Between Self-Leadership and Compassion Competence of Community Mental Health Nurses

BACKGROUND

Compassion competence is a core nursing skill that is significant in understanding and alleviating the physical and mental distress of individuals. Self-leadership and nursing professional values are also reported as important factors in improving the clinical care practices of nurses and may have a positive effect on improving the compassion competence of nurses. However, there are few studies examining the relationship between these variables in community mental health nurses.

AIM

This study investigated the mediating effect of professional values on the relationship between self-leadership and compassion competence of community mental health nurses.

METHODS

A cross-sectional correlational study was conducted with 121 community mental health nurses from 30 mental health welfare centers in South Korea. Participants completed self-report scales on self-leadership, nursing professional values, and compassion competence. Baron and Kenny's regression method and the Sobel test revealed significant mediating effects of nursing professional values on the relationship between self-leadership and compassion competence.

FINDINGS

Participants' mean compassion competence scores were 3.57 (SD = 0.45) on a 5-point scale. Compassion competence positively correlated with self-leadership (r = 0.67, P < .001) and nursing professional values (r = 0.60, P < .001). Nursing professional values played a partial mediating role in the relationship between self-leadership and compassion competence (Z = 3.23, P = .001).

CONCLUSION

Compassion competence of community mental health nurses can be improved by promoting self-leadership and nursing professional values.

The initial validation of an Evidence-informed, competency-based, Applied Compassion Training (EnACT) program: a multimethod study

INTRODUCTION

Compassion is positively associated with improved patient outcomes, quality care ratings, and healthcare provider wellbeing. Supporting and cultivating healthcare providers' compassion through robust and meaningful educational initiatives has been impeded by a lack of conceptual clarity, inadequate content coverage across the domains of compassion, and the lack of validated evaluation tools. The EnACT program aims to address these gaps through an Evidence-informed, competency-based, Applied, Compassion Training program delivered to healthcare providers working in various clinical settings. In this study, we describe the development and initial validation of the program, which will inform and be further evaluated in a forthcoming Randomised Controlled feasibility Trial (RCfT).

METHOD

A multimethod design was used to explore learner needs, experiences, and outcomes associated with the program. Pre- and post-training surveys and qualitative interviews (1 month post training) were conducted among twenty-six healthcare provider learners working in acute care and hospice. Quantitative measures assessed professional fulfillment/burnout, self-confidence in providing compassion, learner satisfaction, and compassion competence. Qualitative interviews explored learners' experiences of the program, integration of learnings into their professional practice, and program recommendations.

RESULTS

Learners exhibited relatively high self-assessed compassion competence and professional fulfillment pre-training and low levels of burnout. Post-training, learners demonstrated high levels of compassion confidence and satisfaction with the training program. Despite high levels of reported compassion competence pre-training, a statistically significant increase in post-training compassion competence was noted. Thematic analysis identified five key themes associated with learners' overall experience of the training day and integration of the learnings and resources into their professional practice: (1) A beginner's mind: Learner baseline attitudes and assumptions about the necessity and feasibility of compassion training; (2) Learners' experiences of the training program; (3) Learner outcomes: integrating theory into practice; (4) Creating cultures of compassion; and (5) Learner feedback.

CONCLUSION

Findings suggest that the EnACT program is a feasible, rigorous, and effective training program for enhancing healthcare provider compassion. Its evidence-based, patient-informed, clinically relevant content; interactive in class exercises; learner toolkit; along with its contextualized approach aimed at improving the clinical culture learners practice holds promise for sustaining learnings and clinical impact over time-which will be further evaluated in a Randomized Controlled feasibility Trial (RCfT).

Initial Validation of a Patient-Reported Compassion Measure in a Mandarin-Speaking Long-Term Care Patient Population

Background and Purpose: Compassion is increasingly considered essential to quality nursing care and is a concept that is strongly embedded across cultures, including Chinese culture. The Patient Compassion Model (PCM) depicts the unique yet overlapping domains of compassion. The Sinclair Compassion Questionnaire (SCQ) was directly developed and validated from this empirical model. In this study, we sought to establish initial validation of a translated SCQ among Mandarin-speaking patients by assessing the transferability of the PCM and the clinical sensibility of the SCQ. Methods: Forward and back-translation of the PCM and SCQ were performed in accordance with World Health Organization guidelines. Qualitative interviews were used to assess the transferability of the PCM with conceptualizations of compassion within a Chinese context. Cognitive interviews were conducted to assess the clarity, readability, wording, questions, and response scales of the Mandarin translation of the SCQ. Qualitative data were analyzed using constant comparative analysis, and cognitive interviews were analyzed using framework analysis. Results: The original categories of the PCM were verified in this Mandarin-speaking patient population. Specifically, participants' understanding of compassion is described as consisting of healthcare provider virtues, emphasizing the importance of a virtuous response that sought to understand the individual and their unique needs, to relationally communicate from a place of shared humanity and to ameliorate suffering. Participants were able to answer, comprehend, and endorse all 15 Mandarin SCQ items, resulting in no modifications to the Mandarin SCQ. Conclusions: This study provides initial validation of the Mandarin SCQ and PCM. Future studies should consider further establishing the validity and reliability of the Mandarin SCQ among a larger Chinese patient population.

End of life care: how nurses can use a compassionate approach

The reality of death and dying is a central facet of life, often surrounded by feelings of sadness, fear and uncertainty. Nurses have an essential role in caring for people who are approaching the end of life and their families, while being mindful of the current demands and challenges in health and social care services. In this article, the author suggests that being more open to the reality of death as part of life may assist nurses in being more attuned to the personal needs of those who are dying. The article emphasises the importance of considering each person's symptoms and concerns through the lens of compassion to address pain, fear and distress. While the focus is on caring for people who are approaching the end of life, the author asserts that there is much that nurses can learn from those they care for about the beauty of life and the naturalness of death.

Compassion in health professionals: Development and validation of the Capacity for Compassion Scale

BACKGROUND

Health professionals witness pain and suffering when they care for sick people and their families. Compassion is a necessary quality in their work as it combines the will to help, alleviate suffering and promote the well-being of both the people they are attending and the professionals themselves. The aim of the study was to design and evaluate the psychometric properties of the Capacity for Compassion Scale (CCS).

DESIGN

A quantitative, descriptive and cross-sectional study was carried out to evaluate the psychometric properties of the scale (reliability, temporal stability, content validity, criterion validity and construct validity).

METHODS

The study was carried out in two phases: pilot study and final validation. The data were collected between April and May 2022. The sample was selected by convenience sampling and was made up of a total of 264 participants, 59 in the pilot phase and 205 in the final validation.

RESULTS

The Capacity for Compassion Scale has been shown to have good psychometric properties in relation to reliability, temporal stability, and content, criterion, and construct validity. Factor analysis showed that there were four subdimensions of the scale: motivation/commitment, presence, shared humanity and self-compassion. The results also indicate that compassionate ability is significantly correlated with age and work experience.

CONCLUSIONS

The Capacity for Compassion Scale shows adequate psychometric properties. This instrument measures the compassion capacity of health professionals, which is a valuable discovery for new lines of research in this field.

IMPACT

Through this scale, low levels of capacity for compassion can be detected that negatively influence the quality of care provided by health professionals. The Capacity for Compassion Scale can therefore contribute to the identification of needs and promote training around compassion for health professionals.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution. WHAT PROBLEM DID THE STUDY ADDRESS?: Compassion in health professionals has positive effects on improving the quality of care, the satisfaction of professionals and the work environment. There are compassion cultivation programmes whose validity has been proven for the development of the dimensions of compassion. There is no specific instrument that measures capacity for compassion in healthcare professionals. WHAT WERE THE MAIN FINDINGS?: A scale is designed to measure capacity for compassion in health professionals. This is the only such scale available up until now. The scale measures four dimensions of compassion: motivation/commitment, presence, shared humanity and self-compassion. WHERE AND ON WHOM WILL THE RESEARCH HAVE AN IMPACT?: The development of specific programmes that can increase the compassion of health professionals with all the benefits that this can bring to health care is encouraged. It will be possible to analyse the effects of training programmes on the cultivation of compassion.

'It's very values driven': A qualitative systematic review of the meaning of compassion according to healthcare professionals

AIMS AND OBJECTIVES

To explore the meaning ascribed to the concept of compassion by healthcare professionals.

BACKGROUND

Compassion is universally regarded as the foundation of healthcare, a core value of healthcare organisations, and essential to the provision of quality care. Despite increasing research on compassion in healthcare, how healthcare professionals understand compassion remains unclear.

DESIGN

A systematic review of qualitative studies was conducted and is reported following PRISMA guidelines.

METHOD

Medline, Emcare, PsychINFO and CINAHL were searched to November 2021 for qualitative studies in English that explored healthcare professionals' understandings of compassion. Included studies were appraised for quality before data were extracted and thematically analysed.

FINDINGS

Seventeen papers met the inclusion criteria. An overarching theme, 'It's very values driven' underpins the four main themes identified: (1) 'It's about people and working with them': Compassion as being human, (2) 'There is this feeling': Compassion as being present, (3) 'If I don't understand them, I won't be able to help': Compassion as understanding, (4) 'Wanting to help in some way': Compassion as action.

CONCLUSIONS

Healthcare professional participants reported compassion as motivated by values and inherent to humanistic healthcare practice. The meanings healthcare professions described were varied and contextual. Qualitative research should further explore healthcare practitioners' experiences of compassion as part of their practice to inform health professions education, policy, and practice.

RELEVANCE TO CLINICAL PRACTICE

To practice with compassion, healthcare professionals require supportive and humanistic organisations that honour each person's humanity and encourage people to be human and compassionate to each other as well as to patients, their families and/or carers. Healthcare professionals need to reflect on what compassion means to them, how it is situated within their unique practice context, and how compassion can enhance clinical practice.

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review had no patient or public contribution.

Compassionate care during the COVID-19 pandemic

BACKGROUND

There was a substantial documented call for healthcare professionals to provide compassionate care during the COVID-19 pandemic and significant criticism voiced when it was lacking. This study aimed to explore perspectives on compassionate care among healthcare professionals providing care during the COVID-19 pandemic. The study focuses on healthcare professionals who participated in a wide range of COVID-19 measures, including testing, quarantine, diagnosis, and care provision (patients with COVID-19 or patients with other illnesses and comorbid with COVID-19).

METHODS

A qualitative design with an interpretative phenomenological analysis approach was used. Twenty frontline healthcare professionals (15 nurses and five physicians) who had worked in COVID-19 facilities in China were interviewed individually.

RESULTS

Participants stated that a commitment to 'offering oneself' and 'balancing the advantages/disadvantages' in providing care during the pandemic were key to alleviate population-level suffering. On a personal level, they described a desire for obtaining 'mutual support' and improving 'professional competencies' to safeguard their physical and mental well-being. Two professional competencies were notable: coping with grief and implementing infection control across the organization. Additionally, they emphasized the importance of receiving support from the health care organization, the public, and leaders in creating an 'environment conducive to fostering compassionate care.'

CONCLUSION

Healthcare professionals recognized the centrality of compassionate care during the pandemic which entailed a commitment to offering themselves, the balancing of advantages and disadvantages in order to find the best solution, as well as the need to safeguard themselves using professional competencies. Such findings can enrich the contemporary understanding of compassion, including when it is lacking. Support from the healthcare organization, the public, and leadership were crucial in fostering compassionate care in healthcare professionals during the pandemic and in moving the field forward in the future.

Disorienting or Transforming? Using the Arts and Humanities to Foster Social Advocacy

Introduction

The arts and humanities (AH) have transformative potential in medical education. Research suggests that AH-based pedagogies may facilitate both personal and professional transformation in medical learners, which may then further enhance the teaching and learning of social advocacy skills. However, the potential for such curricula to advance social advocacy training remains under-explored. Therefore, we sought to identify how AH may facilitate transformative learning of social advocacy in medical education.

Methods

Building upon previous research, we conducted a critical narrative review seeking examples from the literature on how AH may promote transformative learning of social advocacy in North American medical education. Through a search of seven databases and MedEdPORTAL, we identified 11 articles and conducted both descriptive and interpretative analyses of their relation to key tenets of transformative learning, including: disorientation/dissonance, critical reflection, and discourse/dialogue.

Results

We found that AH are used in varied ways to foster transformative learning in social advocacy. However, most approaches emphasize their use to elicit disorientation and dissonance; there is less evidence in the literature regarding how they may be of potential utility when applied to disorienting dilemma, critical reflection, and discourse/dialogue.

Discussion

The tremendous potential of AH to foster transformative learning in social advocacy is constrained due to minimal attention to critical reflection and dialogue. Future research must consider how novel approaches that draw from AH may be used for more robust engagement with transformative learning tenets in medical education.

Discourses of compassion from the margins of health care: the perspectives and experiences of people with a mental health condition

BACKGROUND

Evidence supports the positive influence of compassion on care experiences and health outcomes. However, there is limited understanding regarding how compassion is identified by people with lived experience of mental health care.

AIM

To explore the views and experiences of compassion from people who have lived experience of mental health.

METHODS

Participants with a self-reported mental health condition and lived experience of mental health (n = 10) were interviewed in a community setting. Characteristics of compassion were identified using an interpretative description approach.

RESULTS

Study participants identified compassion as comprised three key components; 'the compassionate virtues of the healthcare professional', which informs 'compassionate engagement', creating a 'compassionate relational space and the patient's felt-sense response'. When all these elements were in place, enhanced recovery and healing was felt to be possible. Without the experience of compassion, mental health could be adversely affected, exacerbating mental health conditions, and leading to detachment from engaging with health services.

CONCLUSIONS

The experience of compassion mobilises hope and promotes recovery. Health care policymakers and organisations must ensure services are structured to provide space and time for compassion to flourish. It is imperative that all staff are provided with training so that compassion can be acquired and developed.

Do I care for you more when you really need help? An experimental test of the effect of clinical urgency on compassion in health care

OBJECTIVES

To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking to address systemic barriers to compassion in health care.

DESIGN

This is a pre-registered online study with an experimental, within-subjects repeated-measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion.

METHODS

Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired-sample t-tests were used to test the effect of the presentation urgency on indices of compassion.

RESULTS

A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient.

CONCLUSIONS

This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system-wide orientation towards efficiency and urgency may exacerbate this 'bias' which must be addressed to ensure more equitable compassion in health care.

Providing compassionate care via eHealth

BACKGROUND

eHealth was widely used during the COVID-19 pandemic. Much attention was given to the technical aspects of eHealth, such as infrastructure and cost, while the soft skill of compassion remained underexplored. The wide belief in compassionate care is more compatible with in-person interactions but difficult to deliver via e-platforms where personal and environmental clues were lacking urges studying this topic.

PURPOSE

to explore the experience of delivering compassionate care via an eHealth platform among healthcare professionals working to contain the COVID-19 pandemic.

METHODS

A qualitative study design with an interpretative phenomenological analysis approach was used. Twenty healthcare professionals (fifteen nurses and five physicians) who provided care using technology platforms, such as telephone hotlines, mobile apps, and social media, were interviewed individually.

ETHICAL CONSIDERATIONS

Permission to conduct the study was obtained from the Institutional Review Board.

RESULTS

Participants stated that "eHealth enabled compassionate care during the pandemic" by ensuring patient care availability and accessibility. They shared experiences of "communicating compassionate care via eHealth" with suggestions of addressing patients' needs with empathy, adopting a structured protocol to guide eHealth communication, and using more advanced visual-media methods to promote human-to-human interaction. They recommended "setting realistic mutual expectations" considering the limitations of eHealth in handling complex health situations and staffing shortages. Participants considered "low eHealth literacy hinders compassion." Additionally, they recommended the need for "institutional/system-level support to foster compassionate care."

CONCLUSION

Participants recognized the importance of integrating compassion into eHealth services. Promotion of compassionate care requires standardization of eHealth services with institutional and system-level support. This also includes preparing adequate staffing who can communicate compassionate care via eHealth, set realistic expectation, and adjust communication to eHealth literacy level while meeting the needs of their patients.

Compassionate Presence in Seriously Ill Cancer Patients

Background: Compassion is a relational response to patients' suffering. Palliative care focuses not only on skills but also on compassion. Nevertheless, incorporated patient perspectives are largely missing from existing research. Aim: Our mixed-method exploratory study in a major Swiss cancer center sought to better understand compassionate presence, its benefits and challenges for patients and providers (ie, close relatives, close friends, and professionals-all referred to here as providers). It also investigated providers' motivation. Method: Twelve multidisciplinary, specially trained professionals interviewed 50 patients who had received compassionate presence. All patients had advanced cancer with risk of death. Providers were also interviewed. Data on the positive and burdensome effects of compassionate presence on patients and providers were gathered using a specific protocol. This also served to record patients' characteristics and providers' motivations to give compassion and whether providers felt sustained (eg, by nature). Results: The study suggests a high impact of compassionate presence with benefits on patients (50/50) and on providers (49/50). Enhanced connectedness was evident not only in the patient-provider relationship (38/50) but also, for instance, in an increased ability to love (8/50) or in an intensified solidarity (29/50). A considerable number of patients and providers experienced mental-spiritual change but also burdensome effects (eg, ambivalences). Providers showed a range of motivations. Conclusion: Compassion is not only necessary in existential crises and near death, but also happens and takes considerable effects precisely in such situations.

Providing compassionate care in a virtual context: Qualitative exploration of Canadian primary care nurses' experiences

Objective

Virtual care presents a promising opportunity to create new communication channels and increase access to healthcare. However, concerns have been raised around the potential for unintended emotional distances created through virtual care environments that could strain patient-provider relationships. While compassionate care is an enabler of emotional connectivity and a core tenant of nursing, little is known about whether or how nurses have adapted their compassion skills into virtual interactions. These concerns are particularly relevant in primary care, where there is a focus on relational continuity (i.e. relationship-based, longitudinal care) and a broad uptake of virtual care. The aim of this study was to explore the meaning of compassionate virtual care and to uncover how nurses operationalized compassionate care through virtual interactions in primary care.

Methods

We used a qualitative interpretive descriptive lens to conduct semistructured interviews with primary care nurses (Ontario, Canada) who had provided virtual care (i.e. video visits, remote patient monitoring, or asynchronous messaging). We used a thematic approach to analyze the data.

Results

We interviewed 18 nurse practitioners and two registered nurses. Participants described how: (1) compassionate care was central to nursing practice, (2) compassionate care was evolving through virtual nurse-patient interaction, and (3) nurses balanced practice with patients' expectations while providing virtual compassionate care.

Conclusions

There is an opportunity to better align nurses' understanding and operationalization of compassionate care in virtual primary care contexts. Exploring how compassionate care is operationalized in primary care settings is a necessary first step to building compassionate competencies across the nursing profession to support the continued virtual evolution of health service delivery.

Patient's views of empathic and compassionate healthcare interactions: A scoping review

BACKGROUND

Compassion and empathy are integral to safe and effective patient care. However, to date, most studies have focused on exploring, defining, measuring and analysing empathy and compassion from the perspective of researchers or clinicians. There has been limited attention to the perspectives of patients.

OBJECTIVE

The objective of this scoping review was to map the literature to identify patients' views of healthcare provider behaviours that exemplify empathic and compassionate interactions.

METHOD

This review used the Joanna Briggs Institute scoping review methodology. A comprehensive search of eight electronic databases was conducted with English language studies published in the last 10 years considered for inclusion.

RESULTS

Database searching resulted in 459 records for initial screening. After de-duplication and conducting a title and abstract review, 32 full-text articles were screened for eligibility. A total of 14 studies met the inclusion criteria and were critically reviewed using the Mixed Methods Appraisal Tool. The included papers profiled studies that had been conducted in clinical settings across seven countries. The healthcare encounters described in the papers were with a range of healthcare providers. Two overarching and interconnected categories of behaviours were identified as indicative of empathic/compassionate encounters: (1) communication skills such as listening, touch, body language, eye contact and positive demeanour; and (2) helping behaviours demonstrated by small acts of kindness that go beyond routine healthcare.

CONCLUSION

Given the breadth of studies describing the positive impact of empathy/compassion on people's physical and psychosocial wellbeing, the results from this review are valuable and shed new light on patients' views and experiences. The results provide a deeper understanding of healthcare provider behaviours that exemplify empathic and compassionate healthcare interactions and can be used to inform the education and training of healthcare providers from all disciplines.

A scoping review of the self-reported compassion measurement tools

BACKGROUND

Compassion is closely linked to psychological well-being, and several assessment tools have been developed and studied to assess the level of compassion in different populations and for more precise measurement. There is currently a scarcity of comprehensive knowledge about compassion-related assessment tools, and our research provides an overview of these tools.

AIMS

To identify scales used to measure compassion from different flows, and to assess their measurement properties and quality.

METHODS

Focusing on compassion assessment tools, the authors conducted a thorough search of 10 Chinese and English databases from their establishment until August 14, 2022. Data extracted included the author, year, country, objectives, target population, as well as the primary evaluation content. Using the COSMIN checklist, the methodological quality and measurement properties of the included studies were appraised. This scoping review was registered with the Open Science Framework and followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) checklist.

RESULTS

There were 15,965 papers searched, and 36 compassion-related measurement tools were identified in this study. None of the 36 studies provided possessed all nine psychometric properties, as outlined by the COSMIN criteria. On the basis of a systematic evaluation of quality, measurement qualities were ranked. The results for internal consistency and content validity were relatively favorable, whereas the results for structural validity were variable and the results for the remaining attributes were either uncertain or negative. A Venn diagram was used to illustrate the overlapping groups of compassion measurement tools based on the three-way flow of compassion. An overview of the reference instrument and theoretical basis for the included studies was provided, and half of them did not contain any theoretical or scale-based evidence.

CONCLUSION

In this study, 36 compassion-related measuring instruments were identified, and the methodological quality and measurement properties of the included studies were acceptable. The included measurements were consistent with flows of compassion. A further focus of further research should be on developing theories in the compassion domain and developing instruments for measuring compassion that are multidimensional, multi-populations, and culturally relevant.

A visual ethnographic study on nurse lecturers' enactment of compassionate care within the adult pre-registration nursing curriculum

BACKGROUND

Nurse lecturers make a valuable contribution to developing the future nursing workforce. However, how this is nurtured within nurse education requires further exploration. There is limited research exploring the experiences of nurse lecturers providing compassionate care within the adult pre-registration nursing curriculum.

OBJECTIVES

This study explores how nurse lecturers enact compassionate care within the adult pre-registration nursing curriculum. To elicit shared patterns of behaviours and use creative methods to promote a critical dialogue.

METHOD

A visual ethnographic approach was used to explore nurse lecturers' experiences at a University in England. Using purposive sampling, nine auto-driven photo-elicitation interviews took place, and five participants attended a focus group to develop individual and collaborative concept maps. A thematic approach to data analysis was employed.

FINDINGS

Five themes were identified, illustrating compassionate care as the human condition involving appropriate behaviours and competent action. Compassionate care is threaded through the curriculum using different teaching and learning approaches, requiring a culture of shared human relationships. The combination of photographs, maps and descriptions provide a unique perspective of how nurse lecturers nurture and role model compassionate care to their students.

CONCLUSION

There are many ways compassionate care is experienced, enacted and enhanced by nurse lecturers within the adult pre-registration nurse curriculum. The five main themes act as a framework to guide nursing education and nursing practice. Future research should aim to understand better how compassionate care can be nurtured within different fields of nursing.

Exploring the relationship between compassion, the practice environment, and quality of care as perceived by paediatric nurses

PURPOSE

To (1) explore associations between paediatric nurses' perceptions of their own compassion, the practice environment, and quality of care, and (2) identify factors that influence perceived quality of care.

DESIGN AND METHODS

Cross-sectional survey of paediatric nurses (n = 113) from a hospital network in Melbourne, Australia. The survey included the Compassion Scale, Practice Environment Scale of the Nurse Work Index (PES-NWI), a single quality of care item, and demographic items. Hierarchical regression was used to explore factors that predicted perceived care quality.

RESULTS

There were moderate positive correlations between perceived care quality and both compassion (rho = 0.36, p < .001) and practice environment (i.e., total PES-NWI: rho = 0.45, p < .001). There were significant differences in perceived care quality based on nurses' work area (i.e., critical care vs medical/surgical wards). The final hierarchical regression analysis included compassion (Step 2) and four of five PES-NWI subscales (Step 3), controlling for work area (Step 1). The model was statistically significant and explained 44% of variance in perceived quality; compassion and PES-NWI subscale 2 (Nursing foundations for quality of care) were statistically significant predictors.

CONCLUSIONS

Paediatric nurses' perceptions of quality were influenced by their own compassion for others and elements of the practice environment, particularly nursing foundations for care quality, which is characterised by a clear nursing philosophy and model of care, with programs and processes to support practice.

PRACTICE IMPLICATIONS

The findings offer insights into potentially modifiable individual and workplace factors that contribute to paediatric nurses' perceptions of care quality.

The Language of Compassion: Hospital Chaplains' Compassion Capacity Reduces Patient Depression via Other-Oriented, Inclusive Language

Objectives

Although hospital chaplains play a critical role in delivering emotional and spiritual care to a broad range of both religious and non-religious patients, there is remarkably little research on the best practices or "active ingredients" of chaplain spiritual consults. Here, we examined how chaplains' compassion capacity was associated with their linguistic behavior with hospitalized inpatients, and how their language in turn related to patient outcomes.

Methods

Hospital chaplains (n = 16) completed self-report measures that together were operationalized as self-reported "compassion capacity." Next, chaplains conducted consultations with inpatients (n = 101) in five hospitals. Consultations were audio-recorded, transcribed, and analyzed using Linguistic Inquiry Word Count (LIWC). We used exploratory structural equation modeling to identify associations between chaplain-reported compassion capacity, chaplain linguistic behavior, and patient depression after the consultation.

Results

We found that compassion capacity was significantly associated with chaplains' LIWC clout scores, a variable that reflects a confident leadership, inclusive, and other-oriented linguistic style. Clout scores, in turn, were negatively associated with patient depression levels controlling for pre-consult distress, indicating that patients seen by chaplains displaying high levels of clout had lower levels of depression after the consultation. Compassion capacity exerted a statistically significant indirect effect on patient depression via increased clout language.

Conclusions

These findings inform our understanding of the linguistic patterns underlying compassionate and effective chaplain-patient consultations and contribute to a deeper understanding of the skillful means by which compassion may be manifest to reduce suffering and enhance well-being in individuals at their most vulnerable.

Predictors of Medical Students' Compassion and Related Constructs: A Systematic Review

Phenomenon: Compassion, and related constructs such as empathy, are core values in healthcare, with known benefits for both patients and staff. Yet research on the factors that affect compassion and compassion-related constructs remains scattered. This review systematizes and synthesizes studies investigating the predictors of compassion and related constructs among medical students, allowing for a better understanding of the factors that both positively and negatively contribute to the development of compassionate future physicians. Approach: A systematic review of 12 databases for studies from database inception up until April 2020 was conducted. Non-peer-reviewed literature and studies in which >50% of the sample were non-medical students were excluded. Intervention studies were also out of the scope of this review. We assessed risk of bias and confidence in the findings using standardized tools. Data were categorized within the Transactional Model of Physician Compassion, a framework in which compassion is influenced by personal (student), environmental, patient/family, and clinical factors. Findings: Of 14,060 retrieved articles, 222 studies were included. Of these, 95% studied student factors, but only 25% studied environmental, 9% studied patient, and 6% studied clinical factors. Predictors of greater compassion included maturity; work and life experiences; personality traits of openness to experience and agreeableness; skills such as perspective taking, reflection, and mindfulness; and positive role modeling. Conversely, negative attitudes/emotions, burnout, stress, detachment, operating in cultures prioritizing knowledge and efficiency over humanistic care, negative role models, time constraints, and heavy workloads predicted lower compassion. Patient-related factors included "difficult" and "noncompliant" patients or those perceived as responsible for their illness. Overall, 60% of studies had a serious risk of bias, particularly confounding and participant selection biases. Insights: Medical student compassion is predicted by a wide range of factors relating to the student, their training environment, their patients, and the clinical situation. However, existing research has largely focused on student factors (e.g., sociodemographic and dispositional traits), many of which are not amenable to intervention. Skills such as perspective taking, reflection, and mindfulness are associated with higher compassion and may present opportunities for intervention. There is also strong evidence that environmental factors shape students' compassion. Researchers and educators should continue to explore the impact of patient and clinical factors on students' compassion. Studies remain at high risk of bias.

Turkish version of the 5-item Compassion Measurement Tool: A validity and reliability study

The aim of this methodological study with a cross-sectional design study was to examine the validity and reliability of the Turkish form of the 5-item Compassion Measurement Tool. The sample was 402 patients in a university hospital. The Content Validity Index was 0.96. Total item correlation values were between 0.559 and 0.685. Cronbach's alpha coefficient was 0.83. The scale could be used as five items, under a single factor as in the original version. A high correlation was found between patients' compassion perception and nursing care satisfaction scores. Turkish version of the 5-item Compassion Measurement Tool is a valid and reliable tool.

The impact of organizational compassion in health care on clinicians: A scoping review

BACKGROUND

The unprecedented exodus of workers from the healthcare system is a patient safety crisis. Organizational compassion in health care is the proactive, systematic, and continuous identification, alleviation, and prevention of all sources of suffering.

AIMS

This scoping review aimed to describe the evidence regarding the impact of organizational compassion on clinicians, identify gaps, and provide recommendations for future research.

METHODS

A comprehensive librarian-assisted database search was conducted. Databases searched were PubMed, SCOPUS, EMBASE, Web of Science, PsychInfo, and Business Source Complete. Combinations of search terms regarding health care, compassion, organizational compassion, and workplace suffering were used. The search strategy was limited to English language articles and those published between 2000 and 2021.

RESULTS

Database search yielded 781 articles. After removing duplicates, 468 were screened by title and abstract, and 313 were excluded. One-hundred and fifty-five underwent full-text screening, and 137 were removed, leaving 18 eligible articles, two of which were set in the United States. Ten articles evaluated barriers or facilitators to organizational compassion, four evaluated elements of compassionate leadership, and four evaluated the Schwartz Center Rounds intervention. Several described the need to create systems that are compassionate to clinicians. Lack of time, support staff, and resources impeded the delivery of such interventions.

LINKING EVIDENCE TO ACTION

Little research has been done to understand and evaluate the impact of compassion on US clinicians. Given the workforce crisis in American health care and the potential positive impact of increasing compassion for clinicians, there is an urgent need for researchers and healthcare administrators to fill this gap.

Discovering compassion in medical training: a qualitative study with curriculum leaders, educators, and learners

Background

Compassion is considered a fundamental human capacity instrumental to the creation of medicine and for patient-centered practice and innovations in healthcare. However, instead of nurturing and cultivating institutional compassion, many healthcare providers cite the health system itself as a direct barrier to standard care. The trend of compassion depletion begins with medical students and is often attributed to the culture of undergraduate medical training, where students experience an increased risk of depression, substance use, and suicidality.

Objectives

This qualitative study aims to develop a more comprehensive understanding of compassion as it relates to undergraduate medical education. We used focus groups with key stakeholders in medical education to characterize beliefs about the nature of compassion and to identify perceived barriers and facilitators to compassion within their daily responsibilities as educators and students.

Methods

Researchers conducted a series of virtual (Zoom) focus groups with stakeholders: Students (N = 14), Small Group Advisors (N = 11), and Medical Curriculum Leaders (N = 4). Transcripts were thematically analyzed using MAXQDA software.

Results

Study participants described compassion as being more than empathy, demanding action, and capable of being cultivated. Stakeholders identified self-care, life experiences, and role models as facilitators. The consistently identified barriers to compassion were time constraints, culture, and burnout. Both medical students and those training them agreed on a general definition of compassion and that there are ways to cultivate more of it in their daily professional lives. They also agreed that undergraduate medical education - and the healthcare culture at large - does not deliberately foster compassion and may be directly contributing to its degradation by the content and pedagogies emphasized, the high rates of burnout and futility, and the overwhelming time constraints.

Discussion

Intentional instruction in and cultivation of compassion during undergraduate medical education could provide a critical first step for undergirding the professional culture of healthcare with more resilience and warm-hearted concern. Our finding that medical students and those training them agree about what compassion is and that there are specific and actionable ways to cultivate more of it in their professional lives highlights key changes that will promote a more compassionate training environment conducive to the experience and expression of compassion.

We will all age and one day be older adults ourselves: College students' reflections on facilitating compassionate presence (CP) sessions for older adults

College students are likely to hold negative ageist views and attitudes toward older people. The compassionate presence (CP) intervention could be a promising approach to reduce ageist attitudes that younger adults have of older adults. College students were trained virtually in deep, active, and compassionate listening and were matched with older adults living in assisted-living facilities. The partners met virtually for an hour once per week. Students completed weekly reflections throughout the ten-week intervention. The weekly reflections revealed that students had preconceived notions about older adults before the CP training. After the CP training and throughout the intervention, we noted a positive shift in perception, knowledge, and attitudes toward older adults and aging. Students built meaningful social bonds with older adults, developed strong communication and interpersonal skills, and acquired research and core leadership skills needed for future careers and professional practice.

Compassion: Learning Needs and Training Opportunities-a Survey Among Palliative Healthcare Providers in Italy

Compassion is a key quality in palliative care; however, there is a lack of evidence of the need to discuss the theme of compassion and professionals' training in the subject. The study aimed to investigate the knowledge of the construct of a sample of Italian healthcare professionals (HCPs) working in palliative care. In addition, their learning needs and training opportunities were explored. An online survey was completed by 330 HCPs. It was divided into five sections which examined knowledge of the construct of compassion and the perception of its utility in palliative care, the activities carried out in eventual training in compassion, and professionals' learning needs thereof. Professionals who had knowledge of the right definition of compassion considered it more useful and training more necessary. Most of the sample never received training about compassion. However, 97% of those who received training believed it to be necessary. Satisfaction with training was higher among those who received multidisciplinary team education. Training occasions are relatively rare in the Italian context, although they seem to increase knowledge and awareness about the construct utility and training necessity. Besides, multidisciplinary team training seems to be more satisfying. Offering team training on compassion can promote a deeper awareness of it and of its utility in clinical practice.

Compassion, emotions and cognition: Implications for nursing education

Compassion is often understood as central to nursing and as important to ensure quality nursing and healthcare. In recent years, there has been a focus on strategies in nursing education to ensure compassionate nurses. However, it is not always clear how the concept of compassion is understood. Theoretical conceptualisations that lie behind various understandings of compassion have consequences for how we approach compassion in nursing education. We present some ways in which compassion is often understood, their philosophical underpinnings and the consequences these understandings can have for nursing education. We argue that it is useful for nursing education to understand compassion as a cognitive emotion and discuss how such an understanding can inform educational approaches to compassion.

Spiritual Care as a Core Component of Palliative Nursing

ABSTRACT

Spirituality is one aspect of the human experience that is unique to each person and may become especially important in the face of life-threatening illness. While evidence supports the need to address spirituality as part of holistic palliative care nursing, it is hoped that "spiritual care" will not become another item on nurses' to-do list, but rather will be part of nurses' everyday lives and nursing practice. Taking time to assess personal needs, and consciously connecting to meaning, hope, and peace, can support nurses' return to the deeper roots of nursing. Addressing spirituality as part of palliative nursing care can also acknowledge the complex and multidimensional experiences of the patients that nurses serve. Connecting, or reconnecting, with nurses' unique sense of spirituality can serve as a powerful resource for resilience. This article highlights the relevance of spiritual care to palliative nursing and offers practical tips to incorporate spiritual care into everyday nursing practice.

Artificial intelligence technologies and compassion in healthcare: A systematic scoping review

Background

Advances in artificial intelligence (AI) technologies, together with the availability of big data in society, creates uncertainties about how these developments will affect healthcare systems worldwide. Compassion is essential for high-quality healthcare and research shows how prosocial caring behaviors benefit human health and societies. However, the possible association between AI technologies and compassion is under conceptualized and underexplored.

Objectives

The aim of this scoping review is to provide a comprehensive depth and a balanced perspective of the emerging topic of AI technologies and compassion, to inform future research and practice. The review questions were: How is compassion discussed in relation to AI technologies in healthcare? How are AI technologies being used to enhance compassion in healthcare? What are the gaps in current knowledge and unexplored potential? What are the key areas where AI technologies could support compassion in healthcare?

Materials and methods

A systematic scoping review following five steps of Joanna Briggs Institute methodology. Presentation of the scoping review conforms with PRISMA-ScR (Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews). Eligibility criteria were defined according to 3 concept constructs (AI technologies, compassion, healthcare) developed from the literature and informed by medical subject headings (MeSH) and key words for the electronic searches. Sources of evidence were Web of Science and PubMed databases, articles published in English language 2011-2022. Articles were screened by title/abstract using inclusion/exclusion criteria. Data extracted (author, date of publication, type of article, aim/context of healthcare, key relevant findings, country) was charted using data tables. Thematic analysis used an inductive-deductive approach to generate code categories from the review questions and the data. A multidisciplinary team assessed themes for resonance and relevance to research and practice.

Results

Searches identified 3,124 articles. A total of 197 were included after screening. The number of articles has increased over 10 years (2011, n = 1 to 2021, n = 47 and from Jan-Aug 2022 n = 35 articles). Overarching themes related to the review questions were: (1) Developments and debates (7 themes) Concerns about AI ethics, healthcare jobs, and loss of empathy; Human-centered design of AI technologies for healthcare; Optimistic speculation AI technologies will address care gaps; Interrogation of what it means to be human and to care; Recognition of future potential for patient monitoring, virtual proximity, and access to healthcare; Calls for curricula development and healthcare professional education; Implementation of AI applications to enhance health and wellbeing of the healthcare workforce. (2) How AI technologies enhance compassion (10 themes) Empathetic awareness; Empathetic response and relational behavior; Communication skills; Health coaching; Therapeutic interventions; Moral development learning; Clinical knowledge and clinical assessment; Healthcare quality assessment; Therapeutic bond and therapeutic alliance; Providing health information and advice. (3) Gaps in knowledge (4 themes) Educational effectiveness of AI-assisted learning; Patient diversity and AI technologies; Implementation of AI technologies in education and practice settings; Safety and clinical effectiveness of AI technologies. (4) Key areas for development (3 themes) Enriching education, learning and clinical practice; Extending healing spaces; Enhancing healing relationships.

Conclusion

There is an association between AI technologies and compassion in healthcare and interest in this association has grown internationally over the last decade. In a range of healthcare contexts, AI technologies are being used to enhance empathetic awareness; empathetic response and relational behavior; communication skills; health coaching; therapeutic interventions; moral development learning; clinical knowledge and clinical assessment; healthcare quality assessment; therapeutic bond and therapeutic alliance; and to provide health information and advice. The findings inform a reconceptualization of compassion as a human-AI system of intelligent caring comprising six elements: (1) Awareness of suffering (e.g., pain, distress, risk, disadvantage); (2) Understanding the suffering (significance, context, rights, responsibilities etc.); (3) Connecting with the suffering (e.g., verbal, physical, signs and symbols); (4) Making a judgment about the suffering (the need to act); (5) Responding with an intention to alleviate the suffering; (6) Attention to the effect and outcomes of the response. These elements can operate at an individual (human or machine) and collective systems level (healthcare organizations or systems) as a cyclical system to alleviate different types of suffering. New and novel approaches to human-AI intelligent caring could enrich education, learning, and clinical practice; extend healing spaces; and enhance healing relationships.

Implications

In a complex adaptive system such as healthcare, human-AI intelligent caring will need to be implemented, not as an ideology, but through strategic choices, incentives, regulation, professional education, and training, as well as through joined up thinking about human-AI intelligent caring. Research funders can encourage research and development into the topic of AI technologies and compassion as a system of human-AI intelligent caring. Educators, technologists, and health professionals can inform themselves about the system of human-AI intelligent caring.

Intensive Care Nurses' Experience of Caring in Greece; A Qualitative Study

BACKGROUND

Whilst nurses and critical care services have been at the forefront of the COVID-19 pandemic, it has become more apparent that intensive care nurses are presented with challenging ethical and clinical decisions and are required to care for individuals with critical illnesses under high-pressure conditions. This is not a new phenomenon. The aim of this study, which was conducted before the outbreak of COVID-19, was to explore the experience of caring through the narratives of intensive care nurses in Greece.

METHODS

A qualitative study was conducted through in-depth, semi-structured interviews with nineteen ICU nurses in Athens. Transcripts were subjected to Braun and Clarke's thematic analysis and organised with Atlas.ti v8 QDA software.

RESULTS

The intensive care nurses' experience of caring in Greece encompassed four themes: (A) being "proximal", "co-present" and caring with empathy, (B) being "responsible" for your patient and negotiating with the doctors, (C) technology and "fighting with all you've got", and (D) "not being kept informed" and disappointment.

CONCLUSIONS

The narratives of this study highlight that ICU nurses in Greece provide patient-centred and compassionate care. Nurse leaders should develop appropriate healthcare policies so as to ensure the adequate provision of staff, specialist education, and support to nurses working in critical care. Failure to address these issues may lead to poor quality of care and negative patient outcomes.

Program Leaders' and Educators' Perspectives on the Factors Impacting the Implementation and Sustainment of Compassion Training Programs: A Qualitative Study

PHENOMENON

Training programs have been used to improve compassion in healthcare, but the factors necessary to make such programs successful and sustainable have not been identified. This thematic analysis aimed to bridge the gap between theory and practice by drawing on the experiences of international leaders and educators of compassion training programs to develop a clear understanding of what is relevant and effective and how compassion training is implemented and sustained.

APPROACH

International leaders and educators of compassion training programs (N = 15) were identified through convenience sampling based on academic and gray literature searches. Semi-structured face-to-face interviews with these participants were conducted between June 2020 and November 2020 in order to identify facilitators, barriers, and environmental conditions influencing the implementation and maintenance of compassion training programs. The interviews were recorded, transcribed verbatim, and analyzed using thematic analysis.

FINDINGS

Six categories affecting the operationalization of compassion training programs were identified 1) origins, foundational principles and purpose, 2) curricular content, 3) methods of teaching and learning, 4) trainer qualities, 5) challenges and facilitators, and 6) evaluation and impact.

INSIGHTS

Compassion training should be rooted in the construct of interest and incorporate patients' needs and their experience of compassion, with patient-reported compassion scores integrated before and after training. Compassion training should be delivered by highly qualified educators who have an understanding of the challenges associated with integrating compassion into clinical practice, a dedicated contemplative practice, and a compassionate presence in the classroom. Prior to implementing compassion training, leadership support should be secured to create an ethos of compassion throughout the organization.

Qualitative study of Oncology Clinicians' Perceptions of Barriers to Offering Clinical Trials to Underserved Populations

INTRODUCTION

Cancer clinical trials represent the "gold standard" for advancing novel cancer therapies. Optimizing trial participation is critical to ensuring the generalizability of findings across patients, yet trial enrollment rates, particularly among minority and socioeconomically disadvantaged populations, remain suboptimal.

METHODS

We conducted in-depth interviews with oncologists at a large academic medical center to explore their (1) attitudes and perceived barriers to offering clinical trials to minority and socioeconomically disadvantaged patients, and (2) recommendations for improving the enrollment of minority and socioeconomically disadvantaged patients in cancer clinical trials.

RESULTS

Of 23 medical oncologists approached, 17 enrolled (74% response rate; mean age = 47; female = 42%; White = 67%). Content analysis revealed several barriers to enrollment: (1) ethical dilemmas; (2) ambivalence about trial risks and benefits; and (3) concern about patient well-being. Concerns about the legitimacy of informed consent, perceived lack of equipoise, and fear of personal bias influenced clinicians' decisions to recommend trials during treatment discussions. Concerns about creating an imbalance between trial risks and benefits among patients with high-level needs, including patients with literacy, psychiatric, and other socioeconomic vulnerabilities, impacted clinicians' enthusiasm to engage in trial discussions. Clinicians identified patient, provider, and system-level solutions to address challenges, including increasing patient and clinician support as well as involving external personnel to support trial enrollment.

CONCLUSION

Findings reveal multi-level barriers to offering cancer clinical trials to underrepresented patients. Targeted solutions, including system level changes to support clinicians, patient financial support, and implementation of clinical trial navigation programs were recommended to help reduce access barriers and increase enrollment of underrepresented patients into cancer clinical trials.

Conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation: a scoping review

The purpose of this review is to scope the literature on the conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation. Eligible studies included quantitative, qualitative, or mixed-methods research that presented primary data on the conceptualization, use, and outcomes associated with empathy and compassion in physical medicine and rehabilitation. Relevant studies were identified through CINAHL, Cochrane Library, EMBASE, MEDLINE, and PEDRO. Twenty-four studies were included (participant n = 3715): 13 quantitative, six mixed-methods, and five qualitative. In qualitative analysis, empathy and compassion were conceptualized as both intrinsic and exhibitory. Where self-compassion was examined as an intervention for patients, improvements in anxiety, depression, and quality of life were reported. Survey data suggested that when rehabilitation health care providers were perceived to be more empathic, patients reported greater treatment satisfaction, acceptance, adherence, and goal attainment. Individuals receiving and health care providers who deliver rehabilitative care conceptualize empathy and compassion as valuable in physical medicine and rehabilitation settings, with cognitive and behavioural elements described. Health care provider empathy and compassion-based interventions may influence outcomes positively in this context. More research is needed to understand the mechanisms of action of empathy and compassion and effectiveness in physical medicine and rehabilitation settings.

Central yet overlooked: engaged and person-centred listening in rehabilitation and healthcare conversations

PURPOSE

Listening in healthcare practice is often overlooked. This article addresses the misconception that listening in rehabilitation and healthcare is a simple skill, and proposes a conceptual framework of effective listening in healthcare conversations, based on conceptualizations, attributes, and outcomes associated with listening.

METHOD

A critical review was conducted, encompassing literature on listening in everyday and healthcare conversations. Articles were retrieved through database and hand searching.

RESULTS

Although various types of listening have been proposed, they share common attributes, including being attentive, emotionally involved, and non-judgmental. A conceptual framework is proposed in which listening in healthcare is seen as a relational process fostered by the 'engaged and person-centred listener', leading to relational outcomes (e.g., mutual engagement, collaboration) and client-specific outcomes. Listening in healthcare conversations can be difficult due to situational conditions and the level of self-regulation required.

CONCLUSIONS

Effective listening in healthcare differs from everyday listening with respect to its attributes, intentionality, and challenges. In healthcare, listening is essential to mutual engagement and other relational outcomes that mobilize the client towards pursuing goals. There is a need for greater understanding of the centrality and challenges to effective listening in healthcare conversations. Implications for rehabilitation practice are discussed.Implications for RehabilitationListening in rehabilitation conversations is a core skill or advanced competency-not a 'soft' skill with little effect on client outcomes.Effective listening is essential to mutual understanding, engagement, relationship building, and collaboration, which mobilize the client towards pursing goals in rehabilitation.Listening effectively in rehabilitation conversations involves deliberately adopting a person-centred perspective.Effective rehabilitation professionals have several listening intentions in mind in addition to understanding, including engaging the other person in the therapy session, building relationship, and collaborating.Rehabilitation professionals can deliberately adopt the intention to be an "engaged and person-centred listener" who is with and for the client.

The measurement of compassionate leadership: Adaptation and Spanish validation of the compassionate leadership self-reported scale

BACKGROUND

A culture of shared leadership is widespread among palliative care teams based on a commitment to valuing and including all people equally. As compassion is a core value for end-of-life care work, compassionate leadership may be the best way to lead in palliative care.

AIMS

The aims of this study were twofold: (1) to adapt and validate the Compassionate Leadership Self-reported Scale in a sample of palliative care professionals; and (2) to study the relation between compassionate leadership and associated concepts of self-compassion, awareness and self-care.

METHODS

A cross-sectional survey of 296 Spanish end-of-life care professionals was conducted. Analyses included descriptive statistics, a confirmatory factor analysis (CFA) with four-correlated factors, reliability estimates and a structural model.

RESULTS

Results suggested there were medium to high levels of compassionate leadership in the sample. The CFA showed an adequate overall fit: χ² (98) = 277.595 (p < 0.001); CFI = 0.986; SRMR = 0.047; RMSEA = 0.088 [0.076, 0.100]. Reliability estimates for four subscales of compassionate leadership (attending, understanding, empathising and helping) were also adequate, ranging from 0.72 to 0.96. Finally, the structural model predicting compassionate leadership suggested that the dimensions of attending and understanding were most highly related to positive self-compassion and awareness; empathising, to self-care and awareness; and helping, to positive self-compassion and self-care.

CONCLUSION

The Compassionate Leadership Scale has adequate psychometric properties when used to assess compassionate leadership in the context of end-of-life care. Our results indicate that self-compassion, awareness and self-care are important correlates of such compassionate leadership.

Epidemiology of compassion: A literature review

Psychology and neuroscience have contributed significantly to advances in understanding compassion. In contrast, little attention has been given to the epidemiology of compassion. The human experience of compassion is heterogeneous with respect to time, place, and person. Therefore, compassion has an epidemiology, although little is known about the factors that account for spatial or temporal clustering of compassion or how these factors might be harnessed to promote and realize a more compassionate world. We reviewed the scientific literature to describe what is known about “risk factors” for compassion towards others. Studies were included if they used quantitative methods, treated compassion as an outcome, and used measures of compassion that included elements of empathy and action to alleviate suffering. Eighty-two studies met the inclusion criteria; 89 potential risk factors were tested 418 times for association with compassion. Significant associations with compassion were found for individual demographic factors (e.g., gender, religious faith); personal characteristics (e.g., emotional intelligence, perspective-taking, secure attachment); personal experience (e.g., previous adversity); behaviors (e.g., church attendance); circumstantial factors during the compassion encounter (e.g., perceptions of suffering severity, relational proximity of the compassion-giver and -receiver, emotional state of the compassion-giver); and organizational features. Few studies explored the capacity to receive, rather than give, compassion. Definitions and measures of compassion varied widely across disciplines; 87% of studies used self-report measures and 39% used a cross-sectional design. Ten randomized clinical trials documented the effectiveness of compassion training. From an epidemiologic perspective, most studies treated compassion as an individual host factor rather than as transmissible or influenced by time or the environment. The causal pathways leading from suffering to a compassionate response appear to be non-linear and complex. A variety of factors (acting as effect modifiers) appear to be permissive of—or essential for—the arising of compassion in certain settings or specific populations. Future epidemiologic research on compassion should take into account contextual and environmental factors and should elucidate compassion-related dynamics within organizations and human systems. Such research should be informed by a range of epidemiologic tools and methods, as well as insights from other scientific disciplines and spiritual and religious traditions.

Towards the idea of 'clinical capital': A longitudinal study exploring nurses' dispositions and workplace manifestations in an Australian intensive care unit

OBJECTIVE

To explore the concept of 'capital' through the study of successive interventions and outcomes (patient and staff) in a quaternity intensive care unit (ICU) across a 5-year time frame.

DESIGN

A longitudinal intrinsic single site, a survey study was designed. The concept of 'capital' was explored through an adopted interpretive approach that involved understanding meanings from different sources, for example, discussions at compassion cafés, follow-up from staff-initiated activities, informal responses to organizational imperatives external to the unit (i.e. staff reductions and resource constraints), alongside empirical data about workplace climate and patient incidents.

SETTING

A single ICU employing approximately 220 registered nurses at a quaternary hospital in Queensland, Australia.

PARTICIPANTS

All nurses employed in the ICU at the time of compassion cafes participated in providing feedback to inform successive activities. All nurses in the unit had equal opportunity to complete surveys, participate in subsequent unit-based sessions, take-up options; and all nurses had a responsibility to complete incident data.

RESULTS

Survey and incident data from 2015 to 2019 identify the complexity of workplace environments. Between 35% and 45% of nurses consistently completed the survey. Activities based on staff requests initially improved incident data but did not impact the work environment; negative perceptions of the work environment at the endpoint (2019) were associated with external factors.

CONCLUSION

Quality care environments are labile; sensitive to both unit activity and external organization directives (namely staff reductions). Quality care can be sustained in adverse situations with increased nurse engagement in patient care dynamics in the short term.

IMPACT

This study articulates a previously unidentified concept, 'clinical capital'. Activities facilitating nurse engagement in broad care dynamics gave rise to a more robust climate than just focusing on social and psychological well-being activities for nurses. Participation in issues of concern about patient care can promote resilience to short term fluctuations.

Nursing and Midwifery Managers’ Views on Compassion in Daily Practice: A Survey in Greece and Cyprus

Compassionate care is a key component in nursing and midwifery quality care. It leads to positive patient outcomes, greater patient satisfaction, higher level of compliance, lower costs and reduction of nurse’s burnout. The aim of this article is to describe how nurses’ and midwives’ managers understand and practice compassion in Cyprus and Greece. This is a cross-sectional, descriptive, exploratory online survey using close and open-ended questions. Descriptive statistics and thematic analysis were applied. This is part of a larger study participating 17 countries. This article discusses Cyprus (Greek-Cypriots n = 47) and Greece data (n = 58). The sample included nurses and/or midwives in management positions, nurse educators/managers in the hospital, community or in educational setting. Participants in this study reported the necessity to be a compassionate manager. Some stated that nurses and midwives do not receive compassion from their managers. Thematic areas revealed include: (a) Defining compassion, (b) Giving/receiving compassion, (c) Manager as advocate (d) Importance of cultural characteristics (e) Advantages/barriers of compassion. Managing and leading staff with compassion have a positive effect in the quality, effectiveness and efficiency in daily practice. It enhances work satisfaction. Nurses’ and midwives’ managers in Cyprus and Greece highlight the importance of reinforcing themselves in providing compassionate care and supporting their staff.

"Compassion is the mainstay of nursing care": A qualitative study on the perception of care and compassion in senior nursing students

PURPOSE

To describe nursing students' perceptions of care and compassion in the context of the clinical environment.

DESIGN AND METHODS

This phenomenological study data were collected by focus groups and Giorgi et al. stages used in the data analysis.

FINDINGS

Sixteen students participated in this study. Four themes and 12 subthemes were determined. The themes were "Discovering the existence of care and facing up to care", "advancing on the road to becoming a nurse: from theory to practice," "compassionate care, beyond medical care," and "the effect of nursing education on professional compassion."

PRACTICE IMPLICATIONS

This study showed that nursing students grew by giving care and knowledge. In addition, compassionate care is gained by real-life stories and a supportive environment.

Components of Compassionate Care in Nurses Working in the Cardiac Wards: A Descriptive Qualitative Study

Introduction: Compassion is the essence and the core of nursing care. Nurse's affectionate and emotional work leads to many caring behaviours that are considered to be the basis of caring with kindness. The purpose of this study was to describe the components of compassion care in nurses working in the cardiac ward. Methods: This descriptive qualitative study was conducted in the medical and surgical cardiac wards of the selected hospital affiliation to Isfahan University of Medical Sciences in 2020- 2021. The participants were 36 nurses, 20 patients and 8 family members that selected using purposive sampling. Data collection was conducted through, in-depth semi-structured interviews; focus group discussions, and the field notes. Data analysis was carried out using the qualitative content analysis approach proposed by Graneheim and Lundman. Results: The results of this study are presented in one main category, four sub categories including "using verbal and non-verbal language to express feelings", "doing empathy activities", "organizing patient-centered care", and "adhering to the cultural context", and twelve sub- sub categories. Conclusion: The patient-centered emotional discourse is the main issue in shaping the compassion care in nurses. Nursing managers can have a significant role in achieving care with affection by preparing appropriate work environment, paying attention to lack of nursing staff, ensuring the principles defined in compassion care, and supporting nursing staff. Teaching the concept of compassion, patient-centered care in the clinical setting are among the most important issues that should be considered.

Mental health nurses' constructions of compassion: A discourse analysis

Compassion is an important element of contemporary nursing work. Compassion has been recognized as necessary for improving health outcomes. However, very little is known about how compassion is understood in the mental health practice setting. We conducted interviews with seven mental health nurses to explore their perspectives on compassion and views on compassion policy. Analysis of the data revealed that compassion was identified and discussed as Compassion as part of the person (and the profession); Compassion: Fundamental to the nursing role; Barriers to compassion; Perspectives on compassion policy. In addition, findings demonstrated ethical constraints on compassion in the mental health context, as well as the administrative burden on nurses more broadly, which was also a reported barrier to compassion. Mental health nurses identified compassion as fundamental to their clinical practice, yet compassion was impeded owing to practical and emotional constraints upon nurses. System-wide action must be taken to increase and support the mental health nursing workforce to strengthen the practice of compassion. This will be fundamental to improving health outcomes that are claimed to be enhanced by compassion. This study is reported according to the COREQ guidelines.

Behavioural indicators of compassionate nursing care of individuals with complex needs: A naturalistic inquiry

AIMS AND OBJECTIVES

To explore behavioural indicators of compassionate nursing care from the perspectives of individuals with multimorbidities and complex needs.

BACKGROUND

Complex patients are individuals with multimorbidity and/or mental health concerns, andoften with medication and drug-related problems requiring ongoing person-centered care, mental health interventions, and family and community resources. They are frequent consumers of health-care services and it is documented that these patients experience discrimination and substandard care. Compassionate care can improve patient care experiences and health outcomes. However, missing is the guidance on how to provide compassionate care for this population from the perspectives of complex patients.

DESIGN

A qualitative descriptive approach was conducted in eastern Canada from December 2020-April 2021. The COREQ guidelines were followed for reporting.

METHODS

Data from in-person and virtual semi-structured interviews with 23 individuals having experiences as complex patients were analysed using reflexive thematic analysis. Among them 19 were homeless and lived in a shelter.

FINDINGS

Six indicators of compassionate nursing care were generated: sensitivity, awareness, a non-judgmental approach, a positive demeanour, empathic understanding, and altruism.

CONCLUSIONS

Individuals perceived that nurses who acknowledge personal biases are better at providing compassionate care by manifesting compassion through their genuine and selfless interest in the complicated health problems and underlying socio-cultural determinants of each patient. Kindness, positivity, and a respectful nursing approach elicit openness and the sharing of heartfelt concerns.

RELEVANCE TO CLINICAL PRACTICE

Comprehensive health assessment, dedicated efforts to know the patient as a human being, and listening to the patient's preferences can improve health outcomes among individuals with complex needs. Healthcare administrators can effect the change by supporting nurses to address complex health and social care needs with compassion.

PATIENT OR PUBLIC CONTRIBUTION

Patients and healthcare professionals helped in data collection at the community care centre.

More than a feeling? What does compassion in healthcare 'look like' to patients?

OBJECTIVE

Compassion is important to patients and their families, predicts positive patient and practitioner outcomes, and is a professional requirement of physicians around the globe. Yet, despite the value placed on compassion, the empirical study of compassion remains in its infancy and little is known regarding what compassion 'looks like' to patients. The current study addresses limitations in prior work by asking patients what physicians do that helps them feel cared for.

METHODS

Topic modelling analysis was employed to identify empirical commonalities in the text responses of 767 patients describing physician behaviours that led to their feeling cared for.

RESULTS

Descriptively, seven meaningful groupings of physician actions experienced as compassion emerged: listening and paying attention (71% of responses), following-up and running tests (11%), continuity and holistic care (8%), respecting preferences (4%), genuine understanding (2%), body language and empathy (2%) and counselling and advocacy (1%).

CONCLUSION

These findings supplement prior work by identifying concrete actions that are experienced as caring by patients. These early data may provide clinicians with useful information to enhance their ability to customize care, strengthen patient-physician relationships and, ultimately, practice medicine in a way that is experienced as compassionate by patients.

PUBLIC CONTRIBUTION

This study involves the analysis of data provided by a diverse sample of patients from the general community population of New Zealand.

Compassionate Discourses: A Qualitative Study Exploring How Compassion Can Transform Healthcare for 2SLGBTQ+ People

Compassion can be seen as a necessary, but often lacking, concept and practice in healthcare. Due to the cis-heteronormative nature of societies, people who identify as Two-Spirit, lesbian, gay, bisexual, transgender, queer (2SLGBTQ+) often experience health disparities and disparities in accessing compassionate healthcare. We aimed to explore the meanings of compassion in healthcare for Canadian 2SLGBTQ+ people. Using a poststructuralist framework, 20 self-identifying 2SLGBTQ+ participants were interviewed. Data was analyzed through discourse analysis. Three main discursive considerations are discussed, including (1) meanings and expectations of compassion in healthcare, (2) compassionate healthcare is not guaranteed, and (3) prescription for care: self-compassion for healing and health. The results provide insights into how compassionate healthcare is framed for 2SLGBTQ+ participants and how compassion is often lacking for them due to discourses of cis-heteronormativity and healthism.

What is the Most Valid and Reliable Compassion Measure in Healthcare? An Updated Comprehensive and Critical Review

Our previous review of compassion measures in healthcare between 1985 and 2016 concluded that no available measure assessed compassion in healthcare in a comprehensive or methodologically rigorous fashion. The present study provided a comparative review of the design and psychometric properties of recently updated or newly published compassion measures. The search strategy of our previous review was replicated. PubMed, MEDLINE, CINAHL, and PsycINFO databases and grey literature were searched to identify studies that reported information on instruments that measure compassion or compassionate care in clinicians, physicians, nurses, healthcare students, and patients. Textual qualitative descriptions of included studies were prepared. Instruments were evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. Measures that underwent additional testing since our last review included the Compassion Competence Scale (CCS), the Compassionate Care Assessment Tool (CCAT)^©, and the Schwartz Center Compassionate Care Scale (SCCCS)™. New compassion measures included the Sussex-Oxford Compassion for Others Scale (SOCS-O), a self-report measure of compassion for others; the Bolton Compassion Strengths Indicators (BSCI), a self-report measure of the characteristics (strengths) associated with a compassionate nurse; a five-item Tool to Measure Patient Assessment of Clinician Compassion (TMPACC); and the Sinclair Compassion Questionnaire (SCQ). The SCQ was the only measure that adhered to measure development guidelines, established initial construct validity by first defining the concept of interest, and included the patient perspective across all stages of development. The SCQ had the highest EMPRO overall score at 58.1, almost 9 points higher than any other compassion measure, and achieved perfect EMPRO subscale scores for internal consistency, reliability, validity, and respondent burden, which were up to 43 points higher than any other compassion measure. These findings establish the SCQ as the ‘gold standard’ compassion measure, providing an empirical basis for evaluations of compassion in routine care.

The Mediating Role of Compassion between Social Job Resources, and Healthy Healthcare Professionals: A Cross-Sectional Study with Gender Perspective

The aim of this study is to examine the role of Compassion towards others as a mediator between Social Job Resources (social support climate, coordination, and positive leadership), Healthy Employees (psychological well-being such as resilience, engagement, and optimism) and Healthy Organisational Outcomes (in-role performance, extra-role performance and commitment) from a gender perspective in healthcare professionals. Through the multiple analyses of variance, structural equation models, and multiple-group analyses in a sample of 1420 healthcare professionals from different public and private hospitals in Spain, this study proved the existence of gender differences, with women perceiving higher levels of Compassion. Moreover, this study shows that Compassion partially mediates the relationship between Social Job Resources and Healthy Employees. In addition, Compassion partially mediates the relationship between Social Job Resources and Healthy Organisational Outcomes. Finally, Healthy Employees mediate the positive relationship between Social Job Resources and Healthy Organisational Outcomes. This is an innovative contribution to the limited research examining Compassion towards others as a personal resource that can have a positive impact in the workplace. The results also propose a way to develop and conduct interventions in order to increase Compassion towards others in the healthcare context.

Compassion Competence Among Nursing Students From Different Cultures: A Multinational Study

BACKGROUND

Compassion competence is a nurse's ability to provide patient-centered care and communicate with patients in a sensitive and insightful manner. This descriptive cross-sectional survey study aimed to assess the compassion competence of a multinational group of nursing students.

METHOD

A total of 1,158 undergraduate nursing students participated in this study, and stratified random sampling method was used to select participants from the 100 study level to the 400 or 500 level. Data were collected using the Compassion Competence Scale.

RESULTS

Significant differences were found in students grouped by country of residence, marital status, and level of study. Age had a significant relationship with compassion competence, whereas gender did not. Students had high mean scores on sensitivity to patient needs across all countries.

CONCLUSION

Effective communication skills and insights into patient problems are important aspects of compassion competence, and undergraduate nursing programs should emphasize both of these aspects. [J Nurs Educ. 2022;61(6):289-295.].