Compassionate nursing professionals as good citizens of the world

Training in Cultural Competence for Mental Health Care: A Mixed-Methods Study of Students, Faculty, and Practitioners from India and USA

Although the need to train clinicians to provide effective mental health care to individuals from diverse backgrounds has been recognized worldwide, a bulk of what we know about training in cultural competence (CC) is based on research conducted in the United States. Research on CC in mental health training from different world populations is needed due to the context-dependent nature of CC. Focusing on India and USA, two diverse countries that provide complementary contexts to examine CC, we explored graduate students', practicing clinicians', and faculty members' perspectives regarding CC training they received/provided and future training needs using mixed-methods. The data were collected using focus groups (n = 25 groups total: 15 in India, 11 in USA), and a survey (n = 800: 450 in India, 350 in USA). Our data highlight the salient social identities in these countries, and the corresponding constituents of CC training. Participants in India described a practical emphasis to their CC training (e.g., learning about CC through life experiences and clinical practice experiences) more so than through coursework, whereas participants in USA described varying levels of coursework related to CC along with practice. Participants in both countries considered enormity of CC as a challenge, while those in the US also identified CC training limited to a white, straight, male perspective, hesitancy in engaging with diversity topics, and limited time and competence of the faculty. Strengths of CC training in India and USA are mutually informative in generating recommendations for enhancing the training in both countries.

Investigating the effect of seeing patients' pre-burn face photo on the quality of care and level of empathy of nurses with patients admitted to BICU

BACKGROUND

One of the results of burn injuries is the appearance of scars and deformities in various organs of the body, which can cause many physical and psychological challenges to burn patients. Lack of proper communication between nurse and patient leads to inaccurate identification of psychological and social needs of these patients and thus affects the quality of care.

AIM

This study aimed to investigate the effect of seeing the patient's pre-burn face photo on the quality of care and empathy of nurses with patients admitted to the burn intensive care unit.

METHODS

The present study is a quasi-experimental interventional study conducted on 26 Burn Intensive Care Unit (BICU) nurses who were selected by census sampling method in 2018. Data were collected through QUALPAC Nursing Care Quality Questionnaire, Lumonica Empathy Questionnaire and Demographic Questionnaire, which were completed by nurses before and after the intervention. Pre-burn photos of patients with facial burns were displayed at the nursing station for one month and the data were compared before and after the intervention. Descriptive statistics and paired t-test and independent t-test, Mann-Whitney and Pearson correlation tests were used to analyze the data.

FINDINGS

The results of present study showed that there was a statistically significant difference between the quality of nursing care (p = 0.001) and its psychological dimension (p < 0.001) before and after the intervention in the group of nurses. However, no significant relationship was found between nurses' empathy with patients before (p = 0.901) and after intervention (p = 0.001).

CONCLUSION

Seeing the photo of the patient's pre-burn face and establishing a relationship between the nurse and the patient had an effect on the quality of nursing care and especially its psychological dimension. However, in order to generalize the results and implement this low-cost, convenient and low-complication intervention for all patients admitted to the intensive care unit, more studies are needed in this field.

Contextual Facilitators and Maintaining of Compassion-Based Care: An Ethnographic Study

BACKGROUND

Compassion is an important part of nursing. It fosters better relationships between nurses and their patients. Moreover, it gives patients more confidence in the care they receive. Determining facilitators of compassion are essential to holistic care. The purpose of this study was to explore these facilitators.

MATERIALS AND METHODS

This ethnographic study was conducted in 2014-2015 with 20 nurses, 12 patients, and 4 family members in the medical and surgical wards. Data collection was done through observations and in-depth semi-structured interviews with purposive sampling. The study was carried out in 15 months. Data analysis was performed using constant comparison based on Strauss and Corbin.

RESULTS

Data analysis defined three main themes and eight subthemes as the fundamentals of compassion-based care. Nurses' personal factors with subcategories of personality, attitudes, and values and holistic view; and socio-cultural factors with subcategories of kindness role model, religious, and cultural values are needed to elicit compassionate behaviors. Initiator factors, with subcategories of patient suffering, patient communication demands, and patient emotional and psychological necessity are also needed to start compassionate behaviors.

CONCLUSIONS

The findings of this study showed that nurses' communication with patients is nurse's duty in order to understand and respect the needs of patients. Attention should be paid to issues relating to compassion in nursing and practice educational programs. Indeed, creating a care environment with compassion, regardless of any shortcomings in the work condition, would help in the development of effective nursing.

Measuring compassion in nurses and other healthcare professionals: An integrative review

BACKGROUND

Compassion is an essential part of nursing practice. However recent high profile public inquiries have uncovered failings in the NHS and revealed a need for nursing education to assure that both undergraduate and postgraduate healthcare professionals receive training in compassion.

OBJECTIVES

The aim of this study was to review how compassion is being measured in nurses and other healthcare professionals.

REVIEW METHODS

An integrative review methodology was used. The literature was searched systematically, using electronic databases, internet searches, recommendations by experts in the field, and manual searches.

RESULTS

Six papers on measuring compassion in healthcare were included in the final analysis. Several overarching themes were identified as the main elements of compassion being measured. These included: being empathetic, recognising and ending suffering, being caring, communicating with patients, connecting to and relating with patients, being competent, attending to patients needs/going the extra mile, and involving the patient.

CONCLUSIONS

Further research is needed to develop and test tools that nurse and healthcare educators can use to assess the levels of compassion in their undergraduate and postgraduate students, as well as making this available to qualified nurses in practice.

Islamic Values and Nursing Practice in Kuwait

Purpose:This qualitative study sought to illuminate the perception among Muslim nurses in Kuwait of the role of Islamic values on their nursing practice. Design: Ethnography, specifically Leininger’s small scale ethnonursing design, guided the study. Method: Eighteen male and female Muslim nurses from five countries, who were working as nurses in Kuwait, were interviewed. The interviews were transcribed and examined for themes. Findings: Seven themes emerged (1) altruistic relationships as a core value; (2) all care as spiritual care; (3) desire for greater understanding and respect as nurses and as Muslims; (4) professional kinship that transcends culture, religion, and nationality; (5) nursing ethics from divine ethics; (6) religious teachings promoting health; (7) radical acceptance of God’s will, balanced with hope of reward. Conclusions: The centrality of the value altruism to nursing care from the Islamic perspective and the apparent seamless integration of care of the spirit with care of the body were significant findings consistent with the literature. The deep longing to be better understood, both as nurses and as Muslims, speaks to needed public education across the spectrum of religious belief and needed strengthening of professional kinship.

Global health competencies according to nursing faculty from Brazilian higher education institutions

OBJECTIVES

to identify the agreement of faculty affiliated with Brazilian higher education institutions about the global health competencies needed for undergraduate nursing students' education and whether these competencies were covered in the curriculum offered at the institution where they were teaching.

METHOD

exploratory-descriptive study, involving 222 faculty members who answered the Brazilian version of the "Questionnaire on Core Competencies in Global Health", made available electronically on the website Survey Monkey.

RESULTS

participants predominantly held a Ph.D. (75.8%), were women (91.9%) and were between 40 and 59 years of age (69.3%). The mean and standard deviation of all competencies questioned ranged between 3.04 (0.61) and 3.88 (0.32), with scores for each competency ranging from 1 "strongly disagree" to 4 "strongly agree". The results demonstrated the respondents' satisfactory level of agreement with the global health competencies.

CONCLUSIONS

the study demonstrated a high mean agreement level of the nursing faculty from Brazilian HEI with the global health competencies in the questionnaire. The curricula of the HEI where they teach partially address some of these. The competencies in the domain "Globalization of health and health care" are the least addressed.

Cultural competence in health care: an emerging theory

This study examined the current state of cultural competence in health care using a qualitative descriptive design. Interviews were conducted with 20 multidisciplinary experts in culture and cultural competence from the United States and abroad. Findings identified 3 themes; awareness, engagement, and application that crossed 4 domains of cultural competence; intrapersonal, interpersonal, system/organization, and global.

In Real Time: Exploring Nursing Students’ Learning during an International Experience

Nursing education has increasingly turned to international learning experiences to educate students who are globally minded and aware of social injustices in local and global communities. To date, research with international learning experiences has focused on the benefits for the students participating, after they have completed the international experience. The purpose of this qualitative study was to explore how nursing students learn during the international experience. The sample consisted of eight nursing students who enrolled in an international learning experience, and data were collected in “real time” in Zambia. The students were observed during learning activities and were interviewed three times. Three major themes emerged from the thematic analysis: expectations shaped students’ learning, engagement facilitated learning, and critical reflection enhanced learning. Implications are discussed, related to disrupting media representations of Africa that shape students’ expectations, and educational strategies for transformative learning and global citizenship.

Caring about caring: developing a model to implement compassionate relationship centred care in an older people care setting

AIM

This study actively involved older people, staff and relatives in agreeing a definition of compassionate relationship-centred care and identifying strategies to promote such care in acute hospital settings for older people. It was a major component of a three year programme (the Leadership in Compassionate Care Programme, LCCP) seeking to integrate compassionate care across practice and educational environments.

BACKGROUND

Compassionate caring and promoting dignity are key priorities for policy, practice and research worldwide, being central to the quality of care for patients and families, and job satisfaction for staff. Therapeutic relationships are essential to achieving excellence in care but little is known about how to develop and sustain such relationships in a culture that increasingly focuses on throughput and rapid turnover.

APPROACH AND METHODS

The study used appreciative inquiry and a range of methods including participant observation, interviews, story telling and group discussions to actively engage older people, relatives and staff. A process of immersion crystallization was used to analyze data with staff as co-analysts.

FINDINGS

The study adds considerably to the conceptualization of compassionate, relationship-centred care and provides a model to aid staff deliver such care in practice, based on 'appreciative caring conversations' that enable all parties to gain two forms of 'person and relational knowledge' about 'who people are and what matters to them' and 'how people feel about their experience'. Such knowledge enables staff, patients and carers to 'work together to shape the way things are done'. The study generated a model called the 7 'C's that captures in detail the factors necessary to promote 'appreciative caring conversations'.

CONCLUSIONS AND IMPLICATIONS

The study demonstrates that engaging in 'appreciative caring conversations' promotes compassionate, relationship-centred care but that these conversations involve practitioners taking risks. Such 'relational practices' must therefore be valued and accorded status. Staff require appropriate support, facilitation and strong leadership if these practices are to flourish.

The relevance of globalization to nursing: a concept analysis

BACKGROUND

This paper emerged alongside the development of learning materials for a new unit of study on global health and nursing. The proposed unit was for inclusion in a graduate entry master of nursing course leading to registration. It became evident that there has been growing attention within the nursing literature to the demands of an increasingly globalized world and the subsequent challenges confronting nursing as a profession. At the same time, the literature is inconsistent and contains mixed messages with regard to how nurses and nursing might respond to these challenges.

AIM

This paper aims to (i) present the findings of a narrative analysis of the current nursing discourse on globalization, and (ii) to identify directional cohesiveness for the nursing profession in the seemingly disparate literature.

METHOD

Concept analysis following extensive literature review.

FINDINGS

Several nursing authors argue that nurses globally are increasingly sharing concerns expressed by nurses at a local level. Concerns such as the future sustainability of the profession and more specifically practice concerns such as the continuing failure of nurses to adequately deal with social justice issues requires careful consideration by every nurse. While strategies recommended for dealing with these concerns lack a cohesive thread, some interesting themes and innovative recommendations have emerged. For example, the need for nurses to consider replacing environmental considerations with ecological considerations and that nurses consider preventative nursing practice beyond the immediate needs of clients and from a more global perspective.

Application of the M technique to two severely disabled children in Belarus

Following the early-morning explosion of reactor four at the Chernobyl nuclear plant on 26 April 1986, radioactive fallout fell over 80% of Belarus. More than 2.2 million people were affected, including thousands of children. As a result, there are now over 50,000 children in 600 orphanages in Belarus. Many of the orphanages are without basic amenities and are operating in dire circumstances. This article outlines two case studies of orphaned children with profound disabilities in one of these orphanages. The first author, a nurse volunteer from Ireland, used a method of touch called the 'M technique' to calm and soothe the children. The M technique is a gentle repetitive method of touch that can be learnt in a few hours. The results suggest that even when the situation appears very challenging, simple touch can have a beneficial effect.

Nurse migration in an increasingly interconnected world: the case for internationalization of regulation of nurses and nursing regulatory bodies

Psychiatric/Mental Health nursing has a long history of professional self-regulation; nevertheless, interest in how governments protect consumers of health care from poor or dangerous practice(s) is on the increase. Correspondingly, there have been calls, in several parts of the world, for greater watchfulness and due diligence from regulatory bodies. Mindful of the concept of "globalization" and the unequivocal data regarding the significant increase in the migration of nurses, it is difficult to ignore/deny the reality of an increasingly mobile and connected international nursing workforce. However, the extant literature also indicates the existence of significant disparities between countries and even states/provinces within countries as to the enforcement of professional regulation. What this means is that decisions made by one regulatory body can have a direct impact on the standard(s) of nursing quality and practice in a country on the opposite side of the world. As a result, the authors attempt to advance the debate that there is a clear need to reconcile these positions, and they introduce the argument for the creation of an international oversight body. Using case study material, the relevant theoretical and policy literature in this area (such as it is), and by drawing on examples of analogous oversight bodies from other areas, we draw attention to the need to create a genuinely international body for the oversight of nurse regulation.

Enhancing nursing knowledge through democratic cross-national collaboration

Enhancing nursing knowledge requires the exchange of ideas worldwide through the collaboration of nurse scientists. Healthy partnerships abide by the values of collaboration, mutual trust, respect and dignity. However, a lack of information exists regarding the nature of cross-national academic partnerships in nursing. The purpose of this article is twofold: to explore democratic cross-national collaborations in nursing and to pose theoretically-based interventions to enhance future democratic collaborations cross-nationally in nursing. While a review of the literature revealed some model nursing partnerships, nursing can benefit from having a better evidence based understanding of the topic. Theoretical formulations from education, philosophy and critical anthropology offer complementary lenses to aid in the analysis. The process can help nursing academics to think more critically about the issues and to delineate theory driven protocols for democratic cross-national collaboration with the ultimate aim of enhancing nursing knowledge.

The importance of being humble

Scholarly work in philosophy, positive psychology, and other applied disciplines reconceptualize humility as an important element of reflection, change, and growth, but the change has not been mirrored in the nursing literature. Humility has a rich heritage and may be an implicit but fundamental construct in nursing. The value of humility for nursing education and practice rests in its conceptual basis for strategies that are currently being used. It is on the ground of humility that self-reflection, response to weaknesses and accomplishments, and our orientation to relationships should rest.

Linking global citizenship, undergraduate nursing education, and professional nursing: curricular innovation in the 21st century

As we move into the 21st century, our roles as nurses are becoming more complex. Inequities in health within and across nations demand that nursing students examine the interconnectedness between local and global health challenges and contribute to the development and implementation of solutions to these challenges. In this article, we examine concepts related to global citizenship, globalization, social responsibility, and professionalism and link them to curricular innovation in nursing education. We argue that the development of global citizenship is a fundamental goal for all nursing students and that to achieve this, nurse educators must move beyond the creation of international placement opportunities or the use of global examples within existing courses. Nurse educators must develop strategies and design innovative curricula to provide opportunities for all students to become engaged with the concept of global citizenship and the role of nurses in a global world.

Identifying ethical issues from the perspective of the registered nurse

A review of the formal ethics consultations performed at a rural academic medical center during 2006 revealed that only 5 of 72 consultations were initiated by nurses. A descriptive exploratory convenience study used a 3-item survey to collect information from registered nurses who provide direct patient care at the rural academic medical center. The purpose of this study was to (1) identify and describe the ethical issues perceived by registered nurses employed at a rural academic medical center and (2) analyze the variables influencing the registered nurses' ethical decision making and the process used by these registered nurses when resolving ethical issues.The 17 registered nurses who completed the survey identified a total of 21 ethical issues that they had experienced during the last year. The ethical issues that nurses recalled were significantly more likely to be relationship issues, whereas issues documented within the ethics consultation service were significantly more likely to involve limiting treatment. Communication was a major variable influencing nurse's ethical decision making. Nurses felt the ethical issue resolved satisfactorily when the patient's needs were met, communication occurred with the patient and/or family, the entire healthcare team was involved and in agreement, and there was sufficient time available to make a decision. The nurses did not feel that the ethical situation was resolved satisfactorily when not handled from the patient's perspective; the patient suffered; there was a lack of teamwork, agreement, and/or support; and the process took too long. The nurses' recommendations for resources needed to assist with the resolution of ethical issues included accessible ethics mechanisms, education, improved interprofessional relationships and collaboration, and unbiased support for patient and family decision making. Implications for nurse managers are discussed and future research questions are identified.

Patients’ Transcultural Needs and Carers’ Ethical Responses

Many Turkish people migrated to Germany between 1955 and 1975. This study was carried out in Göttingen, Germany. Fifty Turkish people (described as patients) were asked about the care they had received from German health care personnel, and 50 German nurses and 50 German physiotherapists were questioned about care they had given to Turkish patients. Significant findings were the needs of the Turkish patients for good communication, physical contact and understanding of their culture-based expressions of illness. The German nurses and physiotherapists expressed the need for language barriers to be minimized and for education in the specific culture of Turkish patients. Our findings are discussed from an ethical viewpoint. The International Council of Nurses’ code of ethics is used to guide the ethical debate about the findings within the context of transcultural and multicultural care. Suggestions for better transcultural health care paradigms are made for relating to patients from different cultures when patients and care providers have little understanding of each other’s needs and expectations.

Compassionate Care

Compassion may be nursing's most precious asset, yet the concept of compassion (or compassionate care) remains notably absent from nursing scholarship and the practicalities related to contemporary care delivery models. The provision of compassionate care is more than a professional mandate or an attribute of a model expressed in theoretical terms; it is the result of an authentic bond between a nurse and a patient. A concept analysis using Walker and Avant's methodology is employed using compassionate care as the virtue that allows a nurse to enter into the pain, suffering, and adversities a patient experiences as a way of establishing a meaningful connection.

Towards a viable and just global nursing ethics

Globalization, an outgrowth of technology, while informing us about people throughout the world, also raises our awareness of the extreme economic and social disparities that exist among nations. As part of a global discipline, nurses are vitally interested in reducing and eliminating disparities so that better health is achieved for all people. Recent literature in nursing encourages our discipline to engage more actively with social justice issues. Justice in health care is a major commitment of nursing; thus questions in the larger sphere of globalization, justice and ethics, are our discipline's questions also. Global justice, or fairness, is not an issue for some groups or institutions, but a deeper human rights issue that is a responsibility for everyone. What can we do to help reduce or eliminate the social and economic disparities that are so evident? What kind of ethical milieu is needed to address the threat that globalization imposes on justice and fairness? This article enriches the conceptualization of globalization by investigating recent work by Schweiker and Twiss. In addition, I discuss five qualities or characteristics that will facilitate the development of a viable and just global ethic. A global ethic guides all people in their response to human rights and poverty. Technology and business, two major forces in globalization that are generally considered beneficial, are critiqued as barriers to social justice and the common good.

Globalization, commodification and mass transplant of nurses: Part 1

This two-part article examines the mass transplantation of nurses within the context of globalization. Part one focused on the international data regarding the global shortage of nurses, the increase in nurse migration from 'underdeveloped' to 'Western' countries, definitions and descriptions of global health and summarized the debate so far, such as it is. Part two draws attention to how this group of migrating nurses is more often than not comprised disproportionately of women and accordingly, draws on critical feminist ideas to demonstrate how such mass transplantation of nurses adds to the idea of women as a commodity. It then draws attention to other similar examples of the commodification of women and highlights the impacts of the loss of this labour force on the 'exporting' countries. The article concludes by joining with others who have proffered constructive suggestions for addressing this problem.

Naming of depression: nursing, social and personal descriptors

This paper explores descriptors of depression and begins by exploring nursing descriptors including the nature of assessment and nursing diagnosis and progresses to underpin these major processes by considering social descriptors such as cultural and spiritual constructs. The role and influence of stigma is discussed and an examination of gender influences and experiences is undertaken. The paper concludes by examining personal descriptors in the literature. The overall aim of the paper is (1) to add to nursing knowledge by depicting the grounded realities of the experience of depression and (2) stimulate discussion on the need to provide holistic care pathways that are responsive to the uniqueness of this lived experience and finally to (3) encourage further research on key psycho-social factors associated with depression and the concurring advancement of nursing care. This paper has been completed in the context of an ongoing study into the grounded experience of 'Depression' and the development of a psychiatric nursing theory of connectivity.