Routine, empathic and compassionate patient care: definitions, development, obstacles, education and beneficiaries

Empathy in Wound Care: A Scoping Review of Its Role, Impact, and Barriers to Person-Centred Healing

Empathy plays an important role in delivering healthcare, influencing both patient outcomes and satisfaction. However, its role, impact, and barriers to implementation in wound care remain underexplored. This scoping review aims to synthesise existing literature on empathy in wound care, highlighting its contributions to person-centred healing. Following the Joanna Briggs Institute methodology, a systematic search was conducted across multiple databases in English, French, German and Italian. Eighteen studies published between 1946 and 2024 met the inclusion criteria. The review identified empathy as a fundamental element in wound care, improving adherence to treatment, reducing psychological distress, and enhancing wound healing through physiological and psychological mechanisms. However, systemic challenges including time constraints, lack of training, and resource limitations hinder its consistent application in clinical practise. This review highlights the need for enhanced education, training, and systemic support to integrate empathy into wound care. Future research should focus on developing validated strategies to adopt empathetic care, ensuring a holistic approach to patient management.

Exploring the impact of compassion and leadership on patient safety and quality in healthcare systems: a narrative review

BACKGROUND

Patient safety and healthcare quality are considered integral parts of the healthcare system that are driven by a dynamic combination of human and non-human factors. This review article provides an insight into the two major human factors that impact patient safety and quality including compassion and leadership. It also discusses how compassion is different from empathy and explores the impact of both compassion and leadership on patient safety and healthcare quality. In addition, this review also provides strategies for the improvement of patient safety and healthcare quality through compassion and effective leadership.

METHODS

This narrative review explores the existing literature on compassion and leadership and their combined impact on patient safety and healthcare quality. The literature for this purpose was gathered from published research articles, reports, recommendations and guidelines.

RESULTS

The findings from the literature suggest that both compassion and transformational leadership can create a positive culture where healthcare professionals (HCPs) prioritise patient safety and quality. Leaders who exhibit compassion are more likely to inspire their teams to deliver patient-centred care and focus on error prevention.

CONCLUSION

Compassion can become an antidote for the burnout of HCPs. Compassion is a behaviour that is not only inherited but can also be learnt. Both compassionate care and transformational leadership improve organisational culture, patient experience, patient engagement, outcomes and overall healthcare excellence. We propose that transformational leadership that reinforces compassion remarkably improves patient safety, patient engagement and quality.

Nurses' Professional Quality of Life and Self-Care: A Mixed-Methods Study

BACKGROUND

Improving retention of nurses working in critical care is an urgent priority. Ideas on how to do this abound, but actual data are inconclusive. One common theory is that simply increasing nurse resiliency will minimize turnover.

OBJECTIVE

To determine whether knowledge and application of compassionate self-care practices can significantly improve nurses' professional quality of life and thereby promote their retention.

METHODS

This pilot study had a mixed-methods design. A training program in self-care techniques was implemented in a level IV trauma care secondary hospital, with data collected before and after the intervention by means of written surveys. Study participants were 40 nursing professionals working in an intensive care unit and a medical/surgical unit. The underlying theory was Jean Watson's framework of human caring.

RESULTS

The study results showed that, although the participants evaluated the training program positively and reported improved work-life balance, they did not experience a statistically significant change in professional quality of life from before the intervention to after the intervention.

CONCLUSIONS

The study findings are consistent with current literature indicating that prevention of compassion fatigue and burnout cannot be achieved by the efforts of individuals alone but requires collaboration between professionals and their institutions, with special attention to 3 elements: (1) a healthy work environment, (2) organizational support, and (3) nurse resiliency.

Perceptions of barriers to providing good cat care in Malaysian clinical practices

Many veterinary practices around the world do not meet basic post-operative cat care, thereby compromising cat welfare. Understanding why the appropriate care is not always given is important. The current study used a mixed methods approach of two phases, to investigate the barriers Malaysian veterinarians face in seeking to provide good cat care in practice. Phase 1 involved a survey consisting of 14 questions which were divided into three sections (demographic details, basic management and barriers experienced by practices) and emailed to 143 Malaysian veterinarians. While for phase 2, 20 interviews were undertaken (recruited from the survey sample) to further elaborate on the results. A Thematic Analysis was conducted to extract the main barriers experienced by participants. A total of 49 veterinarians completed the survey. Over half of the respondents were senior veterinarians (i.e. those with two or more years in practice) (53.1%; n = 26) who were aware of the basic environmental provisions that cats need post-surgery such as bedding and toileting facilities (57.1%; n = 28). Cost (47%; n = 23) was the biggest restriction to good care provision. Interview findings showed that participants were aware of comfortable post-surgery environments helping recovery, but barriers were highlighted: workload factors and a lack of understanding of cat pain behaviours and associated stress. This suggested that participants had the knowledge required to provide good cat care but experienced difficulties putting this into practice. Therefore, to improve cat welfare in veterinary practice, instead of focusing purely on education, interventions to increase good cat care could include targeted elements that support behaviour change to overcome the barriers.

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.

Kindness: Definitions and a pilot study for the development of a kindness scale in healthcare

BACKGROUND

Empathy and compassion currently receive the most attention in healthcare with respect to the medical humanities and while these skills are important for any clinician to learn, they are complex and can be daunting to healthcare trainees when first encountered. Kindness is a simple, time-sensitive behavior not yet well characterized in the healthcare setting. With this study, we aim to clearly define it as well as investigate a few common examples of kindness that might be used to create a scale for use in the healthcare setting.

METHODS

A literature search was performed to rigorously define kindness. A kindness scale based on this definition was then compiled and administered to 45 patients across three outpatient clinical settings to evaluate the association between several actions and the patient's perception of kindness.

RESULTS

Kind actions are small, take little effort, and are short in duration to their intended effect. We define kindness as an action that benefits another, as perceived by the recipient of the kind action. The results from our clinical study indicate several actions such as greeting the patient with a smile, asking questions about the patient's daily life, listening carefully, and appearing interested in the patient have a moderate strength correlation to a perception of kindness. The physician being perceived as kind also had a weak-moderate strength correlation to the patient subjectively reporting improvement after their visit.

CONCLUSIONS

Definitions in the medical humanities are important as they guide the scales used to measure them. This article defines kindness and describes some examples of its manifestation in the healthcare setting. Our study indicates that performing kind actions may improve a patient's subjective perception of their care, however, future studies are needed to evaluate whether this benefit extends to health outcomes as has been demonstrated for skills such as empathy and good communication. "Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate." ~Albert Schweitzer.

Evolving Scope of Clinical Empathy in the Current Era of Medical Practice

Clinical empathy is one of the most essential tools of medical practice, and it is an act of correctly acknowledging the emotional state of another without experiencing that state oneself. Empathy comprises four components. Mounting evidence exists to support the use of clinical empathy as a tactic for effective health care. Resolving the multi-fold barriers of clinical empathy is important. Clinical empathy is very important in the current era, and a trust-based relationship in patient care is a way to optimal clinical outcomes that can be achieved through better communication and treatment-compliance plans between health care professionals and patients.

Working in value-discrepant environments inhibits clinicians' ability to provide compassion and reduces well-being: A cross-sectional study

BACKGROUND

The practice of compassion in healthcare leads to better patient and clinician outcomes. However, compassion in healthcare is increasingly lacking, and the rates of professional burnout are high. Most research to date has focused on individual-level predictors of compassion and burnout. Little is known regarding how organizational factors might impact clinicians' ability to express compassion and well-being. The main study objective was to describe the association between personal and organizational value discrepancies and compassion ability, burnout, job satisfaction, absenteeism and consideration of early retirement among healthcare professionals.

METHODS

More than 1000 practising healthcare professionals (doctors, nurses and allied health professionals) were recruited in Aotearoa/New Zealand. The study was conducted via an online cross-sectional survey and was preregistered on AsPredicted (75407). The main outcome measures were compassionate ability and competence, burnout, job satisfaction and measures of absenteeism and consideration of early retirement.

RESULTS

Perceived discrepancies between personal and organizational values predicted lower compassion ability (B = -0.006, 95% CI [-0.01, -0.00], p < 0.001 and f ²  = 0.05) but not competence (p = 0.24), lower job satisfaction (B = -0.20, 95% CI [-0.23, -0.17], p < 0.001 and f ²  = 0.14), higher burnout (B = 0.02, 95% CI [0.01, 0.03], p < 0.001 and f ²  = 0.06), absenteeism (B = 0.004, 95% CI [0.00, 0.01], p = 0.01 and f ²  = 0.01) and greater consideration of early retirement (B = 0.02, 95% CI [0.00, 0.03], p = 0.04 and f ²  = 0.004).

CONCLUSIONS

Working in value-discrepant environments predicts a range of poorer outcomes among healthcare professionals, including hindering the ability to be compassionate. Scalable organizational and systems-level interventions that address operational processes and practices that lead to the experience of value discrepancies are recommended to improve clinician performance and well-being outcomes.

A survey of clinical empathy training at UK medical schools

BACKGROUND

The benefits of enhancing practitioner empathy include better patient outcomes and improved job satisfaction for practitioners. Evidence suggests empathy can be taught and empathy is listed as an outcome for graduates in the General Medical Council requirements. Despite this, empathy training is not mandatory on medical school curricula and the extent to which medical students are given empathy-specific training is unknown.

AIM

To conduct a survey of empathy training currently offered to medical students in UK medical schools.

METHODS

An invitation to participate in an online survey was sent to all UK medical schools (n = 40). The survey was developed through a consultancy and pilot process to ensure validity and reliability. Questions explored what empathy-focused training is offered, and asked educators whether or not they believed that current provision of empathy training is sufficient. In parallel, medical school websites were searched to identify what information regarding empathy-focused training is described as being part of the degree course. Descriptive statistics were used to describe empathy training delivery from the results of the online materials survey and closed survey questions. Thematic analysis was used to explore free text comments.

RESULTS

Response rate was 70% (28/40), with 28 medical schools included in the analysis. Twenty-six schools reported that their undergraduate curriculum included some form of empathy-focused training with variation in what, when and how this is delivered. Thematic analysis revealed two overarching themes with associated sub-themes: (i) empathy-focused training and development (considering where, when and how empathy training should be integrated); (ii) challenges presented by including empathy on the curriculum (considering the system, students and faculty). All schools agreed empathy training should be on the undergraduate curriculum.

CONCLUSION

This is the first nationwide survey of empathy-focused training at UK medical schools. While some form of empathy-focused training appears to be provided on the undergraduate curriculum at most UK medical schools, empathy is rarely specifically assessed. Most medical educators do not feel their school does enough to promote empathy and the majority would like to offer more.

Empathy as a silent art-A doctor´s daily balancing act: A qualitative study of senior doctors' experiences of empathy

Empathy in the doctor-patient relationship is of great importance and has long been considered a true professional virtue for doctors. Despite the general agreement concerning the importance of empathy, there is no consensus regarding the definition of empathy in medical research. While several quantitative studies, measuring empathy as an individual trait, show a decline in empathy among medical students, other studies have shown that empathy is influenced by contextual factors as well as the availability of role models. Therefore, further studies about the transition from medical school to clinical work also including the perspective of senior doctors are needed. The study presented in this article aims to better understand the clinical conditions for empathy through interviews with senior doctors about their lived experience of empathy. Twelve senior doctors, from different specialities were interviewed using a semi-structured approach. The data was analysed using content analysis. The analysis resulted in the main theme: Empathy as a silent art-a doctor`s daily balancing act. This main theme comprised three categories: "A tacit, yet language-dependent process", "A daily balancing act" and "An unsupported path towards mastery". Doctors face many challenges in their daily balancing act between individual and structural conditions that may affect empathy. In order to maintain and further develop empathy, doctors need working conditions allowing for collegial reflection and conversations that promote empathy.

Establishing Empathetic Collaborative Care for Survivors of Violence Through Multidisciplinary Simulation

BACKGROUND

Although nurses are introduced to an array of patient populations in nursing school, how to care for and treat survivors of violence typically does not get the same time and attention. Treating survivors of violence not only includes professional competency, but also empathy and the ability to work collaboratively with multidisciplinary professionals. This article describes a multidisciplinary survivors of violence simulation involving nursing, criminal justice, and psychology students that addresses empathetic and collaborative care for victims of violence.

METHOD

Students participated in sexual assault, domestic violence, and human trafficking simulations. A Socratic debriefing technique with the standardized patient present was used.

RESULTS

Students established positive relationships within their groups through respect and effective communication. Discussions during debriefing indicated students understood the importance of competent, empathetic, collaborative care.

CONCLUSION

This educational initiative suggests the potential to improve multidisciplinary care for victims of violence through simulation. [J Nurs Educ. 2022;61(12):716-719.].

Predictors of Physician Compassion, Empathy, and Related Constructs: a Systematic Review

BACKGROUND

Compassion in healthcare provides measurable benefits to patients, physicians, and healthcare systems. However, data regarding the factors that predict care (and a lack of care) are scattered. This study systematically reviews biomedical literature within the Transactional Model of Physician Compassion and synthesizes evidence regarding the predictors of physician empathy, compassion, and related constructs (ECRC).

METHODS

A systematic literature search was conducted in CENTRAL, MEDLINE, PsycINFO, EMBASE, CINAHL, AMED, OvidJournals, ProQuest, Web of Science, and Scopus using search terms relating to ECRC and its predictors. Eligible studies included physicians as participants. Methodological quality was assessed based on the Cochrane Handbook, using ROBINS-I risk of bias tool for quantitative and CASP for qualitative studies. Confidence in findings was evaluated according to GRADE-CERQual approach.

RESULTS

One hundred fifty-two included studies (74,866 physicians) highlighted the diversity of influences on compassion in healthcare (54 unique predictors). Physician-related predictors (88%) were gender, experience, values, emotions and coping strategies, quality of life, and burnout. Environmental predictors (38%) were organizational structure, resources, culture, and clinical environment and processes. Patient-related predictors (24%) were communication ease, and physicians' perceptions of patients' motives; compassion was also less forthcoming with lower SES and minority patients. Evidence related to clinical predictors (15%) was scarce; high acuity presentations predicted greater ECRC.

DISCUSSION

The growth of evidence in the recent years reflects ECRC's ongoing importance. However, evidence remains scattered, concentrates on physicians' factors that may not be amenable to interventions, lacks designs permitting causal commentary, and is limited by self-reported outcomes. Inconsistent findings in the direction of the predictors' effects indicate the need to study the relationships among predictors to better understand the mechanisms of ECRCs. The current review can guide future research and interventions.

Compassionate nursing care and the use of digital health technologies: A scoping review

BACKGROUND

Compassion is an essential component of quality patient-centered care and a core value in nursing practice. Although much work has been done to enhance nurses' informatics competency, there is limited understanding of how nurses can use, express, and preserve compassion when they use digital health technologies in the provision of patient care.

PURPOSE

This study aimed to explore the nursing literature on how nurses provide compassionate care when they use digital health technologies. A secondary aim was to identify best practices that could be used to guide nursing education and practice toward enhancing compassionate care in digital environment.

METHOD

A scoping review was conducted to address the following research question: What is known about compassionate care in relation to the use of digital health technologies within the nursing literature? A comprehensive search strategy was applied to CINAHL Plus with full text, Ovid Medline, Ovid HealthStar, Embase, APAPsychINFO, Scopus, and ProQuest Dissertations and Theses. In addition, a search of selected organizational websites and a hand search of reference lists of included studies were conducted. The eligibility of articles was determined by two reviewers independently. Descriptive and content analyses were applied. Findings were presented narratively and in a tabular format.

RESULTS

Twenty-eight articles were included in this review. Most of this research was published between 2004 and 2020, using mostly qualitative methods. Narrative results were organized into three themes: 1) evolving understanding of compassionate nursing care in relation to use of digital health technology, 2) compassionate nursing care in relation to the type of digital health technology, and 3) strategies and interventions to improve education and competence relevant to digital health and compassionate nursing care.

CONCLUSION

The use of technology influences how nurses do their work and interact with patients. As advances in digital health continue to evolve, future research should aim to expand understanding of compassion relevant to digital health by articulating its characteristics and associated competencies for nurses to further enhance their ability to provide compassionate care when digital health technologies and services are used to support care delivery.

TWEETABLE ABSTRACT

A scoping review that identified how nurses can provide compassionate nursing care in technologically rich practice environments.

Compassion within an academic setting: Experiences of student nurses

Compassion is fundamental to the delivery of quality nursing care and is an expected core competency that students must achieve to become a registered nurse. Nurse educators have a role in teaching compassion and in cultivating compassionate behaviours, among students, thus this novel study explores the student nurse's experience and understanding of compassion within the academic setting. A qualitative descriptive study using digitally recorded focus group interviews was undertaken with student nurses (n = 32) to explore their experiences of compassion in an academic setting. Data analysis was performed based on Braun and Clarke's framework of thematic analysis. Three themes were identified: students understanding of compassion, students experience of compassion within the academic setting and supporting compassion in an academic space. Student nurses reported their experiences of compassion as predominantly positive. They advocated for further 'space' within the curriculum for more formalised approaches to foster supportive relationships and to improve their experience of compassion within the academic setting. It is important to understand students' perspectives as this can guide teaching practice, organisational policy reform, and future research.

Nurses' perceptions of their supportive role for cancer patients: A qualitative study

Aim

Supporting cancer patients is one of the integral, ethical and professional components and concepts of nursing care. Given the prominence of nurses' understanding of their supportive role in providing quality and humane nursing care for cancer patients, it is crucial for them to acquire sufficient knowledge to achieve a positive attitude towards patient support.

Design

Qualitative conventional content analysis approach was used.

Methods

This study was conducted with a qualitative approach and conventional content analysis in 2020. Participants consisted of 18 nurses of different oncology wards of teaching hospitals in Northwestern Iran recruited using the purposive sampling method. Data were collected through semi‐structured interviews and analysed simultaneously with data collection (22 july ‐ 20 june 2020).

Findings

The analysis of interviews showed that the main theme of “a canopy as a supportive role for cancer patients” was formed. In this theme, related subcategories included patient's psychological support (compassionate care with emotional support, having an intimate/friendly relationship with the patient and communicative behaviour facing patient needs), patient training (need‐based training, having good theoretical knowledge about the patient and having a role model for playing a supportive role for the patient) and supporting the patient with clinical self‐efficacy (being responsible with clinical competency, understanding the patient's behaviour and attempt to provide extra‐duty care).

Compassion Fatigue: Understanding Empathy

In clinical medicine, empathy is considered a central feature of holistic caretaking and successful patient interaction. It is unclear whether characteristics of empathy are innate, learned, or a combination of both. The means to evaluate clinical empathy are ill-defined, but perception of empathy has been shown to influence patient outcomes as well as professional well-being. This article reviews what is known about empathy in a medical setting and how it relates to negative mental health outcomes, such as compassion fatigue.

Learning compassionate care: Experiences of nursing students

Compassion is a core value of the nursing profession which enables nurses to empathize with and help alleviate patient suffering. Literature increasingly reports a lack of compassion in patient care by students and junior nurses; empirical knowledge regarding experiences of compassionate care among nursing students remains understudied. Student experiences in the clinical setting may influence their development of compassion competencies. This study explored the experiences of baccalaureate nursing students in gaining competencies to deliver compassionate care during their clinical practice year. A descriptive qualitative study using semi-structured in-depth interviews was conducted. Thematic analysis was employed, generating six themes. The first three themes depict positive aspects of compassion development, including 'gaining patient acceptance,' 'motivation for professional growth,' and 'establishing an emotional bond with patients.' On the other hand, the other three themes capture the barriers to compassionate care, 'distrust,' 'fear of harm due to violence,' and 'heavy workload.' The positive and negative experiences shared by students indicate that hospital and nursing administrators need to foster a positive practice environment and nursing instructors should become role models to encourage compassionate care.

Exploring the Experience of Healthcare Workers Who Returned to Work After Recovering From COVID-19: A Qualitative Study

Background: To date, a large body of literature focuses on the experience of healthcare providers who cared for COVID-19 patients. Qualitative studies exploring the experience of healthcare workers in the workplace after recovering from COVID-19 are limited. This study aimed to describe the experience of healthcare workers who returned to work after recovering from COVID-19. Methods: This study employed a qualitative descriptive approach with a constructionist epistemology. Data were collected through semi-structured in-depth interviews with 20 nurses and physicians, and thematic analysis was used to identify themes from the interview transcripts. Results: Three major themes about the psychological experiences of healthcare workers who had recovered from COVID-19 and returned to work were identified: (1) holding multi-faceted attitudes toward the career (sub-themes: increased professional identity, changing relationships between nurses, patients, and physicians, and drawing new boundaries between work and family), (2) struggling at work (sub-themes: poor interpersonal relationships due to COVID-19 stigma, emotional symptom burden, physical symptom burden, and workplace accommodations), (3) striving to return to normality (sub-themes: deliberate detachment, different forms of social support in the workplace, and long-term care from organizations). Conclusions: The findings have highlighted opportunities and the necessity to promote health for this population. Programs centered around support, care, and stress management should be developed by policymakers and organizations. By doing this, healthcare workers would be better equipped to face ongoing crises as COVID-19 continues.

Ways of Knowing Compassion: How Do We Come to Know, Understand, and Measure Compassion When We See It?

Over the last decade, empirical research on compassion has burgeoned in the biomedical, clinical, translational, and foundational sciences. Increasingly sophisticated understandings and measures of compassion continue to emerge from the abundance of multidisciplinary and cross-disciplinary studies. Naturally, the diversity of research methods and theoretical frameworks employed presents a significant challenge to consensus and synthesis of this knowledge. To bring the empirical findings of separate and sometimes siloed disciplines into conversation with one another requires an examination of their disparate assumptions about what compassion is and how it can be known. Here, we present an integrated theoretical review of methodologies used in the empirical study of compassion. Our goal is to highlight the distinguishing features of each of these ways of knowing compassion, as well as the strengths and limitations of applying them to specific research questions. We hope this will provide useful tools for selecting methods that are tailored to explicit objectives (methods matching), taking advantage of methodological complementarity across disciplines (methods mixing), and incorporating the empirical study of compassion into fields in which it may be missing.

Delivery of Compassionate Mental Health Care in a Digital Technology-Driven Age: Scoping Review

BACKGROUND

Compassion is a vital component to the achievement of positive health outcomes, particularly in mental health care. The rise of digital technologies may influence the delivery of compassionate care, and thus this relationship between compassion and digital health care needs to be better understood.

OBJECTIVE

This scoping review aimed to identify existing digital technologies being used by patients and health professionals in the delivery of mental health care, understand how digital technologies are being used in the delivery of compassionate mental health care, and determine the facilitators of and barriers to digital technology use among patients and health professionals in the delivery of compassionate mental health care.

METHODS

We conducted this scoping review through a search of Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online (MEDLINE), MEDLINE In-Process and EPub Ahead of Print, PsycINFO, and Web of Science for articles published from 1990 to 2019.

RESULTS

Of the 4472 articles screened, 37 articles were included for data extraction. Telemedicine was the most widely used technology by mental health professionals. Digital technologies were described as facilitating compassionate care and were classified using a conceptual model to identify each digital intersection with compassionate care. Facilitators of and barriers to providing compassionate care through digital technology were identified, including increased safety for providers, health care professional perceptions and abilities, and the use of picture-in-picture feedback to evaluate social cues.

CONCLUSIONS

Implementing digital technology into mental health care can improve the current delivery of compassionate care and create novel ways to provide compassion. However, as this is a new area of study, mental health professionals and organizations alike should be mindful that compassionate human-centered care is maintained in the delivery of digital health care. Future research could develop tools to facilitate and evaluate the enactment of compassion within digital health care.

Delivery of compassionate mental health care in a digital technology-driven age: protocol for a scoping review

INTRODUCTION

As digital technologies become an integral part of mental health care delivery, concerns have risen regarding how this technology may detract from health professionals' ability to provide compassionate care. To maintain and improve the quality of care for people with mental illness, there is a need to understand how to effectively incorporate technologies into the delivery of compassionate mental health care. The objectives of this scoping review are to: (1) identify the digital technologies currently being used among patients and health professionals in the delivery of mental health care; (2) determine how these digital technologies are being used in the context of the delivery of compassionate care and (3) uncover the barriers to, and facilitators of, digital technology-driven delivery of compassionate mental health care.

METHODS AND ANALYSIS

Searches were conducted of five databases, consisting of relevant articles published in English between 1990 and 2019. Identified articles will be independently screened for eligibility by two reviewers, first at a title and abstract stage, and then at a full-text level. Data will be extracted and compiled from eligible articles into a data extraction chart. Information collected will include a basic overview of the publication including the article title, authors, year of publication, country of origin, research design and research question addressed. On completion of data synthesis, the authors will conduct a consultation phase with relevant experts in the field.

ETHICS AND DISSEMINATION

Ethical approval is not required for this scoping review. With regards to the dissemination plan, principles identified from the relevant articles may be presented at conferences and an article will be published in an academic journal with study results. The authors also intend to engage interested mental health professionals, health professional educators and patients in a discussion about the study findings and implications for the future.

“Al-Khabith”—The malignant cunning disease: Sociocultural complexity and social representations of cancer in the occupied Palestinian territory

This qualitative research aims to understand the sociocultural complexity and social representations of cancer in the occupied Palestinian territory. The researcher conducted 16 in-depth semi-structured individual interviews with Palestinians from the occupied Palestinian territory, using thematic analysis as a methodology and social representation theory as the theatrical framework. The findings revealed three main themes. The first theme is social representations of cancer and cancer treatments divided into four subthemes: (1.1) manifestations of dilemmatic indeterminacy and vagueness. The second subtheme (1.2) refers to social representations of cancer in close proximity with death. The third subtheme (1.3) is constituted by metaphorical social representations of cancer, and the fourth (1.4) refers to social re-presentations of cancer. The second theme is the paradoxical social representations of cancer patients as divided into three subthemes: (2.1) pity-based societal responses, (2.2) manifestations of stigma, and (2.3) cancer rumors, a form of collective sense-making. The third theme, religious discourses and social representations of cancer, is divided into three subthemes: (3.1) cancer as predestined by the will of God, (3.2) cancer as a punishment or a trial, and (3.3) a spiritual journey of healing. The implications of this research suggest that social representations research can take a lead in promoting social and health change. The biomedical paradigm alone is failing in Palestine to encounter the sociocultural complexity connected to representations of cancer and its impact on future-health behaviors. Thus, stakeholders and policy-makers in Palestine need to build a mutual interaction between scientific encounters and lay thinking encounters. This requires building community-based health interventions and a sustainable health promotion programs to ensure higher penetration to the social outreach (families, hospital setting, clinics, and schools). To combat ill-health beliefs, stakeholders can benefit from utilization of community participation through creating space for dialogue and debate about cancer and its representations, which accordingly moving towards social and health change.

Defining compassion in the digital health age: protocol for a scoping review

INTRODUCTION

The notion of compassion and compassionate care is playing an increasingly important role in health professional education and in the delivery of high-quality healthcare. Digital contexts, however, are not considered in the conceptualisation of compassionate care, nor is there guidance on how compassionate care is to be exercised while using digital health technologies. The widespread diffusion of digital health technologies provides new contexts for compassionate care, with both opportunities for new forms and instantiations of compassion as well as new challenges. How compassion is both understood and enacted within this evolving, digital realm has not been synthesised.

METHODS AND ANALYSIS

This scoping review protocol follows Arksey and O'Malley's methodology to examine dimensions of compassionate professional practice when digital technologies are integrated into clinical care. Relevant peer-reviewed literature will be identified using a search strategy developed by medical librarians, which applies to six databases of medical, computer and information systems disciplines. Eligibility of articles will be determined using the two-stage screening process consisting of (1) title and abstract scan, and (2) full-text review. Screening, abstracting and charting will be conducted by two independent reviewers, with a third reviewer available for resolution when consensus is not achieved. In order to look at the range of current research in this area, extracted data will be thematically analysed and validated by content experts. Descriptive statistics will be calculated where necessary.

ETHICS AND DISSEMINATION

Research ethics approval and consent to participate is not required for this scoping review. The results of the review will inform resource development and strategy for Associated Medical Services (AMS) Healthcare, a Canadian charitable organisation at the forefront of advancing research and leadership development in health and humanities, as part of the AMS Phoenix Project: A Call to Caring, particularly for digital professionalism frameworks so that they are inclusive of a compassion competency.

Recurrent oral squamous cell carcinoma-incorporating advance care planning in education and practice

This reflection describes a life-limiting case of oral squamous cell carcinoma (SCC) that required thoughtful management facilitated by an advance care plan (ACP). A 70-year-old female was diagnosed with a T4aN2bM0 biopsy-proven invasive, well-differentiated keratinizing SCC. Surgical wide-local excision included teeth #11-16 with left unilateral neck dissection, levels I-V. She was rehabilitated with maxillary obturator prosthesis and underwent chemoradiation therapy. Her course was complicated by dysphagia and trismus. She experienced multiple recurrences. At a certain point, negative margins could not be achieved without facial disfigurement. The patient, her husband, and providers decided together that further management would be palliative. Before the additional surgical procedures, she communicated a thorough ACP with her husband and providers who were prepared to facilitate difficult care decisions on her behalf. The patient passed away at home with hospice care at the age of 74. This motivated patient with oral SCC and impactful postmanagement complications appreciated the clarity of an ACP. Her values and goals of care were incorporated with ongoing communication and documentation of this plan, which was instrumental in facilitating her person-centered care. The providers apply lessons learned here in future practice and education of residents and students.

Assessing the credibility and transferability of the patient compassion model in non-cancer palliative populations

BACKGROUND

A lack of evidence and psychometrically sound measures of compassion necessitated the development of the first known, empirically derived, theoretical Patient Compassion Model (PCM) generated from qualitative interviews with advanced cancer inpatients. We aimed to assess the credibility and transferability of the PCM across diverse palliative populations and settings.

METHODS

Semi-structured, audio-recorded qualitative interviews were conducted with 20 patients with life-limiting diagnoses, recruited from 4 settings (acute care, homecare, residential care, and hospice). Participants were first asked to share their understandings and experiences of compassion. They were then presented with an overview of the PCM and asked to determine whether: 1) the model resonated with their understanding and experiences of compassion; 2) the model required any modification(s); 3) they had further insights on the model's domains and/or themes. Members of the research team analyzed the qualitative data using constant comparative analysis.

RESULTS

Both patients' personal perspectives of compassion prior to viewing the model and their specific feedback after being provided an overview of the model confirmed the credibility and transferability of the PCM. While new codes were incorporated into the original coding schema, no new domains or themes emerged from this study sample. These additional codes provided a more comprehensive understanding of the nuances within the domains and themes of the PCM that will aid in the generation of items for an ongoing study to develop a patient reported measure of compassion.

CONCLUSIONS

A diverse palliative patient population confirmed the credibility and transferability of the PCM within palliative care, extending the rigour and applicability of the PCM that was originally developed within an advanced cancer population. The views of a diverse palliative patient population on compassion helped to validate previous codes and supplement the existing coding schema, informing the development of a guiding framework for the generation of a patient-reported measure of compassion.

Having the "Headspace" for Compassion Toward Self and Others: A Qualitative Study of Medical Students' Views and Experiences

Phenomenon: Debate about compassion exhibited by healthcare professionals has escalated, following a perceived decline over recent years. At the same time, a growing interest in self-compassion has emerged, which is seen as facilitating compassion toward others. Little research has explored, in depth, what compassion to self and others means to medical students. Therefore, a study was designed to address this gap in knowledge.

APPROACH

A qualitative study was conducted, involving students from all 4 years of a graduate-entry medical school in the United Kingdom. Focus groups were used to obtain the views of students on compassion for self and others (patients). Care was taken to achieve variation within the sample in terms of age, gender, and year of study. Focus groups were completed between September and October 2016. An inductive thematic analysis was performed.

FINDINGS

A total of 31 students participated in 4 focus groups, each lasting between 60 and 90 minutes. Having the cognitive freedom-"headspace"-to be aware of and respond to one's own and others' difficulties and distress was identified as an overarching theme within the data. This was underpinned by the themes developed during analysis: (a) bringing humanity into the workplace; (b) compassion as a variable, innate resource; (c) zoning into an individual's current needs; and (d) collective compassion. Students talked about the importance of being adaptable and responsive to situational factors in relation to self-compassion and compassionate care. They also highlighted the contribution of role models in promoting compassion to self and others. Insights: It is important for medical educators to explore ways of enhancing students' compassion to self and others during their training and beyond. Integrating approaches to "well-being" into the curriculum can create opportunities for self-compassion development, but rigid protocols could derail these efforts.

Teaching Empathy: the Implementation of a Video Game into a Psychiatry Clerkship Curriculum

OBJECTIVE

Empathy plays an important role for physicians, but the literature demonstrates that it often deteriorates during medical school. The purpose of this study is to investigate the use of the interactive video game "That Dragon, Cancer" as a tool to teach empathy to third-year medical students.

METHODS

The authors gave a modified, Jefferson Scales of Physician Empathy (JSPE) to 84 third-year medical students in their psychiatry clerkship before and after they played and completed "That Dragon, Cancer" during the 2016-2017 academic calendar year.

RESULTS

The average level of empathy in the students as measured by least squares means of the answers to the truncated JSPE improved after playing through "That Dragon, Cancer" (5.7738 vs 6.2322, p < 0.0001). The majority of students agreed that learning empathy through video games was preferable and more effective than traditional didactics.

CONCLUSIONS

Interactive video games such as "That Dragon, Cancer" may be useful as part of innovative curricula to improve empathy among third-year medical students.

What are healthcare providers' understandings and experiences of compassion? The healthcare compassion model: a grounded theory study of healthcare providers in Canada

BACKGROUND

Healthcare providers are considered the primary conduit of compassion in healthcare. Although most healthcare providers desire to provide compassion, and patients and families expect to receive it, an evidence-based understanding of the construct and its associated dimensions from the perspective of healthcare providers is needed.

OBJECTIVES

The aim of this study was to investigate healthcare providers' perspectives and experiences of compassion in order to generate an empirically derived, clinically informed model.

DESIGN

Data were collected via focus groups with frontline healthcare providers and interviews with peer-nominated exemplary compassionate healthcare providers. Data were independently and collectively analysed by the research team in accordance with Straussian grounded theory.

SETTING AND PARTICIPANTS

57 healthcare providers were recruited from urban and rural palliative care services spanning hospice, home care, hospital-based consult teams, and a dedicated inpatient unit within Alberta, Canada.

RESULTS

Five categories and 13 associated themes were identified, illustrated in the Healthcare Provider Compassion Model depicting the dimensions of compassion and their relationship to one another. Compassion was conceptualised as-a virtuous and intentional response to know a person, to discern their needs and ameliorate their suffering through relational understanding and action.

CONCLUSIONS

An empirical foundation of healthcare providers' perspectives on providing compassionate care was generated. While the dimensions of the Healthcare Provider Compassion Model were congruent with the previously developed Patient Model, further insight into compassion is now evident. The Healthcare Provider Compassion Model provides a model to guide clinical practice and research focused on developing interventions, measures and resources to improve it.

Measuring Compassionate Care: Reliability and Validity of the Greek Version of a Compassionate Care Assessment Tool

This study attempts to fill the gap regarding the adequacy of a compassionate care assessment tool by evaluating the tool for use with Greek patients. The Greek version of the compassionate care assessment tool was developed by using forward and backward translation. The reliability and validity of the measures were investigated in a sample of patients hospitalized in public hospitals in Athens. The internal consistency of the instrument was examined based on Cronbach's α coefficients, and the validity was evaluated by subjecting the items of the instrument to factor analysis. The reliability was found to be acceptable for the instrument as a whole and for each of its subscales. Explanatory and confirmatory factor analysis results were satisfactory, indicating the validity of the tool.

Sympathy, empathy, and compassion: A grounded theory study of palliative care patients' understandings, experiences, and preferences

BACKGROUND

Compassion is considered an essential element in quality patient care. One of the conceptual challenges in healthcare literature is that compassion is often confused with sympathy and empathy. Studies comparing and contrasting patients' perspectives of sympathy, empathy, and compassion are largely absent.

AIM

The aim of this study was to investigate advanced cancer patients' understandings, experiences, and preferences of "sympathy," "empathy," and "compassion" in order to develop conceptual clarity for future research and to inform clinical practice.

DESIGN

Data were collected via semi-structured interviews and then independently analyzed by the research team using the three stages and principles of Straussian grounded theory.

SETTING/PARTICIPANTS

Data were collected from 53 advanced cancer inpatients in a large urban hospital.

RESULTS

Constructs of sympathy, empathy, and compassion contain distinct themes and sub-themes. Sympathy was described as an unwanted, pity-based response to a distressing situation, characterized by a lack of understanding and self-preservation of the observer. Empathy was experienced as an affective response that acknowledges and attempts to understand individual's suffering through emotional resonance. Compassion enhanced the key facets of empathy while adding distinct features of being motivated by love, the altruistic role of the responder, action, and small, supererogatory acts of kindness. Patients reported that unlike sympathy, empathy and compassion were beneficial, with compassion being the most preferred and impactful.

CONCLUSION

Although sympathy, empathy, and compassion are used interchangeably and frequently conflated in healthcare literature, patients distinguish and experience them uniquely. Understanding patients' perspectives is important and can guide practice, policy reform, and future research.

Compassionate communication in acute healthcare: establishing the face and content validity of a questionnaire

The National Health Service is committed to measuring the quality of nursing care through adopting a number of indicators which are not nationally standardised. Compassionate communication is one indicator, but it is unclear how this is assessed or demonstrated in practice. This is primarily a methodological paper which aims to establish the face and content validity of a questionnaire to measure nurses’ non-verbal methods of compassionate communication with patients in acute healthcare. An existing questionnaire was amended to meet the study’s requirements. A ‘lay expert sample’ was used to rate the face validity and a ‘research expert sample’ to rate the content validity of the instrument. Modification of one response and adding instructions on how to complete the questionnaire meant that Version 2 potentially has high face validity. The questionnaire demonstrated excellent content validity (Scale-Content Validity Index = 0.85). Recommendations include pilot testing to further investigate the construct of non-verbal compassionate communication in an acute healthcare context. This research can be used to inform the measurement of compassionate communication and promote standardisation nationally.

Professionalism, professionalization, expertise and compassion: a qualitative study of medical residents

BACKGROUND

Formal and informal medical curricula convey expectations about professionalization, that is, the development of physician identity, and also about professionalism. This study examined whether, in general, junior residents experienced any dissonance between these roles and focused particularly on how they negotiated conflicts between compassion, self-care, duty and medical expertise.

METHODS

In 2015, purposive sampling was used to select 21 first-year residents at a Canadian medical school. Participants listened to a 5-min audio-recording narrated in either male or female voice. Facing compassion fatigue after three obstetrical disasters over less than 2 days the resident narrator asks to go home. Participants reacted in writing to questions about this request and relevant teaching/modelling. Responses were analyzed using a qualitative, exploratory, thematic research design.

RESULTS

Four themes were identified: i) empathy, self-doubt and fear of weakness, ii) the need for support from and communication with physicians and others, iii) education received, and iv) professionalization outranks professionalism. Participants agreed that under the circumstances the narrator's care, compassion and request were appropriate. Never the less, many grappled with feeling that asking to be relieved of work demonstrated weakness and a shirking of responsibility. Respondents had received no formal teaching about balancing compassion for patients or self with professional duty. Preceptors' informal teaching and modeling valorized scientific disengagement above all else. What emerged was participants' drive to become detached clinicians who set aside emotional responses and interactions that could impede and be incompatible with professionalization. However, participants also recognized and lamented what was lost in such a transformation.

CONCLUSION

In the transition from student to practitioner, trainees' views and the modeling they receive shift emotion and compassion, whether for self or patients, from assets to liabilities as they aim to be invincible medical experts.

Compassion fatigue: A meta-narrative review of the healthcare literature

BACKGROUND

Compassion fatigue describes a work-related stress response in healthcare providers that is considered a 'cost of caring' and a key contributor to the loss of compassion in healthcare.

OBJECTIVE

The purpose of this review was to critically examine the construct of compassion fatigue and to determine if it is an accurate descriptor of work-related stress in healthcare providers and a valid target variable for intervention.

DESIGN

Meta-narrative review.

DATA SOURCES

PubMed, Medline, CINAHL, PsycINFO, and Web of Science databases, Google Scholar, the grey literature, and manual searches of bibliographies.

REVIEW METHODS

Seminal articles and theoretical and empirical studies on compassion fatigue in the healthcare literature were identified and appraised for their validity and relevance to our review. Sources were mapped according to the following criteria: 1) definitions; 2) conceptual analyses; 3) signs and symptoms; 4) measures; 5) prevalence and associated risk factors; and 6) interventions. A narrative account of included studies that critically examines the concept of compassion fatigue in healthcare was employed, and recommendations for practice, policy and further research were made.

RESULTS

90 studies from the nursing literature and healthcare in general were included in the review. Findings emphasized that the physical, emotional, social and spiritual health of healthcare providers is impaired by cumulative stress related to their work, which can impact the delivery of healthcare services; however, the precise nature of compassion fatigue and that it is predicated on the provision of compassionate care is associated with significant limitations. The conceptualization of compassion fatigue was expropriated from crisis counseling and psychotherapy and focuses on limited facets of compassion. Empirical studies primarily measure compassion fatigue using the Professional Quality of Life Scale, which does not assess any of the elements of compassion. Reported risk factors for compassion fatigue include job-related factors, fewer healthcare qualifications and less years experience; however, there is no research demonstrating that exemplary compassionate carers are more susceptible to 'compassion fatigue'.

CONCLUSION

In the last two decades, compassion fatigue has become a contemporary and iconic euphemism that should be critically reexamined in favour of a new discourse on healthcare provider work-related stress.

Embedding compassionate care in local NHS practice: developing a conceptual model through realistic evaluation

The aim of this study was to critically analyse the impact of the ‘Leadership in Compassionate Care Programme’ and offer a conceptual model of factors that can embed compassionate care in contemporary health care environments. This three-year initiative (2008–2011) was designed to embed compassionate care in both practice and pre-registration education. Using a realistic evaluation approach this longitudinal qualitative study involved data collection in eight participating wards. The ‘level of adoption’ of the Programme varied across the wards, which pointed to key context and mechanisms that were influential in embedding compassionate care. Contextual factors that promoted adoption of the Programme were stability, support and leadership. The most important mechanisms were appreciative inquiry coupled with skilled facilitation. Powerful practice development techniques focused on articulating and demonstrating values; giving patients, relatives and staff a voice to express their experiences and emotions; and instituting effective feedback mechanisms. In the high adopting wards the main outcomes included personalisation of patient care, an increased sense of involvement for relatives and ‘caring conversations’ becoming an accepted part of working practice. Embedding and sustaining compassionate care demands strategic vision and investment in a local infrastructure that supports relationship-centred care, practice development and effective leadership at all levels.

Compassion: a scoping review of the healthcare literature

BACKGROUND

Recent concerns about suboptimal patient care and a lack of compassion have prompted policymakers to question the preparedness of clinicians for the challenging environment in which they practice. Compassionate care is expected by patients and is a professional obligation of clinicians; however, little is known about the state of research on clinical compassion. The purpose of this scoping review was to map the literature on compassion in clinical healthcare.

METHODS

Searches of eight electronic databases and the grey literature were conducted to identify empirical studies published over the last 25 years. Eligible studies explored perceptions or interventions of compassionate care in clinical populations, healthcare professionals, and healthcare students. Following the title and abstract review, two reviewers independently screened full-texts articles, and extracted study data. A narrative approach to synthesizing and mapping the literature was used.

RESULTS AND DISCUSSION

Of 36,637 records, 648 studies were retrieved and 44 studies were included in the review. Less than one third of studies included patients. Six themes emerged from studies that explored perceptions of compassionate care: nature of compassion, development of compassion, interpersonal factors related to compassion, action and practical compassion, barriers and enablers of compassion, and outcomes of compassion. Intervention studies included two compassionate care trials with patients and eight educational programs that aimed to improve compassionate care in clinicians and students.

CONCLUSIONS

This review identifies the limited empirical understanding of compassion in healthcare, highlighting the lack of patient and family voices in compassion research. A deeper understanding of the key behaviors and attitudes that lead to improved patient-reported outcomes through compassionate care is necessary.