Compassion: a critical review of peer-reviewed nursing literature

Implementing interventions to improve compassionate nursing care: A literature review

AIM

To identify strategies which support the implementation of interventions to promote compassionate nursing care with a focus on interventions designed to support improved patient outcomes and/or patient experience in acute hospitals.

METHODS

An integrative review using the PRISMA guidelines and a 5-stage framework consisting of problem identification, literature search, data evaluation, data analysis and presentation. CINAHL, Embase, Medline, PsychInfo and Web of Science were systematically searched using key search terms. Hand searches were conducted of the reference lists of eligible articles and searching key journals.

RESULTS

Six articles met the inclusion criteria with six different interventions described. A thematic analysis of the findings identified three key themes relating to the implementation of interventions which promote compassionate nursing care: (1) the importance of evidence; (2) support for nursing development; and (3) planning for and leading implementation.

CONCLUSION

Compassionate care improves quality of life, the hospital experience and overall recovery. Strong nursing leadership and a supportive team environment are facilitators for delivery of compassionate care in acute settings. Excessive workload, overly rigid reporting and organisational indifference are barriers to delivery of compassionate care.

IMPLICATIONS FOR NURSING POLICY

Health policy is used to inform the systematic implementation and delivery of patient care informed by best evidence. Health setting, environment and culture are important facets of the implementation of a compassionate care framework. Furthermore, nurse engagement, teamwork and nurse leadership are key facilitators for delivery of compassionate care in acute hospital settings. These findings need to be taken into consideration by policy makers and nursing leaders when designing and implementing compassionate care interventions.

IMPLICATIONS FOR NURSING POLICY

Implementing interventions to improve compassionate nursing care can be challenging. This review identified the factors which should be considered by policy makers when implementing these interventions systematically throughout the healthcare system.

Current nursing and midwifery contribution to leading digital health policy and practice: An integrative review

AIM

To review the current nursing and midwifery contribution to leading digital health (DH) policy and practice and what facilitates and/or challenges this.

DESIGN

Integrative literature review.

METHODS

Pre-defined inclusion criteria were used. Study selection and quality assessment using the appropriate critical appraisal tools were undertaken by two authors, followed by narrative synthesis.

DATA SOURCES

Six databases and hand searching for papers published from 2012 to February 2024.

FINDINGS

Four themes were identified from 24 included papers. These are discussed according to the World Health Organization's Global Strategic Directions for Nursing and Midwifery and indicate nurses/midwives are leading DH policy and practice, but this is not widespread or systematically enabled.

CONCLUSION

Nurses and midwives are ideally placed to help improve health outcomes through digital healthcare transformation, but their policy leadership potential is underused.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

Nurses/midwives' DH leadership must be optimized to realize maximum benefit from digital transformation. A robust infrastructure enabling nursing/midwifery DH policy leadership is urgently needed.

IMPACT

This study addresses the lack of nursing/midwifery voice in international DH policy leadership. It offers nurses/midwives and health policymakers internationally opportunity to: drive better understanding of nursing/midwifery leadership in a DH policy context; enhance population outcomes by optimizing their contribution; Develop a robust infrastructure to enable this.

REPORTING METHOD

Reporting adheres to the EQUATOR network, Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

PATIENT OR PUBLIC CONTRIBUTION

No patient or public contribution.

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

AIMS AND OBJECTIVES

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

BACKGROUND

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

DESIGN

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

METHOD

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

FINDINGS

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

CONCLUSIONS

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

RELEVANCE TO CLINICAL PRACTICE

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

NO PATIENT OR PUBLIC CONTRIBUTION

This systematic review had no patient or public contribution.

Implementing Sensitivity and Contingency in Medical Contexts: The Case of Prematurity

In the context of relational situations, sensitivity and contingency are identified as pivotal variables that contribute to the enhancement of patients' overall wellbeing [...].

Compassion, emotions and cognition: Implications for nursing education

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

Nurse practitioners on 'the leading edge' of medication abortion care: A feminist qualitative approach

AIMS

To explore nurse practitioners' experiences of medication abortion implementation in Canada and to identify ways to further support the implementation of medication abortion by nurse practitioners in Canada.

DESIGN

A qualitative approach informed by feminist theory and integrated knowledge translation.

METHODS

Qualitative interviews with stakeholders and nurse practitioners between January 2020 and May 2021. Data were analysed using critical feminist theory.

RESULTS

Participants included 20 stakeholders, 16 nurse practitioner abortion providers, and seven nurse practitioners who did not provide abortions. We found that nurse practitioners conduct educational, communication and networking activities in the implementation of medication abortion in their communities. Nurse practitioners navigated resistance to abortion care in the health system from employers, colleagues and funders. Participants valued making abortion care more accessible to their patients and indicated that normalizing medication abortion in primary care was important to them.

CONCLUSION

When trained in abortion care and supported by employers, nurse practitioners are leaders of abortion care in their communities and want to provide accessible, inclusive services to their patients. We recommend nursing curricula integrate abortion services in education, and that policymakers and health administrators partner with nurses, physicians, midwives, social workers and pharmacists, for comprehensive provincial/territorial sexual and reproductive health strategies for primary care.

IMPACT

The findings from this study may inform future policy, health administration and curriculum decisions related to reproductive health, and raise awareness about the crucial role of nurse practitioners in abortion care and contributions to reproductive health equity.

PATIENT OR PUBLIC CONTRIBUTION

This study focused on provider experiences. In-kind support was provided by Action Canada for Sexual Health & Rights, an organization that provides direct support and resources to the public and is committed to advocating on behalf of patients and the public seeking sexual and reproductive health services.

Conectarnos con la compasión para preservar el cuidado humanizado

Este artículo revisa la compasión como requerimiento esencial para la atención humanizada, abordando elementos definitorios desde sus raíces filosóficas y su vínculo con la práctica de la enfermería. Objetivo: reflexionar sobre la compasión como un atributo inherente al cuidado humanizado, según lo reportado en la literatura. Materiales y métodos: artículo de reflexión, para el cual se realizó una búsqueda y la revisión de literatura en bases de datos científicas especializadas, con descriptores y operadores boleanos relacionados con el tema. Resultados: se presentan elementos conceptuales útiles para adoptar la compasión como un rasgo ético que se debe promover en la formación y el trabajo académico en las áreas de ciencias de la salud y, en especial, en enfermería.

Hermeneutic phenomenological research on how nurse educators make meaning of compassion and understand its role in their professional practice

BACKGROUND

In the United Kingdom (UK), whilst nurse educators are responsible for developing compassion through providing high quality education, there is limited literature exploring how their lived experience of compassion is interpreted in nurse education.

OBJECTIVES

To explore how nurse educators make meaning of compassion through their lived experiences in the UK.

DESIGN

Hermeneutic phenomenology.

SETTING

A UK school of nursing.

PARTICIPANTS

Purposeful sampling was used to recruit twelve nurse educators.

METHOD

Semi-structured interviews were used to explore participant experiences of compassion. Data analysis involved crafting stories and was interpreted by applying Heideggerian and Gadamerian philosophical notions to surface meanings of everyday experiences.

FINDINGS

The phenomenological themes identified nurse educators interpreted compassion through Being-with is Care; settling their colliding worlds of nursing practice and nurse education, and balancing Kairos or 'felt' time with negotiated time for compassion in nurse education.

CONCLUSION

This research demonstrates that nurse educators share genuine concern for Being-with others that is interpreted as compassion. However, the emotional aspect of compassion is avoided in their professional practice as a means of protecting students and their own feelings of vulnerability. There are colliding views in understanding compassion. Emotional intelligence is identified as necessary to grasp 'felt' moments or negotiate a time to Be-with that is interpreted as compassion. Training and support is necessary for nurse educators to understand and develop compassion in their professional practices.

Hospital nurses' experiences and expectations of compassion and compassionate leadership

RATIONALE AND AIM

Nurses caring for critically ill patients need compassionate attention and support, especially during exceptional times. The aim of this study was to provide a trustworthy description of nurses' experiences and expectations for compassionate leadership and compassion at a central hospital in Finland. The study was conducted during the early stage of the coronavirus 2019 pandemic.

ETHICAL ISSUES AND APPROVAL

The voluntary nature and anonymity of the survey were stressed in the cover letter, to make sure that participants did not perceive any undue influence caused by participating in the study.

METHODS

The participants were 50 intensive care and emergency nurses of a central hospital. An online survey tool with open questions was used to collect data on the meaning of compassion and on nurses' experiences and expectations of compassion and compassionate leadership. Inductive content analysis was used to analyse the data.

RESULTS

The nurses reported a great variety of positive experiences of compassion, although the emphasis in this study seemed to be on the absence of compassion, especially in regard to leadership. The nurses expected individual attention and genuine physical and psychological presence from their immediate supervisors.

STUDY LIMITATIONS

One researcher analysed the data, which can cause some bias in the qualitative analysis.

CONCLUSIONS

Immediate supervisors express compassion by being physically present and by fostering an open dialogue. Compassion received from leaders and colleagues may be reproduced in patient contacts, which can increase patients' confidence and psychological safety. Participatory and simulation-based learning methods, which involve shared reflection, are recommended for compassionate leadership skills.

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

BACKGROUND

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

METHOD

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

RESULTS

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

CONCLUSION

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

Evaluation of the relationships between nurses' forgiveness, compassion, and professional commitment

PURPOSE

The aim of this study was to examine the relationship between nurses' forgiveness, compassion, and professional commitment.

METHODS

This cross-sectional study was carried out on 243 nurses between March and June 2019.

FINDINGS

The effect of nurses' compassion levels on forgiveness levels (predictive power) was -0.49 and the effect on their professional commitment was 0.82.

CONCLUSIONS

Results of the study reflect that forgiveness and compassion are effective on nurses' professional commitment.

PRACTICE IMPLICATIONS

The study results emphasize the need to consider the links between forgiveness, compassion, and professional commitment for hospital administrators, nurse leaders, and policymakers.

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.

Posttraumatic Growth as a Model to Measure and Guide Implementation of COVID-19 Recovery and Resiliency

The COVID-19 pandemic has forced leaders to reconsider the various factors that attribute to work-life balance, a healthy work environment, and resilience among nurses. Posttraumatic growth (PTG) provides a lens through which clinicians and leaders can measure, articulate, and espouse resilient recovery through unprecedented times. This article suggests the use of PTG as a framework, measured by the Posttraumatic Growth Inventory to guide leaders as they implement job-specific resiliency interventions for professional nurses. This article also suggests 3 science-based interventions intended to increase PTG. Published data support the efficacy of these interventions: resilience retreats, resilience rounds, and "The Pause," while longitudinal impacts of PTG following these interventions remain currently unknown.

The Impact of Work Environment on Nurses’ Compassion: A Multicenter Cross-Sectional Study

Introduction

Compassionate care is considered as the main part of the nurses’ identity and a core component of nursing care. One clinical environment where patients experience a lot of pain and nurses play a vital role in delivering care is the intensive care unit (ICU).

Objective

Considering the importance of compassionate care in intensive care units, this study aimed to assess the relationship between the work environment and nurses’ compassion in intensive care units.

Methods

In this cross-sectional survey, a total of 235 nurses were randomly selected from the intensive care units of four educational hospitals of Tabriz University of Medical Sciences from January to March 2021. Data were collected by demographic questionnaire, the Sussex-Oxford Compassion for Others Scale (SOCS-O) and the Practice Environment Scale of the Nursing Work Index (PES-NWI).

Results

The results showed that there was a significant and inverse relationship between the patient per nurse ratio and the mean score of nurses’ compassion (P < .05). Moreover, Pearson correlation coefficient showed that the mean total score of the nursing work index had a significant positive relationship with the mean score of the compassion for others (r = 0.16, P = .016).

Conclusion

Health care managers and leaders should pay more attention to the promotion of nurses’ working environments and they should remove the organizational barriers of compassionate care delivery.

Before compassion: sympathy, tact and the history of the ideal nurse

The word 'compassion' is ubiquitous in modern healthcare. Yet few writers agree on what the term means, and what makes it an essential trait in nursing. In this article, I take a historical approach to the problem of understanding compassion. Although many modern writers have assumed that compassion is a universal and unchanging trait, my research reveals that the term is extremely new to healthcare, only becoming widely used in 2009. Of course, even if compassion is a new term in nursing, the concept could have previously existed under another name. I thus consider the emotional qualities associated with the ideal nurse during the interwar period in the UK. While compassion was not mentioned in nursing guidance in this era another term, 'sympathy', made frequent appearance. The interwar concept of sympathy, however, differs significantly from the modern one of compassion. Sympathy was not an isolated concept. In the interwar era, it was most often linked to the nurse's tact or diplomacy. A closer investigation of this link highlights the emphasis laid on patient management in nursing in this period, and the way class differentials in emotion between nurse and patient were considered essential to the efficient running of hospitals. This model of sympathy is very different from the way the modern 'compassion' is associated with patient satisfaction or choice. Although contemporary healthcare policy assumes 'compassion' to be a timeless, personal characteristic rooted in the individual behaviours and choices of the nurse, this article concludes that compassionate nursing is a recent construct. Moreover, the performance of compassion relies on conditions and resources that often lie outside of the nurse's personal control. Compassion in nursing-in theory and in practice-is inseparable from its specific contemporary contexts, just as sympathy was in the interwar period.

Compassionate practice in a hospital setting. Experiences of patients and health professionals: A narrative inquiry

AIM

To explore how compassion is received by patients in a hospital setting and how compassion is expressed by health professionals in a hospital setting.

BACKGROUND

Compassion is important to health professionals and patients. Perceived deficits in compassion in healthcare have led increasing concerns about the quality of care for patients. To better understand compassionate practice in a hospital setting we used narrative inquiry to explore the expression of compassion by health professionals and the experience of receiving compassion by patients.

DESIGN

Narrative Inquiry. Reported in line with Consolidated Criteria for Reporting Qualitative Research (COREQ).

METHODS

Qualitative interviews were conducted with 24 patients and health professionals in Australia. Data were collected between August 2018 and August 2019. Narrative analysis processes were used to develop a thematic framework.

RESULTS

Compassionate practice is presented as an overarching theme and comprises of three themes: (1) Amalgamation of various knowledges and skills (2) Delivery of meaningful actions which alleviate suffering and (3) Meeting individual needs and prevention of further preventable suffering. The expression of compassion by health professionals involved the fusion of many skills and knowledges. Patients received compassion through the actions of the health professional which alleviated their suffering.

CONCLUSION

Compassionate practice is both important, and complex. Presence, skilled and purposeful action and the alleviation of suffering are essential to the expression and receipt of compassion in the hospital setting.

IMPACT

Findings from this study contribute to the growing body of literature on compassionate practice in health settings, specifically in how it is expressed and received in a hospital setting. The complexity of compassion is explained for health professionals. Compassion was shown to be embedded in the caring moments between health professionals and patients. This paper explains the different elements that comprise compassion which can guide health professional practice. The importance of seemingly small acts has a big impact on patients, families and health professionals. There is a need for greater stakeholder value and recognition of this aspect of practice.

The expression and receipt of compassion through touch in a health setting; a qualitative study

AIM

To investigate and understand how compassion is expressed by nurses and received by patients in a hospital setting.

BACKGROUND

Concerns regarding the absence of compassion in a healthcare setting has necessitated further research in the field. To define and measure compassion is difficult and problematic. Compassion is subjective and in the contemporary literature the views of patients are under-represented. Touch is an important component of nursing practice and can also be considered problematic.

DESIGN

Secondary analysis of narrative interviews.

METHODS

Secondary analysis of 12 participant interviews with nurses (n-4) and patients (n-8). Data were collected between August 2018 and August 2019.

FINDINGS

Compassion was expressed and received through touch for nurses and patients. Patients receive compassion through the touch of the nurse and this touch conveyed comfort and safety. Touch allowed for the establishment of an authentic connection between nurse and patient. Nurses used touch to express compassion and patients received compassion when they were comforted with touch. Compassion was present in incidental touch and deliberate comforting touch. Nurses were respectful of the meanings of touch. Patients describe nurses knowing when to touch and using touch appropriately.

CONCLUSIONS

Nurses in our study were respectful of the meaning of touch for their patients and described using touch to convey compassion. Patients in our study perceived compassion through the touch by the nurse. Through these narratives, touch is revealed as an essential part of compassionate practice conveying safety, authenticity and connection.

IMPACT

Patients in this study describe receiving compassion through the use of touch which made them feel safe. Nurses in this study used touch to create an authentic connection with patients and were aware of the different meanings of touch. Avoiding touch, being wary of touch, or considering touch taboo robs patients of compassion moments.

Validation of the Persian version of the Compassionate Care Assessment Tool

OBJECTIVES

The present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©.

METHODS

The study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8.

RESULTS

The results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks' interval. At the two areas of importance and provision of compassionate care, Cronbach's α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively.

CONCLUSION

The results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

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.

Considering the relationship between sleep and empathy and compassion in mental health nurses: It's time

Sleep plays a critical role in overall health, well-being, and daytime functioning. Provision of 24-hour care means that nurses undertake shift work and therefore have been found to commonly not get the recommended amount of sleep, resulting in sleep deprivation. Research to date has focused on how sleep deprivation impacts their cognitive performance (e.g., reaction time, memory consolidation); however, less considered is how nurses' sleep impacts on their ability to understand and provide emotional care to consumers. In this paper, we examine how sleep may influence nurses' ability to empathize and provide compassionate care, both of which are fundamental aspects of their work. We begin by considering the unique challenges nurses face as shift workers and the impact of sleep on physical and psychological functioning. We examine how empathy and compassion drive nurses' attempts to understand consumers' perspectives and experiences and motivate them to want to help those in their care. Work directly investigating the relationship between sleep and these processes indicates emotional recognition and experience are hampered by poor sleep, with greater compassion towards oneself or from others associated with better sleep. Much of this work has, however, been conducted outside of the nursing or health professional space. We discuss issues that need to be addressed in order to move understanding forward regarding how sleep impacts on mental health nurses' empathy and compassion, as well as how an understanding of the sleep-empathy/compassion link should be an important priority for nurse education and well-being.

Spouse's participation in perinatal care: a qualitative study

Background

Pregnancy is one of the most important periods of any woman’s life, wherein the support of her relatives, especially her spouse, enables her to tolerate the difficulties with good memories. However, in Iran, there are very few studies on the participation of spouses in the perinatal period. Therefore, the present study aimed to explain the concept of spouse participation in perinatal care.

Methods

This is a qualitative study that was carried out in 2018 on spouse participation in perinatal care in Qom, Iran. Purposive sampling from pregnant or postpartum women, spouses, midwifery care providers, and key informants was performed according to study inclusion criteria. Semi-structured in-depth interviews were carried out until the data saturation was met. Also, the data analysis was performed based on a conventional content analysis approach according to Graneheim & Lundman steps using MAXQDA software (v.10). Five Guba and Lincoln criteria were applied to ensure the trustworthiness of data.

Results

Fifty-three final codes were classified into 18 sub-categories, 7 categories, and 3 themes including empathy (emotional and cognitive understanding), accountability (supporting, position management, compassion), and consequences (help improvement of family function, improvement of maternal-neonatal health).

Conclusions

Based on the findings of this study, the concept of men’s participation in this period has been defined as a set of empathic and responsive behaviors that can lead to improvement of the family function and mother and baby health.

Healthcare providers perspectives on compassion training: a grounded theory study

BACKGROUND

There is little concrete guidance on how to train current and future healthcare providers (HCPs) in the core competency of compassion. This study was undertaken using Straussian grounded theory to address the question: "What are healthcare providers' perspectives on training current and future HCPs in compassion?"

METHODS

Fifty-seven HCPs working in palliative care participated in this study, beginning with focus groups with frontline HCPs (n = 35), followed by one-on-one interviews with HCPs who were considered by their peers to be skilled in providing compassion (n = 15, three of whom also participated in the initial focus groups), and end of study focus groups with study participants (n = 5) and knowledge users (n = 10).

RESULTS

Study participants largely agreed that compassionate behaviours can be taught, and these behaviours are distinct from the emotional response of compassion. They noted that while learners can develop greater compassion through training, their ability to do so varies depending on the innate qualities they possess prior to training. Participants identified three facets of an effective compassion training program: self-awareness, experiential learning and effective and affective communication skills. Participants also noted that healthcare faculties, facilities and organizations play an important role in creating compassionate practice settings and sustaining HCPs in their delivery of compassion.

CONCLUSIONS

Providing compassion has become a core expectation of healthcare and a hallmark of quality palliative care. This study provides guidance on the importance, core components and teaching methods of compassion training from the perspectives of those who aim to provide it-Healthcare Providers-serving as a foundation for future evidence based educational interventions.

The characteristics of compassionate care during childbirth according to midwives: a qualitative descriptive inquiry

BACKGROUND

Although compassion is considered to be of prime importance in nursing and midwifery, there is no clear understanding of what compassionate care in childbirth entails, and how midwives perceive compassionate care is largely unknown. This study accordingly seeks to describe the characteristics, of compassionate care during childbirth as perceived by midwives.

METHODS

A qualitative descriptive inquiry was undertaken with a voluntary online survey, where participants were recruited via snowball sampling on the social networking site, Facebook. The participants were midwives, and the unit of analysis was the received responses. Participants reported on instances of compassionate care during childbirth. The data was thematically analysed using Tesch's eight steps to identify common themes.

RESULTS

Ninety-eight responses were analysed and three themes with eight sub-themes emerged as dominant characteristics. Themes and sub-themes were as follows: making meaningful connections with women (displaying good interpersonal skills, conduct based on dignity and respect, establishing trust); initiating individualised understanding of each woman (showing empathy, permitting maternal choice) and action through care and support (providing emotional support, assistance through instrumental care, continuous informational support).

CONCLUSIONS

In seeking to determine what characterises compassionate care in childbirth, the findings reveal a process of making meaningful connections with women through recognising their needs, initiating individualised understanding of each woman's needs and desiring to ease it, which is subsequently manifested in action through emotional, instrumental and informational care and support. A better understanding of how midwives perceive compassionate care could potentially improve the quality of care midwives offer during childbirth.

Impact of workplace incivility on compassion competence of Korean nurses: Moderating effect of psychological capital

AIM

This study aimed to examine the association between workplace incivility and compassion competence of Korean nurses, as well as the moderating effect of psychological capital.

BACKGROUND

Workplace incivility affects the quality of patient care and as such is worthy of critical examination regarding its impact on the compassion competence of nurses.

METHODS

In this descriptive cross-sectional study, data for 192 Korean hospital nurses were used to analyse the relationship between workplace incivility and compassion competence and the moderating effect of psychological capital.

RESULTS

Workplace incivility was negatively associated with compassion competence of nurses. Furthermore, psychological capital had a conditional moderating effect on the relationship between workplace incivility and nurses' compassion competence. The negative associations of workplace incivility with compassion competence were significant at low and medium levels of psychological capital but not at high psychological capital. Moreover, the association was stronger for those with low psychological capital.

CONCLUSION

Workplace incivility is negatively associated with compassion competence among nurses, and psychological capital has conditional moderating effects in its relationship.

IMPLICATIONS FOR NURSING MANAGEMENT

Management efforts to reduce workplace incivility and to improve nurses' psychological capital are needed to improve patient care quality.

Caring from the heart as belonging-The basis for mediating compassion

Aim

The aim of this study was to illuminate nurses' experiences of mediating compassion to patients in the home care context.

Design

A phenomenological-hermeneutical approach was used.

Methods

The data comprised of texts from interviews with 12 nurses in a home care context. Informed consent was sought from participants regarding participation in the study and the storage and handling of data for research purposes.

Results

Four themes were seen: Encountering one another as human beings, Being in the moment, Bearing responsibility for the other and Being in a loving communion. The overall theme was Acting from one's inner ethos, heart of goodness and love. Mediating compassion as belonging can be interpreted as the "component" that holds the caring relationship together and unites the different levels of health as doing, being and becoming in the ontological health model. Further research should focus on revealing compassion from the perspective of patients.

A Lexicon of Concepts of Humanistic Medicine: Exploring Different Meanings of Caring and Compassion at One Organization

PURPOSE

There has been scant scholarly attention paid to characterizing how the numerous definitions of terms associated with compassion and humanism have been mobilized or what the organizational implications of pursuing different constructs might be. This study explored the uses and implications of the terminology associated with humanistic medicine in the work of the Associated Medical Services (AMS) Phoenix Project.

METHOD

This study involved two phases (2014-2015). First, two pilot group workshops with AMS Phoenix Project participants and stakeholders were conducted to explore ways of parsing and interpreting core concepts used in the project. The authors then assembled an archive of texts associated with the project, comprising the project website and blog posts, conference proceedings, and fellowship and grant applications. Informed by critical discourse analysis, the authors identified, described, and analyzed core terms related to the project's mission and explored the type of health care practices and reforms implied by their use.

RESULTS

Two recurring core terms, care/caring and compassion, and eight clusters of terms related to these core terms were identified in the archive. Caring and compassion as terms were articulated in various psychological, sociological, and political configurations. This polysemy reflected a diverse array of health care reform agendas.

CONCLUSIONS

Understanding how different interpretations of caring and compassion cluster around core topics and concerns of humanistic medicine offers scholars an entry point for comparing and appraising the quality and direction of reform agendas, including multilevel strategies that involve systems-level changes.

Compassionate Knowing: Building a Concept Grounded in Watson's Theory of Caring Science

Compassionate knowing is the practice of intentional presence to relieve suffering. Inspired by Carper's patterns of knowing, it is an additional form of knowing grounded in caring science. Likewise, the concept of compassionate knowing is framed by tenets of Buddhist philosophy and George's emancipatory theory of compassion. Intentional presence is defined as a conscious and altruistic choice, born of moral virtue and selflessness, to act in a thoughtful, empathetic, and humanistic way that honors and gives meaning to the uniqueness of each patient and caring-healing nurse-client interaction. Relieving suffering is defined as the nurse responding to the needs of the patient with loving-kindness to alleviate a perceived or real threat to self-integrity.

Compassionate Care in Healthcare Systems: A Systematic Review

BACKGROUND

In spite of emphasis on patient-centered cares and promotion of their quality, shortcomings have been seen in health systems due to lack of compassion.

PURPOSE

The aim of the present study was to determine the definition, fields, facilitating and inhibiting factors of compassionate care in healthcare systems and the interventions designed to promote it.

METHODS

This study was conducted through narrative synthesis which is supposed to do systematic and synthesized review. Searching was done in English databases including Pub Med, CINAHL, Google Scholar, Web of Science, and Cochrane library, Ovid, Science Direct, WILEY by using keywords of Compassionate Care, Delivery of Health Care, Healthcare Systems, Compassion and Health Care Providers from 1987 to 2017.

RESULTS

Compassionate care has some dimensions including ethical, professional, effective communication, human, spiritual/religious and getting involve with patients. Facilitating and inhibiting factors consisted of the nurse's personal characteristics, patients' behavior and organizational factors included workload, role model, and value of compassionate care in healthcare systems. Educational interventions such as providing feedback and reorienting have been mostly used to improve the compassionate care.

CONCLUSIONS

Although compassionate care has been known as the main element of improving services quality in health care system, it has been studied restrictively from the viewpoints of the patients and all personnel in healthcare systems. The improvement of compassionate care through education cannot remove completely the gap between theory and practice, because it seems that clinical environment and organizational values of healthcare system are the largest facilitating and inhibiting factors for filling this gap. Therefore, it is necessary to take measures for promoting organizational culture.

Implementing a Peer Support Network to Promote Compassion Without Fatigue

OBJECTIVE

The aims of this study were to implement a Peer Support Network (PSN) pilot project including education/training, peer support, and resiliency training and to explore how interventions impact compassion satisfaction (CS) and compassion fatigue (CF) in a community hospital.

BACKGROUND

CF has been reported to negatively affect nurse retention. The PSN provides a 3-tiered team approach to enhance CS and support nurses experiencing CF symptoms.

METHODS

Twenty nurses participated in PSN training and completed preimplementation and 6-week postimplementation surveys: Professional Quality of Life, Compassion Practice Instrument, and self-care resource utilization.

RESULTS

Statistically significant improvements in CS and nonstatistical improvements in CF were found.

CONCLUSION

Promoting a PSN may increase CS and potentially prevent work-related physical, emotional, social, and intellectual CF sequelae.

Nurses', patients', and family caregivers' perceptions of compassionate nursing care

BACKGROUND

Compassion is the core of nursing care and the basis of ethical codes. Due to the complex and abstract nature of this concept, there is a need for further investigations to explore the meaning and identify compassionate nursing care.

OBJECTIVES

The purpose of this study was to identify and describe compassionate nursing care based on the experiences of nurses, patients, and family caregivers.

RESEARCH DESIGN

This was a qualitative exploratory study. Data were analyzed using the conventional content analysis method.

PARTICIPANTS AND RESEARCH CONTEXT

Nurses, hospitalized patients, and family caregivers in different educational hospitals in an urban area of Iran were selected from February 2016 to December 2017 using a purposeful sampling method (n = 34). In-depth and semi-structured interviews, focus group interviews, and field notes were used for data collection.

ETHICAL CONSIDERATIONS

The study was approved by the University's Ethics Committee. The participants were informed about the aim and method of the study, reasons for recording the interviews, confidentiality of data, and voluntary nature of participation in this study.

FINDINGS

Data from interviews and filed notes were analyzed and classified into three themes: "effective interaction," "professionalism," and "continuous comprehensive care."

DISCUSSION AND CONCLUSION

Emerged themes of this study involved holistic care in the current literature on nursing with an emphasis on effective interaction and professionalism. Nurses can understand patients' and family caregivers' comprehensive needs through interaction skills. In addition, clinical proficiency, maintaining professional ethics' standards along with holism, and continuity in care are examples of compassionate care. Education program about compassionate care can enhance the quality of nursing care.

International study on nurses' views and experiences of compassion

BACKGROUND

Compassion is considered the cornerstone of nursing practice. However, the recent failures in delivering high-quality compassionate nursing care in the UK's National Health Service have brought the topic of compassion to the attention of the public, service providers, policy makers and academics.

AIM

The aim of this study was to explore the nurses' views and experiences of a number of compassion-related issues in nursing and describe similarities and differences at an international level as well as from the different nursing roles of the participating nurses.

METHODS

An exploratory, cross-sectional descriptive study, using the International Online Compassion Questionnaire. A total of 1323 nurses from 15 countries completed the questionnaire.

RESULTS

The majority of participants (59.5%) defined compassion as "Deep awareness of the suffering of others and wish to alleviate it" but definitions of compassion varied by country. Of participants, 69.6% thought compassion was very important in nursing and more than half (59.6%) of them argued that compassion could be taught. However, only 26.8% reported that the correct amount and level of teaching is provided. The majority of the participants (82.6%) stated that their patients prefer knowledgeable nurses with good interpersonal skills. Only 4.3% noted that they are receiving compassion from their managers. A significant relationship was found between nurses' experiences of compassion and their views about teaching of compassion.

CONCLUSION

Our study is unique in identifying the views and experiences of nurses from 15 different countries worldwide. The findings reveal that compassion is neither addressed adequately in nursing education nor supported in the practice environment by managers.

LIMITATIONS

Self-report bias was inherent to our survey study design. Furthermore, the individual cultural differences and similarities in the findings are difficult to extrapolate owing to the fact that our analysis was at country level, as well as at the level of the participating nurses.

IMPLICATIONS FOR NURSING POLICY

Understanding the influence of culture on nurses' views about compassion is critical in the current multicultural healthcare environment and merits further research. This will potentially drive changes in nursing education (ensuring that compassion is taught to nurses) and in the way healthcare leaders and managers foster a compassionate culture within their organizations (e.g. by leading by example and compassionate to their staff).

Qualities, teaching, and measurement of compassion in nursing: A systematic review

BACKGROUND

Compassion has global implications for nursing care. However, failure to provide compassionate care is reported by patients. Nursing and nurse education have been scrutinized about the impact training can have on student's compassion. Furthermore, there is a paucity of standardised measures to assess levels of nurses' compassion.

OBJECTIVES

To identify (1) the qualities of a compassionate nurse, (2) how compassion is taught to nursing students, and (3) the instruments used to measure compassion in nursing.

DESIGN

Systematic literature review.

DATA SOURCES

CINHAL, EBSCO, SCOPUS, PubMed, Ovid Nursing.

SEARCH METHODS

A systematic review of published research was conducted with. No limitations in the search timeframe were used. Articles were included if they were (1) nurses (2) nursing students (3) educators and (4) patient groups, (5) written in English. Articles that were, peer reviewed, research articles, or articles grounded in evidence based practice were also included.

RESULTS

Fourteen studies (6 UK, 3 USA, 2 Canada, 1 Korea, 1 Thailand, and 1 Netherlands) identified eleven characteristics of a compassionate nurse. Two UK and one Australian study investigated teaching compassion to nursing students. Four articles reported on instruments used to measure compassion in nursing. Three were American, and one Korean.

CONCLUSION

This review identified only 21 papers overall. Several qualities of a compassionate nurse were found. In addition, few studies have explored how compassion is taught to nursing students. Also, there are a limited number of instruments for measuring compassion in nursing. More research is needed in nurse education to develop a teaching approach and psychometric measure for nurses' compassion.

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.

The effect of organizational and personal variables on the ability to practice compassionately

BACKGROUND

Nursing governing bodies assert that compassion is essential to nursing practice. Despite the relevance compassion has in nursing, and ample theoretical literature, until now, there has been little empirical work conducted to examine the nature of compassion in nursing and how the expression of compassion in nursing practice may be affected.

OBJECTIVES

This study aimed to examine the personal and organizational variables that might affect nurses' ability to practice with compassion.

DESIGN

A predictive, non-experimental cross-sectional design was used to explore the relationships amongst the variables of structural and psychological empowerment, inter-professional collaboration, and compassion.

PARTICIPANTS

191 registered nurses of any age, with any length of experience, in any inpatient or outpatient unit, in any hospital (community, long term care, and teaching) with any education level participated in the study.

DATA COLLECTION

Data were collected via surveys sent to randomly chosen registrants from the College of Nurses of Ontario (Canada) Registry.

RESULTS

Statistically significant correlations were found amongst all the variables. A simple linear regression was calculated to predict the effect of the independent variables of structural empowerment, psychological empowerment, and inter-professional collaboration on the dependent variable compassion. All three had a statistically significant positive relationship to the dependent variable compassion.

DISCUSSION AND CONCLUSIONS

Each of structural empowerment, psychological empowerment, and inter-professional collaboration has been discussed in the literature as a possible predictor of compassion. This study shows that that is the case. This is critical information for both organizations and individual nurses to have, as currently there is an inclination to blame nurses for having insufficient compassion rather than considering there may also be environmental and structural reasons for nurses being unable to practice with compassion. With this study as a beginning, future studies could test for models of how these variables interact in order to make more informed decisions about how to enable compassionate nursing practice. These strategies as it turns out, may be both personal and environmental. This study is a step towards the building of nursing compassion literacy.

Beyond vulnerability: how the dual role of patient-health care provider can inform health professions education

In order to prepare fully competent health care professionals, health professions education must be concerned with the relational space between patients and providers. Compassion and compassionate care are fundamental elements of this relational space. Traditionally, health professions educators and leaders have gone to two narrative sources when attempting to better under constructs of compassion: patients or providers. Rarely have there been explorations of the perspectives of those who consider themselves as both patients and providers. In this study, we interviewed nineteen health care providers who self-disclosed as having had a substantive patient experience in the health care system. We engaged with these participants to better understand their experience of having these dual roles. Anchored in Foucault's concepts of subjectivity and Goffman's symbolic interactionism, the interviews in this study reveal practices of moving between the two roles of patient and provider. Through this exploration, we consider how it is that providers who have been patients understand themselves to be more compassionate whilst in their provider roles. Rather than describing compassion as a learnable behaviour or an innate virtue, we theoretically engage with one proposed mechanism of how compassion is produced. In particular, we highlight the role of critical reflexivity as an underexplored construct in the enactment of compassion. We discuss these findings in light of their implications for health professions education.

Lack of compassion or poor discretion? Ways of addressing malpractice

In this article, our point of departure is the 'compassion crisis' in the National Health Service in the UK and the initiatives introduced in the aftermath of scandals that were intended to strengthen healthcare professionals' ability to show compassion. We look at the two main strategies, which we term the 'recruitment and staff development strategy' and the 'amelioration of the quality systems strategy' and the debate that has arisen related to them. Based on this analysis, we question whether compassion really is a helpful concept to understand the crisis and hence to underpin relevant strategies. We introduce the concept of discretion as an alternative and better concept to comprehend the situation. One of the benefits of the concept of discretion is that it clarifies how problems can be addressed, both as structural problems and as epistemic problems and how these aspects are intertwined. It also helps us to see how solving these problems is complicated and demands comprehensive, in-depth approaches, involving formative aspects related to healthcare education, as well as development of new healthcare policies.

Burnout and its relationship to empathy in nursing: a review of the literature

Compassion and empathy are viewed as important by both nurses and patients. The positive emotions that nurses feel as a result of compassionate and empathic practice are known as compassion satisfaction, whilst the negative consequences are known as burnout and compassion fatigue. Empathy has two distinct components: emotional empathy, which involves feeling the emotions of another, and cognitive empathy, which relates to self-regulation of the emotion felt. The purpose of this literature review is to examine the relationship between burnout and empathy in the nursing literature. The results suggest that the relationship between these constructs is complex, and an ability to self-regulate emotions during empathic engagement may reduce the risk of burnout. The implications for nurses, health care organisations, educators and health care policy makers are discussed. This review provides insight into how adaptive empathic engagement may reduce the risk of burnout.

Compassionate care during withdrawal of treatment: A secondary analysis of ICU nurses' experiences

BACKGROUND:

Withdrawal of treatment is a common practice in intensive care units when treatment is considered futile. Compassion is an important aspect of care; however, it has not been explored much within the context of treatment withdrawal in intensive care units.

OBJECTIVES:

The aim was to examine how concepts of compassion are framed, utilised and communicated by intensive care nurses in the context of treatment withdrawal.

DESIGN:

The study employed a qualitative approach conducting secondary analysis of an original data set. In the primary study, 13 nurses were recruited from three intensive care units within a large hospital in United Kingdom. Deductive framework analysis was used to analyse the data in relation to compassionate care.

ETHICAL CONSIDERATIONS:

The primary study was approved by the local Research Ethics Committee and the hospital's Research and Development services.

FINDINGS:

Compassionate care was mostly directed to the patient's family and was demonstrated through care and emotional support to the family. It was predominantly expressed through attempts to maintain the patient's dignity by controlling symptoms, maintaining patient cleanliness and removing technical apparatus.

CONCLUSION:

This study's findings provide insight about compassionate care during treatment withdrawal which could help to understand and develop further clinicians' roles. Prioritising the family over the patient raised concerns among nurses, who motivated by compassion, may feel justified in taking measures that are in the interests of the family rather than the patient. Further work is needed to explore the ethics of this.

Nurse’s perceptions of organisational barriers to delivering compassionate care: A qualitative study

Background:

Compassionate care is an international priority of healthcare professionals. There is little understanding about how workplace issues impact provision of compassionate care in nursing practice. Therefore, it is important to address the workplace issues and organizational factors which may hinder compassionate care delivery within nursing practice.

Objective:

The aim of this study was to explore workplace and organizational barriers to compassionate care from the nurses’ perspective.

Research design:

The study used a qualitative exploratory design, and data were analyzed by conventional content analysis.

Participants and research context:

A total of 15 nurses working in different fields of nursing were recruited from four hospitals at northwest of Iran. Participants were selected by purposive sampling. Semistructured interviews were conducted for data collection.

Ethical consideration:

Ethical approval of this study was gained from the Ethical Review Board of Tabriz University of Medical Sciences.

Findings:

The main theme which emerged from data analysis was “unsupportive organizational culture.” This theme had two main categories including “excessive workload alongside inadequate staffing” and “the lack of value on compassionate care.”

Discussion:

Organizational barriers to development of compassionate in clinical practice were identified in this study. A closer examination of these barriers is required to move compassionate practice from an individual responsibility to a collective responsibility that is owned and shared by organizations.

Conclusion:

For compassionate care to flourish, policy makers, managers, and healthcare providers must foster an organizational atmosphere conducive to compassionate care.