Embodying compassion: A systematic review of the views of nurses and patients

Professional Quality of Life Among Mental Health Nurses: A Systematic Review and Meta-Analysis

The professional quality of life (ProQOL) is increasingly applied to nurses and is a measure of the positive and negative aspects of their work. This systematic review and meta-analysis evaluated the level of compassion satisfaction, burnout and secondary traumatic stress (STS) in empirical studies. Electronic databases Scopus, PubMed and Web of Science were searched on 7th February 2024, and the review followed PRISMA guidelines. The pooled estimate of compassion satisfaction, burnout and secondary traumatic stress mean scores using a random-effects model for meta-analyses was undertaken. R statistical software and the dmetar program were used to execute the analysis. Heterogeneity was evaluated with the I2 statistics, while publication bias was evaluated using Egger's regression test. Twenty-four studies (sample size = 4274) were systematically reviewed and 18 studies (n = 3163) were incorporated into the meta-analysis. Burnout, secondary traumatic stress and compassion satisfaction are found to be at moderate levels in this research. The qualitative analysis informs that variables such as healthy lifestyle, work environment and psychological resilience contribute towards optimum ProQOL scores. The pooled mean estimate was 32.79 (95% CI = 29.57-36) for compassion satisfaction, 24.99 (95% CI = 23.75-26.23) for burnout and 21.99 (95% CI = 18.93-25.06) for secondary traumatic stress, respectively. Mental health nurse managers need to address the factors in the work environment and promote interventions to enhance coping with burnout and STS. Subgroup analyses of country-based economies & regions and years revealed significant results.

Enhancing nurse practitioner research through reflexivity

ABSTRACT

This article highlights the essential role of reflexivity in research, using a qualitative project involving interviews with nurse practitioners during the COVID-19 pandemic as an example. It discusses the potential biases inherent in research, particularly when the researcher's experiences closely align with those of the participants. Drawing on the perspective of a nurse practitioner engaged in both research and health care provision, this article explores the importance of reflexivity in addressing these biases. Examining the lead author's experiences conducting interviews with fellow nurse practitioners, the article illustrates how reflexivity was used, particularly in data collection and analysis, to enhance transparency and minimize subjectivity. By advocating for the integration of reflexivity in qualitative research, this article emphasizes the significance of shared experiences between nurse practitioner researchers and participants in reducing biases and improving research outcomes. It demonstrates how reflexivity contributes to a more authentic and comprehensive methodology, especially when researchers share similar experiences with participants. Furthermore, this article offers practical suggestions to assist nurse practitioners in enhancing reflexivity throughout the research process, thereby contributing to ongoing discussion and strategy development in the field.

Does fear of compassion effect nurses' caring behaviours? a cross-sectional study

Aims: The aim of this study is to determine the levels of nurses' fear of compassion for others, fear of compassion from others, and fear of self-compassion and to examine the effect of fear of compassion on caring behaviors. Design: A cross-sectional, quantitative design was used. Participants and research context: The study was conducted between October 2022 and April 2023 with 304 nurses working in two public hospitals. Data collection tools were the "Fears of Compassion Scales" and the "Caring Behaviors Inventory." Data were analyzed using a t test, one-way ANOVA, Pearson correlation analysis, and stepwise multiple regression model. Ethical considerations: Ethics committee approval of the research was obtained from the non-invasive ethics committee of Kütahya Health Sciences University (Reference No: 25.05.2022/2022/06-19). The principles of the Declaration of Helsinki were followed in the study. The purpose of the research was explained to all participants, and their verbal/written informed consent was obtained. Results: The mean scores of nurses on fear of compassion for others and from others were at a moderate level, and their scores on fear of self-compassion were close to a moderate level. It was found that the level of nurses' fear of compassion was related to their sociodemographic and professional variables. Fear of self-compassion, fear of compassion for others, and fear of compassion from others explained 33.5% of the total variance in caring behaviors. Conclusions: Nurses' caring behaviors were shown to be more associated with fear of self-compassion than fear of compassion for others. Fear of compassion may be one of the barriers to compassionate care. Interventions that will reduce nurses' fear of compassion may be one way to provide compassionate care. It is recommended to conduct awareness studies on self-compassion and accepting compassion from others in nurses.

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

BACKGROUND

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

DESIGN

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

IMPACT

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

PATIENT OR PUBLIC CONTRIBUTION

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

Comparison of student nurses' expectations and newly qualified nurses' experiences regarding clinical practice: A secondary analysis of a cross-sectional survey

AIM

To compare student nurses' expectations and newly qualified nurses' experiences regarding clinical practice in Switzerland 1 year after graduation.

DESIGN

A secondary explorative analysis of a cross-sectional survey.

METHODS

The data were sourced from the Swiss National Graduate Survey of Health Professionals covering six universities of applied sciences between 2016 and 2019, with information on three cohorts of bachelor student nurses, with a 1-year follow-up between each year. The participants were 533 bachelor-prepared nursing graduates.

RESULTS

The student nurses' overall expectations included the following top two prioritized aspects: 'contributing to something important' and 'adequate time to spend with patients'. Newly graduated nurses' clinical practice experiences demonstrated that not all expectations were met 1 year after graduation. The largest gaps were found in 'adequate time to spend with patients', 'work-life balance' and experiencing 'good management'.

CONCLUSION

The most crucial expectation gaps are related to having sufficient time to spend with patients and a good work-life balance. The most important result is whether there is a shortage of places for nurses to work rather than the oft-cited shortage of nurses.

IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE

The expectations of Swiss newly qualified nurses can be better met by an assessment in the first year about which individual perceptions of workplace characteristics cause them to make choices to change something about their work, affect their job satisfaction or influence their intention to stay.

IMPACT

Few of the student nurses' expectations were met 1 year after graduation, therefore Swiss healthcare institutions should improve needs assessments to strengthen the nurse workforce starting early in employment. The results underscore the importance of a constructive management culture, such as that in magnet hospitals in the United States which underpins the philosophy of changing in nursing. The results can be used internationally as a benchmark and as a basis for introducing potential interventions for nurse retention.

REPORTING METHOD

This study was reported following the Standardized Reporting of Secondary Data Analyses Checklist.

PATIENT OR PUBLIC CONTRIBUTION

There were no patient or public contributions.

TRIAL AND PROTOCOL REGISTRATION

This study has not been registered.

'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.

Digital clinical empathy in a live chat: multiple findings from a formative qualitative study and usability tests

BACKGROUND

Clinical empathy is considered a crucial element in patient-centered care. The advent of digital technology in healthcare has introduced new dynamics to empathy which needs to be explored in the context of the technology, particularly within the context of written live chats. Given the growing prevalence of written live chats, this study aimed to explore and evaluate techniques of digital clinical empathy within a familial cancer-focused live chat, focusing on how health professionals can (a) understand, (b) communicate, and (c) act upon users' perspectives and emotional states.

METHODS

The study utilized a qualitative approach in two research phases. It examined the expected and implemented techniques and effectiveness of digital clinical empathy in a live chat service, involving semi-structured interviews with health professionals (n = 9), focus group discussions with potential users (n = 42), and two rounds of usability tests between health professionals (n = 9) and users (n = 18). Data were examined using qualitative content analysis.

RESULTS

Expected techniques of digital clinical empathy, as articulated by both users and health professionals, involve reciprocal engagement, timely responses, genuine authenticity, and a balance between professionalism and informality, all while going beyond immediate queries to facilitate informed decision-making. Usability tests confirm these complexities and introduce new challenges, such as balancing timely, authentic responses with effective, personalized information management and carefully framed referrals.

CONCLUSIONS

The study reveals that the digital realm adds layers of complexity to the practice of clinical empathy. It underscores the importance of ongoing adaptation and suggests that future developments could benefit from a hybrid model that integrates the strengths of both AI and human health professionals to meet evolving user needs and maintain high-quality, empathetic healthcare interactions.

Exploring the impact of a compassion-oriented training program on personal care workers in a nursing home: A mixed-methods pilot study

This pilot study aimed to explore the impact of a compassion-oriented training program on Personal Care Workers (PCWs) in a nursing home. A mixed-methods approach was used, including pre- and post-questionnaire surveys to measure changes in compassion, and in-depth interviews and daily diaries to explore PCWs' perceptions and experiences. A convenience sample of five female PCWs from a nursing home in Hong Kong participated in the study. The quantitative results showed that the PCWs experienced a decline in compassion after participating in the program. The qualitative data analysis identified three themes: (1) the multifaceted nature of compassion, (2) barriers and threats to compassion, and (3) transfer of skills at the workplace. Overall, These findings highlighted the complexity of implementing effective compassion training programs in nursing home, and emphasized the importance of recognizing the multifaceted nature of compassion and addressing barriers and threats to compassion in the workplace.

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

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

Qualitative research in suicidology: a systematic review of the literature of low-and middle-income countries

BACKGROUND

Suicide is more prevalent among disadvantaged, discriminated, and marginalised people with the majority of global suicide deaths occurring in the low-and middle-income countries (LMICs). This can be attributed to sociocultural contexts and exacerbated by access to limited resources and services that can assist with early identification, treatment, and support. Accurate information on the personal experiences of suicide is lacking, as many LMICs legislate that suicide is illegal.

METHODS

This study aims to review the qualitative literature to explore the experiences of suicide in LMICs from the first-person perspective. Following the PRISMA-2020 guidelines, the search for qualitative literature published between January 2010 and December 2021 was undertaken. A total number of 110 qualitative articles from 2569 primary studies met the inclusion criteria. Included records were appraised, extracted, and synthesised.

RESULTS

The results provide lived experience insight into suicide from those living in LMICs, including understanding variations of the causes of suicides, the impacts on others exposed to suicide, existing support systems, and prevention measures to reduce suicide among LMICs. The study offers a contemporaryunderstanding of how people in LMIC experience suicide.

CONCLUSIONS

The findings and recommendations are derived from the similarities and differences within the existing knowledge base that is dominated by evidence from high-income countries. Timely suggestions for future researchers, stakeholders, and policymakers are provided.

Ethical sensitivity and compassion in home care: Leaders' views

BACKGROUND

With an increasing older population, the pressure on home care resources is growing, which makes it important to ensure the maintenance of quality care. It is known that compassion and ethical sensitivity can improve the quality of care, but little is known about care leaders' perceptions on ethical sensitivity and compassion in home care and how it is associated with staff competence and thus quality of care.

AIM

The aim of the study was to explore home care leaders' perceptions of ethical sensitivity and compassion associated with care quality in home care.

RESEARCH DESIGN, PARTICIPANTS, AND RESEARCH CONTEXT

A hermeneutical approach with a qualitative explorative design was used. The data consists of texts from 10 in-depth interviews with home care leaders. Content analysis was used as a method.

ETHICAL CONSIDERATIONS

The study was conducted following the ethical guidelines of the Declaration of Helsinki and the Finnish Advisory Board of Research Ethics. Research ethics permission was applied for from a Research Ethics Board.

FINDINGS

One overall theme and four subthemes were found. The overall theme was: "Compassion provides deeper meaning and ethical sensitivity provides means for knowing how to act".

DISCUSSION

If nurses fail to be sensitive and compassionate with patients, good and high qualitative home care cannot be achieved. Ethical sensitivity and compassion can be seen as resources in home care but the organization and the care leaders need to provide the support for these to develop.

CONCLUSION

This study provides an understanding of the meaning of ethical sensitivity and compassion as sources of strength and their link to quality of care in a home care context. Further studies could focus on how to build compassion and ethical sensitivity into home-based care and how to ensure adequate support for healthcare professionals' compassion and ethical sensitivity.

How do ethically competent nurses behave in clinical nursing practice? A qualitative study

AIM

This study explored how ethically competent nurses behave in clinical nursing practice.

BACKGROUND

Nurses' ethical competency is crucial in nursing practice as it promotes patients' safety and quality of care.

METHODS

Using a purposive sampling technique, 20 clinical nurses in South Korea were interviewed via an online video platform. The data were analysed using a thematic analysis based on phenomenological approach.

RESULTS

The main theme found among the participating nurses' ethical competency was caring beyond egocentrism, with two subthemes: (1) patient-centred care based on compassion and (2) responsible behaviour based on nursing professionalism. Factors that enabled this included (1) reasonable work conditions, (2) interpersonal relationships, and (3) nurses' rich personal experiences.

CONCLUSIONS

Nurses' ethical competency depends on how far they can move away from their own egocentrism and act for their clients' benefit, wherein an appropriate workload and warm human relationships with one's colleagues are essential. Nurses should thus receive education on ethics and professionalism and participate in volunteer and leisure activities that cultivate their degree of empathy.

IMPLICATION FOR NURSING MANAGEMENT

Nursing leaders and managers should understand nurses' ethical competency and its enabling factors to devise effective strategies to promote it.

Mental health nurses' constructions of compassion: A discourse analysis

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

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSION

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

PUBLIC CONTRIBUTION

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

Emotional Intelligence and Perceived Health Related to Expressed Compassion Fatigue: A Study in Health Sector at Regional Level

Background: The work of health professionals often involves physical as well as psychological strain. They constantly deal with traumatic situations of pain and suffering, which destabilize the sense of well-being. Compassion fatigue is a feeling that appears in these cases and is related to other variables such as burnout or emotional drain.

Aims: The principal aim of this project was to deepen the analysis of compassion fatigue and how it could be explained through the relationship with other constructs such as emotional intelligence and perceived health.

Methods: This work followed the STROBE checklist for cross-sectional studies. In this study 1,521 nurses (M_age = 47.32; SD = 8.44) participated. The responses reported by the nurses were analyzed by classifying them as high or low compassion fatigue and the differences of both groups were analyzed for the variables of emotional intelligence, perceived health and quality of professional life.

Results: It was obtained significant differences for all factors except for emotional intelligence factor. A linear regression analysis showed both emotional intelligence and perceived health helped to explain (12%) compassion fatigue.

Conclusion: This study provides light on comprehending the conception of compassion fatigue. It highlights the importance of intervention programs that improve the quality of professional life.

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.

Residential aged care leadership in Australia-Time for a compassionate approach: A qualitative analysis of key leader skills and attributes

AIMS

To examine the perceptions of leadership by leaders within residential aged care and to identify the crucial requirements for successful leadership in this complex industry.

BACKGROUND

As an industry capitalizing on the concept of 'care', one of the critical attributes this research has found to be absent in many aged care leadership approaches is compassion.

METHODS

A qualitative methodology using thematic analysis was used to explore the construction of leadership attributes needed within residential aged care, as perceived by leaders in these organisations.

RESULTS

Senior staff in the aged care industry believe that compassion is both a key component and a gap in the skill set of aged care leadership and leaders. While most studies define good leadership and care in relation to clinical 'safety' and 'efficiency', this research demonstrates that compassionate caring is central to high-quality care in residential aged care.

CONCLUSIONS

The aged care industry needs to enhance and encourage compassionate leadership as a cornerstone of humane and dignified care.

IMPLICATIONS FOR NURSING

When developing theoretical explanations for the role of leadership in aged care, researchers should contemplate compassion as a key attribute required in residential aged care leaders. Education and training in this industry must incorporate the attributes associated with compassion, including emotional intelligence and person-centred leadership.

Meta approaches in knowledge synthesis in nursing: A bibliometric analysis

OBJECTIVE

To analyze the bibliometric patterns of meta-approaches use in nursing research literature.

METHODS

Descriptive, exploratory and historical bibliometrics analyses were used. The papers were harvested from the Web of Science Core Collection.

FINDINGS

The search resulted in 2065 publications. The trends in using most individual meta approaches show that the use of meta-analysis is increasing exponentially, the use of meta-synthesis is increasing linearly, while the use of meta-ethnography is constant in last 6 years. Most productive countries were United States of America, United Kingdom and Peoples Republic of China. Most publications were published in the Journal of Advanced Nursing, International Journal of Nursing Studies, and Journal of Clinical Nursing. Twenty-seven percent of all publications were funded. Thirty-four meta approaches were identified.

DISCUSSION

The study revealed that the trend in the literature production is positive. Research community use of meta-approaches in nursing exhibit considerable growth. Regional concentration of literature production was observed.

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.

Nurse with smile: Does it make difference in patients' healing?

Smiling is a highly significant component of nurses' caring behavior. Nurses have to deal with too many people at workplace and interpersonal relation building is the key secret for quality work and also enhances job satisfaction. A genuine smile given by a nurse can do wonders as it conveys acceptance, builds trust and establishes inter-personal relationship. It also helps nurses to feel better and avoid anxiety or stress burnout in clinical situation. This paper of ours highlights the importance of nurses' smile in patients' recovery and important research literature to support smiling culture among health-care professionals.

Quality of life, tuberculosis and treatment outcome; a case-control and nested cohort study

BACKGROUND

Global tuberculosis policy increasingly emphasises broad tuberculosis impacts and highlights the lack of evidence concerning tuberculosis-related quality of life (QOL).

METHODS

Participants were recruited in 32 Peruvian communities between July 13, 2016 and February 24, 2018 and followed-up until November 8, 2019. Inclusion criteria were age ≥15 years for "patients" (n=1545) starting treatment for tuberculosis disease in health centres; "contacts" (n=3180) who shared a patient's household for ≥6 h·week^-1; and randomly selected "controls" (n=277). The EUROHIS-QOL questionnaire quantified satisfaction with QOL, health, energy, activities of daily living (ADL), self, relationships, money and living place.

FINDINGS

Newly diagnosed tuberculosis was most strongly associated with lower QOL scores (p<0.001). Patients initially had lower QOL than controls for all EUROHIS-QOL questions (p≤0.01), especially concerning health, ADL and self. Lower initial QOL in patients predicted adverse treatment outcomes and scores <13 points had 4.2-fold (95% CI 2.3-7.6) increased risk of death versus those with higher QOL scores (both p<0.001). Patient QOL was re-assessed 6 months later, and for patients with successful treatment QOL became similar to participants who had never had tuberculosis, whereas patients who did not complete treatment continued to have low QOL (p<0.001). Multidrug-resistant tuberculosis was associated with lower QOL before and during treatment (both p<0.001). Contacts had lower QOL if they lived with a patient who had low QOL score (p<0.0001) or were a caregiver for the patient (p<0.001).

CONCLUSIONS

Tuberculosis was associated with impaired psychosocioeconomic QOL which recovered with successful treatment. Low QOL scores predicted adverse treatment outcome. This brief EUROHIS-QOL eight-item questionnaire quantified the holistic needs of tuberculosis-affected people, potentially guiding patient-centred care.

Intelligent humanoid robots expressing artificial humanlike empathy in nursing situations

Intelligent humanoid robots (IHRs) are becoming likely to be integrated into nursing practice. However, a proper integration of IHRs requires a detailed description and explanation of their essential capabilities, particularly regarding their competencies in replicating and portraying emotive functions such as empathy. Existing humanoid robots can exhibit rudimentary forms of empathy; as these machines slowly become commonplace in healthcare settings, they will be expected to express empathy as a natural function, rather than merely to portray artificial empathy as a replication of human empathy. This article works with a twofold purpose: firstly, to consider the impact of artificial empathy in nursing and, secondly, to describe the influence of Affective Developmental Robotics (ADR) in anticipation of the empathic behaviour presented by artificial humanoid robots. The ADR has demonstrated that it can be one means by which humanoid nurse robots can achieve expressions of more relatable artificial empathy. This will be one of the vital models for intelligent humanoid robots currently in nurse robot development for the healthcare industry. A discussion of IHRs demonstrating artificial empathy is critical to nursing practice today, particularly in healthcare settings dense with technology.

Maximising comfort: how do patients describe the care that matters? A two-stage qualitative descriptive study to develop a quality improvement framework for comfort-related care in inpatient settings

OBJECTIVE

To develop a multidimensional framework representing patients' perspectives on comfort to guide practice and quality initiatives aimed at improving patients' experiences of care.

DESIGN

Two-stage qualitative descriptive study design. Findings from a previously published synthesis of 62 studies (stage 1) informed data collection and analysis of 25 semistructured interviews (stage 2) exploring patients' perspectives of comfort in an acute care setting.

SETTING

Cardiac surgical unit in New Zealand.

PARTICIPANTS

Culturally diverse patients in hospital undergoing heart surgery.

MAIN OUTCOMES

A definition of comfort. The Comfort ALways Matters (CALM) framework describing factors influencing comfort.

RESULTS

Comfort is transient and multidimensional and, as defined by patients, incorporates more than the absence of pain. Factors influencing comfort were synthesised into 10 themes within four inter-related layers: patients' personal (often private) strategies; the unique role of family; staff actions and behaviours; and factors within the clinical environment.

CONCLUSIONS

These findings provide new insights into what comfort means to patients, the care required to promote their comfort and the reasons for which doing so is important. We have developed a definition of comfort and the CALM framework, which can be used by healthcare leaders and clinicians to guide practice and quality initiatives aimed at maximising comfort and minimising distress. These findings appear applicable to a range of inpatient populations. A focus on comfort by individuals is crucial, but leadership will be essential for driving the changes needed to reduce unwarranted variability in care that affects comfort.

Optimising professional communication with patients

Communication between a nurse and a patient may seem intuitive. However, communicating effectively with patients while applying the principles of person-centred care can be challenging. Patients' perceptions of suboptimal care and healthcare services may be influenced by how nurses communicate with them, since communication may be used as a quality indicator, as well as an indicator of patient experience. This article considers how nurses can communicate effectively with patients to optimise care. It explores the theoretical principles of interpersonal and professional communication, and discusses practical methods of listening and speaking to patients that nurses can apply in their clinical practice.

Optimising compassionate nursing care at the end of life in hospital settings

BACKGROUND

An urgent need to improve palliative care in hospital has been identified. Moreover, service users consistently report care delivered by nurses in hospital as lacking compassion. Compassion is a fundamental component of nursing care, and promoting compassionate care has been identified as a policy priority in many countries. To help address this within the hospital context, we recently completed research exploring bereaved family experiences of good end of life care in hospital. We found that family accounts of good care aligned with Nolan and Dewar's compassionate care framework and subsequently extended the framework to the bi-cultural context of Aotearoa, New Zealand.

AIMS AND OBJECTIVES

In this discussion paper, we explore synergies between our newly developed Kapakapa Manawa Framework: a bi-cultural approach to providing compassionate care at the end of life and the Fundamentals of Care. We argue that our framework can be used to support the implementation of the relational component of the Fundamentals of Care and the delivery of compassionate nursing practice in hospitals in Aotearoa, New Zealand.

DESIGN

Discussion paper.

METHODS

Review of relevant literature and construction of two vignettes describing good end of life care from the perspectives of bereaved family-one Māori and one non-Māori. The vignettes provide practical examples of how the values of the Kapakapa Manawa Framework can be enacted by nurses to provide compassionate care in alignment with the relationship component of the Fundamentals of Care.

CONCLUSIONS

Whilst the Kapakapa Manawa bi-cultural compassionate care framework has grown out of research conducted with people nearing the end of their lives, it has the potential to improve nursing care for all hospital inpatients.

RELEVANCE TO CLINICAL PRACTICE

Addressing the wider policy and health system factors detailed in the Fundamentals of Care will support its implementation in the clinical setting.