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

Examining nurses' humanistic behaviour ability and empathy levels in clinical practice: A descriptive and exploratory study

BACKGROUND

It is critical for nurses to provide healthcare services to healthy/sick individuals with a humanistic approach and with empathy.

AIMS

This research aimed to determine nurses' humanistic behaviour ability, empathy levels and related factors in clinical practice.

DESIGN

A descriptive cross-sectional and exploratory study.

METHODS

Probability sampling method was used, and 337 nurses working in two public hospitals were included in the study. Data was collected using the Humanistic Practice Ability of Nursing Scale and the Empathy Level Determination Scale. Structural equation model analysis and descriptive statistics were used to evaluate the hypothesised model. This study adhered to the STROBE checklist for reporting.

RESULTS

Nurses' humanistic ability and empathy level in nursing practices were found to be above average. Both the ability to act humanely in nursing practices and their empathy levels were found to be significantly higher in nurses who were married and had children. A significant relationship was found between empathy levels and humanistic behaviours. Accordingly, nurses' empathy levels positively affected their humanistic care behaviours, and the model established between the two concepts was found to be statistically appropriate.

CONCLUSIONS

Nurses' empathy levels positively affect their ability to act humanistically. The result of the model established between the two concepts also supports this. Care strategies should be developed that consider factors that will improve empathetic and humanistic behaviours in nurses and maximise individualised care practices.

IMPLICATIONS FOR THE PROFESSION

Increasing the awareness of nurses about the factors affecting humanistic behaviours and empathic attitudes while caring for individuals in clinical practice, will contribute to improving the quality of nursing care.

Compassionate care through the eyes of patients and physicians: An interview study

BACKGROUND

Although compassion is a crucial element of physicians' professional performance and high-quality care, research shows it often remains an unmet need of patients. Understanding patients' and physicians' perspectives on compassionate care may provide insights that can be used to foster physicians' ability to respond to patients' compassion needs. Therefore, this study aims to understand how both patients and physicians experience the concept and practice of compassionate care.

METHODS

We conducted semi-structured interviews with eight patients and ten resident physicians at a University Medical Center in the Netherlands. Using thematic analysis, we separately coded patient and resident transcripts to identify themes capturing their experiences of compassionate care. This study was part of a larger project to develop an educational intervention to improve compassion in residents.

RESULTS

For both patients and residents, we identified four themes encompassing compassionate care: being there, empathizing, actions to relieve patients' suffering, and connection. For residents, a fifth theme was professional fulfillment (resulting from compassionate care). Although patients and residents both emphasized the importance of compassionate care, patients did not always perceive the physician-patient encounter as compassionate. According to residents, high workloads and time pressures hindered their ability to provide compassionate care.

DISCUSSION AND CONCLUSION

Patients and residents have similar and varying understandings of compassionate care at the same time. Understanding these differences can aid compassion in medical practice. Based on the findings, three topics are suggested to improve compassion in residents: (1) train residents how to ask for patients' compassion needs, (2) address residents' limiting beliefs about the concept and practice of compassion, and (3) acknowledge the art and science of medicine cannot be separated.

Patient-reported assessment of compassion in Spanish: a systematic review

Aims and objectives

This systematic review aims to: (1) explore which tools have been used in Spanish to measure compassion; (2) know which of these tools could be used to assess compassion in healthcare settings from the perspective of patients; (3) evaluate the quality of these patient-reported measures in Spanish contexts; and (4) determine which of these instruments would be best suited to be used in healthcare settings.

Background

Compassion has been recognized as a fundamental dimension of quality healthcare.

Methods

Several scientific databases were consulted for relevant records published up to December 16th, 2021. In accordance with PRISMA guidelines, 64 studies were included.

Results and conclusions

while existing instruments, validated in Spanish, allow for the measurement of self-compassion or compassion to others, there are no valid and reliable measures currently available in Spanish to measure patient-reported compassion.

Relevance to clinical practice

In order to ensure and promote compassion in the health care context, it is essential to have a valid and reliable tool to measure this construct in a patient-informed way, and this is currently not possible in the Spanish-speaking context because of the lack of such an instrument in Spanish.

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

INTRODUCTION

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

METHOD

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

RESULTS

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

CONCLUSION

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

Conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities: a scoping review

Introduction

To examine the scope of existing literature on the conceptualization, use, and outcomes associated with compassion in the care of youth with childhood-onset disabilities.

Methods

A protocol was developed based on the Joanna Briggs Institute (JBI) scoping review method. MEDLINE, EMBASE, PsycINFO, Cochrane Central Register of Controlled Trials, and EBSCOhost CINAHL, were searched.

Results

Eight studies were selected for inclusion; four used quantitative methodology, and four used qualitative methods. Compassion was not defined a priori or a posteriori in any of the included studies. The concept of self-compassion was explicitly defined only for parents of youth with childhood-onset disabilities in three studies a priori. The most reported outcome measure was self-compassion in parents of youth with childhood-onset disabilities. Self-compassion among parents was associated with greater quality of life and resiliency and lower stress, depression, shame and guilt.

Discussion

There is limited evidence on the conceptualization, use, and outcomes associated with compassion among youth with childhood-onset disabilities. Self-compassion may be an effective internal coping process among parents of youth with childhood-onset disabilities. Further research is required to understand the meaning of compassion to youth with childhood-onset disabilities, their parents and caregivers.

Systematic review registration

https://doi.org/10.17605/OSF.IO/2GRB4.

A Path to Inclusiveness - Peer Support Groups as a Resource for Change

Being bullied is associated with anxiety, depression symptoms, and long-term negative health outcomes. The aim of this qualitative pilotstudy was to explore bullied children's experiences of support groups and how participating in a group affected the children. The sample consisted of 24 children aged 11-13 years. Four of them were bullied, while 20 participated in support groups. Individual and focus group interviews were conducted. The main theme identified was that support groups provide an opportunity for change and can help children to be included among peers. The changes were achieved through encouragement and support from peers. The children participating in the support groups reported a feeling of being selected. The groups provided fellowship, and an opportunity for change. Both getting support from and being part of a support group contributed to inclusion, strength, and valuable experiences. The findings suggest that a systemic approach to bullying is advantageous.

Self-compassion training in palliative care during COVID-19: A pilot study

OBJECTIVES

This pilot project replicated a self-compassion program to support health-care professionals in palliative care settings. We anticipated that undertaking this program would enhance participants' psychological well-being.

METHODS

Participants were recruited by convenience sampling from palliative care services in an area of Melbourne, Australia. Because of the COVID-19 pandemic, the program was offered online and comprised six once-weekly gatherings. Three survey rounds with identical questions were conducted prior to, immediately after, and 3 months after the training. The surveys consisted of 6 scales: the Self-Compassion Scale, the Santa Clara Brief Compassion Scale, the Cognitive and Affective Mindfulness Scale, the Depression Anxiety Stress Scale, the Professional Quality of Life Scale, and the Interpersonal Reactivity Index Scale. Paired-sample t-test and repeated measures analysis of variance analyses were used to compare participant responses.

RESULTS

Nine participants working in palliative care completed the training and 3 surveys and included qualitative responses. The experience was overwhelmingly positive. Self-compassion (F = 14.44; p < 0.05) and mindfulness (F = 18.44; p < 0.05) scores significantly increased post-training, were picked up in a short time and endured. The emotional state improved by compassion satisfaction, showing a positive improvement 3 months post-training, along with there being no changes in compassion satisfaction, burnout, and dispositional empathy.

SIGNIFICANCE OF RESULTS

Participants all worked in a supportive environment, which encouraged self-care. Even against the pandemic difficulties, a short online program was effective, assisting participants to cultivate their inner resources in mindfulness and self-compassion. While a small sample size, expansion of the training may benefit the wider palliative care workforce.

The effects of psychological interventions on suicide for cancer patients: a systematic review and network meta-analysis

Numerous psychological interventions are available for suicidal and death ideation (SDI) and suicidal behavior among cancer patients. To identify the optimal psychological interventions for reducing SDI and suicidal behavior in cancer patients. However, it remains unclear which psychological intervention is the most effective. We performed a pairwise and network meta-analysis by searching seven databases from the date of inception until 8 April 2022. An important focus of this network meta-analysis was the comparison of the effects of various psychological interventions on the reduction of SDI and suicidal behavior among cancer patients. For determining efficacy, we used standardized mean differences (SMDs) and 95% confidence intervals (CIs). Besides, a pairwise meta-analysis, inconsistency test, network meta-analysis, the surface under the cumulative rankings curve (SUCRA), comparison-adjusted funnel plot, subgroup analysis, and sensitivity analysis were also carried out. A total of 8 studies involving 1,350 patients were searched in this study. It showed that empathy therapy (SUCRA = 95.3%) has the best effect among the six interventions. Comprehensive psychological intervention (SUCRA = 77.6%) was ranked in the top two positions, followed by meaning-centered therapy (SUCRA = 40.7%). Comparison-adjusted funnel plots revealed no significant publication bias. In addition, our conclusions have not changed significantly after the sensitivity analysis. In this network meta-analysis, empathy therapy was identified as the optimal choice for reducing SDI and suicidal behaviors in cancer patients. Further multi-center and high-quality RCT studies should be conducted to make our conclusion more rigorous.

"Unless someone sees and hears you, how do you know you exist?" Meanings of confidential conversations - a hermeneutic study of the experiences of patients with palliative care needs

BACKGROUND

Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.

METHODS

In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.

RESULTS

The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life's challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.

CONCLUSIONS

Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients' suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients' varying preferences.

Nursing undergraduates' ageism and attitudes toward dementia: Serial multiple mediating effects of person-centered care and compassion - A cross-sectional survey

Background

Although ageism has a strong relationship with attitudes toward dementia, no study has confirmed how person-centered care and compassion mediate the relationship between nursing students' ageism and attitudes toward dementia.

Objectives

This study aimed to examine the mediating effects of person-centered care competency and compassion competency on ageism and attitudes toward dementia among nursing undergraduates.

Participants

Participants were 295 undergraduate nursing students from four universities.

Methods

A descriptive cross-sectional electronic survey was conducted, involving the selection of four Korean nursing schools for the study. Data was obtained via an online survey conducted from March to July 2022. Data were analyzed with Pearson's correlations, and multi-mediating effects using the PROCESS Macro for software, utilizing bootstrap techniques.

Results

Attitudes toward dementia was correlated with ageism (r = -0.386, p < 0.001), person-centered care (r = 0.422, p < 0.001), and compassion competency (r = 0.457, p < 0.001). The total effect (β = -0.326, p < 0.001) and direct effect (β = -0.243, p < 0.001) of ageism on attitudes toward dementia were significant. Ageism does not have a direct effect on compassion competency (Std. estimate = -0.0213, CI: -0.0518∼0.0048). However, person-centered care and compassion competency had multiple serial mediating effects on the relationship between ageism and attitudes toward dementia (Std. estimate = -0.0357, CI: -0.0624∼-0.0145).

Conclusions

Person-centered care and compassion competency may mediate the association between ageism and attitudes toward dementia. Ageism was negatively associated with person-centered care and compassion competency, which in turn positively contributed to attitudes toward dementia. Therefore, an educational program that considers the interaction between generations and the context of older people must be applied to increase person-centered care and compassion competency.

The interpersonal conversation is also a medical task

Existential suffering refers to the distress arising from an inner realisation that life has lost its meaning or when life is threatened by disease. Compassionate and conscious conversation conducted by healthcare professionals is a way to alleviate existential suffering. In this review, we present a simple conversation tool which can be used to structure and build experience in end-of-life conversations and alleviation of existential suffering. The tool aims for patients to feel dignified and better understood in their existential questions and for doctors to feel better equipped in helping the patients with their suffering.

Cultural adaptation and validation of the caring behaviors assessment tool into Spanish

BACKGROUND

The aim of the research was to translate, culturally adapt and validate the Caring Behaviors Assessment (CBA) tool in Spain, ensuring its appropriateness in the Spanish cultural context.

METHODS

Three-phase cross-cultural adaptation and validation study. Phase 1 involved the transculturation process, which included translation of the CBA tool from English to Spanish, back-translation, and refinement of the translated tool based on pilot testing and linguistic and cultural adjustments. Phase 2 involved training research assistants to ensure standardized administration of the instrument. Phase 3 involved administering the transculturally-adapted tool to a non-probabilistic sample of 402 adults who had been hospitalized within the previous 6 months. Statistical analyses were conducted to assess the consistency of the item-scale, demographic differences, validity of the tool, and the importance of various caring behaviors within the Spanish cultural context. R statistical software version 4.3.3 and psych package version 2.4.1 were used for statistical analyses.

RESULTS

The overall internal consistency of the CBA tool was high, indicating its reliability for assessing caring behaviors. The subscales within the instrument also demonstrated high internal consistency. Descriptive analysis revealed that Spanish participants prioritized technical and cognitive aspects of care over emotional and existential dimensions.

CONCLUSIONS

The new version of the tool proved to be valid, reliable and culturally situated, which will facilitate the provision of objective and reliable data on patients beliefs about what is essential in terms of care behaviors in Spain.

Understanding how volunteer companionship impacts those during the end of life: A realist evaluation

Volunteers are a popular unpaid support role in end of life care yet how accompaniment influences the dying is underdeveloped. This study examined how companionship works, for whom, in what circumstances and why. Initial realist ideas were developed through participant observation (14 months), document analysis, and realist interviews with companionship trainers (n = 6). Theory testing involved volunteer interviews (n = 7), accounts from the dying, proxy accounts for the dying, and written reflections from companionship training. Companionship helps people live well until they die, prepare for death, and experience a good death. Four areas of volunteering explain these outcomes namely a loving friend, a holistic presence, a non-judgmental intermediary, and wrap around care. The four areas activate mechanisms related to reminiscing, preserving dignity/personhood, and easing suffering, contingent on specific contexts. The findings unpack how volunteering exerts its influence and what contextual factors facilitate outcomes, advancing the knowledge in this area.

Characteristics and Influencing Factors of Post-Traumatic Growth: A Cross-Sectional Study of Psychiatric Nurses Suffering from Workplace Violence in Guangdong China

Background

Workplace violence (WPV) had become an important issue that endangered the occupational safety of psychiatric nurses. A growing number of studies showed positive post-traumatic growth (PTG) resulting from coping with trauma.

Objective

To investigate the characteristics of PTG in psychiatric nurses who experienced violence in the workplace and analyze its influencing factors.

Methods

A total of 1202 psychiatric nurses participated in the study. From October 2022 to December 2022, this cross-sectional study collected data on psychiatric nurses from five tertiary hospitals in Guangdong Province, China. Twenty-item Chinese version post-traumatic growth inventory (PTGI), Jefferson Scale of Empathy Health Professional (JSE-HP), Confidence in Coping with Patient Aggression Instrument (CCPAI), Post-traumatic Stress Disorder Checklist-Civilian Version (PCL-C), and Connor-Davidson Resilience Scale (CD-RISC) measured PTG level, empathy, the confidence in coping with WPV, post-traumatic stress disorder, and resilience, respectively. Bivariate analysis and multiple linear regression explored potential influencing factors of PTG. This study complies with the EQUATOR (STROBE) checklist.

Results

The sample was composed of a total of 1202 psychiatric nurses suffering from WPV. The average score of PTGI in psychiatric nurses was above average (65.75 points; SD = 20.20). Linear regression analyses showed from single-child family (β=0.052,95% CI=0.342,5.409, P<0.05), education background (β=0.108,95% CI=1.833,5.097, P<0.001), the confidence in coping with patient aggression (β=0.106,95% CI=1.385,4.317, P<0.001), empathy (β=0.057,95% CI=0.312,4.374, P<0.05), and resilience (β=0.484,95% CI=7.737,9.575, P<0.001) were associated with PTG level.

Conclusion

Psychiatric nurses who were non-single child, had received higher education, had confidence in coping with patient aggression, had good resilience and strong empathy were prone to PTG after experiencing WPV. The study findings could help hospitals and nursing managers identify vulnerable individuals and take early intervention measures against such populations.

The current state of empathy, compassion and person-centred communication training in healthcare: An umbrella review

OBJECTIVES

This umbrella review consolidates evidence available on empathy training, its effectiveness and design mechanisms that contribute to effectiveness.

METHODS

We conducted an umbrella review (review of reviews) of empathy, compassion and person-centred communication training in healthcare published between 2018 and 2022. One reviewer screened titles, abstracts and full-text articles, with a second reviewer at full-text stage. Quality appraisal was done in duplicate. Data extraction was piloted by two reviewers and conducted by one reviewer with a quality check of all extracted data. All reviewers provided input into synthesis of results and analysis.

RESULTS

Twenty-five reviews were included. We provide an overview of the definitions of empathy, compassion and person-centred communication, outcome measures used, a synthesis of findings on the mechanisms and effectiveness of training and a summary of review recommendations.

CONCLUSIONS

For policy and practice, we advise the inclusion of empathic communication into the curriculum; longitudinal and sequenced learning; debriefing, targeted feedback, enabling self-reflection, deliberate practice, experiential learning; improving motivation by teaching the benefits of empathy and teaching sustainable empathy. Future research should involve patients in training and research and study the effect of targeting interventions at healthcare practitioners and patients.

Compassionate Presence in Seriously Ill Cancer Patients

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

Interventions for Compassion Fatigue in Healthcare Providers-A Systematic Review of Randomised Controlled Trials

BACKGROUND

Compassion fatigue is a significant issue considering its consequences including negative feelings, impaired cognition, and increased risk of long-term morbidities. We aimed to assess current evidence on the effects of interventions for compassion fatigue in healthcare providers (HCP).

METHODS

We used the Cochrane methodology for Systematic Reviews and Meta-Analyses (PRISMA) for conducting and reporting this review.

RESULTS

Fifteen RCTs (n = 1740) were included. The sample size of individual studies was small ranging from 23 to 605. There was significant heterogeneity in participant, intervention, control, and outcome characteristics. The tools for assessing intervention effects on compassion fatigue included ProQOL, compassion fatigue scale, and nurses compassion fatigue inventory. Thirteen out of the fifteen included RCTs had overall high risk of bias (ROB). Meta-analysis could not be performed given the significant heterogeneity.

CONCLUSIONS

Current evidence on interventions for reducing compassion fatigue in HCPs is inadequate. Given the benefits reported in some of the included studies, well-designed and adequately powered RCTs are urgently needed.

Cross-Sectional Study of the Professional Quality of Life of Palliative Care Professionals during the COVID-19 Pandemic

BACKGROUND

The display of compassionate care by palliative care professionals is of the utmost importance to the patients, their families, and even to their own professional well-being. Lately and, especially due to the emergence of the COVID-19 pandemic, palliative care professionals have been subjected to greater pressures stemming from their work environment, organizational standpoint, and emotional sense of view. Not only have these factors made it harder for professionals to deliver compassionate care to their patients, but they have also decreased their overall well-being. The aim is to study how sociodemographics, workplace characteristics, internal resources, and the COVID-19 pandemic-derived pressures have affected the professionals' capacity to perform compassionate care and their well-being while at the same time exploring the relationship between compassionate care and well-being.

METHODS

This study used a cross-sectional design with data gathered from Spanish palliative care professionals. The final sample was formed by 241 participants. They were surveyed about compassion, professional quality of life, well-being, sociodemographic data, working conditions, self-care, and coping with death competence, and the impact of the COVID-19 pandemic. The analyses used were descriptive statistics, bivariate tests, and the construction of a structural equation model.

RESULTS

Compassion was predicted by the ability to control their workload and the ability to cope with death. Burnout was predicted by age, workload, workload control, self-care, material resources, and changes in teamwork. Moreover, compassion, age, workload control, and changes in teamwork and self-care were shown to significantly predict compassion satisfaction. When it comes to compassion fatigue, different variables were shown to predict it, those being compassion, control over the workload, social self-care, and the ability to cope with death.

CONCLUSIONS

Having a healthy lifestyle and an adequate social support system is key to maintaining professional well-being in the case of palliative care professionals. Inner resources such as the ability to perform self-care and the capacity to cope with death are of vital importance to taking care of these professionals. Thus, it would be beneficial to establish training programs focused on these aspects in the myriad of sanitary centers that perform these tasks, as these abilities are necessary to withstand the work-related pressures and, at the same time, be able to provide compassionate care for patients.

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

BACKGROUND

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

OBJECTIVE

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

METHOD

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

RESULTS

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

CONCLUSION

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

Compassion in Autism Services: A Preliminary Framework for Applied Behavior Analysis

Many have suggested that a compassion-focused approach to applied behavior analysis (ABA) services may improve provider-client therapeutic relationships and has the potential to improve program acceptability and clinical outcomes experienced by our clients. In this article, radical compassion is defined and explored as a foundational approach to the implementation of ABA, with special emphasis on practical applications in the area of service delivery for families living with autism. In this framework for care, compassion is offered as a measurable repertoire and as a philosophical guidepost for future developments in the profession. This article explores preliminary tenets of compassion-focused ABA and their implications for practice. This approach is offered in the hope of moving the field toward a future of improved acceptability and sustainable consumer preference.

Communication About Negative and Uncertain Results: Interactional Dilemmas During a Genetic Telehealth Consult

This case study focuses on a video telehealth consult to discuss genetic testing results. Participants include a Genetic Counselor (GC) and a Patient (P) previously diagnosed with ovarian cancer who is currently undergoing chemotherapy treatments. Utilizing conversation analysis (CA), attention is first given to a series of interactional dilemmas as GC delivers and P responds to negative, uncertain, and complex test results. Specific findings address practices employed by GC to structure the encounter and establish authority, impacts on P's participation and understandings, recurring and at times problematic orientations to "negative" findings, and inherent ambiguities faced by GC and P when attempting to discern good and bad news. Close examination of these moments provides a unique opportunity to identify, describe, and explain genetic counseling as a co-produced, interactional achievement. These findings are then integrated with patient's post-counseling survey (susceptibility, anxiety, uncertainty, fear, and hope), including reported experiences which broaden understandings of the interactional environment. Specific recommendations are raised for improving counseling skills, enhancing patients' understandings, and building therapeutic alliances addressing both patients' emotional circumstances and the complexities of genetic test results.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

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

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

Proactive method for identification and handling of patient complaints with root cause analysis in Surabaya Islamic Hospital

Background

Errors or cases that occur in health care organizations are very fatal because they can reduce the quality of life of patients and the worst is cause the death of the patient. One of the appropriate tools to be applied in analyzing cases/problems that occur in Surabaya Islamic Hospitals is root cause analysis. The complaints were addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance sections.

Design and methods

This research uses secondary data on hospital patient complaints in 2022 and is supported by the results of online interviews with the head of marketing public relations. Secondary data was processed through a six stages of root cause analysis and analyzed with the help of a fishbone diagram to determine the root cause of the problem in the health care sector.

Results

There were 261 complaints received by customer service addressed to the medical services, medical support, general, administration and verification, information systems and management, and finance departments. There are eight root causes found in Surabaya Islamic Hospital inpatient complaints. This proves that there must be improvements/ interventions made by the Surabaya Islamic Hospital to overcome inpatient complaints.

Conclusions

Inpatient complaints at Surabaya Islamic Hospital prove the need for a number of interventions/improvements, especially in the field of human resources, namely the level of discipline, skills, empathy, communication, limited medical, and financial staff.

Experiences of Family Caregivers Caring for Patient with Alzheimer's Disease: A Hermeneutic Phenomenological Study

Introduction

Alzheimer's disease (AD) becomes one of the diseases that greatly increased in the older adult population. Family caregivers play an important role in caring for family members who suffer from AD. The aim of this study was to illuminate the meaning of family caregivers' lived experiences caring for a family member with AD from the perspective of an Indonesian.

Methods

Narrative interviews were conducted with 13 family caregivers. These interviews were audio-taped and transcribed verbatim and analyzed using a phenomenological hermeneutic approach.

Results

The findings are presented under two main themes: Descent and ascent in caring for which emerged from category from being denial to acceptance, from lack of patience to compassion, from using to not using medication, and desperate yet responsibility. Another theme, caregivers' life learning emerged from the category of ongoing caring for and getting through in caring for.

Conclusion

Expressed concerns have shown that family caregivers not only face challenges in caring for family members suffering from AD, but also gain a lesson for life. It is necessary for family caregivers to manage caring processes for family members who suffer from AD.

Self-awareness, empathy, and patient-centered care among critical care nurses in Jordan

Self-awareness, empathy, and patient-centered care are essential components for nurses for improving nurse-patient relationship and providing high-quality care for the patients. There is limited research regarding these components among critical care nurses in Arab countries, including Jordan. Thus, this study purposed to evaluate the self-awareness, empathy, and patient-centered care among critical care nurses in Jordan. A cross-sectional, descriptive correlational design was applied. Data were collected from 140 registered nurses from six hospitals in different health sectors. Findings showed that the mean scores for self-awareness, empathy and patient-centered care were as follows: 1.92 (SD = 0.27), 4.87 (SD = 0.88), and 3.71 (SD = 0.80), respectively. These results indicate that nurses had a high level of self-awareness and empathy and a low level of patient-centered care. There was no relationship between self-awareness and socio-demographic variables, perceived stress, and social support. Also, there was a positive relationship between empathy and social support (r = 0.310, p < 0.001). Patient-centered care had a positive relationship with social support (r = 0.202, p < 0.05) and perceived stress (r = 0.175, p < 0.05), also, male nurses had higher patient-centered care than female encounters. Social support was a predictor of empathy, while social support and perceived stress were the main predictors for patient-centered care. The results of the study reflect the need for educational programs to promote self-awareness and empathy to enhance patient-centered care and achieve high-quality patient care. Additionally, correlating factors with PCC (social support and perceived stress) should be taken into consideration upon implementing any interventional programs.

A compassion-based program to reduce psychological distress in medical students: A pilot randomized clinical trial

OBJECTIVES

Physicians and medical students are subject to higher levels of psychological distress than the general population. These challenges have a negative impact in medical practice, leading to uncompassionate care. This pilot study aims to examine the feasibility of Compassion Cultivation Training (CCT) to reduce psychological distress and improve the well-being of medical students. We hypothesize that the CCT program, as compared to a waitlist control group, will reduce psychological distress (i.e., stress, anxiety, and depression) and burnout symptoms, while improving compassion, empathy, mindfulness, resilience, psychological well-being, and emotion-regulation strategies after the intervention. Furthermore, we hypothesize that these improvements will be maintained at a two-month follow-up.

METHODS

Medical students were randomly assigned to an 8-week CCT or a Waitlist control group (WL). They completed self-report assessments at pre-intervention, post-intervention, and a 2-month follow-up. The outcomes measured were compassion, empathy, mindfulness, well-being, resilience, emotional regulation, psychological distress, burnout, and COVID-19 concern. Mixed-effects models and Reliable Change Index were computed.

RESULTS

Compared with WL, CCT showed significant improvements in self-compassion, mindfulness, and emotion regulation, as well as a significant decrease in stress, anxiety, and emotional exhaustion component of burnout. Furthermore, some of these effects persisted at follow-up. No adverse effects of meditation practices were found.

CONCLUSIONS

CCT enhanced compassion skills while reducing psychological distress in medical students, this being critical to preserving the mental health of physicians while promoting compassionate care for patients. The need for institutions to include this type of training is also discussed.

Physicians' narratives of communication with patients and their relatives in different phases of the palliative pathway

OBJECTIVES

To explore physicians' experiences of the communication with patients and their relatives in the different phases of the palliative pathway.

METHODS

Purposeful sampling was employed to recruit a total of 13 oncologists and general practitioners who engaged in palliative care. A qualitative study with a narrative approach was conducted. Interviews with physicians working in primary and specialist healthcare were conducted via Skype Business in the spring of 2020. The interview guide had open-ended questions with each interview lasting between 35 and 60 min.

RESULTS

Communication between the physicians, their patients and their relatives was contextual and changed depending on the phase in the palliative pathway. In the first phase, physicians told us that patients and their relatives experienced an emotional shock. Transitioning from the curative to palliative phase was difficult, which emphasised the need for trust through communication. In the middle phase, they revealed that communication about the death process became the priority: what was probably going to happen, the family's role in what was going to happen and perhaps, depending on the illness, any medical decisions that needed to be made. It was important for the physicians to communicate information about the palliative pathway while providing the relatives with knowledge that facilitated any decision making. In the terminal phase, physicians employed a compassionate approach, as bereaved family members needed to process their feelings of guilt and grief.

CONCLUSIONS

The study gives new insight into communication with patients and their relatives during different phases of the palliative pathway, from the physician's perspective. The findings may help physicians improve the quality of communication with patients and their relatives over these vulnerable pathways. The findings also have practical implications in training contexts. The study reveals ethical dilemmas in physicians' communication with patients and their relatives during a palliative pathway.

Effect of empathy training on the empathy level of healthcare providers in Ethiopia: a cluster randomized controlled trial

Objective

Empathy has deteriorated throughout clinical training and medical practice, and little is known about the effect of empathy training on the empathy level of healthcare providers. To address this gap, we assessed the effect of empathy training on the empathy level of healthcare providers in Ethiopia.

Design

A cluster randomized controlled trial study design was conducted from 20 December 2021 to 20 March 2022. The empathy training intervention was conducted for three consecutive days.

Setting

The study was conducted in five fistula treatment centers in Ethiopia.

Participants

The participants were all randomly selected healthcare providers.

Main outcome measures

Total mean score, percentage changes, and Cohen's effect size were computed. A linear mixed effects model and independent t-test were used for data analysis.

Results

A majority of the study participants were nurses in the profession, married, and first-degree holders. There was no statistically significant difference in the baseline empathy score of the intervention arm across their socio-demographic features. At the baseline, the mean empathy scores of the control and intervention arms were 102.10 ± 15.38 and 101.13 ± 17.67, respectively. The effect of empathy training on the total mean score changes of empathy of the intervention arm compared to the control arm at each follow-up time had a statistically significant difference. After a week, a month, and three months of post-intervention, the total mean empathy scores between the intervention and control arms were as follows: (intervention 112.65 ± 18.99, control 102.85 ± 15.65, d = 0.55, p = 0.03); (intervention 109.01 ± 17.79, control 100.52 ± 12.57, d = 0.53, p = 0.034); and (intervention 106.28 ± 16.24, control 96.58 ± 14.69, d = 0.60, p = 0.016) with the overall percentage changes of 11, 8, and 5% from the baseline scores, respectively.

Conclusion

In this trial, the empathy training intervention was found to have more than a medium effect size. However, over the follow-up intervals, there was a decreasing trend in the total mean empathy scores of healthcare providers; suggesting that there should be continued empathy training and integration of it into educational and training curriculums to enhance and sustain the empathy of healthcare providers.Clinical Trial Registration: Pan African Clinical Trial Registry: http://www.edctp.org/panafrican-clinical-trials-registry or https://pactr.samrc.ac.za, PACTR202112564898934.

Social responsiveness: The key ingredient to achieve social accountability in education and health care

While social accountability (SA) is regarded as an obligation or mandate for medical school administration, it runs the danger of becoming a bureaucratic checkbox. Compassion which leads to social responsiveness (SR), in contrast, is often recognized as an individual characteristic, detached from the public domain. The two, however, complement each other in practice. Institutions must be truly socially accountable, which is possible if there is spontaneous SR to the needs, and is fueled by compassion. Compassion in this article is defined as a "feeling for other people's sufferings, and the desire to act to relieve the suffering." Compassion has a long history, whereas SA is more recently described concept that follows the historical development of social justice. SR is the moral or ethical duty of an individual to behave in a way that benefits society. Not everyone feels the need to do something for others. Even if the need is felt, there may be a lack of will to act for the needs or to act effectively to fulfill the needs of society. The reasons are many, some visible and others not. SR provides the basis for being compassionate; hence, medical schools need to include SR as a criterion in their admissions process for student recruitment and inculcate compassion in health professions education and health care. By fostering SR and engaging compassion and self-compassion to achieve SA, we can humanize medical education systems and health care.

Palliative care stay room - designing, testing and evaluating a gamified social intervention to enhance palliative care awareness

INTRODUCTION

The message of palliative care can be promoted using creative thinking and gamification. It can be an innovative strategy to promote changes in behaviour, promote thinking, and work on skills such as empathy.

AIM

Design, test and evaluate a gamified social intervention to enhance palliative care awareness among young university students from non-health background.

METHODS

Participatory action research study with mixed methods, Design Thinking and using the Public Engagement strategy. Forty-three undergraduate students participated in a Palliative Care Stay Room and completed the Test of Cognitive and Affective Empathy (TECA) before and after the game. At the end of the game, a ten-minute debriefing was held with the participants, which was concluded with an open conversation. The content analysis was done independently and the sum of the scores of each dimension was compared before and after the activity.

FINDINGS

The Stay Room improved the participants' knowledge and new perspectives about palliative care. Before the game, their views focused on the end of life and after the game on their values, highlighting the dedication of the healthcare professionals who do not treat death but the life until death. After de game, participants (N = 43: female = 23; male = 20; x̄ 19.6 years old) presented higher values in perspective adoption (intellectual ability to put oneself in the other's place) p = 0.046 and in emotional understanding (ability to recognize emotional states) p = 0.018, and had high scores on empathic joy (p = 0.08).

CONCLUSION

Gamification can be used in teaching and transmitting positive attitudes. Palliative Care and can help young university students to think positively about care issues.

Teaching compassion for social accountability: A parallaxic investigation

BACKGROUND

In an arts integrated interdisciplinary study set to investigate ways to improve social accountability (SA) in medical education, our research team has established a renewed understanding of compassion in the current SA movement.

AIM

This paper explores the co-evolution of compassion and SA.

METHODS

The study used an arts integrated approach to investigate people's perceptions of SA in four medical schools across Australia, Canada, and the USA. Each school engaged approximately 25 participants who partook in workshops and in-depth interviews.

RESULTS

We began with a study of SA and the topic of compassion emerged out of our qualitative data and biweekly meetings within the research team. Content analysis of the data and pedagogical discussion brought us to realize the importance of compassion in the practice of SA.

CONCLUSIONS

The cultivation of compassion needs to play a significant role in a socially accountable medical educational system. Medical schools as educational institutions may operate themselves with compassion as a driving force in engaging partnership with students and communities. Social accountability without compassion is not SA; compassion humanizes institutional policy by engaging sympathy and care.

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.

Communication skills training for improving the communicative abilities of student social workers

Background

Good communication is central to effective social work practice, helping to develop constructive working relationships and improve the outcomes of people in receipt of social work services. There is strong consensus that the teaching and learning of communication skills for social work students is an essential component of social work qualifying courses. However, the variation in communication skills training and its components is significant. There is a sizeable body of evidence relating to communication skills training therefore a review of the findings helps to clarify what we know about this important topic in social work education. We conducted this systematic review to determine whether communication skills training for social work students works and which types of communication skills training, if any, were more effective and lead to the most positive outcomes.

Objectives

This systematic review aimed to critically evaluate all studies which have investigated the effectiveness of communication skills training programmes for social work students. The research question which the review posed is: 'What is the effectiveness of communication skills training for improving the communicative abilities of social work students?' It was intended that the review would provide a robust evaluation of communication skills training for social work students and help explain variations in practice to support educators and policy-makers to make evidence-based decisions in social work education, practice and policy.

Search Methods

We conducted a search for published and unpublished studies using a comprehensive search strategy that included multiple electronic databases, research registers, grey literature sources, and reference lists of prior reviews and relevant studies.

Selection Criteria

Study selection was based on the following characteristics: Participants were social work students on generic (as opposed to client specific) qualifying courses; Interventions included any form of communication skills training; eligible studies were required to have an appropriate comparator such as no intervention or an alternative intervention; and outcomes included changes in knowledge, attitudes, skills and behaviours. Study selection was not restricted by geography, language, publication date or publication type.

Data Collection and Analysis

The search strategy was developed using the terms featuring in existing knowledge and practice reviews and in consultation with social work researchers, academics and the review advisory panel, to ensure that a broad range of terminology was included. One reviewer conducted the database searches, removing duplicates and irrelevant records, after which each record was screened by title and abstract by both reviewers to ensure robustness. Any studies deemed to be potentially eligible were retrieved in full text and screened by both reviewers.

Main Results

Fifteen studies met the inclusion criteria. Overall, findings indicate that communication skills training including empathy can be learnt, and that the systematic training of social work students results in some identifiable improvements in their communication skills. However, the evidence is dated, methodological rigour is weak, risk of bias is moderate to high/serious or incomplete, and extreme heterogeneity exists between the primary studies and the interventions they evaluated. As a result, data from the included studies were incomplete, inconsistent, and lacked validity, limiting the findings of this review, whilst identifying that further research is required.

Authors’ Conclusions

This review aimed to examine effects of communication skills training on a range of outcomes in social work education. With the exception of skill acquisition, there was insufficient evidence available to offer firm conclusions on other outcomes. For social work educators, our understanding of how communication skills and empathy are taught and learnt remain limited, due to a lack of empirical research and comprehensive discussion. Despite the limitations and variations in educational culture, the findings are still useful, and suggest that communication skills training is likely to be beneficial. One important implication for practice appears to be that the teaching and learning of communication skills in social work education should provide opportunities for students to practice skills in a simulated (or real) environment. For researchers, it is clear that further rigorous research is required. This should include using validated research measures, using research designs which include appropriate counterfactuals, alongside more careful and consistent reporting. The development of the theoretical underpinnings of the interventions used for the teaching and learning of communication skills in social work education is another area that researchers should address.

Caregivers' perception of teenagers' dignity in end of life stages: A phenomenological study

Introduction: Maintaining patient dignity in a caregiving environment is one of the most important moral responsibilities for caregivers. Nonetheless, there are vulnerable groups, specifically teenagers, who in their final stages of life are prone to their dignity being threatened. Moreover, dignity is an abstract concept and there is no studies done on teenagers' dignity in the final stages of life available in Iran.Purpose: The purpose of this study is to describe the caregivers' experiences regarding teenagers' dignity in the final stages of life.Research design: This study is a descriptive phenomenological qualitative research project. The data was collected using deep individual and semi-structured interviews as well as taking notes. The Colaizzi analysis method was used to analyze the data.Participants and research context: 22 caregivers working with teenagers in the final stages of life in a public health centers in Iran who had the criteria to enter the study were selected using a purposeful sampling method and invited to join the study from August 2018 to June 2019. The sampling continued until data saturation.Findings: The findings of the present study were presented in the form of three main themes including "private," "respecting individual identity," and "attention to teenagers' needs" and an additional eight categories.Ethical Considerations: The study's protocol was approved by the Research Ethics Committee of the Shiraz University of Medical Sciences and all ethical principles were followed throughout the study.Discussion and conclusion: Based on the present study from the caregivers' point of view, teenagers in their final stages of life required to be cared for and taught in an environment that their privacy was maintained and their individual identity was respected as well as getting attention from the caregivers and companions. In such situations, the teenagers felt calm and their dignity was maintained; therefore, providing a cultural, professional, and organizational setting where all the components of maintaining dignity in teenagers are supported and prioritized is necessary.

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

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

Factors associated with medical radiation and imaging professionals' willingness to work during the SARS-COV-2 pandemic: A cross-sectional study

BACKGROUND

Resilient health systems effectively respond to health crises and coordinate post-event recovery. Central to a resilient system is the willingness of its workforce to work in high-risk scenarios. This study explored traits that may affect Medical Radiation and Imaging Professionals (MRIPs) willingness to work during a pandemic. Specifically, intrapersonal traits of compassion, empathy, and resilience were examined. Understanding such relationships can inform interventions that enhance individuals' willingness and health system resilience (HSR).

METHODS

In Fall 2020, a cross-sectional survey of Nova Scotian MRIPs was conducted. Witte's Extended Parallel Process Model, Professional Quality of Life, Intrapersonal Reactivity Index and Adult Resilience Measures-17 tools were used to assess willingness, compassion, empathy, and resilience. Statistical tests included chi-square, binomial, and multinomial logistic regression.

RESULTS

MRIPs were willing to report to work during the SARS-CoV-2 pandemic if required (92%); asked but not required (89%); or regardless of severity (94%). Individuals with very high levels of willingness reported lower personal distress (a facet of empathy) compared to those with high (p=.018) or moderate levels (p=.005). MRIPs with < 10 years experience were more likely to report high personal distress (p≤.37). Job role was associated with willingness (p<.001). There were no significant associations between level of willingness, and gender, age, experience, education, or the intrapersonal traits resilience and compassion.

CONCLUSION

Willingness was associated with job role and levels of personal distress. Personal distress was higher in participants with less years of practice. Interventions to reduce personal distress in early career MRIPs may enhance willingness to work during crises and thereby support HSR.

Novel mixed-method, inclusive protocol involving global key stakeholders, including carers as experts, to co-develop relevant Caregiver-Reported Outcome Domains (CRODs) in skin disease

INTRODUCTION

Ichthyoses comprise a heterogenous group of rare genetic skin disorders that involves the entire skin surface, often with additional syndromic features, and pose many clinical challenges. Without curative intervention, the mainstay of life-long symptom management is supportive in nature and can remain the responsibility of the caregiver. Although impact on the wider family is considered an important outcome of policies and services, there is a lack of caregiver consensus on what outcome domains to measure to fully assess the impact of ichthyosis on the patient and the caregiver. This project aims to identify a set of core outcome domains towards a core outcome set for ichthyosis that can measure all relevant concepts of ichthyosis in clinical practice, service delivery and research.

METHODS AND ANALYSIS

Following the COMET (Core Outcome Measures in Effectiveness Trials) initiative, this project will employ a mixed-method study design which was developed using public and patient involvement and an international multidisciplinary expert group (clinical experts, patients and their representatives, policymakers, researchers and service providers). Experts by experience, or caregivers, will be recruited through online ichthyosis support groups. Phase one will focus on item generation and involve: (1) a systematic literature review, (2) a multimethods international qualitative study with ichthyosis caregivers and (3) co-development of items for an e-survey. Phase two, item refinement, will employ a novel four-pronged consensus approach: (1) an e-Delphi survey, (2) statistical analysis of e-Delphi survey results, (3) online qualitative feedback and (4) an online consensus discussion. All methodological considerations will be clearly linked with each Core Outcome Set-STAndards for Developing recommendation.

ETHICS AND DISSEMINATION

Research Ethics Committee approval obtained from the School of Psychology, Ulster University (UK)(Ref:REC/20/0004). Results will be presented in published international peer-reviewed journals, at scientific meetings and support groups.

REGISTRATION

COMET database (January 2019).

Providing person-centred dementia care on general hospital wards

Dementia is caused by conditions that result in a progressive loss of brain function. People with dementia often have complex multimorbidity which increases their risk of admission to hospital. However, care in acute hospitals is often not adapted to patients with dementia, who have reported negative experiences of their hospital stay from admission to discharge. Person-centred care has been shown to make a positive difference to how well people with dementia cope in hospital. This article discusses how nurses working on general hospital wards can enhance the experiences of people with dementia and improve their outcomes by providing person-centred care.

The Relationship Between Coping Strategies, Compassion Satisfaction, and Compassion Fatigue During the COVID-19 Pandemic

Introduction

The rapid spread of COVID-19 poses a significant threat to nurses' lives and health, resulting in varying degrees of mental distress. Nurses may experience compassion fatigue, and their professional quality of life and satisfaction may suffer as a result. Their coping mechanisms may vary as well, influencing their compassionate and safe care.

Objectives

The study's objectives are to explore levels of compassion satisfaction and fatigue among nurses and identify their coping strategies. Further, to investigate the relationship between coping strategies, compassion satisfaction, and compassion fatigue during the COVID-19 pandemic.

Methods

Using a descriptive correlational design, this study was conducted with a convenience sample of 443 nurses working in an Egyptian university hospital. Nurses completed the coping strategy indicator scale and the professional quality of life (compassion satisfaction and compassion fatigue) scale. The data were analyzed using descriptive statistics, Pearson correlation, and regression analysis.

Results

Nurses' professional quality of life was average in terms of compassion satisfaction (2.95 ± 0.92) and compassion fatigue (2.38 ± 0.35). Nurses have a moderate use of coping strategies (2.13 ± 0.35). Problem-solving was rated as the highest coping strategy, while avoidance was rated as the lowest. Coping strategies showed a positive correlation with compassion satisfaction (r = 0.503, p < .001) and a negative correlation with compassion fatigue (r = -0.352, p < .001). In addition, coping strategies could predict 25.4% and 12.4% of compassion satisfaction and compassion fatigue, respectively (p < .001).

Conclusion

Compassion satisfaction and fatigue are key determinants of nurses' quality of work life. Coping strategies, especially problem-solving and support systems, are vital to increase compassion satisfaction and mitigate burnout and secondary stress syndrome. Nurse managers should establish supportive work environments that promote nurses' well-being. Resilience-building programs and coping strategies' training are recommended to enhance the nurses' quality of work life and positive work attitudes.

Conceptualization, use, and outcomes associated with compassion in the care of people with multiple sclerosis: a scoping review

OBJECTIVE

Compassion is widely regarded as an important component of high-quality healthcare. However, its conceptualization, use, and associated outcomes in the care of people with multiple sclerosis (PwMS) have not been synthesized. The aim of this review is to scope the peer reviewed academic literature on the conceptualization, use, and outcomes associated with compassion in the care of PwMS.

METHODS

Studies were eligible for inclusion if reporting primary research data from quantitative, qualitative, or mixed-methods studies on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Relevant studies were identified through searching five electronic databases (CINAHL, Cochrane Library, EMBASE, MEDLINE, and PsycINFO) in January 2022. We followed the guidance outlined in the Joanna Briggs Institute (JBI) manual for evidence synthesis, and also referred to the Preferred Reporting Items for Systematic Reviews and Meta-analyses extension for Scoping Reviews Checklist (PRISMA-ScR). Simple descriptive methods were used to chart quantitative findings, and a descriptive approach with basic content analysis was employed to describe qualitative findings.

RESULTS

Fifteen studies were included (participant n = 1722): eight quantitative, six mixed-methods, one exclusively qualitative. Synthesized qualitative data revealed that PwMS conceptualize compassion as involving self-kindness, agency, and acceptance. PwMS report using self-compassion in response to unpleasant sensations and experiences. Quantitative findings suggest that compassion may mediate benefit finding, reduced distress, and improved quality of life (QoL) in PwMS, that those with the condition may become more compassionate through time, and that self-compassion specifically can be increased through training in mindfulness. In this context, greater self-compassion in PwMS correlates with less depression and fatigue, better resilience and QoL. Among studies, self-compassion was the most common outcome measure for PwMS.

CONCLUSIONS

A nascent literature exists on the conceptualization, use, and outcomes associated with compassion in the care of PwMS. Further research is required to better understand what compassion means to PwMS and those caring for them. However, self-compassion can be cultivated among PwMS and may be helpful for managing unpleasant somatic symptoms and in benefit finding. Impact on other health outcomes is less clear. The use of compassion by health care providers in the care of PwMS is unstudied.

Teaching perspectives on the communication of difficult news of genetic conditions to medical students

Informing parents that their child has a diagnosis of Down syndrome (DS) is a common example of the delivery of unexpected or difficult news. Expectations and life planning will change, and if detected prenatally, discussions might include the option of pregnancy termination. Medical school curricula currently include training in breaking unexpected news; however, it is difficult to teach and assess. We use the perspectives of clinicians, educators, and a medical student who is the parent of a child with DS to frame a discussion on teaching, practicing, and assessing communication of difficult news in human genetics during medical school.

Development of a systematic multidisciplinary clinical and teaching model for the palliative approaches in patients with severe lung failure

Palliative medicine has traditionally focused on people affected by cancer with rapidly advancing disease progression. However, as more people live longer time with serious illnesses, including lung diseases, the need of palliative care for these patients if also increasing. There is a lack of research and clinical knowledge about what palliative care is for people affected by chronic obstructive pulmonary disease and interstitial lung disease. The aim of this paper is to describe the development process of an easy to use and clinically relevant model for the palliative care approach in people affected by severe illnesses. The developed model consists of four components, which originated the title” 4,2,4,2 model”. Each number has a specific meaning: the first 4 = the four disease trajectories that patients may experience; 2 = the two forms of knowledge, objective, and intuitive that must be achieved by the health professionals to gain an understanding of the situation; 4 = the four dimensions of suffering physically, mentally, socially and existentially/spiritually; and 2 = the two roles that health-care professionals must be able to take in when treating patients with serious illnesses. The 4-2-4-2 model proposes an easy-to-use and clinically relevant model for palliative approach and integration of PC and pulmonary medicine. Another important purpose of this model is to provide HPs with different educational backgrounds and from different medical fields with a ‘golden standard approach’ to enhance the focus of the palliative approach in both the clinic and teaching. The effect and consequences of the use of the 4-2-4-2 model should be explored in future clinical trials. Furthermore, it should be investigated whether teaching the model creates a change in clinical approach to patients with serious illnesses as well as whether these changes are long-lasting.

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

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

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

BACKGROUND

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

AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

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.

Empathic Communication in Specialty Palliative Care Encounters: An Analysis of Opportunities and Responses

Background: Although empathic responding is considered a core competency in specialty palliative care (PC), patterns of empathic communication in PC encounters are not well understood. Objectives: In this secondary analysis, we delineate types and frequency of empathic communication and examine relationships between patient empathic opportunities and clinician responses. Design: We used the Empathic Communication Coding System to analyze empathic opportunities across three types: emotion (i.e., negative affective state), progress (i.e., stated recent positive life event or development), and challenge (i.e., stated problem or recent, negative life-changing event) and clinician responses. Setting/Subjects: Transcripts from a pilot randomized trial of communication coaching in specialty PC encounters (N = 71) audio-recorded by 22 PC clinicians at two sites in the United States: an academic health system and a community-based hospice and PC organization. Results: Empathic opportunities were frequent across encounters; clinicians often responded empathically to those opportunities (e.g., confirming or acknowledging patients' emotions or experiences). Even though challenge empathic opportunities occurred most frequently, clinicians responded empathically more often to progress opportunities (i.e., 93% of the time) than challenge opportunities (i.e., 75% of the time). One in 12 opportunities was impeded by the patient or a family member changing the topic before the clinician could respond. Conclusions: PC patients frequently express emotions, share progress, or divulge challenges as empathic opportunities. Clinicians often convey empathy in response and can differentiate their empathic responses based on the type of empathic opportunity. PC communication research and training should explore which empathic responses promote desired patient outcomes.