Developing tools to promote culturally competent compassion, courage, and intercultural communication in healthcare

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.

Translation, Adaptation, and Validation of the Cultural Competence Assessment in Portuguese Nurses

Background and Purpose: Previous research shows significant benefits resulting from improving culturally competent nursing care. Thus, the purpose of this study was to translate, adapt, and validate the Cultural Competence Assessment (CCA) in a sample of Portuguese nurses. Methods: A psychometric study of the CCA, after translation into European Portuguese, was performed with a snowball sample of 284 nurses. Participants were asked to fill in a sociodemographic questionnaire and the CCA. Results: The four-factor model of the CCA (Portuguese version) exhibited satisfactory indices of fitness without item nine. Cronbach's alpha was 0.85. Correlations between subscales and the total score scale were strong and statistically significant. Conclusions: These data add to the cultural competence knowledge of nurses to promote better practices and culturally competent care.

From a learning opportunity to a conscious multidimensional change: a metasynthesis of transcultural learning experiences among nursing students

BACKGROUND

Several educational activities in nursing schools worldwide have been implemented to promote transcultural nursing and cultural competence. Despite the diversity of their experiences and outcomes, the available evidence has not been systematically reviewed and reinterpreted. This study aimed to review and reinterpret all rigorous qualitative evidence available, providing an opportunity to understand how students learn transcultural nursing and assisting faculties, researchers, managers, and practitioners in designing new interventions to improve transcultural training.

METHODS

A meta-synthesis was conducted to review and integrate qualitative studies of these phenomena. English, Spanish and Portuguese articles were searched in Pubmed and Scopus databases. Only peer-reviewed journals in which qualitative approaches were used were included. Quality was assessed using the CASP qualitative version checklist. The metasynthesis technique proposed by Noblit and Hare was used to analyse the data.

RESULTS

Twenty-nine studies were included in the analysis. Most studies used phenomenological approaches that were conducted in Australia and the United States of America, with international internships being the most popular learning method. The data revealed one central theme, "From learning opportunity to conscious multidimensional change," and six subthemes. The transcultural nursing learning experience is not a simple or linear process. Instead, it appears to be a complex process formed by the interaction between a) self-awareness, b) reflective thinking, c) Cultural Encounters, d) cultural skills, e) Cultural Desire, and f) Cultural Knowledge.

CONCLUSIONS

Transcultural nursing learning is a multifaceted process that arises from specific learning opportunities. This process is still to evolving. Therefore, specific educational strategies should be implemented to encourage attitudinal change and promote reflective thinking.

A scoping review of interventions seeking to improve aspects of patient–provider relationships involving Black pregnant and post‐partum people

AIMS

To provide a map of the evidence related to interventions targeting patient-provider relationships among Black perinatal people.

DESIGN

A scoping review of the literature was conducted.

DATA SOURCES

The database search included English language articles within three databases: PubMed, the Cumulative Index for Nursing and Allied Health Literature, and Medline without date restriction on June 15 and16 2022.

REVIEW METHODS

This scoping review used the six-stage process first described by Arksey and O'Malley and recommended by the Joanna Briggs Institute: (1) specify the research question, (2) identify relevant literature, (3) select studies, (4) map out the data, (5) synthesize, and report the results and (6) consult experts. Studies were included if they (1) reported results of intervention studies related to patient-provider interaction, (2) were written in English and (3) were original research. The articles were reviewed with content analysis methodology to categorize and interpret the findings.

RESULTS

Studies included randomized controlled trials (n = 5) and qualitative studies (n = 3) published between 2001 and 2018. Black pregnant people made up more than half of the participants in five of the eight studies (63%). Interventions were divided into three categories: delivery models (n = 4), mHealth risk assessment tools (n = 2) and patient-provider communication tools (n = 2).

CONCLUSION

This study addressed the unknown role of patient-provider relationship interventions in improving the quality of care received by Black perinatal people. Findings suggest that structural and interpersonal components may have the potential to improve outcomes for Black pregnant people but could be further improved if culturally tailored. Further research is urgently needed to address discrimination and stigma in patient-provider relationships. The findings of this study could inform novel intervention development and should drive research.

IMPACT

A scoping review determined that there are no interventions with Black pregnant people which targeted discrimination and bias in patient-provider relationships.

NO PATIENT OR PUBLIC CONTRIBUTION

The authors did not include stakeholders such as patients, service users, caregivers or members of the public in the development of this scoping review, as it is a work that serves to set the stage for further community-based work. The results will however be communicated to community members at a planned advisory board in the future.

ADDRESSING diversity, equity, inclusion and belonging (DEIB) in mentorship relationships

The growing racial, ethnic, and cultural diversity within the United States underscores the importance of neuropsychologists developing cultural competence to improve patient care and support increased practitioner diversity. APA has recognized the importance of expanding the field's diversity, equity, inclusion, and belonging (DEIB) efforts to promote the retention of historically underrepresented practitioners and culturally competent practices. Supervisors and mentors are particularly well suited and ethically required to support DEIB-related professional development in their trainees. However, current literature suggests that a lack of time and perceived lack of competence in initiating and facilitating these conversations remain barriers to DEIB efforts. This paper aims to increase a supervisor's/mentor's self-efficacy in facilitating these efforts. We offer adapted theoretical models of cultural competence and provide a "tool kit" of experiential activities adapted for neuropsychologists that can be utilized to support the initiation, maintenance, and quality of DEIB-focused discussions within these relationships.

Preferred Communication Strategies Used by Physical Therapists in Chronic Pain Rehabilitation: A Qualitative Systematic Review and Meta-Synthesis

OBJECTIVE

Lack of clarity regarding effective communication behaviors in chronic pain management is a barrier for implementing psychologically informed physical therapy approaches that rely on competent communication by physical therapist providers. This study aimed to conduct a systematic review and meta-synthesis to inform the development of a conceptual framework for preferred communication behaviors in pain rehabilitation.

METHODS

Ten databases in the health and communication sciences were systematically searched for qualitative and mixed-method studies of interpersonal communication between physical therapists and adults with chronic pain. Two independent investigators extracted quotations with implicit and explicit references to communication and study characteristics following Standards for Reporting Qualitative Research and Strengthening the Reporting of Observational Studies in Epidemiology guidelines. Methodological quality for individual studies was assessed with Critical Appraisal Skills Programme, and quality of evidence was evaluated with GRADE-CERQual. An inductive thematic synthesis was conducted by coding each quotation, developing descriptive themes, and then generating behaviorally distinct analytical themes.

RESULTS

Eleven studies involving 346 participants were included. The specificity of operationalizing communication terms varied widely. Meta-synthesis identified 8 communication themes: (1) disclosure-facilitating, (2) rapport-building, (3) empathic, (4) collaborative, (5) professional accountability, (6) informative, (7) agenda-setting, and (8) meta-communication. Based on the quality of available evidence, confidence was moderate for 4 themes and low for 4 themes.

CONCLUSION

This study revealed limited operationalization of communication behaviors preferred by physical therapists in chronic pain rehabilitation. A conceptual framework based on 8 communication themes identified from the literature is proposed as a preliminary paradigm to guide future research.

IMPACT

This proposed evidence-based conceptual framework for preferred communication behaviors in pain rehabilitation provides a framework for clinicians to reflect on their own communication practices and will allow researchers to identify if and how specific communication behaviors impact clinical outcomes.

Effectiveness of an online short compassion strengths course on nursing students compassion: A mixed methods non-randomised pilot study

BACKGROUND

Although student nurses are expected to demonstrate and show understanding of compassion in their learning and practice, literature suggests that this is not always the case. To address this, nursing students need to be introduced to the value and behaviours of compassion during their education.

OBJECTIVES

To evaluate the effectiveness of an online course to help nursing students develop their strengths and further validate the Bolton Compassion Strengths Indicators.

DESIGN

A pre-and post-mixed methods non-randomised pilot study.

SETTING

A university in the north west of England.

PARTICIPANTS

A sample of first year undergraduate nursing students (67), in two groups, with 33 in the online control and 34 in the on-site group.

METHODS

Both groups took part in the Short Compassion Strengths Course (SCSC). The online group took the course in their own time over a 3-week period, while the on-site group completed the course during their time at University. In both groups baseline assessments were carried out using the Bolton Compassion Strengths Indicator (BCSI). Post-test data were collected 3 weeks after in the online group and immediately after in the on-site group, for the BCSI and reflective accounts. Data were analysed using ANOVA in SPSS27.

RESULTS

The online group did not complete the course but filled out the questionnaires. The on-site group had significantly higher scores on all indicators but self-care and engagement.

CONCLUSIONS

The SCSC is an effective course for teaching and developing compassion strengths when delivered on-site. This paper adds further validity for the BCSI.

Evaluation of compassionate and respectful care implementation status in model healthcare facilities: a cross-sectional study

Background

Compassionate respectful, and caring (CRC) creates a pleasant environment for health workforce (HWF), customers, and families. For the past five years, the Ethiopian Ministry of Health (EMoH) has developed a CRC plan to improve person-centered care. Therefore, we aimed to assess the implementation status of CRC and associated factors in the 16 model health facilities (MHFs) in Ethiopia.

Methods

A cross-sectional study was employed from February to April 2021. A structured and semi-structured questionnaire was used to assess the level of CRC implementation in model health care facilities. Epi-data version 4.3 and SPSS version 26 software were used for data entry and analysis, respectively. Binary logistic regressions analysis was used and significance was obtained at the odds ratio with a 95% confidence interval and P-value < 0.05.

Results

A total of 429 HWF participated in a self-administered questionnaire. The prevalence of compassionate and respectful care among HWF were 60.4%, and 64% respectively. Nurse professionals, midwives, having training on CRC, leader promoting CRC, having a conducive working environment and burnout management for HWF were significantly associated with compassionate care practice. Leaders promoting CRC, having a conducive working environment, and burnout management for HWF were significantly associated with respectful care practice.

Conclusion

The findings identified distinct issues related to CRC implementation in each 16 MHF. Addressing HWF skill gaps, a conducive working environment, and burnout management are encouraged CRC continuity. Incorporate CRC in pre-service education, health system strengthening, and motivating HWF are important for CRC strategic implementation.

Building Culturally Competent Compassion in Nurses Caring for Vulnerable Populations

Objective: To understand the process of building culturally competent compassion in nurses who care for vulnerable populations. Method: This is a qualitative study of a "single case study" type, developed with 18 nurses who worked in an emergency care unit in the city of Belo Horizonte, Brazil, between October 2020 and January 2021. Data collection was performed through individual online or one-to-one interviews, following a semi-structured script. Data were treated following thematic content analysis, proposed by Bardin. All ethical precepts were taken into account. Results: After data analysis, the following categories were created: a) Looking within: the recognition of cultural identity; b) Paths to be taken: from the gap to cultural knowledge; c) Attentive listening as essential nursing care; d) Culturally competent compassion as an infinite opportunity for growth. Final considerations: Culturally competent compassion is a subjective, complex, and essential construct in holistic nursing care. When implemented successfully, we gain a significant improvement in the quality of healthcare provided to patients and their families as well as a decrease in social inequality, and the protection of human rights.

Too long to wait: South Asian migrants' experiences of accessing health care in Australia

BACKGROUND

Migrants settling in a new country experience multiple complexities in navigating health care systems and adapting to a new way of life in the host country. In South Asia, migrating to another country for better life opportunities has been an ongoing trend and migration to Australia has significantly increased in recent years. Lower utilisation of health services and higher risks of chronic diseases among South Asian migrants poses a continuing challenge for the Australian health care system and little is known about why this demographic group does not access health services at the same rate. This study aimed to explore factors influencing access to health care by South Asian migrants in Australia.

METHODS

Using a mixed-method design, we conducted 62 online survey and 14 in-depth interviews with participants from four South Asian countries: Nepal, India, Bhutan, and Sri Lanka. Participants were recruited using a purposive snowball sampling approach following a standard ethical approval process. Survey data were analysed descriptively in SPSS and interview data were recorded, transcribed, and analysed thematically.

RESULTS

South Asian migrants experienced various complexities while accessing health services in Australia. The findings of this study highlighted a number of negative factors influencing their experiences of accessing health care: long waiting times for public health care, the expense of private health care, and communication problems due to socio-cultural differences. South Asian migrants also expressed their concern for a greater investment of resources into public health care to enable them to access quality and affordable care in these settings.

CONCLUSIONS

Given limited evidence available to help understand factors leading to the lower utilisation of health care and higher risks of chronic diseases among South Asian migrants, this study plays an important role in highlighting social, cultural, financial, and institutional factors that are critical to designing appropriate health-care strategies. This study recommends incorporating a collaborative and culturally competent model of care to increase access to health care and thereby help reduce existing disparities in health outcomes among South Asian migrant populations.

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.

The Relationship Between Past Experience, Empathy, and Attitudes Toward Poverty

BACKGROUND

Nursing educators commonly place service-learning and simulation experiences in prelicensure public health nursing courses. These experiences have varying degrees of success in targeting gaps in students' knowledge and attitudes regarding vulnerable populations. This study sought to identify factors that are associated with attitudes toward poverty and empathy scores of senior-level prelicensure nursing students to improve pedagogy in public health nursing courses.

METHOD

A cross-sectional comparison of senior-level nursing students from traditional and accelerated cohorts at a college of nursing was conducted.

RESULTS

Students with prior volunteer experience reported lower empathy scores compared with students who did not have prior volunteer experience (t[102] = -1.9, p < .05).

CONCLUSION

Nursing educators should engage students in identifying and evaluating their personal background related to poverty when beginning a public health nursing course to address bias and create shared knowledge. [J Nurs Educ. 2020;59(3):158-162.].

Nursing Student Engagement in Cultural Humility Through Global Health Service Learning: An Interpretive Phenomenological Approach

Introduction: This study explored how global health service learning supported nursing student engagement in the process of cultural humility and how it shaped student understanding of themselves and their ability to develop supportive intercultural relationships. Methods: Written reflections were collected from eight second-year students while on a 9-day practicum in a low-resource Caribbean country. Six students participated in posttrip interviews. Thematic analysis was used to illuminate the students' lived experience. Results: Four student themes emerged: (1) overcoming challenges, (2) opening our eyes, (3) seeing difference as a strength, and (4) learning with and from each other. While participants were inherently ethnocentric, the process of cultural humility curbed their sense of superiority and enabled the development of supportive intercultural relationships with their hosts. Discussion: This global health service learning was an effective strategy to enhance student nurses' learning about themselves and intercultural relationships and to develop the attributes of cultural humility.

Developing and validating the Nursing Cultural Competence Scale in Taiwan

Background

Culture influences personal health habits and behavior, and healthcare personnel possess different views of cultural perspectives. Currently, an appropriate instrument to assess cultural competence in clinical practice is limited. The present study aimed to develop and examine the psychometric properties of the Nursing Cultural Competence Scale (NCCS) for clinical nurses.

Methods

Developing and assessing the scale was carried out in two phases: Phase I involved a qualitative research to explore the themes of nurses’ cultural competence and instrument development; Phase II established construct validity of the scale using a sample of 246 nurses in Taiwan. Data from the questionnaire were analyzed using exploratory factor analysis, confirmatory factor analysis, internal consistency and test-retest reliability. Analysis results were used to determine the reliability and validity of the developed scale.

Results

The results showed four factors including cultural awareness ability, cultural action ability, cultural resources application ability, and self-learning cultural ability were generated by exploratory factor analysis, and these factors explained 62.0% of total variance. Cronbach’s α of the Nursing Cultural Competence Scale was .88, and test-retest reliability correlation was .70.

Conclusions

The establishment of the tool will facilitate accurate monitoring of the cultural competence among nurses and nursing managers, which can inform the construction of nursing policies aimed at pledge cultural competence expansion.

Awareness of ocular diagnosis, transportation means, and barriers to ophthalmology follow-up in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study

Purpose: The purpose of this study was to assess factors affecting follow-up eye care in participants enrolled in the Philadelphia Telemedicine Glaucoma Detection and Follow-up Study, such as awareness of ocular diagnosis, availability of transportation methods, and reasons for missing eye care appointments. Methods: The sample included 172 participants who were randomized to the intervention group and contacted by the social worker. Results: A total of 155 participants completed the assessment form, which was used as an instrument to assess factors affecting adherence to follow-up eye care. The main reasons for missing eye exam appointments were feeling ill (38.1%, n = 59) and forgetting the appointment (34.2%, n = 53). In addition, 45 (29.2%) participants were unaware of or did not comprehend the severity of their ocular diagnosis. Common methods of transportation included public transportation (31.6%, n = 49), driving (29.7%, n = 46), and being driven (27.7%, n = 43) to their appointment. Conclusion: These results suggest that individuals in need of eye care may benefit from additional assistance of a social worker regarding ongoing eye exam appointment reminders and in-depth explanation of their ocular diagnosis.

Structural Stress and Otherness: How Do They Influence Psychological Stress?

Background: This study represents the initial steps in researching the cultural distress model and explores the cumulative layering of stressors that place the patient at risk for cultural distress, including structural stress and otherness. Method: A cross-sectional descriptive correlational analysis of intersecting identities (Structural Stressors), ethnicity-related stressors (Otherness) and ethnic-identity (Otherness) on psychological stress. Participants were also asked to define the word culture. Results: Results indicated that structural stressors did not significantly influence on psychological stress but were associated with perception of discrimination. The experience of otherness significantly influenced psychological stress. Discussion: Given the association between structural stress and perceived discrimination, additional research and tool development is needed to better understand how structural stressors influence psychological stress. Participant definitions of culture fell into two primary themes: Collectiveness and Individualness, indicating that the way we live is influenced by shared experiences, yet also a product of individual choices.

Compassion in practice-Evaluating the awareness, involvement and perceived impact of a national nursing and midwifery strategy amongst healthcare professionals in NHS Trusts in England

AIMS AND OBJECTIVES

To report the findings from an evaluation of the impact of the Compassion in Practice Vision and Strategy (National Health Service England (NHSE), 2012) on nursing, midwifery and care staff.

BACKGROUND

The Compassion in Practice Vision and Strategy was a programme of work to highlight the importance of compassionate care following the Francis Report in 2013 into the deficits in care in an NHS Hospital Trust. It was launched by NHS England in 2012 at a time when fiscal cuts were introduced by the Department of Health in England.

DESIGN AND SETTING

Mixed methods.

RESULTS

Inferential statistics were used to test whether there were significant differences between staff at different levels of seniority with regard to awareness and involvement in Compassion in Practice Vision and Strategy and their attitudes to it. Awareness and involvement of staff in Compassion in Practice Vision and Strategy were high amongst middle and senior management but limited at ward level. Staff involvement in Compassion in Practice Vision and Strategy was limited due to a lack of awareness. Ward level staff who were aware and involved, perceived a lack of support and communication from senior leadership to deliver the Compassion in Practice Vision and Strategy.

DISCUSSION

Results reveal professional anger, distress and resistance to the Compassion in Practice Vision and Strategy and a view of the programme as a top-down initiative which did not sufficiently recognise structural constraints on nurses' ability to deliver compassionate care. We discuss the implications of our findings for global nursing.

CONCLUSION

Participants emphasised that compassion for patients is only sustainable where there is compassion for staff and many participants felt that they were not being treated with compassion.

RELEVANCE FOR CLINICAL PRACTICE

National Health Service England should strongly affirm that nurses and midwives in general provide compassionate care. Trust leadership should provide support for ward level staff who deliver compassionate care in difficult circumstances.