Compassion as the foundation of patient-centered care: the importance of compassion in action

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.

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.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

How Can Organizations Support a Culture of Care?

Providing care is central to the operations of health care organizations. This article discusses how organizations can create a culture of care. It also identifies key elements that health care organizations can implement to build a culture that nurtures both patients and employees. Additionally, the article examines the benefits of implementing practices that demonstrate compassion toward both employees and patients. This article explores the significance of creating and supporting a culture of care for both patients and employees in health care organizations. Finally, the article identifies prevalent practices that contribute to a culture of care.

Discourses of compassion from the margins of health care: the perspectives and experiences of people with a mental health condition

BACKGROUND

Evidence supports the positive influence of compassion on care experiences and health outcomes. However, there is limited understanding regarding how compassion is identified by people with lived experience of mental health care.

AIM

To explore the views and experiences of compassion from people who have lived experience of mental health.

METHODS

Participants with a self-reported mental health condition and lived experience of mental health (n = 10) were interviewed in a community setting. Characteristics of compassion were identified using an interpretative description approach.

RESULTS

Study participants identified compassion as comprised three key components; 'the compassionate virtues of the healthcare professional', which informs 'compassionate engagement', creating a 'compassionate relational space and the patient's felt-sense response'. When all these elements were in place, enhanced recovery and healing was felt to be possible. Without the experience of compassion, mental health could be adversely affected, exacerbating mental health conditions, and leading to detachment from engaging with health services.

CONCLUSIONS

The experience of compassion mobilises hope and promotes recovery. Health care policymakers and organisations must ensure services are structured to provide space and time for compassion to flourish. It is imperative that all staff are provided with training so that compassion can be acquired and developed.

Do I care for you more when you really need help? An experimental test of the effect of clinical urgency on compassion in health care

OBJECTIVES

To experimentally investigate whether more urgent patient presentations elicit greater compassion from health care professionals than less urgent, facilitating future research and thinking to address systemic barriers to compassion in health care.

DESIGN

This is a pre-registered online study with an experimental, within-subjects repeated-measure study design. Two clinical vignettes that systematically varied the urgency of patient presentation were utilized. Both vignettes depicted a patient with difficult behaviours typically associated with lower compassion.

METHODS

Health care professionals (doctors, nurses and allied health practitioners) recruited from all 20 District Health Boards across Aotearoa/New Zealand completed two vignettes in a counterbalanced order. Paired-sample t-tests were used to test the effect of the presentation urgency on indices of compassion.

RESULTS

A total of 939 participants completed the vignettes (20% doctors, 47%, nurses and 33% allied health professionals). As expected, participants reported greater care and motivation to help the more urgent patient. However, the more urgent patient was also perceived as less difficult, and exploratory analyses showed that perceived patient difficulty was associated with lower caring and motivation to help, particularly in the less urgent patient.

CONCLUSIONS

This is the first work to experimentally test the relationship between the urgency of patient presentation and compassion in health care. Although the association between urgency and difficulty is complex, our findings are consonant with evolutionary views in which urgent distress elicits greater compassion. A system-wide orientation towards efficiency and urgency may exacerbate this 'bias' which must be addressed to ensure more equitable compassion in health care.

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

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

Understanding the Intricacies of Delivering Compassionate Care in the Intensive Care Unit and What Hinders It: A Qualitative Study of Members of 2 Critical Care Societies

BACKGROUND

Patient-centered care is increasing in importance especially in the post-coronavirus disease 2019 (COVID-19) pandemic era. We sought to understand factors affecting compassionate care faced by intensivists in the intensive care unit (ICU).

METHODS

Using survey methodology incorporating 3 real-life case vignettes, responses were elicited to difficult ethical and moral dilemmas in the ICU setting. Members of 2 critical care societies in the United States and Europe were included in the survey.

RESULTS

Responses from 323 intensivists (32% out of 1000 members who opened the initial email invitation) around the world were analyzed thematically. Conflicts between patient choices and suggested medical care, institutional/work constraints restricting compassionate care and leading to burnout, and personal variables influencing compassionate care were the themes that emerged from our investigation. The results demonstrate that intensivists have compassion for their patients and want to provide patient-centered care, but also experience stress due to their limited ability to improve their patients' conditions.

CONCLUSIONS

Compassionate attitudes can be hindered by an underlying worry about the decision made by the patient and their family, a lack of confidence in making hard moral decisions, and the burdens of burnout.

But what does it mean to us? Radiographic patients and carer perceptions of compassion

INTRODUCTION

An increased focus on compassion was one of the recommendations in the Francis Report following an inquiry into failures of care at the Mid Staffordshire NHS Trust in 2010. Responses to the Francis report did not take up the question of what compassion meant and how its recommendations might be meaningfully implemented in radiography practice. As part of two wider doctoral research studies, the findings presented in this paper reveal patients and carers perspectives of how compassionate care is experienced, based on an exploration of their experiences, views and attitudes in order to better understand its meaning and application in radiographic practice.

METHODS

A constructivist approach was taken with appropriate ethical approval. Using a combination of interviews, focus groups, co-production workshops and online discussion forums the authors explored the experiences and opinions of patients and carers about compassion in radiotherapy and diagnostic imaging. Data were transcribed and analysed thematically.

RESULTS

The thematically mapped findings are presented under four sub-themes: The values of caring vs the 'business' values of the NHS, Person-centred care, Characteristics of the radiographer and Compassion in the radiographer-patient interaction.

CONCLUSION

Looking at compassion through a patient's lens has highlighted how person-centred care consists of components not attributable to radiographers alone. The personal values of a radiographer must not only align with those of the profession they seek to join, but the value placed on compassion must also be reflected in the environment in which they practice. Alignment signifies patients are part of a compassionate culture.

IMPLICATIONS FOR PRACTICE

Equal emphasis should be placed on both technical and caring practices in order to stop the profession being perceived as target-driven, rather than one which ensures patients are at the heart of practice.

PATIENT-CENTERED CARE AND SELF-MANAGEMENT: OPINION OF MILITARY PERSONNEL WITH CORONARY ARTERY DISEASE

OBJECTIVE

The aim: Тo determin attitude of military personnel with coronary artery disease to implementation of the principles of patient- centered care and self-assessment of adherence to treatment.

PATIENTS AND METHODS

Materials and methods: 72 military personnel (male aged 30-58 years) with coronary artery disease, who visited the general practitioners at the Outpatient Care Clinic of the National Military Medical Clinical «Main Military Clinical Hospital» were interviewed anonymously, using the specially designed questionnaire. The patients were divided into two groups: the 1st group with individuals of 49 years old and younger (39 military personnel, mean age 42,8«5,0) and the 2nd group who is 50 years and older (33 military personnel, mean age 53,2«2,4 years).

RESULTS

Results: The results of a sociological survey showed that the majority of military personnel with coronary artery disease believe that doctors do not always provide them with enough information about their health (61,1%) and they do not always provide emotional support to solve their health problems (66,7 %). It has been indicated a mismatch between patients' willingness to participate in shared decision-making regarding a treatment (84,7 % of them) and adher¬ence to treatment - 55,6% of surveyed patients rated adherence to treatment by three points or less on a five-point scale. There is no statistically significant difference between military personnel of the 1st and 2nd groups.

CONCLUSION

Conclusions: The results of the study showed the interest and readiness of surveyed military personnel with coronary artery disease to implementation of the principles of patient-centered medical care.

Influence of Spirituality and Job Satisfaction on the Compassion Competence of Hospice Nurses

Purpose

The aim of this study was to examine the influence of spirituality and job satisfaction on the compassion competence of hospice nurses.

Methods

This was a cross-sectional study of 118 hospice nurses from 16 hospitals in Daejeon, Chungcheong Province, and Jeolla Province. A self-administered survey was conducted using a structured questionnaire including the Spirituality Scale, Index of Work Satisfaction, the Compassion Competence Scale for Nurses, and general socio-demographic information. The data were analyzed using descriptive statistics, the t-test, Pearson correlation coefficients, and hierarchical linear regression analysis using SPSS for Windows version 26.0.

Results

Compassion competence was correlated with spirituality (r=0.66, P<0.001) and job satisfaction (r=0.52, P<0.001), and spirituality was correlated with job satisfaction (r=0.44, P<0.001). Spirituality (β=0.513, P<0.001) and job satisfaction (β=0.273, P<0.001) were significant factors affecting the compassion competence of hospice nurses, after adjusting for the sociodemographic and work-related covariates. The step-by-step results from hierarchical linear regression analysis also indicated that spirituality had a stronger impact than job satisfaction on compassion competence.

Conclusion

Our findings demonstrate the importance of spirituality, which plays a role in guiding the compassion competence of hospice nurses. It is necessary to support the spirituality and job satisfaction of hospice nurses, which could facilitate their compassion competence and thereby contribute to improving the quality of hospice and palliative care.

Validation and Translation of the Relational Aspect of Care Questionnaire into the Malay Language (RAC-QM) to Evaluate the Compassionate Care Level of Healthcare Workers from the Patient's Perspective

BACKGROUND

Compassionate care has been increasingly highlighted in the past few decades worldwide, including in Malaysia. Despite acknowledging its importance, Malaysia still lacks a validated tool that can be used to assess the level of compassionate care from the patient's perspective. Therefore, this study aims to validate and translate the Relational Aspect of Care Questionnaire (RAC-Q) into the Malay language.

METHODS

Permission to use and translate the original RAC-Q into the Malay language was obtained. The RAC-Q was then translated into the Malay language following the 10 steps proposed for the translation of a patient-reported outcome questionnaire. A pretest was conducted based on 30 inpatients to assess the appropriateness and clarity of the finalized translated questionnaire. A cross-sectional study was performed based on 138 inpatients from six adult wards of a teaching hospital so as to validate the translated questionnaire. The data were analyzed using R software version 4.1.3 (R Core Team, Vienna, Austria, 2020). The results were presented descriptively as numbers and percentages or means and standard deviations. A confirmatory factor analysis was performed using robust estimators.

RESULTS

The analysis showed that the measurement model of the RAC-Q Malay version (RAC-QM) fits well based on several fit indices: a standardized factor loading range from 0.40 to 0.73, comparative fit index (CFI) of 0.917, Tucker-Lewis fit index (TLI) of 0.904, root mean square error of approximation (RMSEA) of 0.06, and a standardized root mean square residual (SRMR) of 0.073. It has good reliability, with a Cronbach's alpha of 0.857 and a composite ratio of 0.857.

CONCLUSION

The RAC-QM demonstrated good psychometric properties and is valid and reliable based on the confirmatory analysis, and it can thus be used as a tool for evaluating the level of compassionate care in Malaysia.

"Compassion is the mainstay of nursing care": A qualitative study on the perception of care and compassion in senior nursing students

PURPOSE

To describe nursing students' perceptions of care and compassion in the context of the clinical environment.

DESIGN AND METHODS

This phenomenological study data were collected by focus groups and Giorgi et al. stages used in the data analysis.

FINDINGS

Sixteen students participated in this study. Four themes and 12 subthemes were determined. The themes were "Discovering the existence of care and facing up to care", "advancing on the road to becoming a nurse: from theory to practice," "compassionate care, beyond medical care," and "the effect of nursing education on professional compassion."

PRACTICE IMPLICATIONS

This study showed that nursing students grew by giving care and knowledge. In addition, compassionate care is gained by real-life stories and a supportive environment.

Uncovering the Model and Philosophy of Care of a Psychiatric Inpatient Mother-Baby Unit in a Qualitative Study with Staff

The postnatal period is high-risk time for the first onset and recurrence of maternal mental health disorders. Untreated maternal mental illness can have significant adverse impacts on a woman, her baby, and the wider family unit. For women with mental illnesses that cannot be managed in the community, psychiatric inpatient mother-baby units are the gold standard treatment whereby mothers are co-admitted with their infant for specialist perinatal and infant mental health assessment and treatment. The study explores the model of care and examines the philosophies of care that are used within a psychiatric mother-baby unit. Purposive sampling was used to conduct semi-structured focus group and individual interviews with multidisciplinary staff members at a single mother-baby unit. Themes derived from these interviews were coded into two primary themes and a range of sub-themes. The first primary theme focused on the Model of Care consisting of the following sub-themes: mental health care, physical health care, babies' care, building mother-baby relationship, fostering relationships with supports, and facilitating community support. The second primary theme centered around the Philosophy of Care comprising of: person-centered care, trauma-informed care, compassion-centered care, recovery-oriented care, attachment-informed care, non-judgmental care, strengths-based care and interdisciplinary care. The model can be used to provide consistency across mother-baby units and to support core capabilities of staff in providing an optimal level of care.

The Mediating Role of Compassion between Social Job Resources, and Healthy Healthcare Professionals: A Cross-Sectional Study with Gender Perspective

The aim of this study is to examine the role of Compassion towards others as a mediator between Social Job Resources (social support climate, coordination, and positive leadership), Healthy Employees (psychological well-being such as resilience, engagement, and optimism) and Healthy Organisational Outcomes (in-role performance, extra-role performance and commitment) from a gender perspective in healthcare professionals. Through the multiple analyses of variance, structural equation models, and multiple-group analyses in a sample of 1420 healthcare professionals from different public and private hospitals in Spain, this study proved the existence of gender differences, with women perceiving higher levels of Compassion. Moreover, this study shows that Compassion partially mediates the relationship between Social Job Resources and Healthy Employees. In addition, Compassion partially mediates the relationship between Social Job Resources and Healthy Organisational Outcomes. Finally, Healthy Employees mediate the positive relationship between Social Job Resources and Healthy Organisational Outcomes. This is an innovative contribution to the limited research examining Compassion towards others as a personal resource that can have a positive impact in the workplace. The results also propose a way to develop and conduct interventions in order to increase Compassion towards others in the healthcare context.

Retracted: 'We were on our knees long before COVID': How healthcare workers experienced the compassionate care model during COVID-19

Aim

This qualitative study aimed to explore the impact of a novel compassion‐based intervention on healthcare workers during a pandemic.

Sample

Participants were N  = 10 healthcare workers (HCW) recruited from a healthcare organisation in Northern Ireland, including nurses, allied health professionals, managerial staff and administrative staff. The sample was 80% female with an average age of 45.1 years.

Intervention

All participants engaged in a compassion‐based staff support psychological intervention. The ‘compassionate care’ intervention was based on the compassion‐focussed staff support model. Modalities included face‐to‐face, remote, individual and group intervention, offered by clinical psychologists and psychotherapists.

Method

Ethical approval was obtained through the researcher’s academic institution. After obtaining informed consent, participants completed individual interviews, analysed using reflexive thematic analysis.

Results

Findings highlighted model appropriateness and feasibility, detailing post‐intervention changes. Three themes were generated. The first two, Preparing for war: A threat without boundary and Masking the pain: Externalising resistance to compassion, describe the transition from an initial burnout state to a state of derealisation via avoidance coping. The final theme, Reconnection: Returning to compassion, highlights how participants rehabilitated via the intervention, reconnecting with relationships and personal values.

Conclusion

Participants reported personal and professional experiential changes relating to compassion and resilience, while noting organisational blocks to compassion. The model appears appropriate across a variety of presentations and levels of chronicity of distress, across age, disciplines and gender groups, and for both managers and non‐managerial staff. Participants reported its usefulness in clinical and administrative settings, as well as application of the skills gained to settings outside work.

Compassion satisfaction and compassion fatigue in haematology cancer nurses: A cross‐sectional survey

Aim

This study aimed to investigate compassion satisfaction (CS) and compassion fatigue (CF) in haematology nurses and their associated factors.

Design

A cross‐sectional survey.

Methods

The survey was conducted on 336 haematology nurses from 21 hospitals in Sichuan, China. The CS and CF were assessed by the Professional Quality of Life Scale version 5. The CF was determined by burnout and secondary traumatic stress.

Results

Haematology nurses in China had moderate levels of CS and moderate‐to‐low CF. Better nursing competence of teaching/consultation and communication/coordination and the percentage of critically ill patients >60% predicted higher CS. The permanent nurse, better nursing competence of communication/coordination and specialized clinical practice predicted less burnout, while working >40 hr per week or more nurse‐patient conflict events predicted more burnout. In addition, working >40 hr per week, more nurse‐patient conflict events and having the need of psychological support predicted higher secondary traumatic stress.

Health workforce governance for compassionate and respectful care: a framework for research, policy and practice

The progressive realisation of universal health coverage requires that health services are not only available and accessible, but also that they are rendered to the population in an acceptable, compassionate and respectful manner to deliver quality of care. Health workers’ competencies play a central role in the provision of compassionate and respectful care (CRC); but health workers’ behaviour is also influenced by the policy and governance environment in which they operate. The identification of relevant policy levers to enhance CRC therefore calls for actions that enable health workers to optimise their roles and fulfil their responsibilities.

This paper aims at exploring the health workforce policy and management levers to enable CRC. Through an overview of selected country experiences, concrete examples are provided to illustrate the range of available policy options. Relevant interventions may span the individual, organisational, or system-wide level. Some policies are specific to CRC and may include, among others, the inclusion of relevant competencies in preservice and in-service education, supportive supervision and accountability mechanisms. Other relevant actions depend on a broader workforce governance approach, including policies that target health workforce availability, distribution and working conditions, or wider system -level factors, including regulatory and financing aspects.

The selection of the appropriate system-wide and CRC-specific interventions should be tailored to the national and operational context in relation to its policy objectives and feasibility and affordability considerations. The identification of performance metrics and the collation and analysis of required data are necessary to monitor effectiveness of the interventions adopted.

Vicarious trauma and nursing: An integrative review

Nursing requires empathic engagement, within therapeutic relationships, to ensure the delivery of compassionate care. Empathic engagement with people who have experienced trauma is known to potentially lead to experiences of vicarious trauma occurring in the caregiver. However, relatively little is known about the implications of vicarious trauma for nurses. This integrative review aimed to explore what is known about vicarious trauma and consider its implications for nursing. Twenty-two articles were included in the review, with findings considering how vicarious trauma is conceptualized and applied to nursing in the literature, what implications of vicarious trauma, specific to nursing, are identified in the literature, and what vicarious trauma interventions are identified to apply to nursing. The findings highlight clear articulation of the concept of vicarious trauma and its relevance to nursing, including its pervasive and significant personal and professional effects. Vicarious trauma was identified to be a workplace hazard for nurses working across settings, which also impacts upon organizations. The review highlighted that at individual, team, organizational, and social levels, awareness and preventative approaches are recommended. These approaches require systemic supports that foster individual coping mechanisms, self-care and support networks for nurses, education about vicarious trauma, screening for vicarious trauma, and formalized access to clinical supervision and peer support for all nurses. With increasing awareness of trauma across health care settings, and a move towards the delivery of 'trauma informed care', recognition of vicarious trauma amongst nurses as a likely 'cost' of the delivery of compassionate care to trauma survivors, is essential.

Compassionate Nursing Care Model: Results from a grounded theory study

Compassion, as an indicator for quality care, is highly valued by patients and healthcare professionals. Compassionate care is considered a moral dimension of nursing practice and an essential component of high quality care. This study aimed to answer these questions: (1) What are the facilitators and barriers of providing compassionate nursing care in the clinical setting? (2) Which strategies do nurses use to provide compassionate care? (3) What is the specific model of compassionate care for the nursing context? A grounded theory approach was used in this study. A total of 21 nurses working in diverse clinical settings participated in the study. Purposive and theoretical sampling was used to select the participants. Data were collected by in-depth face to face interviews and analyzed by the constant comparative method. Ethical approval was gained from the Ethical Review Board of Tabriz University of Medical sciences. The analysis resulted in the development of three main themes: (a) contextual factors affecting compassionate care, (b) the compassionate care actions, and (c) the consequences of compassionate care. The main dimensions of compassionate care are demonstrated in a Compassionate Nursing Care Model. Nurses' ability on providing compassionate care is influenced by individual and organizational factors that may facilitate or inhibit this type of care. Leadership and nurse managers should remove the barriers which diminish the nurses' ability to provide compassionate care and support them to engage in compassionate care programs. Identifying and recruiting compassionate nurses, developing their compassionate capacity, and providing role models of compassion could improve the flourishing of person-centered and compassionate care in clinical settings. The Compassionate Nursing Care Model (CNCM) provides a model to guide nursing care and research.

How To Hospital: barriers to developing a patient 'Hospital Survival Guide' to support information transfer during ward-rounds on the patient journey from admission to hospital to discharge

Clinicians can enable patients to actively participate in their care but communication with patients is often poor and highly variable. The aim of this study was to explore patients' understanding of their current illness while in hospital and using a codesign process to create prototype tools to facilitate better communication during ward rounds.A mixed-methods, multistep design with step 1: Application of a questionnaire addressing domains of care in the acute medical unit; step 2: Development of communication aids that were codesigned with active help of patients, students and a specialist in user centric design to address patient needs and step 3: Evaluation of tools with patients in four Plan-Do-Study-Act cycles.In the initial survey of 30 patients 12 (40%) patients did not know what their diagnosis was and 5 (17%) did not know the results of recent key tests. 20 (67%) patients felt that staff communication and coordination could be improved.An intervention was prototyped with four variations: (1) An A6 ward-round summary sheet completed by doctors during ward rounds. The system worked well but was highly person dependent. (2) An A4 patient-owned diary ('How to Hospital') that contained information about key processes in hospital and space to document conversations from rounds and prompts for questions. 10 patients read the diary and commented favourably but did not complete any pages. (3) 'Diary-cards': a basic set of information cards was given to patients on admission to hospital. (4) Patient specific 'diary-cards' were completed by clinicians-10 forms were piloted during rounds and improved subsequent day information retention of diagnosis to 80%.Our study identified interventions that were feasible but remained person-dependent. The patients' ownership of information in relation to their care might facilitate retention and satisfaction but the optimal format for these interventions for enhancing communication remains unclear.

Person-Centered-Care Climate in a Tertiary Hospital: Staff Perspective

Introduction

Most health care systems strive to improve the quality, safety and value of healthcare, with an emphasis on moving towards patient-centered care/person-centered care (PCC) approach. The aim of the current study was to assess health care providers’ perspectives on PCC climate in hospital setting and to identify the role of providers in determining the perception of the PCC climate.

Methods

A survey, using person-centered climate questionnaire-staff version, was employed in health care providers of a tertiary care hospital. Data included variables age, gender, education level, occupation, and years of experience and three PCC dimensions. PCC overall and subscale scores were reported as mean and standard deviation. Factors associated with PCC climate perception were analyzed using a Poisson model.

Results

Out of 1216 respondents; the majority 47% aged between 18 and 34 years; 79% women, 68% were nurses. The overall mean score was 45.96±15.36 (range 0–70). Subscale scores were Safety 20.15±5.0 (range 0–30), Everydayness 12.02±3.52 (range 0–20) and Community 13.79±3.34 (range 0–20). Increasing age was a significant factor associated with PCC scores for the overall, safety, everydayness, and community scales, with a positive association. Lower scores were reported more by women compared with men, for overall (p=0.0005), and everydayness (p=0.006) scales. Higher safety scores were reported by health care providers with a diploma compared to master’s degree (p=0.009), Ph.D. (p=0.007), for technicians compared with nurses (p=0.007), and for day shift compared with day/night shift workers (p=0.025). PCC scores were not significantly different across health care providers’ years of experience.

Conclusion

There is a room for PCC climate improvement based on the low scores compared to the literature. The study findings indicated that the main factors associated with HCPs’ perception of PCC were higher age and female gender, and these factors would benefit from further research.

Development and assessment of the psychometric properties of a compassionate care questionnaire for nurses

Background

Compassionate care is emphasized within professional ethics codes for nursing and is a key indicator of care quality. The purpose of the present study is to develop and assess the psychometric properties of a compassionate care instrument for nurses.

Methods

This methodological study was carried out in two phases -qualitative and quantitative-from February 2016 to October 2018. In the qualitative stage of the study, a content analysis approach was used to establish the concept of compassionate care through interviews with nurses, patients, and family caregivers. The initial draft of the questionnaire was developed based on the qualitative findings and a subsequent review of the literature. In the second phase, the psychometric properties of the questionnaire were assessed for validity and reliability. Data analysis was performed using descriptive and inferential statistics in SPSS v.16.

Results

From the results of the qualitative phase and review of literature, 80 items were extracted. In the quantitative phase, after evaluation of the face and content validity, 40 items were kept. After measurement of the construct validity, 28 items whose factor loading was above 0.4 were retained. Measurement of convergent validity showed a moderate correlation between the questionnaire and the nurses’ caring behaviors scale (r = 0.67, P = 0.01). The reliability of the 28-item questionnaire was tested by measuring its Cronbach’s alpha coefficient and intra-class correlation coefficient which were found to be 0.91 and 0.94 for the whole questionnaire, respectively.

Conclusion

The questionnaire has enough validity and reliability to be used for measuring the nurses’ compassionate care. Therefore, the instrument can be used to measure and record the quality of nursing care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00691-3.

"Walking in the patient's shoes": An innovative training method using storytelling to promote knowledge transfer of patient-centered care in hospital: A quasi-experimental study

OBJECTIVE

To evaluate an onsite patient-centered care (PCC) training program for nurses using a digital patient-storytelling approach.

BACKGROUND

PCC is a dominant model for improving the quality of care. Effective strategies for providing PCC training to nurses can yield numerous benefits.

DESIGN

A pretest-posttest design was used with a nonrandomized control group METHODS: PCC training program involved participants playing a patient role to experience their hospital journey. Nurses' perception of PCC, compassion and knowledge transfer were measured before (pretest) and after (posttest) PCC training (experimental group). Controls received PCC training only after pretest and posttest evaluations.

RESULTS

Changes in PCC perception and compassion were significantly greater in the experimental group (n = 39) than in controls (n = 49; p = .001 and .006, respectively). PCC knowledge transfer was significantly correlated with PCC perception (r = 0.55) and compassion (r = 0.63).

CONCLUSIONS

Through the PCC training program, the perceived improvements of the nurses' views on supporting patient individuality and compassion while providing care were revealed. This program is also potential for promoting PCC knowledge transfer into the daily activities of nurses. Therefore, such PCC training programs could be a good beginning in developing a patient-centered culture in healthcare systems.

Development of an on-job mentorship programme to improve nursing experience for enhanced patient experience of compassionate care

Background

Evidence suggests improvement in nursing staff satisfaction, competence, and retention after implementation of evidence-based mentorship programmes. When guided by a framework of compassion, mentoring as a caring action can not only build healthy, transformative relationships but a similar behavior is reciprocated to patients which subsequently can drive patient experience of care. However, examples of on-job mentorship programs for nurses in low- and middle-income countries (LMIC) are limited.

Objective

The objective of the study was to develop an on-job nursing mentorship programme using a compassionate framework aimed at improving nurses’ experience and thus enhancing patient experience in a tertiary care hospital in Pakistan.

Methods

Designed as an intervention development study, it was completed between January 2018–December 2019. The programme was developed by a team composed of service and nursing leadership, director patient experience of care and a compassion specialist using a theory of change model. The package followed a series of steps, a) identification of a framework, b) creation of working group c) needs assessment and d) multiple meetings to frame the model followed by implementing the preconditions for roll-out of the programme with the frontline staff.

Results

The eventual outcome was improving the patient’s experience of compassion while the intermediate outcome was to have nurses demonstrate compassionate care. The pre-conditions were identified as: recruitment of staff with appropriate skills for pediatric care, provision of compassionate experience to the frontline nurses by addressing their specific pain points, development of competent head nurses as supervisors and creation of a compassionate culture. To ensure the pre-conditions, various interventions were planned with some implemented through the course of the study while others are in the process of being rolled out. These involved, inclusion of pediatric compassion specific module during orientation of new hires, creation of space to talk about compassionate skills with staff, provision of trainings and mentorship to create competent head nurses, and creating a culture that promoted and recognized compassionate care values.

Conclusion

The approach helped to delineate feasible pathways for an on-job compassionate mentorship programme enhancing routine supervisors' role as facilitators of compassionate care.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12912-021-00682-4.

A Survey of Broiler Farmers' Perceptions of Animal Welfare and their Technical Efficiency: A Case Study in Northeast China

This study was conducted to assess the current status of famers' perceptions of animal welfare and technical efficiency in broiler farms using a stochastic frontier analysis (SFA). In this study, 355 farms registered in Heilongjiang Province, China were surveyed, with 240 of them responding. The results showed that 75% of farmers recognize the importance of animal welfare, and 56.3% of them expressed their willingness to implement animal welfare on their farms without conditions or having a negative attitude. The technical efficiency of the farmers' ranged from 55% to 99%. All the variables assessed in this study had a statistical influence on production. Education, experience, and gender of farmers were significant variables and increased efficiency, while age and distance of a farm to the main road increased inefficiency. Based on our survey, we suggest that the implementation of animal welfare measures will require government subsidy or incentive, which could encourage 35% of farmers to implement animal welfare measures. To increase production efficiently, farmer needs to control the mortality rate, but the contribution of vaccine during production is below 1% (0.09%).

How Do Health Professionals Maintain Compassion Over Time? Insights From a Study of Compassion in Health

Although compassion in healthcare differs in important ways from compassion in everyday life, it provides a key, applied microcosm in which the science of compassion can be applied. Compassion is among the most important virtues in medicine, expected from medical professionals and anticipated by patients. Yet, despite evidence of its centrality to effective clinical care, research has focused on compassion fatigue or barriers to compassion and neglected to study the fact that most healthcare professionals maintain compassion for their patients. In contributing to this understudied area, the present report provides an exploratory investigation into how healthcare professionals report trying to maintain compassion. In the study, 151 professionals were asked questions about how they maintained compassion for their patients. Text responses were coded, with a complex mixture of internal vs. external, self vs. patient, and immediate vs. general strategies being reported. Exploratory analyses revealed reliable individual differences in the tendency to report strategies of particular types but no consistent age-related differences between older and younger practitioners emerged. Overall, these data suggest that while a range of compassion-maintaining strategies were reported, strategies were typically concentrated in particular areas and most professionals seek to maintain care using internal strategies. A preliminary typology of compassion maintaining strategies is proposed, study limitations and future directions are discussed, and implications for the study of how compassion is maintained are considered.

The Effect of Self-Compassion on Psychosocial and Clinical Outcomes in Patients With Medical Conditions: A Systematic Review

Studies about the role of self-compassion have focused primarily on psychological well-being, but there is solid evidence to suggest that self-compassion may have larger and more prominent implications in the medical world. Therefore, this systemic review aimed to investigate the effects of self-compassion on psychosocial and clinical outcomes in medically ill patients.

A comprehensive search of several databases from their inception to August 10, 2020, was conducted, which included Ovid MEDLINE(R) and Epub Ahead of Print, Ovid Embase, Ovid Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Eligible studies needed to include psychosocial or clinical outcomes of self-compassion in medically ill patients.

Nineteen articles (n=2,713 patients; 73.3% females) met our eligibility criteria and were included in this systematic review. There was a negative correlation between self-compassion and psychosocial outcomes such as anxiety, depression, and stress. Moreover, based on self-compassion intervention, there was an improvement in clinical outcomes related to diabetes such as hemoglobin A1c (HbA1c) and blood glucose levels.

This systematic review highlights the effect of self-compassion on psychosocial and clinical outcomes. Further studies are needed to evaluate long-term outcomes of a self-compassion-based-intervention to highlight its importance in the role of disease management.

Predictors of patient-centered care provision among nurses in acute care setting

AIM

The study was conducted to assess the predictors of patient-centred care provision among nurses working in an acute care setting. We hypothesized that higher structural empowerment and compassion satisfaction and lower burnout would predict the provision of patient-centred care.

BACKGROUND

Patient-centred care is a crucial aspect of quality health care and the heart of nursing care. Although previous studies have highlighted some determinants of patient-centred care provision among nurses, there remains a gap in understanding the factors that predict the provision of patient-centred care.

METHODS

A cross-sectional predictive design was used. Through random sampling, 255 nurses were recruited from five hospitals providing acute care services in Saudi Arabia.

RESULTS

Multiple linear regression revealed that compassion satisfaction (β = 0.260 [95% CI: 0.201-0.645]), burnout (β = -0.266 [95% CI: -0.998 to -0.403]) and structural empowerment (β = 0.273 [95% CI: 0.462-1.427]) jointly explained significant variance (27.5%) in the provision of patient-centred care by nurses.

CONCLUSIONS

The study findings reveal that lower burnout, higher compassion satisfaction and structural empowerment increase nurses' provision of patient-centred care.

IMPLICATIONS FOR NURSING MANAGEMENT

Leadership and managerial strategies that not only address compassion satisfaction and burnout but also empower nurses are crucial for the provision of patient-centred care by nurses.

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

Background

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

Objective

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

Methods

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

Results

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

Conclusions

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

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

Aim

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

Design

A phenomenological-hermeneutical approach was used.

Methods

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

Results

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

Using graphic illustrations to uncover how a community of practice can influence the delivery of compassionate healthcare

Our modern-day frenetic healthcare culture has progressed to a state where healthcare professionals tend to detach themselves from the emotions of their patients/clients, rather than embed compassion into their daily practice. The AMS Phoenix Project: A Call to Caring was implemented with the goal to instil and sustain empathy and compassion in environments where clinicians learn and work. The purpose of this study is to report on how an interprofessional community of practice (CoP) of healthcare educators can contribute to a cultural shift in promoting and delivering compassion in healthcare through health professionals education. Using an imaginative creative autoethnography that adopts a narrative design through graphic illustrations, data were collected from 25 members of the Phoenix@Queen's CoP during a 1-day retreat. Data collection included a graphic recorder who visually depicted all retreat dialogue, field notes that highlighted emergent themes and artefacts produced during the day. Audio recordings of the discussions were used as secondary sources of data. Using thematic analysis, three themes emerged: the call to caring is a long and winding road with many barriers and rewards; CoP members experienced personal growth in and through the community; and the Phoenix@Queen's CoP matters in terms of professional relationships, leadership and moving forward a shared agenda about practising compassionate healthcare. This study describes the development of a CoP that moves away from traditional committees and discussions to an experiential creation of connections and shared meaning by its members. By using autoethnography, and by demonstrating how graphic illustration can be an innovative and creative method for recording and interpreting group discussions, we have demonstrated the accelerated development of an authentic CoP. With a richer and more authentic community, the shared goals of healthcare professional educators are more likely to be achieved.

Building on Resiliencies of Refugee Families

This article focuses on the resiliency of refugee families and the various ways that pediatric practitioners can use and strengthen those resiliencies in the course of pediatric health care delivery. It reviews common stressors experienced by refugees, information about the concept of resilience, aspects of culturally responsive health care, and clinical recommendations. In addition, 3 cases are presented that highlight both resiliencies of refugee families and successful interventions by pediatric health care providers within the pediatric refugee clinic at the Children's Hospital of Philadelphia.

Keith Haring, Felix Gonzalez-Torres, Wolfgang Tillmans, and the AIDS Epidemic: The Use of Visual Art in a Health Humanities Course

Contemporary art can be a powerful pedagogical tool in the health humanities. Students in an undergraduate course in the health humanities explore the subjective experience of illness and develop their empathy by studying three artists in the context of the AIDS epidemic: Keith Haring, Felix Gonzalez-Torres, and Wolfgang Tillmans. Using assignments based in narrative pedagogy, students expand their empathic response to pain and suffering. The role of visual art in health humanities pedagogy is discussed.

Compassionate Care in Healthcare Systems: A Systematic Review

BACKGROUND

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

PURPOSE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Mind the gap: is the Canadian long-term care workforce ready for a palliative care mandate?

The average expected lifespan in Canadian long-term care (LTC) homes is now less than two years post-admission, making LTC a palliative care setting. As little is known about the readiness of LTC staff in Canada to embrace a palliative care mandate, the main objective of this study was to assess qualities relevant to palliative care, including personal emotional wellbeing, palliative care self-efficacy and person-centred practices (e.g. knowing the person, comfort care). A convenience sample of 228 professional and non-professional staff (e.g. nurses and nursing assistants) across four Canadian LTC homes participated in a survey. Burnout, secondary traumatic stress and poor job satisfaction were well below accepted thresholds, e.g. burnout: mean = 20.49 (standard deviation (SD) = 5.39) for professionals; mean = 22.09 (SD = 4.98) for non-professionals; cut score = 42. Furthermore, only 0–1 per cent of each group showed a score above cut-off for any of these variables. Reported self-efficacy was moderate, e.g. efficacy in delivery: mean = 18.63 (SD = 6.29) for professionals; mean = 15.33 (SD = 7.52) for non-professionals; maximum = 32. The same was true of self-reported person-centred care, e.g. knowing the person; mean = 22.05 (SD = 6.55) for professionals; mean = 22.91 (SD = 6.16) for non-professionals; maximum = 35. t-Tests showed that non-professional staff reported relatively higher levels of burnout, while professional staff reported greater job satisfaction and self-efficacy (p < 0.05). There was no difference in secondary traumatic stress or person-centred care (p > 0.05). Overall, these results suggest that the emotional wellbeing of the Canadian LTC workforce is unlikely to impede effective palliative care. However, palliative care self-efficacy and person-centred care can be further cultivated in this context.

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

BACKGROUND

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

OBJECTIVES

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

RESEARCH DESIGN

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

PARTICIPANTS AND RESEARCH CONTEXT

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

ETHICAL CONSIDERATIONS

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

FINDINGS

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

DISCUSSION AND CONCLUSION

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

The colours and contours of compassion: A systematic review of the perspectives of compassion among ethnically diverse patients and healthcare providers

OBJECTIVE

To identify and describe the perspectives, experiences, importance, and impact of compassionate care among ethnically diverse population groups.

METHODS

A systematic search of peer-reviewed research focused on compassionate care in ethnically diverse populations published between 1946 and 2017 was conducted.

RESULTS

A total of 2296 abstracts were retrieved, out of which 23 articles met the inclusion criteria. Synthesis of the literature identified the perspectives, facilitators and barriers of compassion in healthcare within ethnic groups. Compassion was described as being comprised of healthcare provider (HCP) virtues (honesty, kindness, helpful, non-judgment) and actions (smile, touch, care, support, flexibility) aimed at relieving the suffering of patients. The importance and impact of providing compassion to ethnically diverse patients was also identified which included overcoming cultural differences, alleviating distress at end-of-life, promoting patient dignity and improving patient care. This review also identified the need for more contextual studies directly exploring the topic of compassion from the perspectives of individuals within diverse ethnic groups, rather than superimposing a pre-defined, enculturated and researcher-based definition of compassion.

CONCLUSIONS

This review synthesizes the current evidence related to perceptions of compassion in healthcare among diverse ethnic groups and the role that compassion can play in bridging ethno-cultural differences and associated challenges, along with identifying gaps in literature related to compassionate care within diverse ethnic groups. Establishing an evidence base grounded in the direct accounts of members of diverse ethnic communities can enhance culturally sensitive compassionate care and improve compassion related health outcomes among diverse ethnic groups.

Measuring Compassion in Healthcare: A Comprehensive and Critical Review

BACKGROUND

There is international concern about the lack of compassion in healthcare systems. A valid and reliable tool for measuring compassion in healthcare systems and educational institutions is required. This comprehensive and critical narrative synthesis identified and compared existing measures of compassionate care in clinical settings.

METHODS

PubMed, MEDLINE, CINAHL and PsycINFO databases and grey literature were searched to identify studies that report information on instruments that measure compassion or compassionate care in clinicians, nurses, healthcare students and patients. Textual qualitative descriptions of included studies were prepared. Instruments were evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool.

RESULTS

Nine studies containing information on the Compassion Competence Scale, a self-report instrument that measures compassion competence among Korean nurses; the Compassion Scale, the Compassionate Care Assessment Tool©, and the Schwartz Center Compassionate Care Scale™, patient-reported instruments that measure the importance of healthcare provider compassion; the Compassion Practices Scale, an instrument that measures organisational support for compassionate care; and instruments that measure compassion in educational institutions (instructional quality and a Geriatric Attitudes Scale), were included. Each instrument is associated with significant limitations. Most only measure certain aspects of compassion and lack evidence of adaptability to diverse practice settings. The EMPRO of self-report instruments revealed a lack of psychometric information on measurement reliability, validity, responsiveness and interpretability, respondent, administrative and scoring burden, and use in subpopulations.

CONCLUSION

The findings of this narrative synthesis identified an unmet need for a psychometrically validated instrument that comprehensively measures the construct of compassion in healthcare settings.

Factors facilitating nurses to deliver compassionate care: a qualitative study

BACKGROUND

Compassion is an important ethical foundation of all healthcare professionals especially for nursing. However, there is little understanding of factors which could help and motivate nurses to deliver compassionate care in modern healthcare practices today. Moreover, a cultural context may affect the way compassionate care is delivered by healthcare professionals.

AIMS AND OBJECTIVES

This study aimed to explore what facilitates compassionate care in daily practice from the unique perspective of Iranian nurses.

RESEARCH METHODS

This qualitative exploratory study was conducted in four hospitals. In this study, 16 nurses were selected from various wards. Data were collected by in-depth, face-to-face interviews. For data analysis, a conventional content analysis approach was used.

RESULTS

As the most important theme, the theme 'deepening individual's capacity for compassionate care' emerged, which consisted of three categories: the personal system of values and beliefs, patient experience and positive role models of compassion.

CONCLUSIONS

Addressing and developing nurses' capacity for compassion is possible by providing organisational support and professional education, next to recruiting nurses with a high motivation to relieve patient suffering. These recommendations would help to provide high-quality compassionate care in healthcare practices. Moreover, nurses could improve their individual capacity for compassion by following their value and belief system and by considering their colleagues as a role model of compassionate practice.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

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

Background:

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

Objective:

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

Research design:

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

Participants and research context:

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

Ethical consideration:

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

Findings:

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

Discussion:

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

Conclusion:

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

Who cares? A critical discussion of the value of caring from a patient and healthcare professional perspective

BACKGROUND

This study was undertaken in order to discover and illuminate the essential caring behaviours valued by both patients and staff in an orthopaedic setting within a district general hospital in the United Kingdom.

OBJECTIVES

This descriptive study was undertaken in order to acquire a greater understanding of perceptions of caring from both patient and orthopaedic healthcare professional perspectives.

METHODS

A sample of 30 patients and 53 healthcare professionals consisting of doctors, nurses, physiotherapists and occupational therapists were asked to complete the Caring Behaviours Inventory (CBI) questionnaire (Wolf et al., 1994). Data were analysed using descriptive and inferential statistics.

RESULTS

The findings revealed both similarities and differences relating to the importance of positive caring behaviours exhibited during caring interactions. Healthcare professionals working in the orthopaedic setting acknowledged the value of similar positive caring behaviours to those of the patient group but ranked the importance of these differently.

DISCUSSION

Several important insights into perceptions of caring have been gained. These relate to an overall understanding of the caring behaviours that are considered of importance to patients and healthcare professionals; the differences that exist between the caring perceptions of both groups and the factors which influence these perceptions.