A pattern language of compassion in intensive care and palliative care contexts

Background

Compassion has been identified as important for therapeutic relationships in clinical medicine however there have been few empirical studies looking at how compassion is expressed different contexts. The purpose of this study was to explore how context impacts perceptions and expressions of compassion in the intensive care unit and in palliative care.

Methods

This was an inductive qualitative study that employed sensitizing concepts from activity theory, realist inquiry, phenomenology and autoethnography. Clinicians working in intensive care units and palliative care services wrote guided field notes on their observations and experiences of how suffering and compassion were expressed in these settings. Data were analyzed using constructivist grounded theory.

Results

Fifty-eight field notes were generated, along with transcripts from three focus groups. Clinicians conceptualized, observed, and expressed compassion in different ways within different contexts. Patterns of compassion identified were relational, dispositional, activity-focused, and situational. A pattern language of compassion in healthcare was developed based on these findings.

Conclusions

Recognizing compassion as shifting patterns of diverse attitudes, behaviours, and relationships raises numerous questions as to how compassion can be developed, supported and recognized in different clinical settings.

Electronic supplementary material

The online version of this article (10.1186/s12904-019-0402-0) contains supplementary material, which is available to authorized users.

A Canadian hospital-based HIV/hepatitis C look-back notification program

OBJECTIVE

To describe the process used to notify pediatric patients who received transfusions of blood or blood products at our institution before donor blood was routinely screened for antibodies to HIV (1985) and hepatitis C virus (1990), and to evaluate the effectiveness of the notification program.

DESIGN

Patients who had received transfusions were identified through the hospital's medical records and the records from the Transfusion Medicine Laboratory. Patients were contacted by registered mail to provide notification of transfusion. A questionnaire was included with the notification to obtain information about the patient's awareness of the transfusion and whether he or she had undergone or planned to undergo testing for HIV and hepatitis C virus.

SETTING

Tertiary care university-affiliated teaching hospital in Hamilton, Ont.

PATIENTS

Patients 16 years of age or younger who had received blood products between February 1978 and November 1985. Patients who had received only albumin or immune serum globulin were not included as these products were not associated with viral transmission in Canada.

RESULTS

Notification letters were sent to 1546 patients. Of these letters 522 (33.8%) were returned undelivered. Of the 1024 patients contacted 493 (48.1%) responded to the questionnaire, of whom 157 (31.8%) were not aware of their transfusion. A total of 130 (26.4%) of the respondents had already undergone testing for HIV, and 342 (69.4%) indicated that they would undergo such testing as a result of the notification. In contrast, only 30 (6.3%) of 474 respondents had undergone testing for hepatitis C virus, but 425 (89.7%) indicated that they would undergo such testing. Overall, the patients' response to the notification was neutral or positive; however, a number of patients expressed dissatisfaction and anxiety.

CONCLUSIONS

The high proportion of patients who were unaware that they had undergone transfusion and who decided to undergo testing for HIV and hepatitis C virus as a result of notification supports the use of notification programs such as this one.

"ULtra-clean" isotope diultion/mass spectrometic analyses for lead in human blood plasma indicated that most reported values are artificially high

We measured lead concentrations in venous blood plasma from two subjects, one having a typical exposure and the other a high exposure to lead. Our preliminary data, obtained by isotope dilution/mass spectrometric techniques in an ultra-clean laboratory, show lead concentrations of 0.02 mug/L and 2 mug/L, respectively, in their blood plasma, and 110 mug/L and 800 mug/L, respectively, in samples of whole blood. These results indicate that plasma lead concentrations previously reported have been overestimated by a large factor, and that further improvements in analytical procedures are needed in most laboratories before data on lead concentratios in blood plasma can be properly interpreted. Our preliminary data indicate a positive correlation between lead intake and lead concentrations in blood plasma.

"ULtra-clean" isotope diultion/mass spectrometic analyses for lead in human blood plasma indicated that most reported values are artificially high

We measured lead concentrations in venous blood plasma from two subjects, one having a typical exposure and the other a high exposure to lead. Our preliminary data, obtained by isotope dilution/mass spectrometric techniques in an ultra-clean laboratory, show lead concentrations of 0.02 mug/L and 2 mug/L, respectively, in their blood plasma, and 110 mug/L and 800 mug/L, respectively, in samples of whole blood. These results indicate that plasma lead concentrations previously reported have been overestimated by a large factor, and that further improvements in analytical procedures are needed in most laboratories before data on lead concentratios in blood plasma can be properly interpreted. Our preliminary data indicate a positive correlation between lead intake and lead concentrations in blood plasma.

Phase Chemistry, Structure, and Radiation Effects in Lunar Samples

Phase chemistry, structure, and radiation effects were studied in rock, breccia, and soil samples. The regolith apparently developed in the final stages of accretion and was modified by later impact processes and radiation weathering. Exposure ages indicate transfer of buried igneous rock fragments to the near surface late in lunar history. With a few exceptions igneous rock fragments, soil, and breccia share the same distinctive chemistry, probably acquired before accretion of the moon. The igneous rocks texturally resemble basaltic achondrites, and the soil and breccias contain glassy spheres analogous to chondrules.