Compassion in nursing
The vision set out by the Chief Nursing Officer for England and Department of Health Nursing Director recognised the importance of addressing the quality of care following the failings at Winterbourne View and Mid-Staffordshire Hospital (Cummings, J and Bennett, V, 2012). The Chief Nursing Officer for England and Department of Health Nursing Director consequently founded the six essential values of a care giver; care, compassion, communication, competence, courage and commitment (6C’s) (Cummings, J and Bennett, V, 2012).
This essay is going to look at the meaning of compassion, explore its importance within a healthcare setting and outline how compassionate care can be delivered. This essay will also identify reasons why compassionate care can become exhausted and how to overcome this problem. Compassion is about providing intelligent care which exhibits empathy, kindness, trust, respect and dignity, but moreover, it is how the patient feels about the care they receive (Cummings and Bennett 2012).
To provide compassionate care requires a personal obligation to recognise the suffering of another person and to actively commit to alleviate that pain (Straughair, 2012). The nurse has a duty to provide care and promote health and wellbeing of the patient, therefore, in moments of suffering it is important to provide compassion (Cingel 2009). Nurses and midwives are bound by the NMC Code (2010) to treat patients as individuals with kindness, consideration and dignity in a non-discriminatory way.
Compassion in practice is important to show patients that they are not alone in their suffering, if it is not acknowledged, patients will feel ignored, thus escalating the feelings of distress and denying the importance of a loss (Cingel, 2009). This can be demonstrated from a workplace observation where a patient with a brain injury was left alone sobbing in the dining room while staff ignored and dismissed her usual behaviour, this led to her becoming anxious and more withdrawn.
The absence of compassion gave rise to feelings of uncomfortableness and although it was questioned, on reflection, the lack of experience and courage meant this insensitive behaviour was regretfully not fully challenged. Cingel (2009), suggests acknowledging the suffering can help the patient to deal with underlying emotions such as anger or anxiety, however, compassion does not eliminate the suffering it simply allows a patient to feel cared for.
A workplace example demonstrates this point; whilst comforting someone during the aftermath of a traumatic labour, where the patient’s baby had been rushed to the neonatal unit and the mother left on a post natal ward feeling anxious and scared. This particular case required both compassion and communication i. e. good listening, eye contact, and a gentle hand placed on the patient’s hand represented a caring and compassionate touch. Being empathetic allowed the patient to talk through her emotions which alleviated some of her stress but it did not take away the pain she was feeling inside and the longing to be with her baby.
Foster (2013) believes that compassion is an innate quality which can be delivered in many different ways and Cingel (2009) believes that to deliver compassionate care in practice involves building relationships with patients by creating common ground whilst being able to maintain a professional standard. This means that nursing staff need to be able to distance themselves from making personal judgments whilst being able to connect with the patient on an individual level, in order to personalise compassionate care.
For example, one occasion when helping a distressed breastfeeding mother whose baby would not latch required encouragement in a non-judgemental way so that she did not feel a failure. Remaining professional in order to educate her with a method that best suited her and sharing personal experiences allowed the patient to feel that she was not alone. In order for compassion to be delivered by nursing staff it should be role modelled by leaders (Foster, 2013), this means that health care workers must be supported and leaders must recognise the tiring effects of emotional labour.
In a Nursing Standard (2013) article one student reports that by seeing the delivery of good care by their peers gives student nurses an opportunity to appreciate the value of the 6C’s which could create a passion to adopt them in their own working methods. In a study carried out on student nurses it was discovered that the students were able to better empathise by disclosing information about themselves, this in turn allowed patients to trust and confide in the students which was conducive for better relationships (Curtis, 2013).
It was however, noted that students were uncertain of their boundaries and some student nurses found that they were having to mask their emotions in order to cope with the emotional demands of compassionate practice for them to remain professional. Despite this uncertainty students were encouraged with the obvious relief of suffering as a direct result of their interaction and compassion (Curtis, 2013). Nevertheless, students feared that becoming too emotionally attached could lead to vulnerability and they felt it was necessary to learn to toughen up (Curtis, 2013).
Students were also worried that by hardening their emotional exterior would lead to becoming uncompassionate thus having detrimental effects on patients and their own wellbeing (Curtis, 2013). Detrimental effects seen in one American study discovered that when there was a patient rise in relation to staffing numbers, this resulted in higher numbers of nurse burnout which in turn increased the number of health care associated infections.
The study found that with every ten percent increase of nurse burnout, the urinary tract infection rate went up by nearly one per one thousand patients and surgical site infections went up by two in one thousand patients (Cimiotti, 2012). From experience, staff have been observed performing inefficient hand hygiene techniques during excessively busy spells which could, in part, explain the link between increased infection rates and staff burnout. Research suggests that burnout occurs on a gradual basis when the demands of work become too stressful to manage.
Burnout presents itself in a change of attitudes and behaviours such as lack of enthusiasm and frustration (Sabo 2006). The manifestation of burnout is thought to increase the chances of experiencing the acute onset of compassion fatigue (Sabo 2006). Compassion fatigue occurs with the prolonged suffering of a patient that requires nursing staff to deliver intense levels of care and compassion. When a health care provider is continuously exposed to the stressfulness of emotional situations compassion discomfort can occur.
If compassion discomfort is not acknowledged and dealt with it could lead to compassion stress which further leads to compassion fatigue, this is when compassion has become completely exhausted and is unlikely to be regained. A health care worker who is exhausted of compassion tends to make more errors due to a lack of concentration, they become more irritable and less eager to please. Emotionally they find it hard to cope and when it starts to take over a person’s life both personally and professionally sickness levels may rise (Coetzee and Klopper 2010) which will consequently have an adverse effect on staffing levels.
Increased absences and sickness reporting loses the NHS five billion a year and four billion can be attributed to thirty million days lost from certified psycho-neurotic disorders (Brykczynska, 1997). Since it is important for nurses to be compassionate and caring Coetzee and Klopper, (2010) believes that in order to prevent compassion fatigue it is important to provide in-house training. This would help staff to identify the signs of compassion discomfort and compassion stress thus preventing the debilitating effects of compassion fatigue, furthermore, it would enable staff to spot the signs developing in their colleagues.
They suggest that to prevent the development of compassion fatigue free counselling and life education services should be offered to all members of nursing staff. It was also suggested that student nurses should be educated on compassion fatigue so that they can be empowered to spot the signs and implement strategies to protect themselves against it (Coetzee and Klopper 2010). Curtis (2013) also suggested a better support system would help students achieve and sustain compassionate practice.
One study suggests that nurse burnout can be reduced by providing clinical supervision and as long as there is professional resources available and good mental and physical capacity, it can promote motivation and wellbeing amongst staff. However, the study questioned how many people suffering with staff burnout were more susceptible to stress due to their personality traits; consequently it was unclear if clinical supervision would be of benefit to them (Koivu et al, 2012).
In Conclusion compassion is about identifying the suffering of another person and having a strong will to alleviate the pain. It would suggest that in order to provide good compassionate care it should be role modelled by leaders as well as other members of staff, however, it is important for new healthcare workers coming into the profession to have appropriate personality traits such as a natural compassion.
Compassion can become exhausted due to the stresses and pressures of a busy working environment which puts strain on the emotions of workers. To ensure compassionate care is constantly delivered, there should be a good support network and the provision of education for current members of staff as well as students nurses which would help to reduce vulnerability, burnout and compassion fatigue.
Providing clinical supervision in conjunction with personal and professional resources could boost staff morale and wellbeing. A happy workforce is less inclined to be compromised thus reduces the chance of burnout and compassion fatigue which in turn would create better compassionate care that could be sustainable. If all these support systems are in place, the healthcare associated infection rate could be reduced as well as creating a stronger and healthier workforce thus alleviating a financial burden to the NHS.