Excellence in Compassionate Nursing Care

Leading the Change

Claire Chambers, Elaine Ryder

• Publisher: Taylor & Francis
• Year: 2017
• eBook ISBN: 9781846198298
• Edition: 1
• Topic: Medicine
• Subtopic: Health Care Delivery

We are passionately interested in the importance of nursing values and believe that excellence in compassionate nursing care lies at the heart of nursing practice and that leadership is key to making this happen. Every nurse, whatever their position and role, has a vital leadership role to play in ensuring excellent care remains at the heart of nursing practice. From the preface Highly committed nurses often feel disillusioned, disempowered and angry when they are faced with negative media reports about poor standards of care. They are genuinely concerned, and want to address issues, when patients and clients feel they are not being cared for with compassion. However, complex and under-resourced healthcare environments pose many challenges. Developing ideas and initiatives from the highly successful Compassion and Caring in Nursing, in this new book Claire Chambers and Elaine Ryder focus on these potential difficulties and offers practitioners a chance to build on their current knowledge and experience, and consider ways to take the lead and act as catalysts for change. Each chapter focuses on a particular issue and case scenarios are used and revisited in each chapter, so that theory and practice are integrated throughout. Specific prompts encourage readers to bring about vital change in practice. All nurses, health visitors and health and social care practitioners should find this book motivating and realistic. It also offers thought-provoking inspiration for undergraduate and postgraduate healthcare students.

CHAPTER 1

Introduction: Excellence in compassionate nursing care – the importance of leadership

Overview of the chapter

Key theme one – the importance of compassion and caring in nursing

■ Case study 1.1

■ Compassion and caring in nursing – what is it?

■ Thoughts for your practice

■ Ongoing practice – discussion one

■ Compassion and caring in nursing – why is it essential?

■ Thoughts for your practice

Key theme two – compassion and caring in nursing: taking the lead

■ Ongoing practice – discussion two

■ Why do we need to take the lead on ensuring compassionate nursing?

■ Thoughts for your practice

■ Ongoing practice – discussion three

■ What are the challenges to taking a lead on enhancing compassion in practice?

■ Thoughts for your practice

Summary

References

OVERVIEW OF THE CHAPTER

Disillusioned, disempowered and angry is how nurses often feel about practice at the current time. They are trying to provide high-quality care and respond to the needs of patients, clients and carers as best they can. However, resources are very limited, shortages of staff and under-resourced teams are the norm and nurses feel that nobody is supporting them to enable them to provide caring, safe and effective nursing care. They feel they are doing the most they can possibly do within the resources available, but there is insufficient time to meet the complex needs of those in their care. They are constantly audited against targets that do not feel achievable or even beneficial to patients in their care. Everyone in their management hierarchy seems more concerned about outcomes, targets, number crunching and risk management than about patients. They do not feel valued or listened to and feel unable to take a lead in improving their service or in solving problems. They are criticised verbally and sometimes abused physically by patients, clients and their relatives, who are angry about the care that is, or is not, being provided. Sometimes the anger is justified, but nurses are angry too.

When will they be given enough staff to carry out their role?

When will they be able to finish their working day feeling that they have genuinely carried out their role as well as they would have wanted to?

When will managers actually understand the huge deficit of care and unmet needs that nurses face every day?

When will people start to acknowledge these issues and support them in the care they are trying to carry out?

When will they feel able to take a lead in solving some of the problems that they see affecting their service every day?

When will others stop delivering the final insult of criticising them for their lack of compassion? Don’t they understand that wanting to deliver compassionate care is why they went into nursing in the first place?

Why can’t people understand that nurses are frankly tired, burnt out, undervalued and criticised? When they feel so unappreciated, stressed and disempowered, it is very difficult for them to be as compassionate as they would like to be, or to create a more compassionate practice environment. ‘Compassion can be defined in many ways, but its essence is a basic kindness, with a deep awareness of the suffering of oneself and of other living things, coupled with the wish and effort to relieve it’ (Gilbert 2009, p. 11).

Patients, clients and nurses themselves would generally agree that kindness is a key attribute of nurses, and the one that underlies patients’ perceptions of ‘being cared about’ as well as ‘cared for’. The preceding quote highlights the importance of this innate kindness and the associated desire to relieve distress as being key to compassion. Nurses, more than most people, are in close contact with those needing relief from suffering, and although relief might not always be possible, a caring and kind attitude will undoubtedly help alleviate distress, while a lack of kindness will aggravate the distress.

However, in this incentive-driven and resource-constrained society in which we live and work, compassion and kindness might be seen as a weakness or a luxury when targets are more related to getting things done. Gilbert (2009) suggests that modern societies tend to overstimulate our incentive/resource-seeking and threat/self-protection systems to the detriment of our soothing/ contentment system. This will inevitably lead to nurses – who essentially want to soothe and care for people – feeling stressed if they sense that this aspect of their role is not valued and that only the measurable quantitative outcomes of their practice are important.

According to Mooney (2009), nurses become burnt out with compassion overload and feel too stressed to be kind and compassionate when they are so busy. However, in our experience we have found that the opposite is true. Nurses tend to become stressed and distressed when they feel unable to be as compassionate as they would like to be, because of the sheer amount of work to be done. Firth-Cozens and Cornwell (2009), in their King’s Fund report, agree with this perspective and say that ‘if finance and productivity are perceived as being the only things that matter it can have profound negative effects on the way staff feel about the value placed on their work as care-givers. This makes it more difficult to cope with the inevitable emotional and psychological demands of the job’ (p. 8).

They make a strong case for nurses having greater support in their early post-qualification years, to help them retain their compassion. Their report says (p. 5) that during training, nurses become less empathetic and more distanced from their patients, and that within 2 years of qualification their high-quality, patient-centred care becomes affected by frustration and burnout due to their ideals and values being thwarted.

According to Gilbert (2009), helping people to develop compassion is not always easy. Some people see compassion as a weakness or can be afraid of being drawn into the dreadfulness of someone’s life experiences. In addition, compassionate care is potentially limited by insufficient resourcing. However, the nurse’s attitude and the culture of the organisation are also essential components of the compassionate care environment. Therefore, modelling excellence in compassionate nursing care, through effective leadership, is essential for creating a compassionate environment.

This is not a book about leadership as such. At present, there are undoubtedly many constraints on nursing care that are detrimental to nurses and patients alike. This book, we hope, will help nurses to feel that they can take a lead in influencing nursing care to promote a compassionate care environment – wherever they work – an environment where uncompassionate care is not tolerated, where compassionate care is seen as the norm, and opportunities to develop compassionate care are encouraged and valued.

Breaking the style of leadership, from one based only on outcomes, throughput and efficiency to one in which compassion is focused around care and kindness, is essential to help others develop their compassionate approach to caring.

Staff are the most valued resource in any workplace, particularly in caring environments. If staff are not being treated with empathy, don’t feel listened to, are not given choices where appropriate, are not empowered and helped to develop cultural competence, a compassionate environment and culture will not exist. Individuals who want to be compassionate will find themselves compromised. Therefore, nursing leaders, at all levels, need to foster this positive and compassionate care environment.

This chapter will focus on the importance of excellence in compassionate nursing care and how nurses can take a lead in creating a culture of caring. In the following chapters, case studies will be used to stimulate discussion and will be referred to in ongoing practice discussions throughout the chapter. Thoughts for practice will be drawn out to help readers further develop their own leadership practice in this important area of nursing care.

KEY THEME ONE – THE IMPORTANCE OF COMPASSION AND CARING IN NURSING

CASE STUDY 1.1

Sally was in the middle of a busy shift at the care home where she was the senior nurse. She knew that some members of her team felt disillusioned by caring for older people who did not appear to be always aware of what was going on around them, or even the care they were receiving. She had been very impressed with Rosa, who was a healthcare assistant and relatively new to the team, because she seemed to be very aware of the individual needs of each resident. Rosa seemed to genuinely enjoy the time she spent with the older people in her care. She would laugh and joke with them, and had said that she wanted to treat each resident as if they were her mother or her father.

Rosa had originally worked in the kitchen, but as she seemed to enjoy being with the residents so much, Sally had suggested that she become a healthcare assistant so that her skills with people could be used to maximum effect.

Sally knew that many of the members of her team did not share Rosa’s personalised approach to care. For example, they would not ask residents whether they wanted sugar in their tea, or how many spoonfuls, because they assumed that residents would not know the difference. However, Rosa never took this approach. Sally saw Rosa bend down to talk to each resident and ask them how much sugar they wanted. She heard responses like ‘No sugar for me, I’m sweet enough as I am’ or ‘Two sugars for me, I’ve got a sweet tooth’. Often these residents were not heard to speak at other times. Sally could see what a positive role model Rosa was to other more senior members of the team and resolved to make sure that Rosa knew what an excellent practitioner she was.

Compassion and caring in nursing – what is it?

This case study clearly demonstrates the value of personalised and patient- or client-centred care. Rosa was not prepared to take the quick approach by making assumptions – for example, about how residents liked their tea – but even so, her approach did not involve extra time.

Attitudes like this can seem very minor in the whole caring process, but can make such a difference between someone enjoying a cup of tea or not, due to them feeling respected and valued as an individual.

Rosa’s situation is based on the experience of Maria Carvalho, who is about to qualify as a mental health nurse from Edinburgh Napier University. Maria used to be a kitchen assistant and then a healthcare assistant before she started her nursing programme. Maria is a very compassionate person by nature and in her nursing role, and was chosen to attend an inaugural conference on compassionate care.

Rosa’s client-centred approach lies at the heart of compassionate care. Compassion is a highly complex concept and has different interpretations. For example, Frank (in Firth-Cozens and Cornwell 2009) sees compassion as involving an emotional response, both from the person giving the care as well as the person receiving it. He suggests that this ‘goes beyond acts of basic care and is likely to involve generosity – giving a little more than you have to – kindness, and real dialogue’ (p. 3). This real dialogue involves genuine interest and honesty, a recognition of difference rather than stereotyping and allows the practitioner to see the whole person behind the patient.

We do not believe that any care is ‘basic’, because in any intervention there is opportunity for assessment and advanced communication if the nurse’s approach is holistic. However, the point Frank (2004) makes is that this complexity is inherent in compassionate care. Giving more than you absolutely have to, in any given situation, epitomises a compassionate approach to care, and often this does not involve more in the way of time and resources. Graber and Mitcham (2004), in an American study of hospital clinicians, sought to identify what specific actions, interventions and relationships were present in clinicians who were perceived as compassionate. They found that compassionate clinicians did not attempt to distance themselves from patients but developed warm and empathetic relationships with them, integrating mind and heart in their care while still retaining clinical objectivity.

NHS Lanarkshire in Scotland have embedded compassionate care in their practice, and they identify essential components of effective and compassionate relationships. They say that practitioners use their hands, heart and head and their practice is skilful, caring and knowledgeable. In order for this to be possible, support and direction is available through learning opportunities, feedback mechanisms and clear expectations (www.nhslanarkshire.org.uk).

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Much that is written about compassion reflects the interpretations of different faiths, and much can be learnt from these spiritual perspectives. What underpins the compass...

Table of contents

• Cover
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• About the authors
• Acknowledgements
• 1 Introduction: Excellence in compassionate nursing care – the importance of leadership
• 2 Compassionate care – the challenge of resourcing
• 3 Creating a compassionate culture in practice – taking the lead
• 4 Nurse attitude – the heart of compassionate care
• 5 Conclusion: Excellence in compassionate nursing care – how will you take the lead?
• Index