Supporting compassionate healthcare practice

Understanding the role of resilience, positivity and wellbeing

Claire Chambers, Elaine Ryder

• Publisher: Routledge
• Year: 2018
• ISBN:
  9781351607926
• Edition: 1
• Topic: Médecine
• Subtopic: Compétences dans les soins infirmiers

The pursuit of excellent compassionate care should be at the heart of all practice. However, it can be challenging for practitioners to deliver this day after day in a context of tight budgets and targets, which can erode the passion with which they entered their professions.

Supporting Compassionate Healthcare Practice encourages healthcare professionals to look after themselves in order to maintain and develop their compassionate practice. This book considers how stress management, resilience, wellbeing and positivity can help all health professionals remain close to the values, attitudes and attributes that brought them into the caring professions. It presents and critiques the evidence base for these key concepts, bringing them to life with numerous case studies and examples, and develops a framework - RESPECT - for practice.

This innovative volume is essential reading for all healthcare students, academics and professionals interested in improving both the quality of care and the wellbeing of patients and practitioners alike.

1
A Compassionate Care Environment — What Does This Mean for Patients and Clients?

Overview of the chapter

Case study

Discussion – what does compassion feel like to patients and clients?

• What is compassion?

• Challenges to compassionate care

• What is the impact of ‘non-care’ which is lacking in compassion?

• Why is compassion so important for those who are vulnerable?

• The importance of advanced communication strategies

• How do patients or clients feel if compassion appears to be lacking?

• Are we compassion fatigued or distressed by the pressures of today's health care environment?

• The importance of empathy

• The importance of relational care

• How can we respond more appropriately to the distress of others?

• What difficulties arise when we fail to show compassion?

Implications for us as leaders

Thoughts for your practice

Summary

References

Overview of the chapter

There are many texts that focus on different elements of professional practice. These can be books about professional practice, for example occupational therapy, medical or surgical medicine or nursing practice, or texts focusing on certain age groups or certain conditions or areas of client or patient need, such as palliative care, the needs of children, mental health, older people or those with disabilities. There are also books which focus on key areas of professional practice, such as communication, prescribing, evidence based practice and public health. In addition, there are books which focus on the location of where people need care, such as care homes, hospices, community settings and hospitals.

This book is none of those types of books, although it does incorporate all these elements. This book places the person at the centre of practice, wherever the location, whatever the health need, and whatever health care professional is involved. For the person at the centre of practice, this needs to feel genuinely caring, and the person needs to feel safe in the service that is being provided, and valued as an individual. When complaints happen, as they inevitably do, these are the aspects of the individual’s experience which are criticised. Carers, relatives and friends need to feel that their loved one is being treated with dignity and compassion, and that they feel reassured that they are in safe hands and that they can safely go to sleep, or go home, knowing that that their loved one will be cared for in their absence.

For practice to be at this point of excellence there needs to be consistency, and the culture of the care environment needs to be constantly seeking innovative ways to enhance care. Care that is substandard is actually ‘non-care’ and this needs to be considered to be unacceptable, on every level, by individual practitioners, by the managers of each team and by every organisation. For this to be the case though, individual practitioners and their teams need to strive together to maximize limited resources, such as time and services, and provide the best care possible individually and collectively. Care orientated practitioners are essential to the delivery of excellence in care, and these practitioners have excellent knowledge and skills, but also appropriate values, attitudes and attributes. These person centred values and attributes are so important to those who need our care or intervention.

This is why we have chosen to focus on patients and clients from their perspectives, and have used case studies throughout the book to make their views more transparent. It is also why we have chosen to broaden our discussion to encompass all health care practice, in all its many manifestations, because these issues are key to every environment in which our patients or clients find themselves. So in this chapter we will focus on what a compassionate care environment actually feels like to people in our care, what challenges there could be and why being compassionate is so important. Then an important question is how might patients or clients feel if compassionate care appears to be lacking.

Case Study 1.1

Real life patient experience

I had a lumpectomy 5 weeks ago and I cannot speak more highly of the compassion with which I was treated from finding the lump, the way that terrible news was imparted to me, explanation of what lay ahead, availability of staff to answer questions, care from pre surgery through to post surgery. Amazing. Since then I was compassionately told that I would need a mastectomy and an MRI scan on another cyst. Devastating news which has left me in a sea of emotions but again compassionately and thoughtfully dealt with.

Yesterday I had an appointment for an MRI scan. I felt nervous but felt re-assured by all that had gone before. My husband and I arrived 8 minutes before the planned appointment. There was no-one on the reception desk but another patient told me that a nurse had already been out to call my name. My husband went to the door of the unit to let them know we were here.

A nurse then greeted us by telling us off and telling us that we were late! When we pointed out that it was still not the appointed time she told us off again! She said we should have been there 10 minutes early. I showed her the letter I had received which did not state this. She then argued with us and said patients are always told to be there 10 minutes early. By this time I was shaking. She then asked for my questionnaire and told me off again for posting it to the department rather than bringing it with me. Evidently it had not been received. By this time I was tearful but she did not notice this.

Finally I had done something wrong. I had written on the questionnaire that I had had surgery 5 weeks ago. I admit I should have phoned. Another telling off. By the time she left me I was shaking and crying.

A very, very, very compassionate Scottish radiologist then came to spend time with me. She had to spend some time calming me down. She even wiped my tears away before I was scanned. I streamed with tears the whole time I was in the scanner.

I could not stop the silent tears the rest of the day and I have had a very disturbed night. I have never written a complaint before but this encounter wasted time, caused upset and released all of those emotions that I am trying to bring under control.

99.999 percent of the treatment I have received has been wonderful and I am so grateful that X hospital is caring for me. However, one person has caused terrible upset. I do not want anyone else to have to lie in that scanner crying.’

Response X Hospital on 30/05/2012 at 12:04

Although hugely pleased at the care you received in the X breast unit, we are very concerned at what happened in the MRI unit – such behaviour on the part of any member of our staff, irrespective of the circumstances is simply not acceptable. We were wondering if you would be willing to send us an e-mail to [email protected]. We feel this needs formal investigation because your experience of our MRI service falls way below what we would expect.

Patient Opinion website (2012)

Discussion: what does compassion feel like to patients and clients?

What is compassion?

So why is being compassionate so important, and what influences our ability to demonstrate compassion within our roles? It can be difficult to define what compassion actually is, but we do know when it is not there. Therefore, it is important to view what compassion might feel like from the patient or client’s perspective. This is the only perspective that really matters. If the person who is central to the care does not feel that the practitioner is empathetic, actively listening, non-judgemental and sensitive to their needs then any care that is carried out loses that human touch. Once that happens the therapeutic value of any intervention is minimised considerably, and, in fact, in the worst case scenario the patient feels devalued and dehumanised.

We have identified what we believe to be important features of compassionate practice in six main themes (Chambers and Ryder, 2009). These encompass:

• empathy and sensitivity
• dignity and respect
• listening and responding
• diversity and cultural competence
• choice and priorities
• empowerment and advocacy

In the UK the Department of Health developed a strategy for delivering high quality and compassionate care (DH, 2012). Within this strategy document communication, care, compassion, courage, competence and commitment are identified as fundamental values for compassionate practice. These have since been referred to as the 6Cs and compassion has been described within this report (DH, 2012) “as intelligent kindness, and is central to how people perceive their care” (p.13).

Walking into one service can feel friendly with members of staff genuinely appearing interested in each person who arrives within that service area. Whereas, in another department of the same organisation members of staff rush around looking very busy, with their eyes averted, answering questions in a minimalistic manner and not initiating any conversation unless it is to give instructions. Both these departments are probably operating under the same financial constraints, with staff just as busy, but the overall impression is very different. The first environment is a therapeutic place to be and people leave at the end of their appointment feeling more positive about coming again, regardless of what treatment or intervention has taken place. Whereas the second department would make people feel reluctant to return and feel as if they were merely another appointment to be filled within a busy working day. They might feel patronised, overwhelmed, dismissed and misunderstood as a result. For practitioners working in such an environment it would also seem like a cold and unfeeling place to work. They are just another cog in the wheel and they would not necessarily feel that they had provided a good service at the end of the day. They also might feel as if they had not made any genuine human connection with anybody who has visited their department, or even with colleagues who they work with. In a compassionate practice environment, like the first department, members of staff would feel that they had actually achieved something that day, they had reassured people who were anxious and seen them relax for example, and that they have operated as one of a team to provide a service that they could be proud of.

Challenges to compassionate care

It is clear in the case study that the patient was extremely unhappy with the care that she received and felt devalued and would have felt very worried about coming back to this unit. In these situations action needs to be taken to reassure the patient that her concerns have been taken seriously. She would have felt concerned for anyone else visiting this unit and knowing that this was not perceived as acceptable care by the organisation and that this would not be perceived as the norm would be essential. Knowing that steps would be taken to ensure that this was being investigated and that she would receive feedback about what was being done to address the issues she raised would be very important to her. However, what challenges are there to providing compassionate care in every situation every time?

All practitioners and everyone working in health care have different norms and values which impact on how they feel about situations which can arise in the care setting. We have different understandings and experiences of pain, we also have different views about what constitutes good mental health and what coping strategies could be helpful and who should make health care decisions. These can be particularly apparent when we are caring for people from different cultural backgrounds, with different religious and ethnic backgrounds. Sometimes care that was intended to be caring can appear as over involved or minimalistic, depending on the perspective of patients and their families simply because it is not what would be considered to be normal in their culture or religion. For example, end of life values can be very different and need to be respected (Cornelison, 2001). Effective communication is paramount and if this takes place misunderstandings can be minimised and mutual trust, respect and cooperation can pave the way to mutual understanding and sensitive, person centred care. In the same way, end of life issues in critical care units can be managed with compassion (Benner, 2001) if every situation is managed with sensitivity and a person centred approach, despite the fact that the critical care environment is not the most highly suited for calm and peaceful deaths. This sensitivity is key to compassionate care and every practitioner needs to find ways to develop new strategies to ensure that care is what that person would like at that stage in their life or illness.

Firth-Cozens and Cornwell (2009) in their work with the King’s Fund Point of Care programme try to identify what enables compassionate care to take place in acute hospital settings. In order to do this they examine what prevents compassionate care. Maben et al. (2007) found that newly qualified nurses had very clear beliefs about providing high quality, patient centred, holistic and evidence based care. However, after two years in practice these ideals and values are being compromised to the point that they are feeling frustration and are experiencing some level of burnout. Firth-Cozens and Cornwell (2009) say that the values instilled in clinical training might not be conducive to maximising compassionate approaches. Many curricula adhere to the biomedical model and effective clinical care, with human aspects playing a very secondary role. If this is the case nurses are unable to balance over identification with the patient with the need to empathise with them. This can lead to an undesirable objectification of patients. Therefore more curriculum time should be devoted to psychosocial aspects of care so that clinicians can focus on the patient behind the care, and not merely the interventions themselves. Students are generally taught in a manner which enables them to see the patient as central to the care, so they are in a good position to take a lead in helping others to be empathetic, but not overwhelmed by the experiences of those in their care.

A secondary reason for compassionate care being compromised is a fear of distress and dying (Firth-Cozens and Cornwell, 2009). This can lead to distancing, avoiding and inappropriate uses of humour which can indicate how much the member of staff wants to be away from that situation. If they cut themselves off from their own feelings to this extent they cut themselves off from empathy and...