Compassion and Caring in Nursing

Claire Chambers, Elaine Ryder

• Publisher: Routledge
• Year: 2018
• eBook ISBN:
  9781315357850
• Topic: Medicine
• Subtopic: Health Care Delivery

'Compassion, in its many manifestations, is the key to rediscovering what lies at the heart of nursing practice all over the world. It is absolutely essential that nurses start to revisit compassion as a central focus for nursing practice...' This user-friendly book adopts a patient-centred approach to care. The challenging theories are grounded in practical applications, encouraging readers to recognise opportunities for change in their daily practice. The book focuses on six key concepts central to compassionate care: A*

CHAPTER 1

Introduction: Compassion in nursing – the key to caring

Overview of the chapter

Key theme one – compassion

■ Case study

■ Discussion

■ What does compassion mean to patients and clients?

■ Case study

■ Discussion

■ Thoughts for your practice

■ How do nurses perceive compassion in their practice?

■ Case study

■ Discussion

■ Thoughts for your practice

Key theme two – caring

■ Case study

■ Discussion

■ Do we understand the importance of caring in nursing practice?

■ Case study

■ Discussion

■ Thoughts for your practice

■ How do we build caring relationships with individuals?

■ Case study

■ Discussion

■ Thoughts for your practice

■ Summary – links to compassion and caring

■ References

OVERVIEW OF THE CHAPTER

Compassion is the essence of caring, and therefore the essence of nursing, in our opinion, and yet it is not always the central focus of nursing practice. This book has been written in an attempt to reintroduce the concept of compassion and caring into how we, as nurses, think about our practice and our patients and clients. We not only need to challenge ourselves to show more compassion towards those in our care, but also we need to challenge our colleagues and stimulate discussion with our students to ensure that compassion remains central in our nursing care.

There are many different definitions of compassion, but we strongly believe that it is demonstrated most clearly by acting in a way that you would like others to act towards you. We need to reach out to others with kindness through what we say and by our physical actions. We believe that compassion is a profound feeling, which is brought about by witnessing the pain or distress of others. However, nurses can feel vulnerable by witnessing others’ distress and, therefore, may want to minimise this vulnerability by distancing themselves from the patient or client in distress. After all, if we can believe that the patient’s experience is unique and could never happen to us, then we feel less at risk and more in control of our lives. This distancing of ourselves compromises our ability to be compassionate.

Wilkinson (2007) discusses the acculturation that nursing practice areas can adopt where there is an institutionalised heartlessness. This heartlessness is exemplified by ignoring the needs of patients and reinforcing to others, who work in that environment, that this is acceptable nursing practice. There is a lack of conscience and kindness, and a sense of duty to others is missing. As nurses, we need to ensure that there is a positive culture within our practice areas where tenderness and empathy are paramount. It is only then that we can truly demonstrate our compassion.

There is a growing amount of anecdotal evidence that nursing standards, in relation to compassion, are slipping. Procedures and interventions are being perceived by patients to be taking priority over patient care. Nurses are rushed, unsmiling and perfunctory, not caring or empathetic. Nurses are not being perceived necessarily as patient-focused. There have been criticisms of nurses discussing their social lives while patients are present, rather than engaging in communication with the patient. Examples from patient forums and other written sources will be used throughout the book to demonstrate good nursing practice, and where nursing is perceived to be falling short as a compassionate and caring profession.

Gadsby (2008) tells of her experience as a nurse unexpectedly thrust into the position of being a relative of someone who suddenly becomes acutely unwell. She says that, in retrospect, she was impressed with how well-trained the nurses actually were who cared for her relative, and how good they were at their jobs. However, she also says how hard it was to be on the other side of the fence, and how powerless she felt. She said that there did not appear to be the time or inclination on the part of the nurses to get to know her relative or the family, or to answer their questions. She says:

How many of us, working with patients day after day, get used to not seeing the person behind the patient? How easy do we find it to focus on the task we have to do next, rather than pausing for a moment to check that the person we are with is not desperate to share anxieties or ask questions? I felt vulnerable and unsure, and I am used to the workings of a hospital ward. How much harder must it be for those who do not work in and understand the system? In the midst of being busy, let’s all try to be still for long enough for those in our care and their loved ones to catch up with us and help us to see who they are, and to share something of ourselves with them. (Gadsby 2008, p. 8)

This is a valuable point. If we are constantly concentrating on the next task rather than who the patient is, we cannot be compassionate carers. Therefore, this introductory chapter will focus on compassion and caring as distinct entities in their own right, as well as how they become integral to the whole concept of compassionate care in nursing.

KEY THEME ONE – COMPASSION

CASE STUDY 1.1

Joe did not remember how he had got here. Throughout the 10 years he had been living on the streets he had been so careful not to put himself at risk of injury. He knew that the streets were a dangerous place to be at times and that his health generally was going downhill, but he hated hospitals with a passion.

His wife had died in hospital and although he had visited her frequently at the time, he could not get over the feeling of powerlessness, and the antiseptic smell made him feel sick.

Joe knew that paramedics had brought him into the hospital trauma centre and that his head hurt. But he had no idea why, or what had happened to him. The nurse who was looking after him had introduced herself as Carol. He looked very carefully, but he could see no sign of judgement in her eyes. He was used to seeing looks of disgust or people looking away when they saw him, so he was an expert at sensing people who looked down on him because he was homeless. They did not understand that once you lost all hope, self-respect and money, there was nowhere else to go. When his wife, Gina, had died from cancer, she was in such pain that he genuinely did not want her distress to continue. But he loved her so much, and she was the only person who had ever believed in him or loved him. His childhood had not been a happy one and when he met Gina he could not believe that anyone as bright and bubbly as her could feel the way she did about him. After she died, he could not cope with work or being with anyone. He lost his home, and living on the streets was his only option.

Carol smiled kindly at him as she explained that he had been attacked and that his head injury was quite serious. Apparently, he needed sutures in the wound and a scan to check for internal bleeding. Carol was obviously very busy, but she kept coming back to see him throughout her shift. When he’d had the scan and his head had been stitched there was no reason for him to stay. Carol seemed concerned about how he would cope after he left, which surprised him. She had made sure that he had antibiotics for the chest infection that she recognised that he had. She also told him that she had seen head lice in his hair and discussed with him what treatment he might find easiest to use. She then used the lotion on his hair that they had discussed and told him to wash it off 12 hours later. She had contacted the night shelter and had arranged a bed for him for the night. He knew that he would be able to have a shower there and wash off the lotion in the morning.

Joe knew that Carol must have stayed on after the end of her shift to arrange these things, and felt deeply touched that she had cared so much about him. She obviously could see past what he looked like and saw the person underneath. This made him feel so much better about himself than he could possibly have imagined.

Discussion

Joe was in a very vulnerable position. He hated hospitals, had unpleasant memories of them, and avoided them at all costs. It would have been very easy for Carol to have cared for his head wound, but not to have become involved with his other health needs. She could have justified this to herself because she was busy and nurses in a trauma centre cannot hope to be holistic in their care, in relation to all potential needs of an individual. They need to address the priorities they are faced with, to minimise risk to all of their patients. It would be easy to see that the multiple and complex needs of a homeless man should be restricted to his major presenting problem: his head wound. However, even if this was the only priority, Joe needed to be treated with respect and compassion. He had been attacked in the street and was in pain, but again it would have been easy for Carol to have not seen past the fact that he was homeless. Joe was very clear that he had been treated with compassion, and this experience might have made him feel less frightened of medical and nursing care in the future.

From Carol’s perspective, she felt real compassion for Joe and went out of her way to assess his health needs and work in partnership with him to treat his head lice in a way that fitted in with his lifestyle. She could see beyond the fact that Joe was homeless, to the frightened and vulnerable man in her care. Carol’s non-judgemental attitude and her understanding of the fact that we are all different, and that our diversity makes us special, allows us to develop a level of cultural competence, which will be discussed further in Chapter 5. It is easy to be compassionate and caring in some situations, while others stretch our ability more. In a busy trauma centre, a homeless man with a head wound might stretch some nurses’ ability to be compassionate to a greater extent, particularly when the person is infested with head lice.

Tweddle (2007), in a Scottish paper, says that ‘compassionate care means to actively care. It’s about assessing individual needs and it’s about the relationships you have with patients. It’s much more complex than just being nice to people’ (p. 18). Carol clearly demonstrated the fact that she was building a trusting relationship with Joe and she was actively caring for him, in his particular situation. In a Norwegian study, Hem and Heggen (2004) say that ‘a compassionate person acts without thought of reward’ (p. 22). Carol did just this and, in fact, stayed on after the end of her shift to arrange a night shelter for Joe. All her actions and attitudes demonstrate clearly her compassionate care for him.

Compassion is viewed differently in different faiths. For example, in the Buddhist faith, compassion is referred to as karuna. The aim is perceived to be to relieve the suffering of others by embracing those in distress with a genuine desire to keep them from further harm. Carol was trying to protect Joe from further harm in his vulnerable state. However, it is also seen in the Buddhist faith as important to have compassion for ourselves in order to feel compassion towards others. This concept of compassion is reflected in other religions and is clearly demonstrated in the parable of the Good Samaritan in Christianity, and as rahman or rahim in the Islamic faith. We are not always compassionate towards ourselves as nurses, or to our colleagues.

We need to try to ensure that our practice areas demonstrate a compassion for other members of the team who are experiencing problems in their personal or professional lives. However, this is often far from the case. Students in our practice areas should be able to feel comfortable in the fact that they are learning nursing in a caring environment, and this should be evident in nurses’ care of other nurses, as well as in the care of their patients.

Joe and Carol’s perspectives on what compassion is might well have been very different, but in this case study both their views were similar. It is important to understand what patients and clients understand by compassion, as well as what nurses feel encompasses compassionate care. These two perspectives will now be discussed in greater depth.

What does compassion mean to patients and clients?

CASE STUDY 1.2

Paula was struggling to know what to say to the new patient on her ward. Pete had been admitted at midnight; the ward was quieter now and she could sit with him and try to discuss his situation, rather than just deal with the physical needs he had on admission.

Pete was lying down, facing away from her and he was clearly very distressed. All she knew was that he had attempted to commit suicide by taking a large overdose. On handover from the trauma ward, where Pete had been briefly, the nurse who had accompanied him had just given her a brief résumé of...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Foreword
• Preface
• About the authors
• Acknowledgements
• 1 Introduction: Compassion in nursing – the key to caring
• 2 Empathy and sensitivity
• 3 Dignity and respect
• 4 Listening and responding
• 5 Diversity and cultural competence
• 6 Choice and priorities
• 7 Empowerment and advocacy
• 8 Conclusion: Compassion in nursing – the way forward
• Index