In a short blog, I can hardly do justice to the presentation by Dr. Stephanie Tierney yesterday at CUHFT Wednesday 5 August (‘Contemplating the place of compassion in 21st Century healthcare’), which gave the audience much food for thought. Although compassionate care is valued and promoted as a goal we should achieve, there are more questions than answers about compassion and compassionate care. Despite its importance, we lack a shared definition and understanding of compassion and compassionate care, research is limited regarding its effects on patients and providers or how to create environments that facilitate compassionate care. Stephanie quoted Dewar B, et al. regarding the need for greater clarity about what is meant by compassion, less it “remain little more than a rhetorical and political device, which trips easily off the tongue but remains elusive” (Dewar B et al. (2014) Clarifying misconceptions about compassionate care. Journal of Advanced Nursing 70: 1738-1747)
Stephanie’s own working definition emphasised that compassionate care comprises elements that are relational, cognitive, volitional, affective, altruistic and moral. In the Chief Nursing Officer’s (CNO) 2012 Compassion in Practice strategy (http://www.england.nhs.uk/nursingvision/), compassion is defined as: “how care is given through relationships based on empathy, respect and dignity – it can also be described as intelligent kindness, and is central to how people perceive their care.”
We do know that the environment has an impact: individuals who feel under threat, that they lack skills or are not valued may be more focussed on relieving their own distress rather than seeking to meet another’s need. The link between staff experience and patient experience was also highlighted in the Compassion in Practice strategy. The National Nursing Research Unit, Kings College London, has developed and tested a Culture of Care Barometer (http://www.england.nhs.uk/wp-content/uploads/2015/03/culture-care-barometer.pdf). Initial analysis revealed 4 key factors: 1) Trust level values and culture; 2) team level support and management; 3) support and respect between colleagues; 4) constraints in undertaking the job. Some interventions have been found to foster a more compassionate workplace, including leadership, celebrating success and Schwartz Rounds (see http://www.kingsfund.org.uk/publications/schwartz-center-rounds-pilot-evaluation). Schwartz rounds were instituted at CUHFT this past year, and staff responses have been very positive.
I came away thinking about some of the questions that we discussed:
• Is compassion innate, or can it be taught so that those not exhibiting compassion become more compassionate?
• Should we measure compassion and compassionate care, and if so how? There are some instruments but more work is needed, especially to incorporate patient perspectives.
• Could compassionate care become another ‘target’ to be measured?
• Can we develop a compassionate workplace that fosters compassionate care despite time and target pressures and financial constraints?
Stephanie is currently collecting data for a grounded theory study on health care professionals’ views on the meaning of compassionate care, as initial work in a programme of research. We look forward to hearing the results in 2016.