Implementation strategies to promote compassionate nursing care of complex patients: An exploratory sequential mixed methods study.

Abstract

Individuals with multiple physical and, or, mental health issues and, or, drug-related problems are known as complex patients. These patients are often recipients of poor-quality care. Compassionate nursing care is valuable to promote better care experiences among this patient population. Implementation strategies should be designed to enhance compassionate nursing care delivery. The study aimed to gain understanding of barriers to compassionate care delivery to propose implementation to promote compassionate nursing care of complex patients. An exploratory sequential mixed methods study was conducted. Phase 1 was the qualitative component during which 23 individuals with multimorbidities were interviewed for exploring their perceptions of barriers to compassionate nursing care. The barriers were integrated with implementation science frameworks using the building technique during phase 2 to develop a Q-sort survey of implementation strategies for phase 3. Nurses, nurse managers, health care administrators, policymakers, and compassionate care experts responded to the survey by ranking the 21 implementation strategies, out of which five met the Q-factor analysis criteria. Participant-perceived barriers to nurse compassion could be categorized under knowledge, intentions, skills, social influences, behavioral regulation, reinforcement, emotion, and environmental context and resources. The five highest-ranked strategies included facilitation, consultation with stress experts, involvement of patients and families, modeling compassion through shadowing, and utilizing implementation teams. Enablement and modeling were the integration functions represented by the highest-ranked implementation strategies. Enabling nurses to provide compassionate care through emotional support and mental health counseling, and, modeling compassion and compassionate care through shadowing were recommended and rated as highly relevant by the majority of stakeholders. Enhancing nurses compassionate behaviors toward complex patients requires facilitating them in enacting compassion in practice through modeling and support from organizations and nurse managers.