Reflections on compassion in care.

Abstract

We recently completed a research and education project on the theme of ‘Cultivating Compassion’. An online Toolkit was developed with colleagues from the University of Brighton and University of Brighton & Sussex Medical School and four healthcare organisations. Funding was made available for the project in response to concerns about serious care deficits as detailed in the Mid Staffordshire National Health Service (NHS) Foundation Trust Public Inquiry. The project was underpinned by an appreciative inquiry approach. The project’s starting assumption was that positive initiatives were already in place and the aim was to recognise and develop these. Nevertheless, some project participants were sceptical about the rationale for the project and the motivation of their organisation’s leadership to embrace it. Colleagues who engaged with the Cultivating Compassion Toolkit reported that they found the activities helpful and that it had given them confidence to raise the topic of compassion with their colleagues. So a mixed picture emerged, suggesting some positive developments in response to the Toolkit and also suggesting hazards of imposing compassion initiatives on a beleaguered and committed workforce. We became aware of the danger of undermining the dignity of the workforce in a bid to cultivate compassion in care. Reflections on the project process suggested the need to contextualise compassion within existing ethical frameworks, not to expect too much from this one value and to recognise that care deficits may not be directly related to compassion failure. Readers will be familiar with definitions of compassion that refer to ‘suffering with’, to being confronted with the suffering of another and feeling motivated to respond to it. There are well-established accounts of compassion within Buddhist philosophy and in virtue ethics. Explanations for care deficits are too readily pinned on bad practitioners with too little focus on organisational culture and leadership. Discussions sometimes proceed as if the value is decontextualised; it is the only value required for all care activities – from palliative care to health promotion, from surgery to rehabilitation and from emergency care to nurse education. A student nurse told me recently of a phenomenon she observed in class and described as ‘outkinding’. She said that this occurred when peers appeared to try to outdo each other with stories of kind acts demonstrated towards patients and families. It is, of course, admirable that student health professionals recognise and are able to articulate examples of kindness and compassion. More admirable still is that they are able to see opportunities to demonstrate such acts in busy care contexts. The student nurse’s concern was that her peers appeared to consider that this was the most important feature of healthcare practice with too little focus on a broader view of professional competence. In response to her concerns, I cited my usual mantra that it is ‘not either/or’ but rather ‘both/and’, it is not ethical care or technical competence but rather ‘both/and’.