Provision Of Compassionate Care Research Articles

Competent to provide compassionate care? A critical discourse analysis of accreditation standards.

Medical school accreditation is recognised internationally as an important quality control process for programmes that lead to the Medical Doctor (MD) degree. Accreditation standards govern the accreditation process which in turn drives educational objectives. Given the power of these standards to shape what becomes valued in the curricula, it is therefore imperative to ensure that core values and ideals of the profession are meaningfully incorporated. As the provision of compassionate care has long been a central medical value, this value should be clearly articulated in MD programme accreditation standards. We conducted a Critical Discourse Analysis of compassionate care within Undergraduate Medical Education (UME) Accreditation Standards governing North American medical schools since 1957. We explored how and to what extent the written language of the accreditation standards incorporated compassionate care. References to compassionate care in the UME Accreditation Standards were few and far between. Historically, a statement of 'The Objectives of Undergraduate Medical Education' published by the Association of American Medical Colleges (AAMC) was referenced for the first and only time in the 1957 standards, describing the development of attributes such as the provision of compassionate care as a basic objective of UME. Thereafter, there was infrequent mention of this value. Terms that could potentially incorporate aspects of compassionate care were identified, yet these were explicated in ways that limited connection to compassion. Instead, the term 'care' has increasingly been used instrumentally (ie acute care, chronic care). The relative absence of language pertaining to compassionate care in accreditation standards is troubling as compassion is integral to good medical care. This absence is particularly important to attend to in the current era of competency-based training where we must be explicit about all important curricular objectives lest essential values and practices be unintentionally lost.

Validation of the Persian version of the Compassionate Care Assessment Tool

ObjectivesThe present study aimed to translate and determine the psychometric properties of the Persian version of the Compassionate Care Assessment Tool (CCAT) ©. MethodsThe study was carried out to translate and validate of the CCAT©. After securing permission from the designer of the tool and translating it, the psychometric properties were determined through examining face validity, construct validity, internal consistency, and test/retest reliability. With regard to construct validity, confirmatory factor analysis was used so that 300 patients in internal and surgery wards were selected by a simple random sampling method from three hospitals. Data were analyzed using SPSS (v.24.0) and LISREL statistical software version 8.8. ResultsThe results of the confirmatory factor analysis supported the validity and reliability of the Persian version of the CCAT© and its four factors. The reliability of the tool and internal consistency were confirmed through test/retest method with two weeks’ interval. At the two areas of importance and provision of compassionate care, Cronbach’s α coefficient equaled to 0.918 and 0.933 and intraclass consistency equaled to 0.848 and 0.907 respectively. ConclusionThe results showed that the Persian version of the CCAT© was adequately valid and reliable for Iranian patients. Given the acceptable psychometric parameters of the tool, using it in future studies to measure importance and provision of compassionate nursing care to Iranian patients at internal and surgery wards is recommended.

Disposição afetiva para o cuidado na recuperação: o cotidiano da equipe de enfermagem

Objetivo: Discutir a implementação dos protocolos para o cuidado ao paciente na sala de recuperação pós-anestésica, considerando a disposiçãoafetiva da equipe de enfermagem no seu cotidiano, em um hospital da região oeste de Santa Catarina. Método: Pesquisa qualitativa, com base na etnografiae na observação participante. Os sujeitos da pesquisa foram nove profissionais da enfermagem. Os dados foram coletados no primeiro semestre de 2019,considerando-se a análise de conteúdo de Bardin, de onde emergiram três categorias. Resultados: Os profissionais de enfermagem compreendem aimportância da disposição afetiva no cuidado aos pacientes na recuperação, elencando a alta demanda de atividades e cirurgias e o número de funcionáriosinsuficiente como dificuldades para um cuidado afetivo, efetivo e empático em seu cotidiano. Há baixa adesão aos protocolos assistenciais disponibilizadosno setor, apesar do reconhecimento de sua importância no cuidado direcionado aos pacientes. Conclusão: Como fatores determinantes apresentaram-se aalta demanda diária do setor, o quantitativo de funcionários inadequado e o atendimento a pacientes críticos por longos períodos na recuperação anestésica.

Perspective and Experience of Operating Room Personnel on Ethical Behaviors

Background: unethical behaviors necessitate a specific focus on ethical behavior. A better understanding of the concept can be obtained through the perspective and experience of surgical teams on ethical behavior. As a direct result, the knowledge and performance of the nurses as well as the patients’ satisfaction can be elevated. Objectives: The present study aimed to assess ethical behavior based on the perspective and experience of the OR personnel. Research Design: A qualitative study to identify the perspective and experience of OR personnel on ethical behavior, using the conventional qualitative content analysis method. Participants and Research Context: OR personnel at educational hospitals affiliated to Isfahan University of Medical Sciences were selected from April 2017 to June 2018 Using a purposive sampling method (n=26).In-depth semi-structured interviews Were Used For Data Collection. Ethical Considerations: The study was approved by University’s Ethics Committee. Prior to the interviews, the research goals and method were explained, the confidentiality of any disclosed information was guaranteed, and voluntary participation was emphasized. Findings: Based on the interview data, four themes were extracted, namely “Enhance professional commitment”, “Strive for excellence”, “Respect for human dignity”, and “Enhance safety”. Discussion and Conclusion: The findings highlighted the provision of compassionate care by the OR personnel, in accordance with scientific standards. Fair job division and non-discriminatory behavior between the members of the OR team were emphasized. Our findings emphasized the importance of psychological and physical safety. Personal and professional excellence can be achieved through conscious actions by the personnel to correct their shortcomings, improvement of the capabilities of colleagues, and effective teamwork.The findings enlighten healthcare personnel and managers on the concept of ethical behavior toward designing better policies and plans for patient care. the nursing profession will be respected more and ethical behavior and professionalism will become widespread.

Culture, courage and compassion: exploring the experience of student nurses on placement abroad

BackgroundNursing is emotional work and learning how to manage their emotions is a valuable part of nurse education. As the workforce becomes increasingly mobile nurses will care for people from diverse cultures and backgrounds. The development of cultural competence and a global mind-set is therefore a valuable asset and engagement in study abroad through overseas clinical placement can help to facilitate this. This study set out to explore the experience of student nurses involved in an exchange programme between Scotland and Western Australia. A particular focus was on the emotional aspects of the experience, responding to challenges and provision of care in a different healthcare setting.MethodsA descriptive qualitative strategy of enquiry was used and semi structured interviews undertaken with a sample of 10 student nurses using emotional touch points. The interviews were recorded, transcribed verbatim and subjected to thematic analysis using NVIVO 11.ResultsFive main themes were identified. Making it happen, connections, feeling vulnerable, culture and assertiveness and affirmation.ConclusionsThis study makes a unique contribution to the nursing student experience of overseas placement as it focuses on the emotional elements. The study shows that the experience of care delivery in an overseas placement has many benefits but also challenges. Management of emotion is required and transition to a different healthcare system can be stressful. Cultural differences were more marked than anticipated but when students responded by questioning, respectful assertiveness and provision of compassionate care there were clear rewards. These manifested as a sense that caring is a privilege and affirmation of career choice.

“The introduction of “What Matters to You”: a quality improvement initiative to enhance compassionate person-centered care in hospitals in Ireland

Rationale for this initiative: On admission and throughout the acute hospital stay, the main focus of the healthcare professional is the medical model of care, which revolves around the physical status of the patient (Dewar & Nolan 2013). Hospital staff work in a system where patient flow and lengths of stay are indicators of effective organisations (Shahin & Mahood 2007). The emphasis appears to centre on “What’s the matter with you” (Doyle et al. 2010). While the presenting health issue is a concern to the patient, their experience of hospital care is measured by the level of dignity, compassion and respect with which they are treated (HSE & Age Friendly Ireland 2015). The Service Plan explicitly emphasises that people’s experience of the health service must be “safe, of high quality, but also caring and compassionate” (HSE 2015 p. 3). Compassionate care involves knowing the patient as a person (Lown et al. 2011) and developing a relationship of equals where the carer conveys an understanding of the patient’s suffering in a way that alleviates some of that suffering (von Dietze & Orb 2000). There is a critical link between services who regard the patient as an equal contributor to their care, where their opinions are sought and valued, and the provision of compassionate care (NHS 2014). The “What Matters to You” (WMTY) initiative supports this concept. It is a process that seeks to identify the concerns of the individual admitted to hospital and, thereby, facilitates the delivery of person-centered, compassionate care. Description of the initiative: WMTY is an approach to care that promotes compassionate relationship-centred care (Dewar & Nolan 2013). It involves introducing a change in practice, whereby, nursing staff ask about what is important to the patient, rather than simply concentrating on their diagnosis and past medical history. The literature suggests that to provide compassionate care we need to know the details of care that matter to the person (Burnell & Agan 2013, Health Foundation 2014). Information captured through WMTY provides staff with a unique knowledge of the person, which then informs the plan of care for that patient. It is recorded on the WMTY board, which is kept at the bedside, or as determined by the patient, for ease of access by all healthcare professionals. The IHF “What Matters to Me” education programme has been adapted for use in the acute hospital to support this initiative. A suite of documents were developed to provide guidance and information, thus supporting the project’s implementation.

Community mental health nurses' and compassion: an interpretative approach

Introduction There is increasing emphasis in policy, research and practice in the UK and internationally on the importance of caring in health care. Compassion needs to be at the core of all healthcare professionals' practice. Recently, health care has received negative attention through media and government reports which cite a lack of compassion in care. Rationale The concept of compassion has received limited attention in community mental health nursing. Aim Based on data taken from semi-structured interviews with community mental health nurses, this paper aims to describe interpretations and perspectives of compassion to gain insight and development of its meaning. Method A naturalistic, interpretive approach was taken to the study. Semi-structured interviews with nine mental health nurses were analysed using Burnard's 14-step model of thematic analysis. Findings The research illuminates the complexity of compassion and how its practice impacts on emotional responses and relationships with self, patients, colleagues and the employing organization. Participants identified difficulties engaging with compassionate practice whilst recognizing it as a driving force underpinning provision of care. Implications for practice Mental health nurses need to be supported to work towards a greater understanding of compassionate care for clinical practice and the need for self-compassion.

Reflections about experiences of compassionate care from award winning undergraduate nurses – What, so what … now what?

From 2007 until 2012 Edinburgh Napier University’s School of Nursing Midwifery and Social Care in conjunction with NHS Lothian, collaborated on a programme of action research entitled, the Leadership in Compassionate Care Programme. One strand of this research focused on learning and teaching about compassionate care within the undergraduate curriculum. This debate article focuses on the care issues raised by two award winning nursing students who reflected on the development of their compassionate caring skills during their three year Bachelor of Nursing programme. The reflective accounts debate the following issues related to compassionate care; Personal drivers supporting the provision of compassionate care, Challenging and influencing care practices, Providing relationship centred care and, Living with what can’t be achieved. Throughout the debate a model of compassionate care developed from the Leadership in Compassionate Care Programme is used to reflect on key practice issues and provide a framework for practice development. The care issues presented in this paper identify a need to support students in healthcare to; Develop strategies in questioning care practices which do not meet expectations of compassionate care; undertake focussed reflective activities where each student can explore personal drivers, values and perspectives of compassion; actively connect learning in practice with theory in university, enable development in compassionate caring and strategies that support self-compassion; facilitate an understanding and development of emotional intelligence supporting development of resilience. Implications for healthcare staff are to; Collectively seek, hear and respond to feedback about their service; activate caring conversations within the healthcare team; consider how the model of compassionate care presented in this paper, can be used to reflect on practice and provide a framework for development; consider how we maximise the experience of care during brief moments of contact with patients/families; activate leadership that promotes a culture of openness facilitating the development of compassionate care.

Support is vital for staff to deliver compassionate care

Provision of compassionate care is one of the six core values (the 6Cs) and behaviours that underpin modern clinical nursing practice. This mixed method study, undertaken by academics and researchers from Edge Hill University, Lancashire, examined healthcare professionals’ and students’ understanding of the concept, and the factors that either positively influenced or impeded its facilitation.

Leadership, Education and Awareness: A Compassionate Care Nursing Initiative.

The Canadian Nurses' Association Code of Ethics (2008) and the College of Registered Nurses of Nova Scotia (CRNNS) Standards of Practice for Registered Nurses (CRNNS 2011) identify the provision of safe, compassionate, competent and ethical care as one of nursing's primary values and ethical responsibilities. While compassion has historically been viewed as the essence of nursing, there is concern that this has become an abstract ideal, rather than a true reflection of nursing practice. This paper describes a compassionate care initiative undertaken by the CRNNS and the initial outcomes of these educational workshops. This work is informed by an exploration of the multiplicity of factors that have brought this issue to the fore for nursing regulators, educators, administrators, the public as well as front-line staff. The two most significant areas of learning reported by workshop participants included understanding the connection between mindfulness, non-judgmental care and compassion/self-compassion and recognizing possibilities for action related to compassionate care, even in the face of personal and environmental constraints. Implications for nursing regulators and leaders include consideration of their roles and responsibilities in supporting nurses to meet professional practice standards, such as provision of compassionate care.

Revitalizing Care Program in UK Healthcare: Does it Add Up?

Background:The National Health Service (NHS) is a publicly funded health service in the United Kingdom that provides free point-of-use services for UK residents. In England, the NHS annual budget currently equates to £106 million. As the global financial climate has changed, so too has the real-terms budget available to meet spiralling healthcare costs in the United Kingdom. There is now unprecedented pressure on NHS Trusts to provide efficiency savings while maintaining the same levels of clinical service availability. In this climate, concerns arise regarding how best to ensure maintenance of the quality of service users experience of their care in addition to efficacy and efficiency targets.Barts Health NHS Trust is the largest healthcare trust in the United Kingdom. A collaboration of stakeholders was established in 2010 to ensure an increased focus on the provision of compassionate care in all patient services as part of enhancing the overall patient experience. This initiative incorporated the implementation of the HeartMath Revitalizing Care Program in order to build staff resilience and enable workers to more efficiently manage their work and personal stress. Additionally, the project implementation enabled the first trial of the HeartMath Revitalizing Care Program within the context of NHS England services.Methods:Using a pilot program model, the HeartMath Revitalizing Care Program was provided in four departments in the Trust from August to October 2011. Pilot areas included three clinical wards and one reception area. Over the 3-month period, 97 staff members participated in the workshops. Evaluation of the project was conducted using pre and post measures at two time points through the completion of the Personal and Organizational Quality Assessment – Revised 4 Scale (POQA-R4) and review of staff turnover, sickness absence rates, and complaints.Results:The evaluation indicated that the participants demonstrated improvements in nine of the 10 personal qualities categories. These changes were statistically significant in eight areas, with fatigue and calmness showing the greatest evidence of change. Only one area in the rating of organizational qualities showed a statistically significant change, which was expected due to the short timeframe of the post-project evaluation. The results of the pre-post comparison of staff turnover, sickness absence, and complaints were inconclusive.Conclusion:The completion of the pilot project clearly demonstrated both a direct benefit for staff and the transferability of the HeartMath Revitalizing Care program to the UK health provider context. Further evaluation is required to determine the impact of building staff resilience on improving service-user's experience of care.

Restoration and re-creation

The clinician-patient relationship is essential to the practice of person-centered care. This healing relationship can present challenges to clinicians when working with patients who suffer. Clinicians today are looking for ways to deal with the stress of care-giving and to find greater meaning in their professional lives. Professional guidelines recognize that medicine, nursing and other healthcare professions are vocations, not jobs. Reports indicate that physicians and other clinicians feel the current healthcare environment is too business-like yet, patient relationships continue to be the primary source of satisfaction for many clinicians. The relationships can be rewarding but also stressful. Spirituality is proposed as a way for clinicians to reconnect with their professional roots to serve those who suffer. Resources are suggested that might enable clinicians to find greater meaning in their profession. Professional development should address spiritual development especially as it relates to the healthcare professional's sense of calling to their profession, the basis of relationship-centered care, and the provision of compassionate care.

Compassion and Cultural Transformation in Chronic Pain

Compassion and Cultural Transformation in Chronic Pain

Edgar Allan Poe, “The Pit and the Pendulum,” and Ventricular Assist Devices

ID: 66 Edgar Allan Poe, "The Pit and the Pendulum", and Ventricular Assist Devices Author Information: Authors List: Presenting Author: Cheryl Zambroski Additional Author: Pamela Combs Additional Author: Sherill Cronin Additional Author: Carol Pfeffer Presenting Author: Cheryl Hoyt Zambroski Address: University of South Florida College of Nursing 12901 Bruce B. Downs MDC 22 Tampa, FL 33647 USA Ph: 813-774-6436 Fax: Email: czambros@health.usf.edu Institution: University of South Florida Additional Author: Pamela S. Combs Address: University of Louisville 12901 Bruce B. Downs MDC 22 Louisville, KY 42092 USA Ph: 812-949-7289 Fax: Email: pscombs)1@louisville.edu Institution: University of Louisville Additional Author: Sherill N Cronin Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Additional Author: Carol Pfeffer Address: Bellarmine University 12901 Bruce B. Downs MDC 22 Louisville, KY 40206 USA Ph: 502-425-5504 Fax: Email: scronin@bellarmine.edu Institution: Abstract InformationInformation Presentation Preference: SNRS Poster Presentation Abstract Categories: Interest Group: Researchers in Clinical Settings Thematic Areas: Chronic illness Introduction: Ventricular Assist Devices (VADs) are being used with increasing frequency in patients with heart failure. VADs are not without adversity, however, as high post-operative morbidity and mortality are of major concern. For those who survive, little is known about the experience from the patients' perspective. The purpose of this qualitative, descriptive study was to gain a better understanding of the experience of living with a VAD Method(s): Through the process of open-ended interviewing, data were collected and analyzed on an ongoing basis to generate conceptual categories. A key informant articulated his experience of living with a VAD through his analogy to Edgar Allen Poe's The Pit and the Pendulum. Furthermore, language of co-informants corresponded closely with themes emerging in Poe's short story. During analysis, a consultant from the English Department provided additional analysis of The Pit and the Pendulum as it related to each theme. Results: Six adults with an average age of 58.8 years participated. Both men were Caucasian; two women were Caucasian and two were African-American. There was wide variation in the length of device implantation. Four key themes: Facing the Unknown, Feeling Confined, Living with Fear, and Hope for the Future emerged. Discussion: Comparison of the experience of living with a VAD to the tale of Poe's Narrator does not provide an easy image for nurses who care for this population. Yet, diagnosis of heart failure can, in fact, be a sentence of sorts: a sentence to an uncertain future, physical decline, even to death. The findings of this study can help clinicians to target interventions toward reducing the uncertainty associated with living with a VAD, providing opportunities to reduce the sense of confinement, recognizing and reducing patient fears, and providing and supporting hope for the future through reduction of symptoms and extending life or through providing a peaceful death. Research Completed : Yes Abstract History: -This material has been presented or accepted for presentation in whole or in part at this or another scientific meeting. -Details: USF (local presentation) Financial Disclosure: Have a financial arrangement or affiliation with commercial companies whose products may be mentioned in this material? No FDA Disclosure: Cleared: Yes Non-Exclusive License: Accepted Terms: Yes Submitted By: czambros@health.usf.edu

Compassionate Care

Compassion may be nursing's most precious asset, yet the concept of compassion (or compassionate care) remains notably absent from nursing scholarship and the practicalities related to contemporary care delivery models. The provision of compassionate care is more than a professional mandate or an attribute of a model expressed in theoretical terms; it is the result of an authentic bond between a nurse and a patient. A concept analysis using Walker and Avant's methodology is employed using compassionate care as the virtue that allows a nurse to enter into the pain, suffering, and adversities a patient experiences as a way of establishing a meaningful connection.

The impact of HIV/AIDS on children in developing countries

HIV infection and AIDS among children continues to be a significant problem in developing countries despite the progress that has been made in HIV prevention and AIDS treatment elsewhere during the past two decades. The reasons for this difference are complex and multifactorial. They include the higher background prevalence of infection among adults in some communities in developing countries, the slow implementation in many countries of prenatal HIV screening programs and prophylaxis which can reduce the transmission to infants during labor and delivery, the social and health consequences of not breastfeeding, and the economic realities associated with expensive diagnostic testing and antiretroviral treatment. While the world waits for an effective HIV/AIDS vaccine, to reduce the prevalence of HIV in the community, public health programs need to continue to emphasize proven methods of HIV transmission prevention among groups with a high-risk of HIV acquisition, as well as provide counselling for the general population about personal protection and the provision of compassionate care for those affected.

Who knows best: the patient or the provider? A nursing perspective.

Who knows best: the patient or the provider? My opinion, based on a review of the literature and practical experience, is that the patient, the provider and the system each offer a unique perspective that we can draw upon in ensuring quality care across the continuum. Nurses have a unique body of knowledge and skill that they bring to each interaction with the patient. They must have an awareness of the patient's and the system's expectations and interact and negotiate realistic expectations for each. The maintenance of balanced expectations and the measurement of effectiveness will continue to be a challenge. However, patients should be involved in and direct aspects of their care and feel satisfied with the process. Ultimately, nurses and the hospitals in which they work are responsible for providing effective and satisfying care. I would like to end by reinforcing the importance of the patient's voice in the provision of compassionate care. It is disheartening to read about patients' experiences of "discompassionate healthcare" (Holloway 1999). Yet I am reassured when I read or experience examples of compassionate and effective care such as that outlined by Valerie McDonald. (Hospital Quarterly Winter 1999/2000) Ms. McDonald, a former social worker and adult educator, is the mother of three daughters, one who had Burkitt's lymphoma diagnosed in 1994 and a second who had acute lymphostatic leukemia diagnosed in 1997 and who died recently in 1999. McDonald provided a wonderful perspective about her hospital experiences--the good and the bad. There would be no denying from this report that patients know the key qualities necessary for effective and compassionate care and that this mother recognized the energy and time it took to provide this care. "I hope," she states, "as the dust settles from restructuring and cutbacks that hospital staff will still have the time, energy and flexibility to practice the art of healing as they did with my children" (p. 24). I too reinforce that we must ensure nurses (and others) have the resources, the flexibility within their roles and the knowledge and skill to practise both the art and science of nursing.