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Compassionate Care

The Chief Nursing Officer for England, Jane Cummings, has called for more emphasis to be placed on nurses providing compassionate care in hospitals. She plans to ’embed values such as compassion, communication and commitment in public health care.’  This comes amidst concerns over neglect and falling standards of care in hospitals and care homes. This also echos the College of Medicine identification of a crisis in care and commitment within healthcare. 

At the same time, another report states that hospitals are ‘full to bursting’ creating a potentially dangerous environment for healthcare. High volume and throughput of patients combined with inadequate staffing levels leads to an over-worked and stressed out workforce and undoubtedly the quality of care provided suffers as a result. I am aware of the stresses and strains that the nursing profession are placed under on a daily basis and that they too are increasingly frustrated at not being able to provide the quality of care they would like to as a result. These demands can come in many forms, be it the high turnover of patients, reduced staffing levels, sickness levels, bureaucracy and red-tape, mutliple form filling and documentation, targets, managerial and medical staff demands, ever-increasing patient/relative expectations all leading to significant pressure on the nursing workforce. So they might well be wondering how are they to fit in ‘compassionate care’ to the already long list of tasks and to-dos that fill their already over-full working day? As highlighted in the article, Prof Crome stated that ‘without adequate numbers of trained staff, this agenda – which must be welcomed – will be difficult to implement.’ 

It is great that recognition is being given to the fact that the nursing and medical professions have lost touch with their caring and compassionate roots and that measures are to be taken to enhance the quality of care provided. A number of initiatives have been or are being implemented to increase awareness on this matter. Dr Robin Youngson, an anaesthetist, has started an intiative called Hearts in Healthcare which is also designed to enhance compassionate care in the healthcare arena.  In addition, the NHS Leadership Academy is undertaking a major programme investing more than £46 M to develop leaders with compassion. 

So what does it mean to provide ‘compassionate care’ and how easy will it be to make a true and signifcant change in the NHS or other healthcare fields in the provision of compassionate care? Compassion is not one of those things that is easily measured by the usual ways we examine a programme of study or learning: it is possible to conceive that someone could answer all the questions in an exam about what compassionate care is in theory, yet fail to deliver it in practice. Common qualities that are associated with it are that the individuals feel truly listened to, they feel heard and met, truly seen for who they are and not just another condition in a bed, another operation on a table. They are recognised as an individual with their own set of concerns or worries and they are treated with respect and dignity and feel cared for.  It need not necessarily take a lot of time to do this and rather than being something that is set aside as a separate task – ‘provision of compassionate care’ tick box exercise, it can be conveyed in simple ways: how you speak to someone, the tone of the voice, how you look at them, how you listen to them and pick up on not just what is said but what is not said.  It can of course take time to go more in-depth in listening to a patient’s concerns but it would be a mistake to think that all compassionate care requires a lot of extra time. It can be delivered in small ways in every single encounter. 

A key factor however, in the provision of compassionate care is understanding the importance of self-care. We cannot truly care for another if we do not care for ourselves. To do so only leads to burn-out, exhaustion, resentment, de-motivation and perhaps one could say the lack of self-care has also been in part responsible for the current crisis in care that we are experiencing. Research has shown that the more healthcare staff look after themselves then there are better outcomes for patients also. Healthy practitioners leads to healthy patients. Those who self-care are more likely to inform patients of how to care for themselves also and encourage healthy behaviours. So in order to truly deliver compassionate care in the health service, part of the focus of any campaign to do so should be aimed at encouraging self-care and understanding what that means. There is a tendancy to focus on the patient and the provision of care to the patient without first considering what is the quality of care the nurse or doctor is providing to themselves. In my opinion, if any true change in the provision of compassionate care is to be achieved then the focus needs to shift to the healthcare provider in the first instance,  ensuring they are truly self-caring, for then it will be an automatic fall-out that compassionate care will be provided to another. 

My own understanding of self-care has been significantly enhanced by the teachings of Serge Benhayon and Universal Medicine, which is based on understanding what is going on energetically and understanding how our daily choices affect us energetically. There is no choice that does not affect us and our physical health in one way or another. By listening to our own body and honouring what we feel, we have a marker or barometer for how our daily choices affect us. I use to be very dismissive of these understandings, in the arrogant belief that I had eaten and drank most things, had the same emotional ups and downs as everyone else and was still ‘alive and well’. However, as I have put the teachings into practice it is clear to me now that I was very mistaken and very arrogant and ignorant about this whole subject and how my daily choices were actually affecting me. It continues to be a daily work in progress, as I too can struggle with the demands of working in a busy NHS hospital and getting caught up in the stress that such an environment typically engenders. However, I personally have no doubt that the more I truly care for myself, go to bed early, eat healthy nourishing food, stay emotionally centred then the more present I am to care for patients, to listen to them, to see them for who they truly are and not just another number in the system. Whilst I applaud initiatives to enhance the quality of care and the provision of compassionate care in the NHS and further afield, experience has taught me and research is beginning to affirm that this will only be truly achieved when heathcare providers become truly self-caring. So let’s encourage intiaitives that raise the awareness of self-care for healthcare practitioners and the steps that can be taken to enhance self-care.

Feel free to share your own experiences of receiving compassionate care and what it means for you or how you have changed your own practice by implementing self-care, or anything else that this blog raises for you.  

 

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6 Comments

  • Reply
    Rebecca Baldwin
    6th December 2012 at 5:02 am

    what a great observation, self-care is where it starts…you can’t give what you don’t first have..

    thanks Eunice

  • Reply
    Alison Moir
    6th December 2012 at 10:47 am

    Thank you Eunice for high-lighting compassionate care in hospitals. In 1997 my husband was diagnosed with cancer, and I broke my wrist. Both of us had not ever experienced the hospital system before so we were unaware of how it ran or what we could ask for. The consultant my husband had, could not have heard of the word ‘compassion’ and we could feel he had no real interest in him as a human being he was just another patient. So much so he was referred to in one of his letters to our doctor to as ‘This chap” which I feel is a very condescending english word. He also mentioned something about him that was totally untrue. What we witnessed, was there was no consistency in the care. The emergency staff were great, but hospital wards lacked any true care, it was about beds and how long you could have one. We dreaded my husband being ill over the weekend because there would be a change over of staff and that is when things would go wrong. After 3 years we got to know how the system worked, that you had to push for things to be done, and to say no to things that you felt were not true. When my husband died, (which was another story in itself of lack of consistency in care,) I wrote a letter of complaint about the consultant and his lack of compassion to the hospital. The consultant in his own words was shocked, for in his eyes he was a “good consultant”. He said he was willing to take on-board what I had said. i feel that in the medical training and the rigours of hospital life, compassion is pushed way down the list in an effort to get things done. I feel like you Eunice that compassion comes from self-care, it comes from within. This would make a true difference to how hospitals are run, and how patients are treated. I saw how the lack of compassion in our consultant had a direct affect on my husband and myself.

  • Reply
    Priscila Azeredo de Souza
    6th December 2012 at 11:17 am

    Eunice, thank you for this beautiful post.

  • Reply
    Julia Manglano
    7th December 2012 at 12:48 pm

    We all need to be seen, listened to and met, even more when we are ill. As a patient I have experienced the joy of feeling talked to as a person, as a human, not as a burden or a task or something they need to do to finish as soon as possible and get on with the rest of their hectic day.

    In my work as a nurse it is a priority to connect, cause when I don´t, I allow myself to say things like:”we have a broken right hip here”, it is awful but it can happen when we allow the time pressure to affect us, and we enjoin the stressfull atmosphere losing ourselves in that moment.
    I agree that time can dominate us if we are not present, and that it is not about time but quality.

    There can be magic in a glance, a word, a hand, a smile.
    And it only takes seconds to let someone know that you care.

    My fear is that now that the people at the top have realized that we need compassionate care, they will put even more pressure on the nurses with more forms to fill, more paperwork to “ensure” compassionate care, and from their office chairs impose more tasks and duties to comply with, instead of getting to the root cause and questioning the care they have themselves and everybody in society.

    How do you measure compassion? and respect and consideration? how do you measure connection? how do you measure warmth?

    As you say in your article, we need to care first for ourselves, and put effort into changing the disregard in our own lives (toxic habits included), committing to living with more love and health and joy, cause the sad reality is that we don´t, we ignore our feelings, and how can we expect to treat someone with care when we ignore our own needs, our body´s true well being?
    How can we be truly caring if we are exhausted, stressed, underpaid, on antidepressants, on sedatives, on stimulants, wanting to get away as soon as possible, feeling the burden of the overloaded work?

    I totally agree that self care is essential nowadays for all of us health workers.
    It would be great to start thinking that the way forward in hospitals and health organizations is through the people, to be true people first, and then be efficient, complying, excellent. First be loving with me, enjoy what I do, and give what I have for me and then for others.

    No more paperwork and ticking boxes, more techniques to b centered, to be connected and to be human first. Have enough trained staff, yes, and train them also in the right breathing, the gentle movement of the body, the tender touch, the caring in practice in their own bodies first. That would be the REAL CHANGE.

  • Reply
    Jane Keep
    10th December 2012 at 8:00 am

    Well said Eunice, absolutely. What I experience over and above all that you express here is that those who will be/are training/developing the nurses and others on ‘compassionate care’ themselves are unlikely to be inspirational role models – but they will be good at intellectually sharing ‘compassionate care’ and what it ‘means’ but the livingness behind it will be lacking.

    On the other hand, I do experience in my days in one of the hospitals that I work, and in other healthcare environments I work some deeply caring and compassionate nurses, doctors, and other staff who naturally work in that way despite the pressures.

    As Rebecca says in the comments here, and you say ‘you cant give what you dont have’ – my phd study has come to that conclusion – without self care, there is no inspiration or role model for those we serve…

  • Reply
    Dragana Brown
    18th December 2012 at 3:41 pm

    Great post Eunice.
    I have spent last 13 years looking after my mum and her various illnesses including number of surgeries so I have had a fair share of experience with the NHS. Last year mum was in a word for elderly (over 80) and it was interesting to observe her and other ladies in her her room. What seemed to be very obvious was that they (the patients) main concern was to be looked after/injected/blood sample taken… by somebody who was compassionate and truly caring and not necessarily ‘an expert’ in their field! My mum doesn’t speak any English, so her choices and decisions have always been based on feeling the person (and yes, my translation too). I have often been amazed how much she could feel the person be that her surgeon, nurses, dinner ladies, even those who did cleaning. Based on that she would refuse certain treatments by some individuals and the hospital stuff although at times looked uncomfortable, would always accommodate her!
    I do feel for medical stuff because they are under lot of pressure (as you know and write about) but this change has to start somewhere, so instead of ‘stiff upper lip’ they are much better of expressing, looking at options and better (more true) way to serve. And yes, fundamentally the true care has to start from the individual!

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