INTRODUCTION:

Nurses’ being an important part of health care team has a major responsibility in providing quality care services to patients because the Nursing profession has always placed quality as a priority on its agenda for nursing care, monitoring and evaluation. In providing quality health care service nurses’ has to be emotionally intelligent, self-compassionate and should have good communication skills, because these parameters are inter-related and strongly influence the nurses’ in delivering services. (Henderson A, 2001).

In this regard Mohammad R.E. (2012) revealed that nursing staffs’ emotional intelligence has a direct effect on the offered services quality. Emotionally intelligent nursing staffs deliver more qualified services and perform beyond the patients’ expectations from service quality that, in turn leads to patients’ loyalty, guarantees their purchases and affects consumer behaviour positively. Similarly, Von Dietze E (2000) conclude that it is important for the nurses to experience compassion, because it affects their decision making and actions contributing to excellence in the practice of nursing and Neff KD (2003) reported that without ability of self-compassion, nurses might be ill prepared to show compassion to those for whom they care. It is also important for the nurses’ to have good communication skills with the personals they work with because effective communication is a fundamental element of nursing and serves as integral to the provision of quality patient care. Effective communication plays a crucial role in meeting the cognitive and affective needs of patients and improving the quality of care delivery (McGilton K, 2006).

Self-compassion/ compassionate care:

Compassion is defined as “sensitivity to the distress of self and others with a commitment to try to do something about it and prevent it”. This sensitivity includes awareness, attention and motivation. Commitment, courage & wisdom are necessary for compassion. Self-compassion refers to the awareness of one’s own emotions/ a desire to help the suffering person and a willingness to be nonjudgmental, as well as having the same for oneself.

Self compassion is the ability to acknowledge and be moved by the suffering of others; it encompasses a desire to help the suffering person and a willingness to be nonjudgmental. Self-compassion is having this same ability for oneself. Examining the compassion that nurses might feel for themselves is a significant nursing issue, because without ability for self-compassion, nurses might be ill prepared to show compassion to those for whom they care. Self-compassion requires that one has a fair and objective awareness of one’s own emotions. True compassion, according to these researchers, includes confronting, not avoiding, thoughts and emotions that are painful. It may be difficult to be an effective helper without the ability to be self-compassionate. (Neff KD, 2003).

Compassion is an essential quality in optimal medical care and constitutes a universal and perennial wisdom in medical ethics. Peabody F.W. (1927) of Harvard Medical School wrote that the secret of the care of the patient is in caring for the patient. In the absence of compassion, patients are dissatisfied and professionals lament a loss of meaning and gratification in their work. (Stephen G, 2011). Emotions form the foundation of nursing practice; they have an important role to play in professional relationships and patient-care decisions & without emotion it is not possible to be able to define the practice of nursing science. (Freshwater, D. & Stickley, T., 2004).

Nurses, in hospital settings, often provide care for patients and families who are suffering. Compassion is an essential component of the care that nurses provide. Self-compassion is the ability to be compassionate to oneself, without this ability nurses might not be prepared to be compassionate to patients. (Heffernan M, Quinn Griffin MT, 2010).

Attributes of compassion

Paul Gilbert and Alys Cole-king (2011) suggested that the human capacity for compassion involve two different psychologies i.e. awareness & engagement; and skilled intervention in action. They described the attributes of compassion as follows:

1. Care for wellbeing/Motivation:

The initial stage of compassion requires the motivation to be caring, supportive and helpful to others. It represents a set of values which define how we would like to be in our roles and also as human beings. Motivation is the fundamental component that shapes compassion’s other attributes. For example, empathy without motivation to help could be exploitative. The motivational system is what provides the focus, the purpose and point of all the other abilities. Individuals who are motivated to help others rather than having ego-focused goals have better social relationships, less conflict and greater wellbeing.

2. Sensitivity

It is the capacity to be sensitive and to maintain open attention, enabling us to notice when others need help. ‘

3. Sympathy

It is our emotional response to distress. Compassion requires an ability to be moved emotionally by another’s distress. The spontaneous feeling of being moved to help would be familiar to most of us. So sympathy is linked to sensitivity plus an urge to relieve suffering.

4. Distress Tolerance

It is the ability to bear difficult emotions both within ourselves and in others. People who feel overwhelmed by another’s distress may feel psychologically unable to face it & so have to turn away. Being able to bear distress & cope with it allows us to be with distress: actively remaining present to listen and feel able to work out with the other person what might be helpful for them.

5. Empathy

Empathy requires an ability to recognize another human being’s feelings, motivations and intentions as well as to make sense of their feelings & our own emotional responses. For example, when we see somebody who looks tearful we tregister this at an emotional level, and we also try and understand that they may have experienced some kind of loss. Empathy also enables us to predict the effects of our actions on others. For example, an empathic nurse sees that one patient needs a lot of information while another may not want it.

6. Non-judgement

It means not judging a person’s pain or distress, but simply accepting and validating their experience. Compassion also involves being non-judgemental in the sense of not condemning. Some clinical encounters may make us feel frustration, but if we don’t find ways to work these feelings out and deal with them, they will hinder empathy. Feeling angry about a situation lowers morale and makes us more vulnerable to burnout.

Becoming compassionate:

Neff KD’S (2003) model focuses on three dimensions which help one to become compassionate. These dimensions are:

1. Kindness

It is understanding one’s difficulties and being kind and warm in the face of failure or setbacks rather than harshly judgmental and self-critical.

2. Common humanity:

It is seeing one’s experiences as part of the human condition rather than as personal, isolating and shaming.

3. Mindful acceptance:

It is the awareness and acceptance of painful thoughts and feelings rather than over-identifying with them. Similarly, Chambers, Ryder (2009) identified the following six key components of compassionate care:

1. Empathy and sensitivity

2. Dignity and respect

3. Listening and responding

4. Diversity and cultural competence

5. Choice and priorities

6. Empowerment and advocacy.

Benefits of providing compassionate care:

Lown B (1996) suggested that compassionate care creates a healing relationship with patients that improves diagnostic clarity, patient outcomes, and patient adherence with difficult treatment regimens and brings immense gratification to the professional.

Stephen G (2011) found that compassionate care benefits patients with regard to elected treatment adherence, wound healing, satisfaction and well-being; it benefits physicians with regard to lowered depression rates, elevated meaning, lower burnout, and more diligent technical care; it benefits healthcare systems that establish reputational gains at no greater use of time or resources; it benefits medical students with regard to their diminished complaints of abusive clinical environments and maladaptive team interactions. There is no doubt that compassionate care has many dimensions of beneficial impact.

Westwood (2010) lists several ways in which nurses can encourage compassionate care:

1. Be clear about what compassion means to you.

2. Act with compassion whether you feel like it or not.

3. Find others who want to change things and form a team, being specific about what you want to see change.

4. Be compassionate to yourself to recharge your batteries.

5. Give positive feedback to others and thank them, whatever grade you are, even if you are no getting that kind of feedback yourself.

6. Get help and support if you are struggling.

Methods to become compassionate:

· Realize that you cannot fix everything

· Entrust your colleagues

· Step back from your initial emotional reactions

· Have some sort of “spiritual” practice

· Keep in mind the meaning and privilege of being a healer

· Have a balanced life & claim the time for it

· Be empathic, but the patient’s suffering is not your suffering (let it go) (Stefen G, 2011)

Importance of compassion in nursing

Staffs are the most valued resource in any workplace, particularly in caring environments. If staff are not being treated with empathy, don’t feel listened to, are not given choices where appropriate, are not empowered and helped to develop cultural competence, a compassionate environment and culture will not exist. Individuals who want to be compassionate will find themselves compromised. Therefore, nursing leaders, at all levels, need to foster this positive and compassionate care environment. Janki Foundation for Global Health Care (2004) developed a compassionate approach which emphasises the importance of the following values at all levels in healthcare practice:

1. Inner values

2. Peace

3. Positivity

4. Compassion

5. Cooperation

6. Valuing yourself

7. Spirituality in healthcare

All these key personal attributes are central to providing excellent health care.

Compassion and caring in nursing: taking the lead:

It is essential that nurses recognize their role as leaders and act as positive role models, give appropriate and positive feedback and help others to feel valued members of the team. Fradd (2010) discusses the essential role that existing nurse leaders have in nurturing and encouraging the next generation of nurse leaders. Such valuing of clinical leadership is a central tenet which highlights nursing and nurse leadership roles as the key enablers in really transforming what happens for patients’ experiences in a ward or the community. Therefore nursing must grasp the opportunities to demonstrate the capability and capacity of nurses to lead.

Another reason why nurses must take the lead on ensuring excellence in compassionate nursing care relates to the changing role of nurses. Nursing has become increasingly task- and technically orientated, due to increased pressures to meet targets. If nurses are to be leaders in practice, and in compassionate care, they need to be emotionally intelligent. Goleman (2002) states that emotional intelligence incorporates personal competence, in the form of self- awareness and self- management, and social competence, in the form of social awareness and relationship management. Marques (2007) say that without emotional intelligence, a leader cannot relate to the hidden messages behind what someone is saying, or the things that are not being said. Nurse leaders also need to be able to deal with conflict, ensure their emotional responses are appropriate and handle emotions and relationships with others (Goleman 1998). The ability to problem solve and understand emotions and respond appropriately is a key component of leadership (Mayer et al. 1999). Yet there is much anecdotal evidence of nurse managers not treating colleagues with respect, expressing inappropriate emotions and being unable to understand the emotional needs of others, or being unable to problem- solve or to predict or deal with conflict. This can only lead to greater problems in the workplace, and when practice is even more stressful and staffing ng levels are even lower, can make the difference between a safe and effective service and an unsafe one.

Challenges for enhancing compassion in practice:

The challenge of retaining the ‘art’ of nursing as well as the ‘science’ is faced by many nurses today. Brophy (2010) agrees with the quote from Hawkins that ‘medicine is not a science; medicine is an art for which medical science is a tool’ (Hawkins 2002, Brophy 2010). This is equally true of nursing; the art of medicine and nursing lies in the holistic, relationship based creative and unique approaches that healthcare professionals use in their interactions with patients and clients. However, if we reduce nursing to a set of tasks that can be quantified and measured, this will undermine the therapeutic value of what we do, and how people feel as a result of our care.

The King’s Fund report (Firth- Cozens and Cornwell 2009) identifies various factors that inhibit compassion, namely (i) the values instilled in clinical training. (ii) a fear of distress and dying, and of stress, depression and overload. (iii) the wider hospital environment with organizational structures that are inflexible and do not focus on the individual. A nurse leader can help to alleviate these factors by ensuring that there is a focus on teaching compassion, by providing opportunities to get closer to patients, by role modeling of caring nursing and by providing positive and constructive feedback to nurses in their practice areas.

REFERENCES:

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Received on 08.12.2014 Modified on 07.01.2015

Asian J. Nur. Edu. and Research 5(2): April-June 2015; Page 279-282

DOI: 10.5958/2349-2996.2015.00055.5