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According to the NHS, the 6C’s of nursing are the guiding principles for anyone working within the healthcare sector (NHS England, 2012) In March 2016, a 3-year study named “Compassion in Practise” was concluded, and a framework of recommendations and best practice called “Leading Change, Adding Value” was created to guide healthcare staff with the work they do. The 6Cs have been listed as care, compassion, competence, communication, courage and commitment.
Whilst it has been emphasised that all these traits should work in unison to create a successful healthcare environment, for this essay I specifically chosen to reflect and explore the importance and meaning of “Compassion” within nursing. Compassion is typically associated with sympathy; Oxford University Press (2019) has defined compassion as condolence and pity towards others’ when they experience hardship.
However, it appears that analysts have unique opinions on what compassion means with relation to nursing. Compassion in nursing does not appear to simply be feelings of sympathy for others. Several researchers have argued that what compassion really includes within the nursing profession is complex and they have put forward differing ideas of what compassion involves.
It has been suggested that numerous definitions of compassionate care exist that incorporate a range of other elements (Bivins and co-authors, 2017). These include:
- Considering other’s perspectives and thoughts
- Aiming to respond to others’ complaints and concerns
- Picturing oneself in the same situation as another to understand their emotions and concerns
- Ensuring charitable, unselfish behaviour is shown towards patients
- Recognising ways they can reduce, and not influence, any types of pain or distress
Furthermore, compassion has been closely associated with a positive, uplifting state of mind (Ling, 2018) A compassionate nurse is likely to sympathise with a patient’s situation, aim to put them at ease and give them the perception that they are “on their side” during the healing process. To do so, a positive mindset from a nurse is believed to be essential as it enables a patient to feel hopeful about their future by promoting a healthy mentality and helping to reduce their concerns and fears.
It has also been hypothesised that there is a direct link between compassionate behaviour and a nurse’s individual work ethic (Ozaras, 2016) A study discovered that patients trusted their nurses to a greater extent when nurses presented themselves as approachable characters who appeared to possess a strong work ethic.
If nurses present themselves as dedicated employees, it can be argued that this can be considered a form of compassion towards their patients and colleagues. A dedicated nurse is prepared to recognise the uniqueness and importance of every patient’s individual situation (as no two may be the same) and aim to improve it for them to their greatest ability. A hardworking nurse will can also be compassionate to their colleagues by working alongside them to ensure tasks are done safely and to the best standard possible.
It is important to consider the value of self-compassion within nursing. When one considers the meaning of compassion within the healthcare sector, they may automatically perceive it be associated with selflessness. Yet, self-compassion is a vital part of maintaining a healthy and positive mental state (Stephenson, 2017) If one fails to show compassion to themselves, they are likely to have a low self-esteem. Stephenson’s investigation recalled that a low perception of oneself is connected to mental health conditions including depression and anxiety and it has been predicted that self-compassion can help lower the risks of these mental health conditions. It is also believed that self-compassion plays a role in working to reduce a negative mindset and unrealistic thoughts.
Overall, there appears to be a recurring opinion from different analysts that compassion is something to be gained by experience, and that compassionate behaviour has many forms and types.
Nurses and other healthcare staff may lose compassion for their patients gradually over time. A term is now widely used to describe declining rates of compassion from nurses and other healthcare professionals towards their patients. This term is known as “compassion fatigue” (Dewey, 2017)
Some factors that are believed to contribute to compassion fatigue are exhaustion from long shifts and emotionally and physically challenging workdays and environments, resulting in a nurse feeling overworked. Ultimately, work related stress can lead to a nurse failing to provide compassion to others. Another contributing factor to compassion fatigue is frequent exposure to numerous incidents of subjection to suffering as this may lead one to feel desensitised to hardship. As nurses are frequently exposed to stressful working environments and suffering of others, every nurse is at risk of developing compassion fatigue.
It is estimated that compassion fatigue affects approximately two thirds of care professionals at some stage in their career (Jarrad, 2018) The article that compassion fatigue may not only be inflicted on patients; nurses and other healthcare staff can also lack compassion towards each other. Consequences of compassion fatigue on the nurses themselves includes less job satisfaction and productive behaviour while on the job. One may be unaware that that they have been affected by compassion fatigue, as nurses can lack self-awareness; compassion fatigue does not have to be deliberate.
It has been well documented within certain sections of the media that the NHS is under continuous economic pressure. For example, it has been reported that patient waiting times have increased in various areas of England, particularly disadvantaged areas, with immigration levels being a contributing factor to this (Guintella, 2015) As more people move into the country, the NHS is under pressure to tend to the needs of the increasing population. It has also been recorded that the NHS has an inadequate amount of staff employed to manage the demanding workload (Gyton, 2017) It has been recalled that the NHS is said to have required 5.9% more staff in practise than they currently have employed. Staff shortages affect areas throughout England, and the number of practise numbers has reduced since March 2016 by 1.4%.
With relation to compassion, as pressure on the NHS increases alongside the population and staffing levels decrease, it is reasonable to assume the remaining nurses are more likely to suffer from compassion fatigue than ever before. As more staff leave the profession there is less support and assistance available, resulting in a heavier workload experienced by the remaining nurses. Nurses who continue to stay in the profession will also have a larger number of patients to care for British population increases; the population of England has increased by 390,000 people since the middle of 2016 (Park, 2018)
There have been instances where compassion has failed to be present in healthcare settings, one of these being the Mid Staffordshire Hospital Scandal. The Francis Report (Francis 2013) summarised the scandal and described situations where patients were neglected during their hospital stay, resulting in psychological trauma, worsened conditions and deaths. Francis recalled that one of the main factors that contributed to the scandal was lack of compassion from staff, particularly nurses. His perception of lack of compassion was described to be a failure to provide necessities to patients in need such as the appropriate medications, nutrients, hygiene and assistance when required.
It has been suggested that Francis gave compassion a great deal of importance in nursing after the Francis Report drew the public’s attention. The report provided recognition to the victims of the Mid Staffordshire scandal and highlighted the consequences when nurses do not show compassion towards their patients (Chadwick, 2015) Francis emphasised his beliefs that compassion must be provided to patients during their hospital stay and that staff have the responsibility to be dedicated to their duty and provide service of a high quality.
Therefore, it is reasonable to conclude that compassion fatigue was a factor that allowed incidents such as the Mid Staffordshire scandal to occur. Many professionals are likely to defend the importance of compassion in nursing practise and recognise compassion fatigue as a danger to patients. When recognising the causes of compassion fatigue and ensuring these are tackled early on, potential scandals like Mid Staffordshire can be prevented from being repeated.
Compassion Cultivation Training (CCT) is a course designed to improve one’s mental state and develop their overall wellbeing, relationships with others and emotional strength (Scarlet, 2017) It has been discovered that Compassion Cultivation Training increases mindfulness in healthcare workers, particularly nurses. The programme enables healthcare workers to prevent “burnout” and compassion fatigue by promoting mental techniques to manage these situations. It has been reported that Compassion Cultivation Training increases job satisfaction and plays a role in reducing negative emotions such as anxiety, as well as improving one’s level of self-compassion. Thus, Compassion Cultivation Training and similar programmes are essential for nurses as they ensure they are emotionally healthy while preventing potential mistreatment of patients.
To conclude, there is no fixed definition on what compassion in nursing is perceived to mean as many authors and investigators hold their own opinions on what qualities and behaviour make a compassionate nurse. It should, however, not be underestimated in its importance towards effective patient care.
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